Boettcher, Brennan J.

ABSTRACT We report the case of a 38‐year‐old recreational female runner with anterior and lateral chronic exertional compartment syndrome treated with ultrasound‐guided fasciotomy using a V‐shaped meniscotome. She began her return‐to‐run protocol 8 days postprocedure and achieved full symptom resolution. At 6 months, ultrasound revealed persistent fascial separation without complications, representing the first report of long‐term sonographic outcomes following fasciotomy for chronic exertional compartment syndrome. These findings support further prospective studies to evaluate the clinical and sonographic outcomes of this technique.

This article introduces a novel, single‐operator stress ultrasound technique for evaluating medial ulnar collateral ligament (MUCL) integrity by assessing medial ulnohumeral joint (MUHJ) widening under valgus stress. Unlike prior methods requiring dual operators, specialized equipment, or the use of hand/wrist weights, this approach was designed for clinical efficiency, reproducibility, and patient comfort. By positioning the patient comfortably in a side‐lying position with the elbow flexed to 50°, MUHJ width is measured at baseline (maximally apposed) and manually stressed positions, in a manner that may reduce muscular compensation, avoid viscoelastic creep, and facilitate consistency. While additional research is needed to evaluate clinical feasibility, assess reliability, and compare our technique with previously published methods of dynamic MUCL assessment, the aim of this manuscript is to describe our technique and provide a rationale for its potential utility in musculoskeletal ultrasound practice and research.

Abstract Adipose‐derived cellular therapies (AD‐CTs) are increasingly used in orthopedics, yet the field lacks a standardized framework for classifying these heterogeneous products. Although prior efforts have standardized platelet‐rich plasma and bone marrow‐derived mesenchymal stromal cells, AD preparations remain inconsistently defined and poorly characterized. AD‐CTs encompass a range of products including enzymatically derived stromal vascular fraction, culture‐expanded adipose‐derived mesenchymal stromal cells (AD‐MSCs), and mechanically processed adipose tissue (AD‐MPT),each with distinct regulatory, cellular, and structural profiles. Unlike stromal vascular fraction and AD‐MSCs, which can be quantified using conventional assays, the intact extracellular matrix in AD‐MPTs complicates objective characterization. This paper introduces the Mechanical Processing (Harvesting) of Adipose Tissue classification system as a novel framework for standardizing the reporting of AD‐MPT harvesting and processing techniques that provides a structured approach to nomenclature and reporting. The system aims to enhance study comparability, facilitate research replication, and support the responsible advancement of adipose‐based therapies in musculoskeletal medicine.

Objective The incidence of hip osteoarthritis (OA) is increasing with the aging population, leading to interest in intra-articular orthobiologic injections to alleviate symptoms and potentially slow disease progression. This systematic review aims to evaluate the clinical outcomes associated with six orthobiologic therapies for hip OA: hyaluronic acid (HA), platelet-rich plasma (PRP), autologous cells therapy (ACT), microfragmented adipose tissue (MFAT), and bone marrow aspirate (BMA) and its concentration (BMAC). Methods We conducted a literature search according to the PRISMA guidelines. Studies were included in our review if they used at least one of the four orthobiologic therapies and reported on the clinical outcome using patient reported outcome measures (PROMs). Since there is a large variability among clinical outcomes, we focused on the three most utilized PROMs (VAS, WOMAC, and HHS) and the latest follow-up time point. Results Of the 716 studies reviewed, thirty-six studies (n=36) fit inclusion criteria. There were 21 studies examining HA, 11 on PRP, 3 for MFAT, 2 for ACT, and 3 on BMA/BMAC. Eight studies were randomized controlled trials and 28 were cohort studies. The mean age of the patient population ranged from 45 ± 17.0 to 74 ± 8.0. The baseline grade of osteoarthritis ranged from 1-4 but was most reported as moderate (2-3). Overall, there was an improvement in PROMs at the latest follow-up after receiving orthobiologic interventions. Discussion Orthobiologic injections have shown promise for improving PROMs in patients with hip OA. Future studies should evaluate long-term efficacy and include randomized trials to establish efficacy.

Abstract Background Plantar vein thrombosis is a rare vascular condition typically presenting with unilateral plantar foot pain and edema. Of interest to the musculoskeletal clinician, mechanical trauma to the plantar foot has been cited as a risk factor for development of these thrombi. Objective To assess the demographics, presenting history, risk factors, treatment protocols, and long‐term sequelae of patients with plantar vein thrombosis secondary to increased mechanical trauma. Design Retrospective chart review. Setting Tertiary care center. Participants Adult patients with mention of plantar vein thrombosis in imaging impressions. Main Outcome Measures Primary outcome measure was determination of the demographic and clinical characteristics of plantar vein thrombosis in patients with mechanical trauma as a preceding risk factor. Secondary outcome was evaluation of treatment options in this patient population. Results Between 2005 and 2023, nine patients at a single institution were diagnosed with plantar vein thrombosis through imaging and were determined to have developed the thrombus due at least in part to mechanical trauma. Patients typically presented with localized plantar foot pain and foot edema. Diagnosis was made via magnetic resonance imaging or ultrasound. The most frequent treatment was therapeutic anticoagulation but initial conservative treatment with serial ultrasound resulted in conversion to anticoagulation in only one patient. Among those patients with mechanical trauma as an inciting factor, the only noted complication was propagation of the thrombosis in one patient. Conclusions Although rare, plantar vein thrombosis should be considered by the musculoskeletal clinician in the differential diagnosis of unilateral plantar foot pain. Treatment of these thrombi is most commonly therapeutic anticoagulation, but in the absence of additional high‐risk factors serial ultrasound evaluations may be an adequate first line treatment due to the overall minimal risk of thrombosis propagation.

Background: Ultrasound-guided percutaneous fasciotomy and debridement (USPFD) is a minimally invasive treatment for patients with plantar fasciopathy refractory to conservative management. Previous studies have shown clinical improvement with USPFD, but pain relief and patient satisfaction have not been demonstrated beyond 2 years. Methods: This retrospective case series included patients who underwent USPFD at a quaternary academic medical center between April 2013 and January 2018, with refractory plantar fasciopathy and at least 4 years’ follow-up. Patient outcomes were assessed through electronic surveys and telephone interviews. Primary outcome measures included mean changes in visual analog scale pain (VAS-Pain) scores and patient satisfaction via Likert scale. Secondary measures included VAS-Pain with the first 5 steps, VAS-Pain during daily weightbearing, and procedural complications. Results: Seventy unique procedures were identified among 62 patients. Follow-up data were obtained from 51 of 62 patients (82%) who responded to surveys or phone calls. This corresponded to 58 of 70 procedures (83%) at a mean postprocedure follow-up of 6.6 ± 1.4 years. Patients had a mean duration of symptoms of 2.1 ± 3.0 years prior to the procedure. Baseline VAS-Pain was 6.8 ± 2.2 and final follow-up VAS-Pain was 0.7 ± 1.1. At the last follow-up, patient-reported VAS-Pain with first 5 steps was 0.9 ± 1.6 and VAS-Pain with weightbearing through the day was 1.3 ± 1.8. Overall, 91% (53/58) of the procedures were considered successful, where patients responded they were “satisfied” or “very satisfied” and 52 of 58 (90%) procedural responses indicated that based on the outcome, they would recommend the procedure to others. Final follow-up VAS-Pain, VAS-first 5 steps, and VAS-weightbearing, were all improved in the success vs failure groups ( P ≤ .002). No complications were reported. Conclusion: USPFD was associated with high patient satisfaction and durable pain relief for chronic plantar fasciopathy at an average follow-up of 6.6 ± 1.4 years.

Background: Plantar vein thrombosis (PVT) is a rare cause of unilateral plantar foot pain not commonly assessed during sonographic scans for venous thromboembolic evaluation. The present study aims to increase awareness of PVT when evaluating musculoskeletal conditions and to discuss the utility and characteristic imaging findings of PVT on magnetic resonance imaging (MRI). Methods: This is a retrospective chart review identifying patients with suspected PVT via search of a single institution’s radiology reports. Twelve patients had an available lower extremity MRI. These 12 MRIs were independently reviewed by 2 fellowship-trained musculoskeletal radiologists for common imaging characteristics. Of note, only 7 of the 12 available imaging studies contained MRI findings consistent with PVT as determined by the radiology reviewers. For these 7 patients, clinical characteristics were also recorded. Results: Between both radiology reviewers, there was 100% agreement confirming, localizing, and describing the findings of PVT. Of the 7 cases of MRI-confirmed PVT, 6 of 7 studies were performed without contrast and 1 of 7 was performed with and without contrast. The lateral plantar vein was the predominant vein involved in 85.7% (6/7). All 7 cases showed signs of intraluminal signal change, venous enlargement, and muscle edema. Two cases (28.6%, 2/7) displayed collateralization and/or enlargement of surrounding veins. In the only MRI performed with contrast, perivascular enhancement and a filling defect were noted. Conclusion: In the evaluation of a painful foot, an MRI can be used to diagnose PVT reliably and may have several advantages over compression ultrasonography (US) because of its ability to identify other unsuspected etiologies of a painful foot and elimination of technical limitations of compression US in the plantar foot region.

Abstract Background: Intra-articular corticosteroid injections (ICSI) have been shown to be an effective symptomatic non-operative treatment for hip osteoarthritis (OA) and other joint-related pain. There has been recent dispute over the true risk of complications from ICSI specifically when injected into the hip. Avascular necrosis (AVN) of the femoral head has been reported to occur in up to 30.5% of patients after undergoing hip ICSI, and up to 50.6% of patients experiencing osteoarthritis progression in as little as 3 months following injection. Purpose: To analyze the current protocol of hip ICSIs performed by two fellowship-trained non-operative sports medicine physicians and assess the rate of femoral head avascular necrosis. We hypothesized that the rate of AVN will be less than what has been recently reported in the literature. Study Design: Retrospective chart review Methods: Patients that underwent at least one intra-articular corticosteroid hip injection by two fellowship trained non-operative sports medicine physicians at this institution were identified using an institutional database. Exclusion criteria included injections with contrast dye used for imaging, injections that administered orthobiologics to the intra-articular, and non-intra-articular injections. Procedure notes were reviewed for anesthetic and steroid type, dosage, and needle size. Each chart was screened for demographic information, post-injection infections, AVN diagnosis, and subsequent hip replacement. 10 patients were identified with an AVN diagnosis. Their MRNs were sent to a board-certified radiologist at the same medical institution. The radiologist was blinded to the patient’s chart and instructed to identify the first radiograph with evidence of AVN. Patients were excluded if the reviewer did not agree with the diagnosis as it appeared in the medical chart or the AVN developed post-traumatically. Results: 449 patients, 530 hips, underwent 1.8 ± 1.4 ICSIs and 16.3% underwent THA at an average of 2.2 ± 2.3 years following their first injection. Of the 530 hips that underwent ICSI, only 1 hip demonstrated findings of AVN on radiographs following the first injection, and this patient had been taking oral prednisone for over 20 years. Conclusions: Intra-articular corticosteroid injections are a relatively safe symptomatic treatment option for hip pain secondary to both OA and non-OA pathology to be considered when other non-operative treatment options have failed. While the use of steroids comes with an inherent risk of osteonecrosis and cartilage damage, these results demonstrate that, when performed properly with ultrasound guidance and sterile technique, the risk of femoral head avascular necrosis is minimal.