Botulinum toxin treatment of plantar fasciitis, clinical applications of point-of-care ultrasound, and other key topics are presented in the new JBJS Guest Editorial “What’s New in Orthopaedic Rehabilitation.” Here, we spotlight the 5 most compelling findings, as selected by co-author Donald Kasitinon, MD.
Elbow
In a study of 20 patients treated with ultrasound-guided percutaneous tenotomy of the common extensor tendon, researchers found no recurrences of recalcitrant lateral elbow tendinopathy at a median follow-up of 90 months1. The procedure “demonstrated good durability of pain relief and functional recovery,” and patient satisfaction remained at a score of 100% at follow-up1.
Foot and Ankle
Symptoms of plantar fasciitis have been shown to improve after treatment with botulinum toxin type-A injections, according to a meta-analysis of RCTs (randomized controlled trials)2. The injections resulted in significant functional improvement and pain relief. Patients reported continued relief from pain at 12-month follow-up.
Spine
Treatment with basivertebral nerve (BVN) ablation vs. standard care was evaluated in a study of 140 patients with chronic low back pain of vertebrogenic origin3. The authors of this prospective, open-label, multicenter RCT found significant improvements in pain and function with BVN ablation over standard care, with treatment results sustained through 1 year. The primary end point was a between-arm comparison of the change from baseline in the Oswestry Disability Index (ODI). Secondary end points included VAS for pain, SF-36, and EQ-5D-5L scores; responder rates; and rates of continued opioid use.
Orthobiologics
A meta-analysis of 5 studies demonstrated that treatment of lateral epicondylosis with platelet-rich plasma (PRP) injections or surgery resulted in equivalent outcomes in pain and function4. A pooled total of 340 patients were included. There were no significant differences in VAS pain scores at 2, 6, and 12 months or Patient-Related Tennis Elbow Evaluation scores at 12, 24, and 52 weeks. The authors concluded that PRP may be a reasonable treatment alternative for patients who are poor candidates for surgery or who are apprehensive about it.
Ultrasound
A recent review examined the clinical applications of point-of-care ultrasound, a technology that has seen increased use as ultrasound machines have become more portable and affordable5. Point-of-care ultrasound provides real-time diagnostic information and may help to make procedures safer with ultrasound guidance. However, questions remain regarding the training required for point-of-care ultrasound and the overall impact of this technology on patient outcomes.
“What’s New in Orthopaedic Rehabilitation” is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org.
Recent OrthoBuzz posts include: “What’s New in Shoulder and Elbow Surgery,” What’s New in Hip Replacement,” and “What’s New in Osteoporosis and Fragility Fractures.”
References
- Ang BFH, Mohan PC, Png MA, Allen JC Jr, Howe TS, Koh JSB, Lee BP, Morrey BF. Ultrasonic percutaneous tenotomy for recalcitrant lateral elbow tendinopathy: clinical and sonographic results at 90 months. Am J Sports Med. 2021 Jun;49(7):1854-60.
- Acosta-Olivo C, Simental-Mendía LE, Vilchez-Cavazos F, Peña-Martínez VM, Elizondo-Rodíguez J, Simental-Mendía M. Clinical efficacy of botulinum toxin in the treatment of plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2022 Feb;103(2):364-371.e2.
- Smuck M, Khalil J, Barrette K, Hirsch JA, Kreiner S, Koreckij T, Garfin S, Mekhail N; INTRACEPT Trial Investigators. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 12-month results. Reg Anesth Pain Med. 2021 Aug;46(8):683-93.
- Kim CH, Park YB, Lee JS, Jung HS. Platelet-rich plasma injection vs. operative treatment for lateral elbow tendinosis: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022 Feb;31(2):428-36.
- Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography. N Engl J Med. 2021 Oct 21;385(17):1593-602.
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