What’s New in Orthopaedic Rehabilitation 2022

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 

1. 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. 
2. 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. 
3. 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. 
4. 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. 
5. Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography. N Engl J Med. 2021 Oct 21;385(17):1593-602.