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What's New — Ankle — August 2026

53 new articles published this month.

Themes: Achilles Tendon Rupture Epidemiology · Achilles Repair Outcomes and Complications · Achilles Tendon Research and Biomechanics · Lateral Ankle Instability Management · Ankle Arthroscopy and Surgical Techniques · Ankle Fracture and Arthrodesis Outcomes · Sports Performance and Injury Prevention

Digest generated 2026-09-14 08:34:04+00:00.

Highlights

Achilles Tendon Rupture Epidemiology

Multiple studies examine Achilles tendon ruptures (ATR) in professional athletes, with a striking rise in NBA cases, seven ruptures in the 2024-25 season versus a historical average of 1.36 per season [30]. Ruptures cluster later in the season and occur more in lighter players post-COVID [38], with in-game ankle load and player incentives proposed as contributing stressors [45]. NFL analyses characterize injury mechanisms, timing across the competitive season [35], and career impact [37], while MLS data detail return-to-play duration and performance decline after both ruptured and nonruptured injuries [12]. Machine learning models using public data predict return-to-play status after NFL Achilles injuries [33].

Achilles Repair Outcomes and Complications

This theme covers surgical repair techniques and factors affecting outcomes after Achilles tendon repair. Percutaneous knotless bridge repair in athletes shows high functional recovery and low complications [39], while biomechanical testing compares suture types and configurations in percutaneous repairs [27]. The timing of revision within two months of primary repair influences acute complication rates [19]. Patient factors matter: cannabis use [14], non-tobacco nicotine dependence [15], mental health disorders [28], and chronic statin therapy [31] are all associated with altered complication or re-tear rates. MRI-based classification of rupture location offers a new framework for guiding treatment [16], and percutaneous speed bridge technique with immediate weightbearing shows safe outcomes for insertional tendinitis [46].

Achilles Tendon Research and Biomechanics

Basic science and biomechanical studies of the Achilles tendon include a novel strap fixation method for biomechanical testing of sheep Achilles tendons [2], and combined extracorporeal shock wave plus platelet-rich plasma therapy demonstrating synergistic effects in a rat model of acute Achilles tendinopathy [11]. Hedgehog signaling upregulation is implicated in heterotopic ossification associated with insertional Achilles tendinopathy and tendon degeneration [41]. Functional studies show fatigue effects are more pronounced on the uninjured side during single-limb jumps two years after rupture [3], and side-to-side neuromuscular differences persist in lower limbs and trunk during walking and running one year post-rupture [8]. Achilles tendinitis in young athletes also predicts subsequent lower extremity injuries [29].

Lateral Ankle Instability Management

Studies address chronic lateral ankle instability from biomechanics to surgical technique. Biomechanical evaluation examines ATFL superior fascicle injury types [40]. Arthroscopic techniques include an all-inside 2-portal repair with knotless suture anchors and suture tape augmentation [50], and immediate weight bearing after suture-tape-augmented modified-Broström reconstruction shows safe accelerated rehabilitation [18]. Suture augmentation may be necessary for patients with generalized ligamentous laxity [23], and suture button fixation for concomitant syndesmotic instability shows good midterm outcomes [13]. A meta-analysis identifies risk factors for recurrence after arthroscopic reconstruction [49], while paediatric studies compare surgical versus conservative treatment for ATFL injuries regarding sprain recurrence [24], and functional testing for return to play is systematically reviewed [44].

Ankle Arthroscopy and Surgical Techniques

Technical notes and arthroscopic studies cover positioning and operating room setup for ankle arthroscopy in supine, prone, and lateral positions [1], a modified Das De procedure for peroneus longus tendon dislocation [6], and peroneal tendoscopy outcomes via systematic review [36]. Paediatric posterior ankle arthroscopy indications and outcomes are prospectively studied [42], and os trigonum size is evaluated relative to return-to-sport after posterior ankle impingement surgery [20]. Beyond the ankle itself, Achilles allograft histology six years after revision ACL reconstruction [10], peroneus longus autograft effects on ankle strength after ACL reconstruction [4], and chronic distal biceps reconstruction using Achilles allograft [43] demonstrate the tendon's role as a graft source.

Ankle Fracture and Arthrodesis Outcomes

Fracture and arthrodesis-related studies include gait recovery after ankle fracture surgery with early mobilization and weight-bearing [7], physeal bar formation after Salter-Harris III and IV medial malleolus fractures in young children [9], and hexapod-assisted tibiocalcaneal arthrodesis after talectomy for limb salvage [5]. Total ankle replacement versus ankle fusion for end-stage ankle osteoarthritis is reviewed with recent literature [47], and subtalar arthrodesis graft comparison shows no union rate differences [48]. Related tibial fracture topics include laparoscopic retrieval of entrapped intramedullary fragments [51], finite element analysis comparing external fixators versus titanium elastic nailing for distal tibial fractures [52], and risk factors for failure of diaphyseal tibial nonunion repair [53].

Sports Performance and Injury Prevention

Broader sports medicine studies relevant to ankle include the effect of artificial turf infill weight on surface-related ankle injuries during high school football over 14 seasons [21], countermovement jump metrics linked to traditional performance measures in youth female soccer athletes [22], the squat as a functional vital sign associated with SF-36 scores [25], lower-body injury linked to upper extremity injury in MLB pitchers via kinetic chain disruption [26], the ankle's role in the baseball kinetic chain following nonoperative ankle injuries in professional players [34], and 3D biomechanical running assessment to identify injury risk [32]. High ankle sprain management in Division 1 football compares semirigid fixation with non-surgical care using GPS workload data [17].

Articles by Theme

Achilles Tendon Rupture Epidemiology (7)

12. Forsythe B, Hand C, Hand F, et al. Achilles Tendon Injuries in Major League Soccer: A 10-year Analysis of Injury Rate, Return to Play, and Performance Metrics. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261449641

A 10-year retrospective matched-cohort study of MLS players (2010-2021) used the league injury surveillance database to compare Achilles ruptures versus nonrupture injuries, with 2:1 matched uninjured controls. The study quantified annual incidence, return-to-play duration, and postinjury performance metrics (games, minutes, goals, assists, defensive contributions). Results inform expectations for professional soccer players' recovery and performance after Achilles injuries.

30. Kumar VS, Sang LL, David W, et al. Poster 120. Rising Achilles Tendon Ruptures in the NBA: The Role Of Playing Time And Experience. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00424

Researchers analyzed NBA Achilles tendon ruptures, noting the record seven ruptures in 2024-2025 versus a historical 1.36 per season, and evaluated workload trends, playing time, and experience surrounding these injuries. The hypothesis was that altered workload patterns precede rupture. Identifying such risk patterns could guide load management to prevent these career-altering injuries.

33. Chen Z, Wang N, Lei Z, et al. Poster 115. Predicting Return to Play After Achilles Tendon Injury in National Football League Players Using Machine Learning. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00419

This study developed machine learning models using publicly available data from NFL players with unilateral Achilles tendon injuries (2004-2024) to predict return-to-play status. The models identified demographic and performance predictors of RTP after AT injury. Clinically, such tools could help teams and clinicians counsel players on prognosis and guide return-to-play decision-making.

35. Malige A, Kress DJ, Waldron P, et al. Poster 111. Timing of Achilles Tendon Ruptures in the NFL: A 15-Year Analysis of In-Season and Preseason Injury Trends. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00415

This 15-year analysis examined the temporal distribution of Achilles tendon ruptures across NFL season phases and weekly intervals. The study identified clustering of ruptures during specific vulnerable periods of the competitive cycle. These findings suggest modifiable risk windows that could guide targeted injury-prevention strategies.

37. Pruneski JA, Hasegawa ME, Samuelsson K, et al. Poster 117. Epidemiology of Achilles Tendon Ruptures in Professional American Football Players. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00421

This study analyzed the epidemiology of Achilles tendon ruptures in NFL players from 2015-2025, using video analysis to determine injury timing and mechanisms and approximate value to assess career impact. It characterized injury mechanisms, return-to-play rates, and performance outcomes over the decade. The results help clarify causes and long-term career consequences of ATRs in professional football, informing prevention and counseling.

38. Petric L, Jacobs CA, Lattermann L, et al. Poster 122. Achilles Tendon Ruptures in the National Basketball Association are More Common Later in the Season and in Lighter Players Post-COVID. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00426

This study compared NBA Achilles tendon ruptures from 1999-2020 versus post-2020 seasons to identify changing injury characteristics. Ruptures were found to occur more commonly later in the season and in lighter players in the post-COVID era, alongside a cluster of injuries in 2024-2025. These shifting patterns can inform targeted risk identification and prevention strategies in professional basketball.

45. Kattady N, Ryali R, Eftekhari M, et al. Poster 113. Stressors and Achilles Tendon Rupture Risk in American Professional Basketball. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00417

This retrospective matched case-control study (20 Achilles tendon ruptures vs 40 controls) examined whether increased in-game ankle load, reflected in rising maximum vertical leap heights and three-point attempts, and external player incentives contributed to the surge in Achilles ruptures in professional basketball, which peaked at seven cases in 2025 versus a historical average of 1.3 per season. The findings may identify modifiable risk factors for this career-altering injury. Results could inform league-level and team-level strategies for load management and injury prevention.

Achilles Repair Outcomes and Complications (9)

14. Kreinces J, Miller P, Vredenburgh Z. Cannabis Use and Postoperative Complications After Primary Achilles Tendon Repair: A Propensity Score-Matched Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261471378

Using the TriNetX database with 1:1 propensity score matching, this cohort study compared postoperative complications after primary Achilles tendon repair between preoperative cannabis users and nonusers. Outcomes included revision repair and reinjury at 1 and 2 years, plus medical/surgical complications at 90 days and 6 months. Contrary to the authors' hypothesis, results clarify whether cannabis use truly elevates complication and revision risk, informing perioperative counseling.

15. Bui V, Florentino S, Kaszluga C, et al. Paper 10. Impact of Non-Tobacco Nicotine Dependence on Postoperative Outcomes Following Achilles Tendon Repair: A Propensity-Matched Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00271

This propensity-matched TriNetX analysis of 25,874 patients undergoing primary Achilles tendon repair (2004-2023) compared 90-day and 2-year outcomes among non-tobacco nicotine dependence (e-cigarettes, vaping, pouches), traditional tobacco users, and non-nicotine users. NTND accounted for 6.2% and tobacco use 9.9% of the cohort. The study addresses an emerging clinical question about whether non-tobacco nicotine products impair healing in a tendon with tenuous vascularity.

16. Mueller MM, Estfeller A, Cychosz CC, et al. Paper 12. MRI-Based Classification of Achilles Tendon Ruptures: Reliability and Predictors of Tear Location. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00272

Reviewing 428 acute Achilles tendon ruptures (2003-2023), five independent observers applied a novel MRI-based location classification: Type I/IA (musculotendinous junction region), Type II (mid-substance), and Type III/IIIA/IIIB (insertional, peel-off, avulsion). Mean tear location was 65 mm proximal to the calcaneal insertion, with male sex, age, and tendinopathy predicting more distal tears. The classification's reliability and tear-location predictors can guide treatment selection and surgical planning.

19. Cherelstein RE, Alkaramany E, Rodriguez-Materon S. Poster 107. Timing of Achilles Tendon Revision within Two Months of Primary Repair Affects Incidence of Acute Complications. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00411

Using the PearlDiver database (2010-2023), this study examined whether the timing of Achilles tendon revision surgery within eight weeks of primary repair influenced acute post-operative complication rates. Contrary to the hypothesis, revision performed earlier within the two-month window was associated with a higher incidence of acute complications. Surgeons may consider delaying revision after acute re-rupture when clinically feasible to reduce perioperative risk.

27. Chin K, Benner N, Telfer S. Poster 109. Does Suture Type or Configuration Matter in Percutaneous Achilles Tendon Repairs?. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00413

In a biomechanical cadaver study, simulated Achilles ruptures were repaired percutaneously with a commercial guide using four suture constructs varying in configuration (single vs. double locked) and type (round vs. flat), then subjected to creep testing and load-to-failure. The study tested whether suture choice affects repair mechanics. Results would guide surgeons in selecting stronger constructs for percutaneous Achilles repair.

28. Raji Y, Rteil A, Mzeihem M, et al. Poster 114. Mental Health Disorders Predict Higher Complication Burden Following Achilles Tendon Repair: A Propensity-Matched National Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00418

Using TriNetX across 107 healthcare organizations, patients with preoperative depression, anxiety, bipolar, adjustment, or OCD diagnoses undergoing Achilles tendon repair were propensity-matched 1:1 to controls and followed for complications, pain, opioid use, and utilisation at 3-24 months. Mental health disorders predicted a higher postoperative complication burden. This supports preoperative psychosocial screening and targeted resource allocation for these patients.

31. Bera S, Brady TT, Parmar RP, et al. Poster 161. Chronic Statin Therapy is Associated with Increased Rates of Rotator Cuff and Achilles Tendon Re-tears After Repair. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00459

A retrospective PearlDiver Mariner claims analysis (2010-2023) compared retear rates and time to retear after primary rotator cuff and Achilles tendon repair in patients aged 40+ with and without chronic statin therapy. Chronic statin use was associated with increased retear rates. Surgeons should consider statin exposure when counseling patients on repair failure risk, though confounding by indication warrants caution.

39. Huntley K, Martin KD, Kuttner N, et al. Poster 101. High Functional Recovery and Low Complication Rates After Percutaneous Knotless Bridge Achilles Repair in Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00406

This retrospective cohort study evaluated outcomes of percutaneous knotless bridge Achilles tendon repair in athletes treated at an academic center (2020-2024). The technique demonstrated high return-to-sport rates, strong functional recovery, patient satisfaction, and low complication rates. These findings support the knotless bridge technique as an effective minimally invasive option for active patients seeking return to pre-injury activity.

46. Martin KD, Cantrell WA. Poster 110. Trajectory of Recovery Following Percutaneous Insertional Achilles Debridement and Repair with Speed Bridge Technique using Radiographic and Patient-Reported Outcome Measurement. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00414

This retrospective cohort evaluated percutaneous insertional Achilles debridement and speed bridge repair with immediate weightbearing as tolerated in a wedged CAM boot, using radiographic measures and FADI/VAS outcomes. The technique safely addressed both Haglund's deformity and enthesophytes percutaneously, with no tendon ruptures or returns to the operating room. The findings support immediate weightbearing as a safe protocol that may accelerate rehabilitation after insertional Achilles repair.

Achilles Tendon Research and Biomechanics (6)

2. Basci O, Aydemir S, Husemoglu RB, et al. Evaluation of a novel strap fixation method for biomechanical testing of sheep Achilles tendons. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06478-y

This biomechanical study compared four proximal fixation methods (strap-based, direct clamp, Kocher clamp, and Krackow suture) for load-to-failure testing of 40 fresh-frozen sheep Achilles tendons repaired with Bunnell sutures. The novel strap fixation method was evaluated as a potentially more stable, tissue-preserving, low-cost alternative to conventional clamp- and suture-based techniques. If validated, this method could improve accuracy and reproducibility of tendon biomechanical testing by minimising slippage and tissue damage.

3. Jónsdóttir US, Tranberg R, Silbernagel KG, et al. Effects of fatigue are more pronounced on the uninjured side during single‐limb jumps 2 years after an acute Achilles tendon rupture. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70579

Thirty patients approximately 2 years after unilateral Achilles tendon rupture performed single-limb drop countermovement jumps before and after a fatigue protocol, with hip, knee, and ankle peak power analyzed during landing and push-off phases. Fatigue reduced ankle peak power more on the uninjured side (mean 1.06 W/kg) than the injured side (0.51 W/kg), revealing greater fatigue vulnerability of the contralateral limb. This suggests rehabilitation and return-to-sport assessment should address endurance deficits in the uninjured limb, not just the injured side.

8. Huseth K, Harðarson GR, Aagaard P, et al. Side-to-side differences in neuromuscular function and associated joint mechanics in the lower limbs and trunk during walking and running one year after acute unilateral Achilles tendon rupture. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101198

This study examined side-to-side differences in neuromuscular function and joint mechanics of the lower limbs and trunk during walking and running one year after acute unilateral Achilles tendon rupture. The analysis linked persistent inter-limb neuromuscular deficits to altered joint mechanics during gait tasks. The results underscore that residual asymmetries persist at one year, informing rehabilitation targets and gait retraining after Achilles tendon rupture.

11. Terakawa F, Mukai M, Ochiai N, et al. Therapeutic Efficacy of Combined Extracorporeal Shock Wave Therapy and Platelet-Rich Plasma Therapy in a Rat Model of Acute Achilles Tendinopathy. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261438101

In a collagenase-induced rat model of acute Achilles tendinopathy, 50 rats were randomised to control, sham, ESWT, PRP, or combined ESWT+PRP treatment. The combination therapy produced earlier and synergistic improvements in pain relief and tendon healing compared with either monotherapy. This supports clinical investigation of combined ESWT/PRP protocols to accelerate recovery when single-modality treatment fails.

29. Hindosh Y, Zvavamwe T, Sayegh J, et al. Poster 170. Achilles Tendinitis and Subsequent Lower Extremity Injuries in Young Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00468

A TriNetX retrospective cohort of athletes aged 13-25 with sports physicals compared propensity-matched patients with left or right Achilles tendinitis to unmatched controls, assessing subsequent ipsilateral and contralateral Achilles rupture, ACL tear, and ankle injuries. Achilles tendinitis appears to signal elevated risk for more severe lower extremity injury. This argues for aggressive early management of tendinopathy in young athletes as a prevention strategy.

41. Capotosto S, Gordon D, Fang F, et al. Poster 100. Hedgehog Signaling Upregulation in Heterotopic Ossification Associated with Insertional Achilles Tendinopathy and Tendon Degeneration. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00405

In a mouse model, Achilles tendons injected with a hedgehog signaling agonist developed heterotopic ossification without prior injury, suggesting that Hh pathway upregulation alone drives tenocyte shift toward chondrogenic and osteogenic lineages. This implicates Hh signaling as a key mechanism underlying ectopic bone formation in insertional Achilles tendinopathy. Targeting this pathway may offer a new therapeutic strategy to prevent or treat tendon ossification.

Lateral Ankle Instability Management (8)

13. Shi P, Wei Y, Li S, et al. Midterm Outcomes After Suture Button Fixation for Arthroscopically Confirmed Concomitant Syndesmotic Instability in Chronic Lateral Ankle Instability: A Retrospective Cohort Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261468979

In this retrospective cohort of chronic lateral ankle instability surgeries (2017-2023), patients with arthroscopically confirmed dynamic syndesmotic instability (≥2-mm diastasis) underwent additional suture button fixation, while those with intact syndesmosis did not; all received standardised lateral ligament repair. Midterm outcomes were assessed with Karlsson-Peterson, FAAM, Tegner, ALR-RSI, VAS, and range-of-motion measures at 12 months and final follow-up. The study clarifies whether adjunctive suture button fixation benefits patients with concomitant syndesmotic instability.

18. Curatolo C, Martin K, Anand S. Paper 61. Immediate Weight Bearing after Modified-Brostrom Reconstruction: A Retrospective Review of an Accelerated Rehab Protocol. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00318

In a retrospective review of 119 patients undergoing suture-tape-augmented modified-Bröström reconstruction, all followed an accelerated protocol allowing immediate weight bearing as tolerated with physiotherapy starting at week 2. Early functional testing at six weeks showed high rates of heel-rise and hop test recovery without increased failures or complications. This supports immediate weight-bearing protocols as safe and effective after suture-tape-augmented ankle ligament reconstruction.

23. Rubin J, Kennedy JG, Tham A, et al. Poster 103. Suture Augmentation May Be Necessary for Patients with Generalized Ligamentous Laxity Undergoing Modified Brostrom Repair: A Systematic Review and Meta-Analysis. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00407

This systematic review and meta-analysis of eight studies (301 patients with generalized ligamentous laxity [GLL] and 367 without) evaluated outcomes after modified Brostrom repair for ATFL insufficiency. GLL patients repaired without suture augmentation showed significantly worse postoperative talar tilt and higher failure rates (14.9%) compared with non-laxity patients, while augmented repairs performed comparably. Suture augmentation should be strongly considered in GLL patients undergoing ankle ligament repair.

24. Maguire K, Bailey J, Swanson ME, et al. Poster 112. Is There a Twist? Differences in Recurrence of Lateral Ankle Sprains Among Pediatric and Adolescent Patients Treated Surgically Versus Conservatively for Anterior Talofibular Ligament Injuries. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00416

In a retrospective cohort of 145 paediatric and adolescent patients with MRI-confirmed ATFL tears at a single children's hospital, recurrence of lateral ankle sprains was compared between surgically and conservatively treated groups. Recurrence rates were similar between treatment approaches, with most injuries occurring during sports. These findings support initial conservative management for paediatric ATFL injuries, as surgery did not demonstrably reduce sprain recurrence.

40. Koyama T, Teramoto A, Mori Y, et al. Poster 99. Biomechanical Evaluation of Ankle Instability by Injury Type of the Superior Fascicle of the Anterior Talofibular Ligament. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00404

This biomechanical study evaluated ankle instability according to injury type of the superior fascicle of the anterior talofibular ligament (ATFL), the structure first tensioned during inversion sprains. The experiments characterized how isolated superior fascicle injury contributes to ankle microinstability. The findings refine understanding of chronic lateral ankle instability and may guide diagnosis and treatment of partial ATFL injuries.

44. Lau BC, Luo EJ, Reed JM, et al. Poster 108. Functional Testing for Return to Play in Ankle Sprains and Instability. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00412

This systematic review of MEDLINE, Web of Science, and SPORTDiscus identified the functional tests most commonly used and most effective for determining return-to-activity readiness after ankle sprains and instability. It found no consensus or gold-standard testing battery exists for assessing functional recovery after ankle injury. The results can inform development of standardised, evidence-based return-to-play protocols to reduce recurrent sprains and chronic ankle instability.

49. Giunta J, Beaudet P. Risk factors for recurrence of chronic ankle instability following arthroscopic reconstruction: a meta-analysis. EFORT Open Reviews 2026. doi:10.1530/eor-2024-0207

This meta-analysis pooled data from studies of patients undergoing arthroscopic reconstruction for chronic ankle instability to identify factors associated with recurrent instability after surgery. The review synthesized recurrence rates and associated risk factors across included studies. Clinically, the findings can help surgeons identify patients at higher risk of failure and guide preoperative counseling and postoperative management.

50. Pereira BS, Sá Malheiro F, D’Hooghe P. The Stabilization Technique for Ankle Lateral Repair: An All‐Inside 2‐Portal Arthroscopic Repair With Knotless Suture Anchors and Suture Tape Augmentation. Arthroscopy Techniques 2026. doi:10.1002/atn2.70050

This surgical technique article describes an all-inside, two-portal arthroscopic repair of the anterior talofibular ligament for chronic lateral ankle instability, using knotless suture anchors augmented with suture tape. The approach aims to achieve anatomic repair while avoiding knot-related irritation and adding biomechanical stability. It offers surgeons a minimally invasive alternative to the open Broström-Gould repair, particularly for athletes seeking faster recovery.

Ankle Arthroscopy and Surgical Techniques (8)

1. Paquot J, Roche D, Lopes R. Standardized Patient Positioning and Operating Room Setup for Ankle Arthroscopy: A Technical Note. Arthroscopy Techniques 2026. doi:10.1002/atn2.70237

The authors describe a standardised patient positioning and operating room configuration for ankle arthroscopy across supine, prone, and lateral decubitus setups, with attention to ergonomics, cable management, and tower/instrument organization. The standardised arrangement improves workflow, visualization, and safety while reducing sterility breaches and technical incidents. Clinically, adopting this reproducible setup can enhance efficiency and safety of ankle arthroscopy, provided adequate space is maintained around the operating table.

4. Kehribar L, Okutan AE, Akdemir E, et al. Peroneus longus autograft in anterior cruciate ligament reconstruction impairs ankle strength, balance and jump performance despite preserved knee function: a one year comparative study. International Orthopaedics 2026. doi:10.1007/s00264-026-06998-7

In this propensity score-matched retrospective study, 60 patients were compared 12 months after ACL reconstruction using either peroneus longus (n=30) or semitendinosus (n=30) autografts, with assessments of isometric strength, jump tests, postural stability, and PROMs. Despite preserved knee function and comparable patient-reported outcomes, peroneus longus graft harvest impaired ankle plantar flexion/eversion strength, balance, and jump performance. These findings caution against routine peroneus longus harvest in ACLR, particularly in athletes requiring high ankle function.

6. Subawa IW, Febyan F. Modified Das De Procedure in Peroneus Longus Tendon Dislocation: Technical Note. Arthroscopy Techniques 2026. doi:10.1002/atn2.70180

This technical note presents a modified Das De procedure for recurrent peroneus longus tendon dislocation (Eckert and Oden type A), involving repair and reinforcement of the superior peroneal retinaculum with minimal osseous manipulation. Intraoperative findings confirmed retinacular insufficiency despite preoperative imaging showing only tenosynovitis, and postoperative provocative testing demonstrated stable tendon positioning without redislocation. The technique offers a safe, reproducible soft-tissue-based alternative that preserves anatomical integrity when treating symptomatic peroneal tendon dislocation.

10. Bruni D, Di Rocco D, Feleppa S, et al. Histological maturation of an Achilles tendon allograft six years after revision anterior cruciate ligament reconstruction: case report. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101206

This case report provides rare 6-year histological data from biopsies of a fresh-frozen Achilles tendon allograft used in revision ACL reconstruction with lateral extra-articular tenodesis. Histology showed a largely organized extracellular matrix with parallel collagen bundles and tenoblasts, alongside focal disorganization and persistent microvascularity, indicating substantial but incomplete intra-articular allograft maturation. The findings support the long-term structural viability of allografts in revision ACL surgery.

20. Nagamoto H, Matsui T, Yabiku H, et al. Poster 104. Does the Size of Os Trigonum Relate to Return-to-Sport After Surgery of Posterior Ankle Impingement Syndrome Among Athletes?. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00408

This study investigated whether os trigonum size correlates with return-to-sport outcomes after arthroscopic or open excision for posterior ankle impingement syndrome in athletes. Larger os trigonum size was associated with longer time to return to sport, and concomitant flexor hallucis longus pathology further influenced outcomes. Preoperative imaging of os trigonum size may help counsel athletes on expected postoperative recovery timelines.

36. Tham A, Rubin J, Rajivan R, et al. Poster 119. Clinical Outcomes of Peroneal Tendoscopy for Peroneal Tendon Disorders: A Systematic Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00423

This systematic review (8 studies, 242 patients/247 ankles, mean follow-up 28.6 months) evaluated clinical outcomes of peroneal tendoscopy for peroneal tendon disorders. Most included studies were Level IV evidence, with tendoscopy showing favourable outcomes and low complication rates compared with open surgery. The findings support peroneal tendoscopy as a viable minimally invasive option after failed conservative management, though higher-quality studies are needed.

42. Kushare I, Ghanta R, Allahabadi S, et al. Poster 116. Pediatric Posterior Ankle Arthroscopy- Indications and Outcomes: A Prospective Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00420

This prospective study of 81 paediatric and adolescent patients (101 ankles, mean age 13.3 years) at a tertiary children's hospital evaluated indications, outcomes, and complications of prone two-portal posterior ankle arthroscopy from 2016-2025, using VAS and AOFAS scores. It addresses the scarcity of literature on this technique in young patients with posterior ankle and hindfoot pathology. The findings help guide surgical decision-making and counsel young athletes and families regarding expected outcomes and risks.

43. Chen L, Berzolla E, Shelbaya S, et al. Poster 206. Chronic Distal Biceps Reconstruction Using Achilles Allograft Demonstrates Excellent Satisfaction and Functional Recovery: A Retrospective Cohort Study with Mean 4-Year Follow-Up. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00503

This retrospective cohort study with mean 4-year follow-up evaluated chronic distal biceps tendon reconstruction using an Achilles allograft with the BRAIDS technique, assessing patient-reported satisfaction, cosmetic appearance, and objective strength recovery. The authors hypothesized excellent satisfaction and functional recovery despite residual cosmetic deformity. Results support Achilles allograft reconstruction as a viable option when primary repair is impossible due to retraction, scarring, and poor tissue quality.

Ankle Fracture and Arthrodesis Outcomes (8)

5. Guerrero Serrano JA, Sánchez Morata E, García López JM, et al. Hexapod-assisted limb salvage after talectomy: outcomes of tibiocalcaneal arthrodesis using the TL-hex system. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06379-0

This retrospective series evaluated talectomy followed by tibiocalcaneal arthrodesis using the TL-HEX hexapod external fixator in high-risk patients with severe talar destruction from infection, trauma, avascular necrosis, Charcot neuroarthropathy, or failed ankle arthroplasty. Radiographic fusion and hindfoot alignment were the primary outcomes, with functional scores, pain, complications, and satisfaction assessed secondarily. The findings support hexapod-assisted tibiocalcaneal arthrodesis as a viable limb-salvage strategy offering computer-assisted multiplanar correction in complex reconstructive cases.

7. Bauer L, Schlegel AS, Scheuer A, et al. Recovery of gait after ankle fracture surgery following early mobilization and weight-bearing. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06472-4

In this prospective longitudinal study, 44 patients after surgical treatment of isolated ankle fractures with early pain-dependent weight-bearing underwent instrumented gait analysis (treadmill with pressure plate and IMU motion capture) at 6 weeks, 3, 6, and 12 months. Self-paced walking velocity improved significantly from 2.2 km/h at 6 weeks to 3.4 km/h at 6 months, though most other spatiotemporal parameters changed only between 6 weeks and later time points. The objective gait recovery data support early mobilization and weight-bearing protocols after ankle fracture surgery.

9. Kodra JD, Patel M, Choudhury A, et al. Physeal Bar Formation After Salter-Harris III and IV Medial Malleolus Fractures in Children Aged ≤10 Years. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-26-00174

In a retrospective cohort of 32 children aged ≤10 years with Salter-Harris III/IV medial malleolus fractures, surgical (ORIF/PRSF) and nonsurgical management showed similar physeal bar formation rates (25% vs 19%). Bar formation was associated with greater pre-reduction articular displacement, suggesting displacement rather than treatment choice drives growth disturbance risk. Clinicians should prioritise anatomic reduction and monitor all young patients radiographically regardless of treatment modality.

47. Rodríguez-Merchán EC, Moracia-Ochagavía I, Delgado-Martínez AD. Total ankle replacement versus ankle fusion for end-stage ankle osteoarthritis: a narrative review of the latest literature data (2023–2025). EFORT Open Reviews 2026. doi:10.1530/eor-2025-0106

This narrative review synthesized comparative studies from 2023-2025 on total ankle replacement versus ankle fusion for end-stage ankle osteoarthritis. Evidence was mixed: some studies found similar long-term clinical results and complication rates, while a meta-analysis favored TAR for patient-reported outcomes and systematic reviews noted fewer total complications, implant removals, and revision surgeries with TAR. The findings underscore the need for individualized surgical selection based on patient factors, alongside attention to reported racial, socioeconomic, and payer disparities in access to TAR.

48. Munoz M, Khvesyuk M, Leroux V, et al. No differences in union rates between grafts for subtalar arthrodesis. EFORT Open Reviews 2026. doi:10.1530/eor-2024-0202

This study compared union rates among different graft options for subtalar arthrodesis. It found no differences in union rates between graft types. Surgeons can therefore select graft material based on factors other than fusion success, such as availability, cost, and handling characteristics.

51. Gray MT, DiCosmo M, Schottel PC. Retrieval of entrapped intramedullary fragments using laparoscopic instruments for fixation of femur and tibia fractures. Injury 2026. doi:10.1016/j.injury.2026.113384

The authors present a technique for retrieving cortical fragments entrapped in the intramedullary canal during nail fixation of femoral and tibial shaft fractures using laparoscopic instruments, avoiding an open approach. They characterize the shaft lengths, diameters, tip configurations, and jaw widths of commonly used laparoscopic graspers for this purpose. This gives trauma surgeons a practical, less invasive adjunct for managing a recognised intraoperative complication of intramedullary nailing.

52. Wen Y, Xu C, Wang Q, et al. External fixators versus titanium elastic nailing for distal diaphyseal-metaphyseal junction tibial fractures: A finite element biomechanical analysis. Injury 2026. doi:10.1016/j.injury.2026.113413

This finite element analysis compared external fixators with antegrade titanium elastic nails for stabilizing distal diaphyseal-metaphyseal junction tibial fractures, using CT-based models from an 11-year-old with transverse and oblique fracture patterns. External fixators provided superior rotational and bending stiffness, while titanium elastic nails offered greater axial stiffness. The results suggest fixation choice for paediatric distal tibial fractures may be tailored to the loading pattern of greatest concern, though clinical validation is needed.

53. Fan S, Wagner RK, Lehle CH, et al. Risk Factors for Failure of Repair of Diaphyseal Tibial Nonunions: A Retrospective Cohort Study of 108 Patients. Injury 2026. doi:10.1016/j.injury.2026.113421

This retrospective cohort study of 108 patients who underwent repair of diaphyseal tibial nonunions by exchange intramedullary nailing or ORIF determined rates of and risk factors for additional nonunion surgery. Overall, 25% of patients required further nonunion surgery and 4.6% ultimately underwent amputation, with multivariable regression identifying characteristics associated with failure. These findings inform patient counseling and may guide selection of fixation strategy and grafting to optimise healing.

Sports Performance and Injury Prevention (7)

17. Aiken C, Mussell EA, Segars B, et al. Paper 60. Preliminary Outcomes and GPS Device-Measured Load and Performance Following High Ankle Sprains and Return-to-Sport in Division 1 Football Players: Comparing Semirigid Fixation and Non-Surgical Management. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00317

This pilot study characterized patient-reported outcomes and GPS-derived workload data from injury through return-to-sport in Division 1 collegiate football players with high ankle sprains, comparing semirigid surgical fixation (e.g., Tightrope) with non-surgical management. Preliminary findings suggest both approaches allow return to play, with wearable GPS data offering novel real-world benchmarks for load and performance recovery. Clinically, the results support individualized treatment decisions while highlighting GPS metrics as a potential tool for monitoring return-to-sport progression, though larger studies are needed.

21. Meyers MC, Sterling JC, Robinson SK, et al. Poster 175. The Effect of Artificial Infill Weight on Surface-Related Ankle Injuries During High School Football Games. A 14-Season Prospective Study. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00473

Across 14 seasons and 104 high schools, this prospective study compared surface-related ankle injuries during football games on heavyweight (≥9.0 lb/ft²) versus lightweight (3.0-6.0 lb/ft²) artificial turf infill systems. Lightweight infill surfaces were associated with significantly higher rates of ankle trauma, particularly grade II and III injuries requiring surgery. Field selection favoring heavier infill may reduce ankle injury risk in high school football.

22. Lambert BS, Momin S, Rivera A, et al. Poster 164. Translating Force Plate Data: Linking Countermovement Jump Metrics to Traditional Performance Measures in Youth Female Soccer Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00462

This study linked countermovement jump (CMJ) force plate metrics, such as peak force, rate of force development, and asymmetry indices, to traditional field-based performance tests in youth female soccer athletes. Several CMJ variables correlated strongly with conventional measures of power and performance, establishing reference relationships for interpreting force plate data. This translation helps coaches and clinicians use CMJ testing to guide training and rehabilitation decisions in a population at high risk for lower extremity injury.

25. Abdalla O, Alqasmi H, Almaat A, et al. Poster 155. Squat as a Functional Vital Sign: Association Between a Novel Squat Classification and SF-36 Scores in Orthopaedic Patients. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00455

Investigators deployed a novel squat classification system across orthopaedic clinics and examined its association with SF-36 patient-reported functional scores. The squat was proposed as a composite 'functional vital sign' integrating mobility, strength, proprioception, and body habitus. If validated, it could serve as a quick, low-cost screening tool for lower extremity dysfunction and a rehabilitative benchmark in the absence of any USPSTF musculoskeletal screening recommendation.

26. Menta S, Locascio L, Sciascia A, et al. Poster 173. Leg Up or Letdown? Exploring the Link Between Lower-Body Injury and Upper Extremity Injury in MLB Pitchers. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00471

A retrospective cohort of MLB pitchers (2017-2024) used public injury and Statcast data with multivariable logistic regression to test whether prior lower extremity injury predicted subsequent upper extremity injury, adjusting for age, workload, velocity, and a novel pitch-mix entropy metric. It addresses the gap between biomechanical theory and large-scale epidemiologic evidence on kinetic chain disruption. Findings could inform workload monitoring and injury-prevention strategies targeting the lower body to protect pitchers' arms.

32. Haddas R, Salazar BP, Shu Y, et al. Poster 184. Running Smarter: Clinically Relevant 3D Biomechanical Insights to Identify and Prevent Injury Risk in Athletes. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00482

A multimodal running assessment protocol combining 3D markerless motion capture, ground reaction force analysis, and surface EMG was developed and applied retrospectively to 20 runners with running-related injuries. The protocol aimed to detect subtle biomechanical and neuromuscular asymmetries beyond the resolution of 2D gait evaluation. Clinically feasible 3D assessment could enable personalized injury-prevention and targeted treatment for runners.

34. Ryali R, Eftekhari M, Burnett ML, et al. Poster 121. Evaluating the Ankle’s Role in the Baseball Kinetic Chain: An Analysis of Performance Changes Following Nonoperative Ankle Injuries in Professional Pitchers and Position Players. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00425

This retrospective study of 49 professional baseball players (25 position players, 24 pitchers) with nonoperative ankle injuries (2020-2024) used public performance data to assess how injury laterality and positional demands affected performance metrics. Findings characterized changes in hitting and pitching performance tied to ankle-based kinetic chain disruption. The results inform expectations for performance recovery and RTP timing after ankle injuries in baseball players.

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