News From ACFAS

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Time is running out to submit your high-quality posters for a chance to be present at the Annual Scientific Conference. Submit your latest discoveries and late-breaking research now to be considered for display at ACFAS 2023, February 9-12 in Los Angeles.

Poster abstracts must be submitted to ACFAS by next Wednesday, September 7 to be eligible for review. PDFs of eligible posters are due November 9.

Visit annualconference.acfas.org to view guidelines/criteria and submit your poster today! The ACFAS Clinical & Scientific Research Grant Program is still accepting applications! Thanks to support from PICA and the ACFAS Regions, the College will again be offering funding of up to $75,000 for an established investigator and $25,000 for a new researcher.

Letters of intent should be submitted by September 15 at 5pm CT and final applications are due by October 15 at 5pm CT. Awards will be announced in December and funding will be provided in January 2023. All applications must follow a modified NIH R21 format.

Visit acfas.org/ResearchGrant for more information. Get expert advice and real-world tips when you join us this October for the new ACFAS Practice Management Webinar Wednesdays. The new three-part series highlights important practice management topics to help enhance your efficiency, simplify administrative burdens, and improve your quality of care.

Register for each webinar individually or save when you register for all three.

Insurance Reviews: Get the Inside Scoop for Proper Reimbursement
October 12 | 7:00 pm CT

How Do I Know If My Practice is Doing Well?
October 19 | 7:00 pm CT

Malpractice Preparation – Because it Happens to Everyone
October 26 | 7:00 pm CT

Registration opens September 1! Visit acfas.org to register and for more information.

Foot and Ankle Surgery

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Researchers used the National Inpatient Sample (NIS) database to identify patients who underwent total ankle arthroplasty (TAA) between 2016 and 2019. Generally, 5,087 patients (average age 65.1, 54 percent males, 85 percent Caucasians and 75 percent from large metropolitan regions) underwent TAA. Eighty-eight percent of patients were sent home, and the median length of hospital stay and hospital-related expenditure were 1.7 ± 1.41 days and $92,304.5 ± $50,794.1, respectively. The overall complication rate was 8.39 percent, with anemia and acute renal failure the most common medical complications and peri-prosthetic mechanical adversities the most frequent local complication. Female and chronic kidney disease patients exhibited significantly more elevated risks of medical and surgical complications, while obesity substantially heightened the risk of medical adversities. The study indicates that US TAA rates are growing, especially in regions with populations greater than 250,000.


Thirty-four cases with grade-2 or grade-3 chronic anterior talofibular ligament lesions were administered the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques. Thirty ankles were followed up for an average of 26.67 ± 4.19 months, with four cases excluded due to insufficient medical records or loss of follow-up reports. The average of the Cumberland Ankle Instability Tool scores, the Karlsson-Peterson scores and Visual Analog Scale scores were 86.63 ± 6.69, 90.17 ± ?4.64 and 0.53 ± 0.63, respectively. Stress fluoroscopic tests also showed significantly improved post-surgical results. Four cases saw mild keloid formation and/or knot irritation, while no wound infections, nerve injuries, recurrent instability or stiffness or arthritis of the subtalar joint were observed.


A study was held to characterize how ankle dorsiflexion range of motion (DF ROM) and frontal plane projection angle (FPPA) related to each other in patients with and without patellofemoral pain syndrome (PFPS) during a step-down test. Seventy PFPS patients and 70 asymptomatic control had their ankle DF ROM measured via inclinometer with the knee flexed and extended. Ankle DF ROM measured with the knee flexed was higher among controls compared to PFPS patients. The correlation between FPPA and ankle DF ROM with the knee flexed was statistically insignificant in both cohorts. Decreased ankle DF ROM can be regarded as a contributor to PFPS development in the context of greater dynamic knee valgus.

Practice Management

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The latest analyst note by the Health Sector Cybersecurity Coordination Center (HC3) at the US Department of Health and Human Services (HHS) warns that voice phishing (vishing) scams are a growing threat to the cybersecurity of physicians' practices. The agency describes vishing as "eliciting information or attempting to influence action via the telephone," and the threat brief noted "a social engineer can manipulate staff members into giving access to their computers, routers or Wi-Fi" to steal protected health information, personal indentifiable information or deploy malware. HHS listed examples of phishing and vishing emails, such as suspicious emails claiming a free trial has ended for a service for which the recipient never signed up; unexpected emails with only the name, address and phone number of an unrecognized organization; individuals asking callers to go to a website to cancel a subscription they did not sign up for; emails from a Gmail account with the name of a high-level individual in medical research and calls or emails pretending to be from a government entity. HC3's recommendations for shielding healthcare organizations against phishing/vishing include educating staff to be alert and cautious and to confirm all requests for information; deploying backups with best practices; a structured program for regular software updates; appropriate credential tracking; holding every department accountable for security and increased physical security.


The COVID-19 pandemic has shown that patients are sicker than ever and demanding higher levels of care, further stressing the medical system. A study from the American Hospital Association (AHA) posited that many Americans deferred their care during the height of the pandemic and consequently require more care. "Non-COVID-19-care has increasingly contributed to rising patient acuity," the AHA noted, adding that this "has contributed to patients experiencing more severe disease, in many cases requiring longer hospitalizations and more intensive treatments." The authors of another study observed that at the pandemic's peak "many countries instituted stay-at-home orders, curfews and lockdowns in an attempt to contain the virus spread. These interventions may have contributed to the perception that the hospital environment represents a reservoir of infection, which translated to an associated reduction in emergency department (ED) visits."

As a consequence, "The subsequent altered care-seeking patterns may lead to unnecessary morbidity by delaying access to care for urgent conditions. The pandemic altered the public's perception of when ED care should be sought. Although, this does not seem to have led to increased mortality in children ... there seems to be increased morbidity associated with other common diseases." In view of these factors, the most effective remedy may be to continue making more people aware of the value of timely care; funding healthcare organizations and doctors to safely attend to patients and giving communities the necessary resources to help the most vulnerable populations.


Amazon intends to wind down its online and in-home health service by the end of this year. Originally developed for Amazon employees, Amazon Care is also available to employees at half a dozen corporate customers including Silicon Labs, Precor, Whole Foods and Hilton. Amazon Care lets patients talk to healthcare providers virtually, set up video visits and in some locations request a provider visit at home for services like vaccinations and screenings for common health issues. "Although our enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers we have been targeting and wasn't going to work long-term," said Amazon spokeswoman Christina Smith. Healthcare consultant Paddy Padmanabhan said Amazon Care's impending closure "raises the question of whether anyone can ever be successful as a stand-alone primary care provider in healthcare or whether you need to be part of an integrated health system to make it work."

Health Policy and Reimbursement

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The US Centers for Medicare and Medicaid Services (CMS) proposes to standardize quality compliance for Medicaid and the Children's Health Insurance Program (CHIP) nationwide and to impose mandatory annual reporting from states. This is expected to promote consistency in the quality of care for beneficiaries and help detect gaps and health disparities among beneficiaries. Three core sets of quality measures are included under the proposed rule, related to health homes and behavioral health for adults under Medicaid and children's health under Medicaid and CHIP. According to CMS, mandating that states assess and disclose this data will help the agency rate how well Medicaid and CHIP are fulfilling their mission to provide quality, affordable health coverage to low-income individuals and communities. "They will allow us not only to identify health disparities but also to implement interventions based on the very data that make those disparities clear," said CMS Administrator Chiquita Brooks-LaSure.


Anthony S. Fauci is stepping down from his government role after more than 50 years of service. Currently the White House's chief medical adviser under the Biden administration, Fauci has served six other presidents, taking over leadership of the US National Institute of Allergy and Infectious Diseases in 1984.


The White House has directed academic journals to provide immediate access to research that is publicly funded, terminating a policy allowing publishers to keep journals behind a paywall for a year. The guidance also requires publications to be made available in machine-readable format to guarantee use and reuse. The US Office of Science and Technology Policy said the directive could potentially save lives and benefit the public in key areas. Proponents of open-research access called the guidance "transformational" for scientists and the wider public, while the Open Research Funders Group's Greg Tananbaum said the policy "broadens the circle of science. It broadens the conversation." The policy is expected to be fully in place by the beginning of 2026.

Medicine, Drugs and Devices

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During the first year of the COVID-19 pandemic, new cases of type two diabetes increased significantly among US youth compared with the previous two years, according to new research. The multicenter, retrospective study, led by Johns Hopkins Children's Center researchers, looked at the records of more than 3,100 COVID-19 patients aged eight to 21 years at US hospitals who had a new type two diabetes diagnosis and a body mass index in the 85th percentile from March 2018 to February 2021. The data show that from March 1, 2020, to February 28, 2021, new diagnoses of type two diabetes increased by 1,463 patients, or 77.2 percent, compared with the average of the previous two years (886 in 2019 and 765 in 2018). During the pandemic period, youth with new type two diabetes diagnoses had higher hemoglobin A1c levels compared with the previous two years and higher blood glucose.


New York officials are calling on parents and physicians to make sure children are current on polio vaccinations following evidence indicating the poliovirus has been present in the state as early as April. Health officials said they have sent notices and discussed the issue with health care providers, community leaders, houses of worship, grocery stores and summer camps in an effort to raise polio vaccination rates in the greater New York City area. Some areas, including Rockland and Orange counties, have polio vaccination rates at approximately 60 percent among eligible children, compared with a national rate of around 93 percent, federal data show. José Romero, director of the US National Center for Immunization and Respiratory Diseases, says: "Persons today don't realize what a significant disease this was because they haven't seen it in a generation."


IFI Claims says roughly 400 healthcare patents have a link to the metaverse, and experts are raising concerns about data privacy. Training is one of the best-use cases for the metaverse in healthcare, and examples include virtual cadavers that medical schools are now using to teach students anatomy. Metaverse technology, particularly virtual reality, lends itself well to mental health care. However, regulations designed to protect patients like the US Health Insurance Portability and Accountability Act do not extend well into the metaverse. Aaron Gani, CEO of virtual reality mental health company BehaVR, said companies will be able to gather even more personal data about a person in the metaverse than they do now, and it remains to be seen how they will or will not shield data not covered by law.