Anterolateral ankle impingement: mr arthrographic assessment of the anterolateral recess.

Purpose: To determine the accuracy of magnetic resonance (MR) arthrography in assessing the anterolateral recess of the ankle.

Materials And Methods: Thirty-two patients with chronic ankle pain prospectively underwent gadolinium-enhanced MR arthrography of the tibiotalar joint. All underwent clinical examination and were included if anterolateral impingement (n = 13) or a control condition (n = 19; suspected osteochondral defect, intraarticular bodies, instability, osteoarthritis) was diagnosed.

Endoscopic plantar fascia release.

An anatomic exploration showed that reliable landmarks could allow a safe division of the plantar fascia. The reference line was the posterior border of the medial malleolus, 1 cm from the plantar skin. A clinical study on 53 patients (65 feet) showed that, at follow-up of over 2 years, the procedure effectively relieved heel pain in 89% of patients, morning stiffness in 92%, and allowed 71% to return to unrestricted sports activity.

Endoscopic bursal resection: the olecranon bursa and prepatellar bursa.

We treated 31 cases of olecranon bursitis and 19 cases of prepatellar bursitis. The average duration of symptoms before surgery was 1.1 years with a range of 3 months to 4 years.

Arthroscopic treatment of post-traumatic cysts of the talus.

We report on 9 patients with persistent ankle pain and radiographic evidence of a cystic lesion on the talus. All had a history of an inversion-type of ankle injury. Radiographs were initially negative, but a cyst developed about 6 months after the injury.

Arthroscopic treatment after previous failed open surgery for osteochondritis dissecans of the talus.

We report on 8 patients with persistent ankle pain after open surgery for osteochondritis dissecans of the talus. At an average of 35 months after initial surgery, arthroscopic treatment was performed in these patients. The patients had residual loose chondral and osteochondral debris at the site of the original lesion.

Arthroscopic treatment of osteochondritis dissecans of the talus.

We report on a retrospective study of 33 patients who underwent arthroscopic treatment for osteochondritis dissecans of the talus. Twenty-eight of the patients (85%) had a history of mild to moderate trauma. Arthroscopic treatment consisted of removal of the osteocartilaginous fragments, debridement of disrupted cartilage, and abrasion of the base to bleeding subchondral bone.

Pseudoaneurysm as a complication of knee arthroscopy.

This is a report of a pseudoaneurysm of the inferior medial geniculate artery following knee arthroscopy. This case was treated successfully with embolization.

Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery.

We reviewed 100 patients treated arthroscopically for symptoms of chronic ankle pain associated with sprains of the ankle. All had pain that had failed to respond to conservative treatment for at least 6 months. The pathology in 95 of the 100 ankles studied could be categorized into one of three groups: the instabilities (lateral and syndesmotic), the impingements (anterior and anterolateral), and articular lesions (chondral and osteochondral).

The diabetic frozen shoulder: arthroscopic release.

Seventeen patients who were diabetics developed frozen shoulders which failed to respond to conservative management. They had persistent pain, stiffness, and limited function. An arthroscopic release was performed by progressively releasing the anterior structures from superior to inferior.

Failure of arthroscopic meniscal repair following septic arthritis.

Three cases are described in which failure of arthroscopic meniscal repair performed with an inside-out technique occurred following postoperative septic arthritis. Confirmation of septic arthritis was made by bacterial culture of joint fluid aspirates. The treatment consisted of arthroscopic lavage and intravenous antibiotics.

Full-thickness rotator cuff tears. A biomechanical comparison of suture versus bone anchor techniques.

We performed a biomechanical comparison of two rotator cuff repair techniques using fresh-frozen human cadavers. Nine pairs of cadaveric shoulders had standardized full-thickness tears made at the supraspinatus tendon insertion. One of each pair of the cadaveric shoulders was repaired by pulling the tendon into a bone trough in the humeral head using standard sutures.

Periarticular heterotopic ossification: a complication of arthroscopic anterior cruciate ligament reconstruction using a two-incision technique.

Extra-articular heterotopic bone formation was recognized as a postoperative complication of arthroscopic anterior cruciate ligament reconstructions in four knees around the femoral drill hole. Although laxity of the reconstructed anterior cruciate ligament was not observed in these patients, local pain, swelling, and deformity at the site of heterotopic ossification required surgical intervention. The ectopic bone can be successfully excised with restoration of function.

Fluid pump systems for arthroscopy: a comparison of pressure control versus pressure and flow control.

We set out to compare two pump systems, one in which pressure alone could be controlled and the second in which pressure and flow could be controlled separately. Assessments were carried out by two observers independently. A variety of arthroscopic procedures were studied including arthroscopy of the knee, anterior cruciate ligament reconstruction, arthroscopy and acromioplasty of the shoulder, and arthroscopy of the elbow and ankle.

The resistant frozen shoulder. Manipulation versus arthroscopic release.

Frozen shoulder is often a self-limited disease, but approximately 10% of patients have long-term problems. Arthroscopy was done in 40 patients with persistent pain, stiffness, and functional loss for at least 1 year without improvement despite conventional treatment. In the first 20 patients, manipulation was done with an arthroscopy before and afterward; in the second 20 patients, the contracted structures were divided through arthroscopy.

Arthroscopic treatment for posterior impingement in degenerative arthritis of the elbow.

Twenty-one patients underwent arthroscopic treatment for posterior impingement associated with degenerative elbow arthritis. Anterior debridement and removal of loose bodies was performed first. The posterior procedure consisted of three parts: removal of posterior loose bodies, removal of the posterior olecranon osteophyte, and removal of the osteophytes in the olecranon fossa to the point of fenestration.

Arthroscopic debridement for the osteoarthritic ankle.

We were able to review 27 out of 32 patients who had arthroscopic debridement for osteoarthritis of the ankle. The patients had symptoms for an average of 4 years before the procedure. The average follow up was 45 months.

Treatment modalities for soft tissue injuries of the ankle: a critical review.

We reviewed the English language medical literature on soft tissue injuries of the ankle published between 1966 and 1993. There were 150 articles reviewed of which 84 dealt substantially with ankle soft tissue injuries. The papers were analyzed for quality and it was found that there were significant weaknesses throughout the literature.

The foot in ballet dancers: the importance of second toe length.

Ballet dancers are prone to foot injuries. Our hypothesis was that the length of the second toe in relation to the big toe affected the distribution of stresses on the foot, correlating with calluses, injuries, and pain. Fifty-nine ballet dancers were examined for second toe length with respect to great toe, calluses, and metatarsophalangeal inflammation.

Arthroscopic synovectomy of the knee: is it helpful?

We performed 211 arthroscopic synovectomies over a 10-year period. The results were assessed at follow-up of at least 2 years using the criteria of pain, synovitis, and effusion, range of motion and function. In rheumatoid knees (112 cases), we had good or excellent results in 80%.

Posterior portals for arthroscopic surgery of the knee.

Posterolateral and posteromedial portals are necessary for certain arthroscopic procedures of the knee. Many surgeons hesitate to use portals. A cadaveric study was performed to identify the structures at risk in establishing these portals.

Disruption of the ankle syndesmosis: diagnosis and treatment by arthroscopic surgery.

Over a 10-year period, 19 patients were seen who had the clinical features of disruption of the syndesmotic ligaments of the ankle. Seventeen of these were available for follow-up by history and 13 by physical examination. The patients underwent an arthroscopy for persistent symptoms an average of 2 years following the injury.

Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints.

We investigated the relative importance to stability of the four component ligaments of the distal tibiofibular syndesmosis. Eight fresh-frozen cadaver specimens were tested on a hydraulic test system during sequential cutting of the ligaments. The percentage resistance to 2 mm of diastasis was measured for the four ligaments.

Partial repair of irreparable rotator cuff tears.

This study analyzes the results of a previously unreported technique of reconstruction for the massive irreparable rotator cuff tear. The technique involves repair of the margins of the tear to restore the force couples and "suspension bridge" system of force transmission in the shoulder. Complete coverage of the defect was not considered to be essential as long as the normal mechanics of the shoulder were restored and the rotator cuff tear was converted to a "functional cuff tear.

Arthrodesis of the ankle. A comparison of two versus three screw fixation in a crossed configuration.

Sixteen human anatomic specimen ankles underwent an arthrodesis using two (medial and lateral) or three (additional anterior) screw fixation. It was shown that significantly greater compression was achieved with three screws (p = 0.001).