Dorsal calcaneocuboid ligament versus lateral ankle ligament repair: a case-control study.

OBJECTIVE: Anatomic reconstruction is the treatment of choice for lateral ankle ligament instability. A similar technique has recently been described for stabilisation of a chronic unstable calcaneocuboid joint as an alternative to the previously proposed tenodesis and arthrodesis procedures. METHODS: Five consecutive young females experiencing recurrent giving way of six calcaneocuboid joints were treated operatively during a 4 year period using anatomic ligament repair reinforced by a periosteal flap. Results were compared to five patients who underwent anatomic lateral ankle ligament repair in a case-control design. Outcome was measured using the Foot and Ankle Outcome Score, physical examination, and stress radiographic and MRI (calcaneocuboid group) investigation. Functional neuromuscular performance was evaluated by isokinetic torque measurements, posturometry, single-leg drop jumps, and single-leg long jumps. RESULTS: Outcome scores at follow up (5-61 months after surgery) revealed excellent results for both groups. No relevant difference was found between the affected legs and the non-affected legs or between groups with respect to the outcome measures. MRI exhibited ligament-like structures at the repaired dorsal calcaneocuboid joints in five out of six joints. CONCLUSIONS: Results of anatomic repair of unstable lateral ankle and isolated calcaneocuboid joint instability equally lead to excellent results.

[Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis-a therapeutic challenge]. / Die Impingementläsion der distalen Achillessehne bei Bursitis subachillae und Haglund-Pseudoexostose--eine therapeutische Herausforderung.

Retrocalcaneal bursitis in athletes is frequently misdiagnosed. Results of conservative treatment are not very promising. This investigation evaluates the results of 39 consecutive cases in 38 patients surgically treated due to chronic retrokalkaneal bursitis in a sport specific population. Preoperative MRI and ultrasound investigation showed corresponding lesions (focal degeneration, partial rupture) of the anterior Achilles tendon. This is possibly the result of a previously undescribed impingement lesion produced by the Haglund's bone and the chronically inflamed retrocalcaneal bursa. During operation this lesion was additionally addressed in 85% of the cases. Follow up was done after 32 months. Success rate was 54%. VISA-A Score at follow up was 80.6 points. Training and competition activities were started at 16 weeks and 9 months respectively. Unsatisfying results were analysed. In two cases Haglund's bone resection was incomplete and had to be removed in a reoperation. Additionally one deep wound infection had to be revised. Due to the distal Achilles tendon fiber extensions around the medial and lateral calcaneal bone, an unintended Achilles tendon lesion, induced by the edge of the osteotome seems to be possible. Two calcanear stress fractures complicated the postoperative rehabilitation.

[Orthopaedic examination of gymnasts]. / Grundlagen der orthopädischen Untersuchung im Kunstturnen.

A gymnast is prone to catch specific acute and overload injuries as well. Those injuries are concentrated at the spine due to the fact, that high load is administered to the growing apophyseal elements. Preventive X-ray examinations are useless in this respect, because the gymnasts training starts at the age of 5-6 years and apophyseal ossification nuclei develop not before the age of about 11-13 years. On the other hand regular performed preventive clinical examinations seem to be important for preventive reasons. For this purpose we developed specific clinical tests which allow early recognition of overuse injuries while they are in a latent phase and while the athlete does not complain any pain. Furthermore staging of the injury is possible and healing response can be controlled.