Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study.

A multicenter study to assess arthroscopic reconstruction of the peripheral attachment of the triangular fibrocartilage complex was undertaken. A total of 44 patients (45 wrists) from three institutions were reviewed. Twenty-seven of the 45 wrists had associated injuries, including distal radius fracture (4), partial or complete rupture of the scapholunate (7), lunotriquetral (9), ulnocarpal (2), or radiocarpal (2) ligaments. There were two fractured ulnar styloids and one scapholunate accelerated collapse (SLAC) wrist deformity. The peripheral tears were repaired using a zone-specific repair kit. The patients were immobilized in a munster cast, allowing elbow flexion and extension, but no pronation or supination for 4 weeks, followed by 2 to 4 weeks in a short arm cast or VersaWrist splint. All patients were reexamined independently 1 to 3 years postoperatively by a physician, therapist, and registered nurse. The results were graded according to the Mayo modified wrist score. Twenty-nine of the 45 wrists were rated excellent. 12 good, 1 fair, and 3 poor. Overall, 42 of the 45 patients (93%) rated as satisfactory and returned to sports or work activities. One patient had chronic pain, and two patients had ulnar nerve symptoms, although motion was normal in all, and their grip strength was at least 75% of the opposite hand. Arthroscopic repair of peripheral tears of the triangular fibrocartilage complex (TFCC) is a satisfactory method of repairing these injuries.

Avulsion of the femoral attachment of the anterior cruciate ligament in a 3-year-old boy.

The incidence of anterior cruciate ligament injury is rare in children. Deficient or absent cruciate ligaments have previously been described as the cause for congenital dislocation of the knee in newborns. We report a case of a 3-year-old boy who presented with a swollen left knee, which did not resolve over a 10-day period. He would not bear weight or extend the knee beyond 45 degrees, and had significant pain with passive extension. Arthroscopy revealed an anterior cruciate ligament that appeared to have been sheared off its attachment to the lateral femoral condyle. This is the youngest patient reported with traumatic disruption of the anterior cruciate ligament.

Technique and clinical evaluation of arthroscopic ankle arthrodesis.

Arthroscopic ankle arthrodesis has recently been shown to be an effective procedure with significant advantages when properly indicated. We report on the results of arthroscopic ankle fusion in 16 patients with idiopathic or posttraumatic osteoarthritis and rheumatoid disease. We used standard ankle arthroscopic technique and simple noninvasive distraction with hanging weights. All 16 patients had a successful fusion at an average of 9.5 weeks postoperatively. Complications included 1 lateral cutaneous neuroma, and 1 patient who required removal of screws because of superficial pain. Postoperative evaluation showed complete resolution of pain in 14 of 16 patients and significant improvement in gait. Fourteen of 16 patients were completely satisfied with the result and cosmesis, and only 1 patient required shoe modification. These results substantiate previous reports that arthroscopic ankle arthrodesis is successful, and where indicated, has significant advantages over the open technique.

Arthroscopy of the acromioclavicular joint.

For many years the Mumford procedure or open resection of the distal clavicle has been the procedure of choice for the treatment of recalcitrant acromioclavicular joint pain. With advancement in shoulder arthroscopy and bursoscopy, arthroscopic resection of the distal clavicle can reproduce similar excellent results, avoiding some of the risks of the open procedure, including joint instability and muscle weakness. The arthroscopist can select from two approaches, a direct or superior approach or the indirect or subacromial approach. Both approaches are effective if the resection is performed in a systematic fashion and the amount of resection measured post-operatively. The authors have attempted to describe the pertinent anatomy of the acromioclavicular joint, clinical indications, and surgical technique for arthroscopic resection of the distal clavicle.

Herbert screw fixation of a capitellum fracture. A case report and review.

Fractures of the capitellum frequently result in significant osteochondral fragments that require internal fixation to restore the anatomic integrity of the elbow joint. Precise reduction is mandatory to maximize articular congruency and diminish the potential for arthrosis. Successful repair of a Type I capitellum fracture in a 54-year-old-woman was accomplished using the Herbert bone screw. This alternative treatment modality allowed for efficient and rigid fixation with less soft-tissue dissection and articular penetration than previously reported.

Locked patellar dislocation with vertical axis rotation. A case report.

Whereas traumatic lateral dislocation of the patella is a well-described clinical entity, other types of patellar dislocations, specifically those that involve patellar rotation, are unusual. These rare types also present a therapeutic problem in which reduction often requires a general anesthetic and, possibly, an open procedure. A 16-year-old boy sustained a laterally directed blow to his knee, resulting in dislocation of the patella. The patella had rotated 90 degrees in the vertical plane and became wedged against the lateral femoral condyle. Initial attempts at closed reduction in the emergency room and under general anesthesia in the operating room were unsuccessful, and the patient required open reduction. A similar type of dislocation has been described; however, the patella is usually intercondylar. The tear along the medial side was extensive enough to allow the patella to dislocate lateral to the lateral femoral condyle, making this a unique case. In these instances of rare patellar dislocation, the surgeon should be prepared to perform an open reduction, because attempts at closed reduction even with a general anesthetic may be unsuccessful.