Late-stage Freiberg disease treated by osteochondral plug transplantation: a case series.

BACKGROUND: The purpose of this study was to investigate the clinical, radiological and arthroscopic results of osteochondral plug transplantation for late-stage Freiberg disease. MATERIALS AND METHODS: We examined 4 consecutive cases of late-stage Freiberg disease of the second metatarsal head. All 4 patients were female with an average age of 12. Osteochondral plug transplantation was performed, harvesting from a nonweightbearing site of the upper lateral femoral condyle of the ipsilateral knee. Clinical evaluation using the American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Metatarsophalangeal-Interphalangeal Scale was performed before surgery and at the final followup. Magnetic resonance imaging (MRI) was performed before surgery and at 6 and 12 months after surgery. Furthermore, arthroscopic evaluation was performed at 12 months after surgery. The mean follow up was 52 (range 36 to 72) months. RESULTS: At the final follow up, the average AOFAS score improved from 70.8 points preoperatively to 97.5 points. Although MRI at 6 months after surgery showed an obvious but slight osteochondral plug-subchondral bone interface, healing of the osteochondral plug was confirmed at 12 months after surgery in all patients. With respect to the patients' arthroscopic findings at 12 months after surgery, two of our patients had an International Cartilage Repair Society Cartilage Repair Assessment Score of normal and 2 had a score of nearly normal. CONCLUSION: Osteochondral plug transplantation for late-stage Freiberg disease yielded satisfactory results upon arthroscopic and radiological evaluations at 12 months after surgery and clinical evaluation for all four cases.

Spontaneous oscillation and mechanically induced calcium waves in chondrocytes.

The characteristics of spontaneous calcium (Ca(2+)) oscillation and mechanically induced Ca(2+) waves in articular chondrocytes were studied. In some, but not all, chondrocytes in sliced cartilage and primary cultures, we observed spontaneous oscillation of intracellular Ca(2+) that never spread to adjacent cells. In contrast, a mechanical stimulus to a single cell by touching with a glass rod induced an increase of intracellular Ca(2+) that spread to neighboring cells in a wave-like manner, even though there was no physical contact between the cells. This indicated the release of some paracrine factor from the mechanically stimulated cells. Application of ultrasonic vibration also induced an oscillation of intracellular Ca(2+). The application of a uridine 5'-triphosphate (UTP), UTP, induced a transient increase in intracellular Ca(2+) and the release of adenosine 5'-triphosphate (ATP) in cultured chondrocytes. A P2 receptor antagonist (suramin) and blockers of Cl(-) channels, niflumic acid and 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS), reduced the UTP-induced ATP release. The results indicated that Cl(-) channels were involved in the extracellular release of ATP following mechanical or P2Y receptor stimulation. Thus, ATP stimulation of P2Y receptors elicits an increase in intracellular Ca(2+), triggering further release of ATP from adjacent cells, thereby expanding the Ca(2+) wave in chondrocytes.

Arthroscopic treatment for anterior impingement exostosis of the ankle: application of three-dimensional computed tomography.

The purpose of this study was to evaluate the operative results of excision of anterior impingement exostoses of the ankle. Preoperative three-dimensional computed tomography (3DCT) was used to make the diagnoses. The authors evaluated 16 ankles of 16 patients who underwent arthroscopic resection of the osteophytes of their anterior distal tibia or dorsal talus. They were followed up for 24-51 months. All 16 patients had 3DCT preoperatively, which allowed the authors to determine the exact location, shape, size, and number of the osteophytes. All of the osteophytes were resected using arthroscopic techniques. At the time of the most recent follow-up, the mean AOFAS score was 80.5 +/- 4.9 points at preoperation, and 97.0 +/- 3.7 points at the most recent follow-up. There were significant differences between the pre- and postoperative AOFAS scores and those of the most recent follow-up period for each group (p <.0001). It is necessary to clarify the location, size, shape, and number of all of the osteophytes preoperatively using 3DCT, and to then resect them all.

Osteochondral lesions of the talar dome associated with trauma.

PURPOSE: The purpose of this study was to clarify the differences in the causes of osteochondral lesions (OCL) of the ankle based on the presence of distal fibular fractures and lateral instability of the ankle. TYPE OF STUDY: Case series. METHODS: We evaluated 92 cases of distal fibular fractures and 86 cases of lateral instability of the ankle, including 36 feet with subacute lateral instability of the ankle and 50 feet with chronic lateral instability of the ankle. In diagnosing OCL, we used a combination of magnetic resonance imaging to evaluate the subchondral conditions and ankle arthroscopy to evaluate the chondral conditions. RESULTS: Of a total of 92 distal fibular fractures, 65 cases (70.7%) had OCL at the time of osteosynthesis and 27 did not (29.3%). Among the latter group, 2 developed OCL about 1 year after surgery. Of a total of 86 cases of lateral instability of the ankle, 35 (40.7%) had OCL. Among the subacute cases, 7 of 36 (19.4%) had OCL, versus 28 of 50 cases (56.0%) with chronic lateral instability of the ankle. CONCLUSIONS: Our study suggests that recurrent ankle sprains with remaining lateral instability and distal fibular fractures could be one of the causes of OCL of the ankle.

Arthroscopic drilling for chondral, subchondral, and combined chondral-subchondral lesions of the talar dome.

PURPOSE: We investigated the efficacy of drilling as a treatment for chondral (C), subchondral (S), and combined chondral-subchondral (CS) lesions of the talar dome associated with trauma, using magnetic resonance imaging (MRI), ankle arthroscopy, and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS score). TYPE OF STUDY: Case series study. METHODS: Arthroscopic drilling was performed on 72 patients whose lesions were less than 7 mm in diameter. The patients included 45 men and boys and 27 women and girls whose age at the time of surgery was between 14 and 57 years (mean age, 30.7 +/- 9.5 years). They were followed up for 24 to 71 months (mean follow-up, 39 +/- 6.4 months). RESULTS: There were 13 cases of chondral lesions, 10 cases of S lesions, and 49 cases of CS lesions. The MRI findings revealed that in the chondral lesion group, 13 cases were unchanged and 0 deteriorated; in the S lesion group, 2 improved, 8 were unchanged, and 0 deteriorated; and in the CS lesion group, 13 improved, 36 were unchanged, and 0 deteriorated. The arthroscopic findings showed that in the chondral lesion group, 2 improved, 9 were unchanged, and 1 deteriorated; in the S lesion group, all 8 cases deteriorated; and in the CS lesion group, 28 improved, 22 were unchanged, and 0 deteriorated. Drilling did not always improve the MRI and arthroscopic findings of the 3 respective types of lesions. However, the mean AOFAS score at the most recent follow-up was excellent; 91.7 +/- 2.4 points in the chondral lesion group, 93.1 +/- 2.1 points in the S lesion group, and 98.8 +/- 1.2 points in the CS lesion group. CONCLUSIONS: Our study shows that drilling did not always improve the MRI and arthroscopic findings. However, the clinical results obtained as measured by the AOFAS score were excellent.

Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis.

PURPOSE: To compare the use of magnetic resonance (MR) imaging with the use of arthroscopy for the diagnosis of tibiofibular syndesmotic injury. MATERIALS AND METHODS: This study involved 58 patients who had ankle sprains or distal fibular fractures and underwent surgery. All patients were examined with MR imaging for diagnosis of tibiofibular syndesmotic injury. When MR imaging revealed ligament discontinuity (criterion 1) or either a wavy or curved ligament contour or nonvisualization of the ligament (criterion 2), the injury was considered to be a ligament disruption. After MR imaging, ankle arthroscopy was performed in all patients for a definitive diagnosis of ligament disruption. RESULTS: Arthroscopic findings showed anteroinferior tibiofibular ligament (AITFL) disruption in 28 patients and posteroinferior tibiofibular ligament (PITFL) disruption in five patients. When an MR imaging diagnosis was based on criterion 1 only, the diagnosis of AITFL disruption was made with a sensitivity of 100%, a specificity of 70%, and an accuracy of 84%, and the diagnosis of PITFL disruption was made with a sensitivity of 100%, a specificity of 94%, and an accuracy of 95%. When an MR imaging diagnosis was based on criteria 1 and 2, the diagnosis of AITFL disruption was made with a sensitivity of 100%, a specificity of 93%, and an accuracy of 97%, whereas the diagnosis of PITFL disruption was made with a sensitivity of 100%, a specificity of 100%, and an accuracy of 100%. CONCLUSION: MR imaging with use of both criteria is highly accurate for the diagnosis of tibiofibular syndesmotic disruption.

Symptomatic os subfibulare caused by accessory ossification: a case report.

Separated ossicles at the tip of the lateral malleolus, the condition known as os subfibulare, are sometimes a cause of ankle pain. There are two theories regarding the origin of os subfibulare. One theory proposes that it is caused by an avulsion fracture attributable to pull of the anterior talofibular ligament, whereas the other theory proposes that it is the result of an accessory ossification center. However, some authors have reported that os subfibulare is an avulsion fracture and few reports of accessory ossification have been described recently. A patient with os subfibulare that may have been caused by accessory ossification rather than an avulsion fracture was treated by the current authors.