Clinical results after tarsal tunnel decompression.

We reviewed the clinical results for thirty patients (thirty-two feet) who had had exploration and decompression of the posterior tibial nerve for the treatment of tarsal tunnel syndrome between 1982 and 1990. The average duration of follow-up was thirty-one months (range, twenty-four to 118 months). Most of the patients were female, and the average age was forty-seven years (range, thirteen to seventy-two years). Over-all, only fourteen (44 percent) of the thirty-two feet benefited markedly from the operative procedure (a good or excellent result). Of the five patients (five feet) who were completely satisfied, three had another lesion (a ganglion cyst, an accessory navicular bone, or a medial talocalcaneal coalition) in or near the tarsal tunnel that had been treated at the same time. Eleven patients (twelve feet [38 percent]) were clearly dissatisfied with the result and had no long-term relief of the pain (a poor result). The pain was decreased in six feet (19 percent), but the patients still had some pain and disability (a fair result). There were four complications (13 percent): three wound infections and one delay in wound-healing. Twenty-two feet had had preoperative electrodiagnostic studies; the results of eighteen studies were considered abnormal and supportive of a diagnosis of tarsal tunnel syndrome. However, there was no correlation between the clinical outcome at the latest follow-up visit and the results of these studies. Over-all, the patients in the current series had less improvement than those who have been reported on previously.2

Double-stem silicone implant arthroplasty of all metatarsophalangeal joints in patients with rheumatoid arthritis.

Double-stem silicone implants have been used to reconstruct destroyed hallux metatarsophalangeal joints (MTPJ) for many years. When smaller implants became available, they were used to reconstruct the lateral four MTPJ. An arthroplasty of all MTPJ was performed using these implants in 44 patients (72 feet) with rheumatoid arthritis (RA). The mean age of patients was 46 years (range, 21 to 66) and 84% were female. Previous surgery had been performed on 28% of the feet. All patients were followed prospectively for an average of 67 months (range, 36 to 111). The patients were evaluated clinically and radiographically; results were recorded on a standardized foot form that allowed computer analysis of the data. The results showed improvement in the hallux valgus angle from 41.6 degrees to 16.1 degrees postoperatively, with no loss of correction over time. Similarly, other forefoot deformities, such as plantar callus and lateral toe abnormalities, all improved both clinically and radiographically. The pain, walking, and function scores all improved, with the greatest improvement being pain relief. Radiographic analysis showed some evidence of fracture in seven hallux (9.7%) and nine lateral toe (3%) implants. Only three toes with implant fracture had some pain at follow-up examination. Three other lateral toe implants were removed for pain. There was no evidence of deep infection or silicone synovitis. Other complications included superficial infection, delayed wound healing, and second surgery for heterotopic bone excision.(ABSTRACT TRUNCATED AT 250 WORDS)

Osteochondritis dissecans of the patella. MRI evaluation and a case report.

Osteochondritis dissecans of the patella is a rare cause of anterior knee pain. An illustrative case in a 22-year-old man demonstrates the current imaging modalities and surgical treatment. Specifically, magnetic resonance imaging (MRI) and arthroscopic knee surgery are discussed along with a review of the literature. Unlike standard roentgenograms, MRI can be helpful in determining the viability of the osteochondritic fragment and the amount of remaining attachment to the surrounding cancellous bone. This finding can have important bearing on choice of treatment. When surgery is indicated, arthroscopic treatment with excision of the fragment and curettage offers distinct advantages over open arthrotomy. Lateral release or other realignment procedures may be done in combination with the primary procedure. Prognosis for full recovery of knee function and relief of patellar pain is guarded in patients who require surgery.

AMMI adjustment for statistical analysis of an international wheat yield trial.

Multilocation trials are important for the CIMMYT Bread Wheat Program in producing high-yielding, adapted lines for a wide range of environments. This study investigated procedures for improving predictive success of a yield trial, grouping environments and genotypes into homogeneous subsets, and determining the yield stability of 18 CIMMYT bread wheats evaluated at 25 locations. Additive Main effects and Multiplicative Interaction (AMMI) analysis gave more precise estimates of genotypic yields within locations than means across replicates. This precision facilitated formation by cluster analysis of more cohesive groups of genotypes and locations for biological interpretation of interactions than occurred with unadjusted means. Locations were clustered into two subsets for which genotypes with positive interactions manifested in high, stable yields were identified. The analyses highlighted superior selections with both broad and specific adaptation.