[Ankle impingement. Indications and arthroscopic therapy]. / Impingement des oberen Sprunggelenks. Indikationen und arthroskopische Therapie.

Ankle impingement syndromes are one of the most frequent chronic and posttraumatic pathologies of the ankle joint. Anterior and posterior impingement result from the abutting of anatomical structures leading to pain and limitation in the range of motion of the ankle joint. Ankle impingement can be classified based on the localization or the underlying cause. Besides chronic ankle pain, further symptoms are movement and load-dependent swelling of the ankle joint and limitations in dorsiflexion and plantar flexion. The clinical symptoms and physical examination play an essential role in diagnosing soft tissue impingement, whereas various imaging techniques are important for the diagnostics of bony impingement. From a therapeutic perspective, conservative treatment should be initially attempted. If non-operative treatment fails, arthroscopic resection and debridement of the underlying cause is nowadays the standard method of surgical treatment. With a current complication rate of approximately 3 % ankle arthroscopy is a safe operative method, which is associated with a high postoperative rate of patient satisfaction and significant relief of symptoms.

The intraoperative use of ultrasound facilitates significantly the arthroscopic debridement of calcific rotator cuff tendinitis.

INTRODUCTION: During arthroscopy, the localization of calcific deposit in patients suffering from calcifying tendinitis can be demanding and time consuming, frequently using ionizing radiation. Intraoperative ultrasound has been recently promoted, facilitating deposit localization and reducing radiation dose. MATERIAL AND METHODS: In this prospective, randomized, controlled and clinical observer-blinded pilot trial, 20 patients with calcific tendinitis were operated. In group I, the deposit was localized conventionally. In group II, the deposit was localized using intraoperative ultrasound. The needle punctures to detect the deposit and operation times were noted. Patients were postoperatively evaluated after 2 and 6 weeks and 9 months. RESULTS: In group II, the needle punctures to detect the deposit were significantly lower than in group I (p < 0.0001). Operation time to localize the deposit was also significantly less in group II (p < 0.033). In both groups, patients improved significantly with increased shoulder function (p < 0.0001) and decreased pain (p < 0.0001) 2 weeks and 9 months (p < 0.001) after surgery. The difference between the groups was not significant. Excellent radiological findings were obtained in both groups after 9 months. CONCLUSIONS: Intraoperative US significantly facilitates the detection of calcific deposits during arthroscopic debridement by speeding up surgery and reducing the number of needle punctures. Hence, we have changed our method of detecting calcific deposits intraoperatively from fluoroscopy to ultrasound.

Ultrasound guidance improves the accuracy of the acromioclavicular joint infiltration: a prospective randomized study.

Degeneration of the acromioclavicular joint (AC) often causes impaired shoulder function and pain. Its infiltration results in reportedly beneficial short-term effects. Misplacement of infiltrations is observed in high numbers. A previous study showed high accuracy of infiltrations of one surgeon comparing conventional palpation technique to ultrasound guidance. This study evaluates if ultrasound-guided AC joint infiltration is feasible for therapists of different levels of experience and if the accuracy can be increased. One hundred and twenty AC joints of 60 cadavers were enrolled into a prospective, randomized observer-blinded study. Six therapists of three different levels of experience infiltrated 20 AC joints each. Half of them were infiltrated after palpation of the joint space, half of them were ultrasound-guided infiltrated. Controls were performed pre- and post-infiltration by an independent radiologist. In total, accurate infiltration was observed in 70%. In 25%, misplacement of the infiltration was recorded in the palpation-, in 2% in the ultrasound- and in 3% in both groups. The difference between the two groups was significant (P = 0.009). Ultrasound-guided infiltration to the AC joint is significantly more accurate than conventional palpation technique. This method is simple, efficient and can be applied by therapists of all levels of experience.