Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies.

PURPOSE: Although simultaneous arthroscopy for the surgical treatment of acute isolated, unstable syndesmotic injuries has been recommended, little knowledge is present about the actual frequency of intra-articular pathologies for this injury. The aim of this study was to investigate the frequency and severity of intra-articular pathologies detected during arthroscopy and their subsequent treatment in acute isolated, unstable syndesmotic injuries. METHODS: A retrospective chart review of patients treated by arthroscopic-assisted stabilization for acute isolated, syndesmotic instability was performed. The primary outcome parameter was the frequency of intra-articular pathologies. Secondary outcome parameters were the type of syndesmotic lesion (ligamentous/bony), severity of chondral lesions, MRI findings, treatment details, complications and the identification of factors associated with intra-articular pathologies. RESULTS: Twenty-seven patients, 19% female, with a mean age of 37 ± 12 years met the inclusion criteria. 70% suffered isolated ligamentous injuries, the remaining suffered avulsion fractures of the syndesmosis. Chondral lesions occurred in 48% (ICRS grade II: 33%; ICRS grade IV 15%) and intra-articular loose bodies in 11% of patients. Overall, arthroscopy revealed intra-articular pathologies necessitating further treatment in 19% of patients. Neither the type of syndesmotic injury (bony vs. ligamentous; ns) nor the degree of ligamentous instability (West Point IIB vs. III; ns) had a significant influence on the occurrence of chondral lesions. One complication (SSI) occurred. Pre-operative MRI revealed a sensitivity/specificity of 100/79% for chondral lesions and 50/93% for loose bodies. CONCLUSION: Intra-articular pathologies in acute isolated, unstable syndesmotic injuries occur in up to 50% of patients, 19% necessitated additional treatment. Simultaneous arthroscopy, independent of the pre-operative MRI findings, appears reasonable in highly active patients. LEVEL OF EVIDENCE: Level III.

Patient perception of Achilles tendon rupture treatment.

The optimal treatment of Achilles tendon ruptures (ATRs) is a subject of some debate amongst orthopedic surgeons. Many patients' understanding of Achilles injuries is limited and may be more informed by popular culture than anything objective. We sought to assess patient perceptions of ATRs using a proprietary questionnaire and correlate that with demographic information and the health literacy of the patient. Patients presenting with an Achilles tendon injury were asked to fill out a demographic form, the Literacy in Musculoskeletal Problems (LiMP) survey, to assess musculoskeletal health literacy, and a 22-question survey on ATRs designed to assess patient knowledge and perception of ATRs. Seventy percent of patients responded that surgery with or without other modalities is the most appropriate treatment for ATRs, while only 20% of patients responded that nonoperative treatment is most appropriate. Perceptions of treatment were not associated with demographic data or LiMP scores and appear to be biased to some degree towards surgery. In a setting in which the optimal treatment has not been fully worked out by surgeons, it is difficult to tell what influence patient perceptions may have on treatment, although it is possible these patient perceptions may cause surgeons to be more surgically aggressive.

Performance Function Tests in Assessing Ankle Fitness.

INTRODUCTION: A challenge for any physician caring for athletes is determining readiness for return to competition after an injury. A wide variety of performance function tests (PFTs) have been described, but no norms or minimum performance levels exist for any of them. In this study, healthy athletes were given a series of PFTs to complete. We propose that there will be a minimum performance level for each of the PFTs that all athletes can complete. We also propose, for tests that assess the right and left legs independently, that performance of the right leg will consistently be within 10% of the left. Finally, we propose that performance on one of the functional tests will be predictive of function on all the tests. METHODS: Athletes were put through a testing protocol, beginning with range of motion and progressing through a series of functional ankle tests of increasing difficulty. Right and left leg data were recorded separately for the first five tests. For each test, mean values, ranges, and SDs were calculated. RESULTS: Eighty-one athletes completed the protocol. A wide variation existed in performance ability between athletes; the SD for any of the tests was too high to determine a minimum performance threshold. However, when comparing right to left leg in any one athlete, the difference in performance testing was always less than 10%. Furthermore, performance on the side hop test was predictive of performance on the other tests. DISCUSSION: A wide range of performance was noted in all the PFTs, so it is not possible to define a minimum threshold. However, performance of an injured leg to within 10% of the opposite (uninjured) leg suggests achievement of normal function. The side hop test might be a good test by itself to represent overall ankle readiness.