Subtalar joint arthroscopy for sinus tarsi syndrome: a review of 29 cases.

Twenty-nine consecutive patients who underwent diagnostic or therapeutic subtalar joint arthroscopy for sinus tarsi syndrome were retrospectively reviewed. The mean length of follow-up was 18 months. There was a history of trauma in 86% of the patients, with an inversion sprain being the most common predisposing injury (63%). All patients had a primary preoperative diagnosis of sinus tarsi syndrome. Magnetic resonance imaging was useful in identifying subtalar joint chronic synovitis and/or fibrosis in all 26 patients who were imaged. Subtalar joint synovectomy was the most common procedure performed. Twelve patients had 15 additional operative procedures. One patient required an arthrotomy secondary to arthrofibrosis. There were no postoperative complications. The mean return to full activity was 4 months. The mean postoperative AOFAS Ankle-Hindfoot Scale score was 85 points. Subtalar joint arthroscopy has proven to be a relatively safe and effective diagnostic and therapeutic technique in the management of sinus tarsi syndrome.

Arthroscopic monopolar radiofrequency thermal stabilization for chronic lateral ankle instability: a preliminary report on 10 cases.

This study represents a preliminary review of 10 patients having undergone arthroscopic monopolar thermal stabilization for ankle instability from October 1996 to June 1998. All patients in this study expressed mild to moderate chronic ankle instability complaints and were dissatisfied with their attempts at conservative care. Subjective clinical results were evaluated in all patients having undergone this procedure utilizing a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. In addition, eight of these patients underwent pre- and postoperative stress radiographs. The average age of the patient population in this study was 34.5 +/- 9.26 years. The preoperative AOFAS scores averaged 58.3 +/- 8.96 and the postoperative were 88.1 +/- 11.09 points. Patients returned to full activities on the average of 3 months. Postoperative ankle varus stress test reduced on the average of 2.8 degrees +/- 2.77 degrees, while the anterior drawer measurements reduced 4.8 +/- 1.83 mm. The reduction in anterior drawer test amounted to an approximate 60% decrease in talar excursion postoperatively. All patients who underwent this procedure achieved ankle stability and commented that they would undergo the procedure again.

Application of distal metaphyseal osteotomy for treatment of high intermetatarsal angle bunion deformities.

This is a retrospective study of 10 patients (13 feet) with moderate to severe hallux valgus who underwent a chevron or modified chevron osteotomy with multiple adjunctive soft-tissue releases for surgical treatment. Radiographic and subjective results were evaluated with an average follow-up of 24 months (range, 10-41). Preoperative criteria included an intermetatarsal (IM) angle of greater than 16 degrees (average of 18.4 degrees) and painful hallux valgus deformity. Average preop hallux abductus was 35.4 degrees (range, 25 degrees-48 degrees). The average reduction in the actual IM angle was (-) 5.2 degrees with a relative IM correction of (-) 11.6 degrees. Average postoperative hallux abductus angle was 7.0 degrees (range, 0 degree-22 degrees). Subjectively, all patients were satisfied with their results and stated they would have the procedure again. No complications were noted in this patient population, including, infection, avascular necrosis, hallux varus, and recurrence of deformity. The chevron osteotomy was found to be successful in this population with high intermetatarsal angles when appropriate consideration was given to correction of soft-tissue-deforming forces and contractures.