Arthroscopic anterior talofibular ligament reconstructin in chronic ankle instability: Two years results.

PURPOSE: In chronic lateral ankle instability, primary ligament repair is not always possible because of poor quality of the local tissues. A free autologous or allograft tendon graft or synthetic grafts are suitable alternative. We describe middle term results of arthroscopic reconstruction of the anterior talofibular ligament (ATFL) using a free autologous ipsilateral gracilis graft in patients with chronic ankle instability. METHODS: Eleven patients with chronic lateral ankle instability with imaging evidence of isolated ATFL tear underwent arthroscopic reconstruction of the ATFL using a free ipsilateral gracilis graft. Functional and subjective assessment were performed after an average of 24 months following the index procedure. RESULTS: At 24 months, all patients showed objective improvements. One patient reported transient dysaesthesiae on the dorsolateral aspect of the foot and heel. CONCLUSIONS: Arthroscopic isolated reconstruction of the ATFL with a free ipsilateral gracilis grafts is safe, allowing restoration of joint stability and low surgical morbidity. STUDY DESIGN: Case series.

Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis.

BACKGROUND: Arthrosis is particularly prevalent in the knee. Infiltration treatment for gonarthrosis is among the most widely used techniques in orthopaedic practice. PURPOSE: To compare the clinical response of hyaluronic acid (HA) and platelet-rich plasma (PRP) treatment in 2 groups of patients affected by gonarthrosis. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 120 patients affected by clinically and radiographically documented gonarthrosis were included in this study. The gonarthrosis was graded using the Kellgren-Lawrence radiographic classification scale. The 120 patients were randomized into 2 study groups in a 1:1 ratio: 60 patients received 4 intra-articular injections of PRP (specifically, autologous conditioned plasma [ACP], 5.5 mL), and 60 patients received 4 intra-articular injections of HA (20 mg/2 mL). An unblinded physician performed infiltration once a week for 4 weeks into the knee affected by clinically relevant gonarthrosis (in both groups). All patients were evaluated with the Western Ontario and McMaster (WOMAC) score before the infiltration and at 4, 12, and 24 weeks after the first injection. RESULTS: Treatment with a local injection of ACP had a significant effect shortly after the final infiltration and a continuously improving sustained effect up to 24 weeks (WOMAC score, 65.1 and 36.5 in the HA and ACP groups, respectively; P < .001), where the clinical outcomes were better compared with the results with HA. In the HA group, the worst results were obtained for grade III gonarthrosis, whereas the clinical results obtained in the ACP group did not show any statistically significant difference in terms of the grade of gonarthrosis. The mean WOMAC scores for grade III gonarthrosis were 74.85 in the HA group and 41.20 in the ACP group (P < .001). CONCLUSION: Treatment with ACP showed a significantly better clinical outcome than did treatment with HA, with sustained lower WOMAC scores. Treatment with HA did not seem to be effective in the patients with grade III gonarthrosis.

Postero-medial approach procedure in the supine position for one-step anterior and posterior ankle arthroscopy.

Standard arthroscopy of the ankle does not allow to approach at the same time the anterior and posterior compartments. Keeping the patient supine and with the application of judicious traction, anterior ankle arthroscopy allows to examine the various intra-articular structures, but treat is limited only to anterior pathology. Also, it is not possible to explore posterior compartment and posterior hindfoot through an anterior approach. Normally, for those patients in whom both the anterior and posterior compartments were to be operated upon, surgery is stopped, and the patient has to be re-positioned. We describe a 2 postero-medial hindfoot portals procedure, which allows to reach both the posterior aspect of the ankle joint and the extra-articular compartment of the hindfoot keeping the patient supine throughout the procedure. After arthroscopy of the anterior compartment using standard anterior portals, 2 postero-medial endoscopic approaches make it possible to visualize and treat pathologies of the posterior ankle and of the hindfoot, without prolonging the operation through the need to reposition the patient in the prone position.