Arthroscopy-assisted correction of hallux valgus deformity.

PURPOSE: Our purpose was to evaluate the clinical and radiologic results of arthroscopy-assisted hallux valgus deformity correction with percutaneous screw fixation. METHODS: Ninety-four feet underwent arthroscopy-assisted hallux valgus deformity correction. Patients in whom the 1,2-intermetatarsal angle could be reduced manually and who had no significant abnormality of the distal metatarsal articular angle were included, and an endoscopic distal soft tissue procedure was performed. Those patients with first tarsometatarsal hypermobility, in whom the 1,2-intermetatarsal angle cannot be reduced manually, or those who had a significantly abnormal distal metatarsal articular angle were excluded. Patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. The pre- and postoperative hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and sesamoid position were measured. RESULTS: The mean score on the AOFAS scale was 93 +/- 8 out of 100 points. The hallux valgus angle improved from 33 degrees +/- 7 degrees (range, 20 degrees to 58 degrees ) to 14 degrees +/- 5 degrees (range, 4 degrees to 30 degrees ). The intermetatarsal angle improved from 14 degrees +/- 3 degrees (range, 10 degrees to 26 degrees ) to 9 degrees +/- 2 degrees (range, 5 degrees to 18 degrees ). Complications of hallux varus, skin impingement, screw breakage, and first metatarsophalangeal stiffness were experienced. Two patients with symptomatic recurrence had revision operation performed. CONCLUSIONS: Our study shows that arthroscopic correction of the hallux valgus deformity can achieve good clinical and radiologic results, provided that careful preoperative clinico-radiologic assessment is made to exclude patients contraindicated for the procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Role of toe flexor tendoscopy in management of an unusual cause of metatarsalgia.

The purpose of this study is to describe an endoscopic approach to toe flexor tendons at the level of metatarsal head region. And this study is a kind of retrospective case series. Three patients with toe flexor tenosynovitis were evaluated after a follow-up of 2 years after toe flexor tendoscopy. One patient suffered from infective toe flexor tendosynovitis resulting from a penetrating injury and other two patients suffered from idiopathic focal toe flexor tenosynovitis. Pre-operative metatarsalgia subsided after toe flexor tendoscopy. No endoscopy-related complication was observed. Toe flexor tendoscopy can be an effective operative means in the management of focal toe flexor tenosynovitis.

Comparison of radiologic and arthroscopic diagnoses of distal tibiofibular syndesmosis disruption in acute ankle fracture.

PURPOSE: The purpose of this study was to compare intraoperative stress radiography and ankle arthroscopy in the evaluation of distal tibiofibular syndesmosis disruption in acute ankle fracture. TYPE OF STUDY: Prospective study. METHODS: We treated 53 Weber type B or C ankle fractures without radiographic evidence of frank syndesmosis diastasis. Intraoperative stress radiography and ankle arthroscopy were performed. Syndesmotic screws were inserted in those patients with syndesmosis diastasis. Screws were removed 12 weeks later and second-look ankle arthroscopy was performed at the same time. RESULTS: Sixteen cases (30.2%) had positive intraoperative stress radiographs; 35 cases (66.0%) had positive arthroscopic findings of syndesmosis diastasis, including various combinations of coronal, sagittal, and rotational planes of instability. During second-look arthroscopy, 31 of 34 patients with syndesmotic screws showed healing of the syndesmotic ligaments and the syndesmosis became stable. CONCLUSIONS: Ankle arthroscopy excels intraoperative stress radiography in detecting syndesmosis disruption. It also provides assessment of different planes of instability and assists anatomic reduction of the syndesmosis. Intraoperative radiography still does play an important role in assessing fracture reduction and proper restoration of fibular length and longitudinal orientation of the syndesmosis. LEVEL OF EVIDENCE: Level 2.

Tendoscopic debridement for stage I posterior tibial tendon dysfunction.

Our objective is to assess whether the tendoscopic synovectomy is effective to control the stage I posterior tibial tendon dysfunction. Our study is a retrospective one. The participants, six patients with stage I posterior tibial tendon dysfunction, were treated with tendoscopy with synovectomy for the past 3 years. The results show that this is a safe procedure and we could achieve similar effectiveness as the traditional open procedure. There was no complication found. None of our patients have progressed to stage II or above posterior tibial tendon dysfunction. In conclusion, tendoscopic debridement is a minimal invasive surgery. It is effective to control the stage I posterior tibial tendon dysfunction. In addition, it had the advantages of smaller scars, less wound pain and a short hospital stay.