The treatment of symptomatic os acromiale.

Os acromiale is an uncommon condition of the shoulder. When symptomatic, os acromiale may cause impingement pain, rotator cuff tears, or pain through abnormal motion at the unfused apophysis. Treatment of symptomatic os acromiale is controversial. This article reports on four patients with symptomatic meso-acromions who were treated with open reduction and internal fixation. All four patients recovered full function postoperatively with UCLA shoulder rating scores improving from 19 preoperatively to 35 postoperatively. Open reduction and internal fixation of a symptomatic meso-acromion is a reliable and reproducible technique in which the deltoid attachment and lever arm are minimally affected.

Arthroscopic meniscal repair with two-year follow-up: a clinical review.

The potential for healing of meniscal tissue has been historically underappreciated, but is currently more widely acknowledged. We have reviewed our experience with arthroscopic meniscal repair in 29 patients who had had a minimum of 2 years' follow-up. Between September 1983 and November 1986, 31 patients who had undergone arthroscopic meniscal repair with a minimum of 2-years' follow-up were identified. Of the 31 patients, 29 were available for additional follow-up. The patient population averaged 31 years of age, with 15 men and 14 women. Utilizing a closed arthroscopic cannulated technique, 16 lateral and 15 medial menisci were repaired. The majority of lesions were vertical bucket-handle tears involving the posterior horn and averaged 2.5 cm in length. Of the 31 tears, 29 were in the red-red or red-white zones. Clinical healing was present in 27 (87%) of the 31 repaired menisci. Nine patients underwent relook arthroscopy at which time healing was confirmed in eight, and a retear noted in one. Four reruptures occurred and the menisci required removal. Of the 29 patients, 16 had concomitant anterior cruciate ligament injuries ranging from partial tears to complete disruptions. Seven patients underwent immediate or delayed anterior cruciate ligament stabilization. Healing occurred in six of the seven patients whose anterior cruciate ligaments had been reconstructed. Among those patients with reruptures, chronic anterolateral rotatory instability was identified as a significant risk factor for rerupture. A complication rate of 13% was noted. Three patients underwent manipulation under anesthesia for postoperative ankylosis and one patient experienced a transient saphenous nerve neuropraxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopic meniscal repair evaluated with repeat arthroscopy.

Arthroscopic meniscal repair is a technically feasible approach to the treatment of meniscal tears in young active individuals. To evaluate this premise, we repaired 29 minisci in 27 patients and then arthroscoped their knees 3 months later. Repairs were limited to displaceable longitudinal tears. In 16 patients ligaments were intact. Eleven patients were anterior cruciate ligament deficient, six of whom underwent concomitant ACL reconstructions. In two patients, bicompartmental tears were encountered. Under arthroscopic control, using curved cannulae, horizontal mattress sutures of absorbable monofilament were placed across the tear, out through the capsule, and tied over the fascia, deep to the skin. No arthrotomies were performed, and all portions of the menisci could be reached with this method. Twenty-four of 29 repairs healed completely; 5 healed partially (30 to 50% healing). Four of the five failed repairs occurred in unstable anterior cruciate ligament deficient knees.

A simple leg-holder for arthroscopy.

A very simple leg-holding device has been devised and used by the author in over 1,200 arthroscopic surgical cases. The device is made from disposable materials that are found in all operating room environments. It has been found safe to use and reliable in its ability to assist in the exposure of either the medial or lateral compartments. It has a very low profile, which permits ready access to superior portals during operative arthroscopy in the suprapatellar pouch and the patello-femoral joint. Perhaps most important of all, its cost is negligible.