Open reconstruction with autologous spongiosa grafts and matrix-induced chondrogenesis for osteochondral lesions of the talus can be performed without medial malleolar osteotomy.

PURPOSE: To evaluate complication rates and postoperative outcomes in patients with osteochondral lesions of the talus who underwent an autologous matrix-induced chondrogenesis (AMIC) procedure with autologous spongiosa grafting without malleolar osteotomy. METHODS: A total of 23 patients with a mean age of 35.6 ± 13.9 years were included in this study. The mean follow-up was 33.5 ± 10.4 months (range 24-52.9 months). The clinical outcomes were evaluated using the visual analog scale (VAS) and the Foot Function Index (FFI). Postoperatively, lesion healing was assessed using the magnetic resonance observation of cartilage repair tissue (MOCART) protocol. RESULTS: There were no intraoperative or perioperative complications. In one patient, arthroscopic arthrolysis was performed due to painful arthrofibrosis. The mean VAS significantly decreased from 7.6 ± 1.1 (range 4.2-9.3) to 1.4 ± 2.2 (range 0-7.4) (P < 0.001). The mean FFI significantly improved from 46.8 ± 14.3 (range 24.3-80.8) to 15.9 ± 11.4 (range 10.0-51.7) (P < 0.001). The mean MOCART score at 1-year follow-up was 74.1 ± 12.4 (range 50-95). Both preoperative and postoperative pains were significantly higher for smokers when compared to non-smokers. CONCLUSIONS: The results of the present study study indicate that AMIC procedure can be performed through the anterolateral and anteromedial arthrotomy without malleolar osteotomy. Thus, the possible complications associated with malleolar osteotomy can be avoided. The AMIC procedure without a malleolar osteotomy can be considered a safe and reliable procedure in patients with osteochondral lesions localized anterior to the midline in the sagittal plane. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.

Technique and results of arthroscopic treatment of posterior ankle impingement.

BACKGROUND: The aim of this study was to investigate the outcome after arthroscopic procedures for treatment of posterior ankle impingement. METHODS: From June 2006 to April 2009 36 patients were treated by hindfoot arthroscopy. Indication was posterior ankle impingement due to symptomatic os trigonum or osteophytes. Pain on the VAS was evaluated pre- and postoperatively. Minimum follow-up was 6 months. RESULTS: 30 patients were available for follow-up. Follow-up averaged 9.7 months (range 6-14 months). Pain measured on the VAS improved significantly from 7.2 points to 1.3 points. One superficial (3.3%) and one deep wound infection (3.3%) occurred, 6.6% of our patients complained about impaired sensitivity of the sural nerve, and 6.6% required resurgery. CONCLUSIONS: Hindfoot arthroscopy is an elegant surgical technique in treatment of posterior ankle impingement. The minimally invasive procedure allows for low complication rates.

[Direct posterior approach for the treatment of posteromedial tibial head fractures]. / Die Osteosynthese posteromedialer Tibiakopffrakturen über einen direkten dorsalen Zugang.

OBJECTIVE: Direct posterior approach requiring minimal soft-tissue dissection for the treatment of posteromedial tibial head fractures. INDICATIONS: Posteromedial fractures of the proximal tibia. Bicondylar tibial plateau fractures involving the posteromedial aspect of the tibial plateau. The approach can be extended for exposure of the posterolateral plateau. CONTRAINDICATIONS: Local soft-tissue problems. SURGICAL TECHNIQUE: Direct posterior approach, mobilization and retraction of the medial head of gastrocnemius muscle. The fracture can be visualized by partial subperiosteal detachment of the popliteal muscle, whereas the medial head of gastrocnemius muscle and the semimembranosus muscle are preserved. Simplified reduction of the posteromedial fragment by extension of the knee and axial traction. Stabilization with lag screws and placement of a buttress plate (i.e., radial LCP T-plate or 3.5-mm LC plate). POSTOPERATIVE MANAGEMENT: Partial weight bearing with 15-20 kg for 6 weeks, unlimited range of motion. RESULTS: From 2001 to 2007, twelve patients (nine female, three male) with "medial split fractures" were treated via the direct posterior approach. Four patients had isolated "medial split fractures", seven patients bicondylar fractures of the tibial plateau, and one patient a four-part fracture. Six of our patients had acute injuries which were primarily treated at the authors' institution. The other six patients presented with malunited fractures or insufficient internal fixation (average 8.4 weeks, 3.5-24 weeks old). In all cases the fracture could be addressed by the described posterior approach. Sufficient reposition and restoration of anatomy could be achieved in all patients.

Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique.

BACKGROUND: The femoral fixation of hamstring tendon grafts by a cross-pin is an established method with excellent biomechanical properties. Until now, this surgical procedure was associated with a transtibial placement of the femoral tunnel and a graft-tunnel diameter mismatch due to the different volumes of the tendon loop and the tendon strands. METHODS: By use of an electrical knee positioning device, the transfixation technique can be performed safely through the anteromedial arthroscopic portal (transarticular technique), reaching the optimal lateral '10:30' position in the intercondylar notch. By use of a specific harvesting and implantation device, a cancellous bone plug is harvested and inserted into the femoral tunnel, thus stabilizing the tendon bundle and eliminating dead space in the tunnel. CONCLUSION: The femoral cross-pin guarantees a secure anchorage of the graft, drilling through the anteromedial portal eases optimum tunnel placement, and the insertion of a solid cancellous bone plug eliminates the femoral graft-tunnel diameter discrepancy and improves the press-fit contact between graft and tunnel wall. The long-term benefit of this technical modification remains to be proven.