Treatment of Intra-Articular Lesions After Posterior Inferior Tibiofibular Ligament Injury: A Case Series of Elite Rugby Players.

Background: Surgical intervention is not typically used to treat symptoms after mild tibiofibular ligament injuries without ankle dislocation or subluxation. Purpose: To describe outcomes in patients arthroscopically treated for unique intra-articular lesions after sustaining syndesmosis injury of the ankle. Study Design: Case series; Level of evidence, 4. Methods: A total of 11 elite male rugby players with a mean age of 21.0 years (range, 17-28 years) were referred to our hospital for prolonged posterior ankle pain after a high ankle sprain during rugby football. The patients were examined using standing view radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine the extent of ligament damage. Posterior ankle arthroscopy was performed to examine intra-articular lesions. The patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot rating scale and sports activity score of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results: The average reduced tibiofibular overlap on the standing mortise view was 1.2 mm (range, 0.5-2.0 mm) compared with the opposite ankles. Mason type 1 fracture was detected on CT in 6 patients, and ossification of the interosseous membrane was detected in 2 patients. A bone bruise in the posterior malleolus was observed on MRI in all but 1 patient. Intra-articular fragments located in the posterior ankle were observed and removed arthroscopically. Symptoms improved rapidly after arthroscopic treatment in all patients. All patients returned to rugby games at a median of 11 weeks postoperatively. The median AOFAS scores improved from 77 preoperatively to 100 postoperatively (P < .01), and the median SAFE-Q sports activity subscale score improved from 49.4 to 100 (P < .01). Conclusion: All unique intra-articular lesions that developed in rugby football players after syndesmosis injury were able to be treated arthroscopically. Patients returned to playing rugby football without syndesmosis reduction. Posterior ankle arthroscopy was effective in patients with residual symptoms after syndesmosis injury.

Osteochondral Lesion of the Tibial Plafond Induced by Malposition of Soft Suture Anchors Used for the Deltoid Ligament Repair: A Case Report.

CASE: A 24-year-old elite female rugby player complained of prolonged symptoms after a surgical repair of the deltoid ligament performed 2 years previously. Ankle arthroscopy revealed an osteochondral lesion in the tibial plafond at the medial gutter, with the fibers of the soft suture anchor exposed in the joint. The anchors were removed, and the cysts were filled with autogenous cancellous bone. The patient returned to the elite-level rugby games 5 months after the operation without any symptoms. CONCLUSION: We must be aware that even soft anchors can cause arthritis if improperly positioned.

Advancement of Periosteal and Capsular Complexes With or Without Augmentation Using a Free Graft From Lower Extensor Retinaculum: A Comparative Study With Propensity Score Matching.

Background: This study compared the outcome of the L-shaped (L-AD) advancement of the periosteal and capsular complexes with or without augmentation using a free graft of the lower extensor retinaculum (AUG) in patients with chronic lateral ankle instability. Methods: A matched pair analysis was performed of retrospectively collected medical records of patients undergoing lateral ankle ligament repair who had completed at least 2 years of follow-up. Patients who underwent L-AD with AUG and patients undergoing L-AD alone were matched for age, sex, stress radiography findings, and body mass index. Patients with general joint laxity, osteoarthritic changes in the ankle, and subtalar symptoms and who underwent simultaneous surgical treatment for conditions other than that for lateral ankle ligament were excluded. A total of 46 patients were included in the study (23 patients in each group). Clinical outcome scores and postoperative mechanical instability were compared. Results: The median American Orthopaedic Foot & Ankle Society (AOFAS) score improved significantly (P < .001) from 72 to 97 in the L-AD alone group and from 77 to 100 in the L-AD with AUG group. The mean (±SD) talar tilt angles improved significantly from 11.1 to 4.7 degrees postoperatively (P < .001) in the L-AD alone group vs 9.7 to 5.2 degrees (P < .001) in the L-AD with AUG group. The mean anterior drawer distances were improved significantly postoperatively from 6.4 to 4.7 mm (P < .001) in the L-AD alone group, and from 6.5 to 4.5 mm (P < .001) in the L-AD with AUG group. Conclusion: The L-AD technique significantly improved AOFAS scores and mechanical instability of ankles with chronic lateral instability with a very low complication rate. Additional augmentation using a free graft showed no advantages in the ankle with a talar tilt of <20 degrees. Level of Evidence: Level III, retrospective case-control series.

Preliminary Screening Method for Low Bone Mineral Density Using a Self-Reported Questionnaire among Peri- and Postmenopausal Women.

STUDY DESIGN: Retrospective cohort study. PURPOSE: We propose a method for screening for low bone mineral density (BMD) among perimenopausal and postmenopausal women using a self-reported questionnaire. OVERVIEW OF LITERATURE: Osteoporosis is a major health problem worldwide. However, it is not cost-effective to evaluate BMD in all patients. Although several tools for predicting osteoporosis have been established, they do not focus much on low BMD prior to the development of osteoporosis. METHODS: We retrospectively reviewed the medical records of 198 women aged 40-70 years who underwent mass screening for osteoporosis at our hospital between 2016 and 2019. The BMD values and the following data were collected: age, body mass index, fracture history, lower back pain, height loss, kyphosis, history of fragility fracture, family history of vertebral or hip fracture, and menopause. The reliability of each data point for the young adult mean <80% was calculated using discriminant analysis. Variables with large weight coefficients were selected and scored. This scoring tool was examined, and a cutoff score for predicting the young adult mean <80% was determined. RESULTS: Sixty-four participants (32.3%) had a young adult mean <80%. According to the weight coefficients, the following five variables were scored as follows: age ≥60 years 3 points, body mass index <22 kg/m2 3 points, lower back pain 1 point, height loss (cm) 1 point, and menopause 1 point. The area under the receiver operating characteristic curve was 0.738 (95% confidence interval, 0.669-0.807). At cutoff scores of ≥5 and <5, the sensitivity was 82.8%, with specificity of 52.0%. CONCLUSIONS: The scoring tool performed well for predicting young adult mean <80% among perimenopausal and postmenopausal women in Japan. This tool may be useful to screen for low BMD.

Severe complication subsequent to surgical site infection after cervical laminoplasty: a case report.

INTRODUCTION: Surgical site infections (SSI) following spinal surgery can result in serious complications. Although early detection and intensive care are essential to minimize possible sequelae, more than one surgical intervention is required to alleviate the infection in some cases. CASE PRESENTATION: A 66-year-old man with long-standing Parkinson's disease (PD) developed SSIs after cervical laminoplasty. Despite surgical debridement and irrigation, his neurological status worsened severely and anterior infectious involvement at the C4-5 level was identified by magnetic resonance imaging. He underwent another urgent surgery for anterior debridement and iliac bone grafting. His laboratory results gradually normalized with antibiotic therapy, and his neurological status improved. One year after surgery, he was ambulatory with walker assistance. However, his right hand remained difficult to control with significant sensory loss and numbness. DISCUSSION: To our knowledge, this is the first case of SSI that extended rapidly to the anterior side despite immediate and intensive treatment in a patient with PD after laminoplasty. During SSI treatment, meticulous observation should be performed to check for exacerbations.