Chronic lateral ankle instability: assessment of subjective outcomes following delayed primary repair and a new secondary reconstruction.

Chronic lateral ankle instability is a condition commonly encountered by the podiatric physician. Chronic instability usually occurs after injuries to the lateral collateral ligamentous complex. The purpose of this article is to report subjective results of a retrospective study comparing delayed primary ligamentous repair and a new secondary ligamentous reconstruction. Our patient population includes 23 patients who responded to a detailed questionnaire. Three patients had bilateral ligamentous repair for a total of 26 ankles. Sixteen ankles underwent delayed primary ligamentous repair, while 10 ankles had a secondary reconstruction utilizing the authors' technique. The overall postoperative improvement was 90% in those with a delayed primary repair and 82% in those with the new secondary reconstruction. The average return to full activity for both groups was 10 weeks. Average follow-up for both groups was 12 months. The authors feel these results demonstrate that delayed primary repair and the authors' new secondary reconstruction both provide favorable clinical and surgical outcomes.

The pulsed holmium: yttrium-aluminum-garnet laser. Applications to ankle arthroscopy.

The holmium:YAG laser has many advantages over conventional surgical instrumentation and techniques in ankle arthroscopy. These include minimal mechanical damage to surrounding tissue structures, better access to tight recesses, and the ability to coagulate, smooth, ablate, and weld tissues. The laser also offers improved contouring of damaged articular surfaces, all with a single instrument. The holmium:YAG laser uses a wavelength of 2.1 microns, which is strongly absorbed by water, the major component of tissue. This wavelength allows the laser to deliver a consistent tissue effect to both pigmented and nonpigmented tissues. It currently may transmit up to 60 watts of power to tissue in high-energy, short-duration pulses. The holmium:YAG laser also operates in a fluid medium, which provides a near physiologic environment and maintains continual irrigation. The holmium:YAG laser beam is transmitted through a flexible fiberoptic handpiece, which greatly increases maneuverability. A variety of angled laser tips are available, depending on the pathology type and location. Different tissue effects can be created by varying the tip to target distance. All these qualities provide precise control without significant thermal damage and make the laser ideal for application to articular structures of the ankle joint. The holmium:YAG laser is a safe and effective arthroscopic instrument with a promising future. We have used it, along with traditional shavers and abraders, to effectively treat numerous pathologies of the ankle joint. The laser's versatility in cutting, ablation, and coagulation has been uniformly successful. Patients surveyed postoperatively have reported less overall symptoms and faster healing. They have reported a decrease in ecchymosis, edema, and postoperative pain. Patients' return to full activity has appeared to be quicker with the use of holmium:YAG laser therapy. Although our results have thus far been very encouraging, further research and clinical applications in the use of the holmium:YAG laser need to be continued.

Posterior tibial tendon rupture: classification, modified surgical repair, and retrospective study.

Posterior tibial tendon rupture is often misdiagnosed. The authors have presented a retrospective study of a new variation to the repair of this tendon. The anatomy, physiology, etiology, clinical manifestations, radiographic and magnetic resonance imaging, and historical methods are reviewed. A classification scheme based on location and appearance is discussed. A review of 17 cases was performed with results of 88% pain relief following the discussed procedure.

Aerobic dance survey. A study of high-impact versus low-impact injuries.

A survey of 275 aerobic dance instructors and participants was performed to determine the overall injury rate for each group, as well as the rate of injury in high-impact versus low-impact aerobics. Injuries occurred in 35% of the combined group. Instructors reported a 53% injury rate. Those who took high-impact classes had a 35% injury rate versus 24% in low-impact classes. The rate of injury was analyzed in terms of age, number of workouts, shoe type, and floor type.

Ankle arthroscopy: a retrospective study.

The following is a retrospective study of 71 patients upon whom diagnostic and operative ankle arthroscopy was performed. The postoperative diagnosis in correlation with chosen operative procedure subjectively demonstrates 96% of the patients claiming excellent, good, or fair results. Three patients were unimproved. The criteria was pain upon range of motion experienced by the patient preoperatively and compared to postoperative status. Indications, contraindications, and complications, and the different forms of pathology encountered also will be reviewed.

Chronic plantar fascial inflammation and fibrosis.

The authors present two cases involving heel spur syndrome and plantar fasciitis. Histologic changes in the plantar fascia are compared, and changes found in chronic inflammation are discussed.

Longitudinal rupture of the peroneus brevis tendon: a study of eight cases.

A study of eight cases of longitudinal rupture of the peroneus brevis tendon is presented. The condition is easily overlooked, and requires surgical intervention. The authors describe their own experiences with this problem, as well as a synopsis of pertinent scientific literature.