Second-look arthroscopic findings and clinical outcomes after management of intra-articular lesions in acute ankle fractures with arthroscopy.

BACKGROUND: Anatomically surgical reduction of ankle fractures does not always result in a clinically favorable outcome. Arthroscopic examination combined with treatment of intra-articular lesion may related to clinical outcomes OBJECTIVES: The purpose of the present study was to review initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 24), supination-adduction type (n = 3), pronation-external rotation type (n = 7), and pronation-abduction type (n = 6), total 40 ankles. Osteochondral lesions were found in 25 ankles (62%) with an initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in secondary arthroscopy were found in 17 cases. According to the Ferkel and Cheng staging at secondary arthroscopy, 4 of 25 ankles with osteochondral lesions of the talus were deteriorating (more than stage D). In terms of ICRS overall repair grades, 5 ankles (20%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles, respectively, in secondary arthroscopy, and correlations were found between AOFAS scores, VAS and intra-articular lesions. CONCLUSION: Second-look arthroscopic examination combined with treatment of intra-articular lesion such as arthrofibrosis and osteochondral lesion arising from ankle fracture surgery may consider to improve clinical outcomes.

Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach.

BACKGROUND: The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis. METHODS: Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union. RESULTS: Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group. CONCLUSIONS: Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.

Radiologic Factors Affecting Ankle Pain Before and After Total Knee Arthroplasty for the Varus Osteoarthritic Knee.

The aim of the present study was to evaluate the radiologic factors related to ankle pain before and after total knee arthroplasty (TKA) among patients with a varus osteoarthritic knee. Fifty-five patients (65 ankles) with a varus osteoarthritic knee who had undergone TKA and were followed up for >24 months were enrolled. For clinical assessment, the visual analog scale for pain and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale were used. For radiologic assessment, the mechanical axis deviation angle, talar tilt, tibial anterior surface angle, distal medial clear space, medial tibiotalar joint space, frontal tibial ground angle, and hindfoot alignment view angle were measured. The patients with ankle pain before TKA (11 ankles) had a larger hindfoot alignment view angle (9.2° ± 2.6°) than that of patients without ankle pain before TKA (54 ankles; 5.5° ± 4.8°; p = .007). The patients with newly developed ankle pain or experienced an aggravation of existing pain after TKA (8 ankles) had a significantly larger degree of residual varus (5.1° ± 2.1°) than did the patients without ankle pain before and after TKA or those with ankle pain before surgery. However, the severity of the pain was not different during the follow-up period (52 ankles; 1.6° ± 2.5°; p = .001). The results of the present study showed that residual varus deformity was associated with ankle pain after TKA. Surgeons should perform evaluations of the ankles of patients who complain of pain before and after TKA and should give careful attention to the correction of alignment during TKA.

Arthroscopic Deltoid Repair: A Technical Tip.

Deltoid ligament repair can be challenging, and implementation of an arthroscopic method can be useful in terms of minimizing morbidity associated with open dissection, as long as the repair is effective and durable. In this brief report, we describe a method of arthroscopic deltoid ligament repair that we have found to be useful.

A Comparison of Screw Fixation and Suture-Button Fixation in a Syndesmosis Injury in an Ankle Fracture.

The present study compared the quality of reduction and the clinical assessment between screw fixation and suture-button fixation with an ankle fracture accompanied by syndesmosis injury. We studied the clinical and radiologic findings 1 year postoperatively through retrospective examination of 24 patients who had undergone screw fixation from January 2011 to December 2012 and prospective examination of 20 patients who had undergone suture button fixation from January 2013 to May 2014. Regarding the tibiofibular clear space, tibiofibular overlap, and medial clear space, the screw fixation group had improvement from a preoperative mean of 6.97 (range 2.79 to 15.81) mm, 4.43 (range 0 to 7.87) mm, 7.90 (range 4.24 to 19.50) mm to a postoperative mean of 4.95 (range 2.72 to 9.08) mm, 6.29 (range 0 to 10.37) mm, and 4.32 (range 1.98 to 6.57) mm, respectively. The corresponding improvement for the suture-button fixation group was from a preoperative mean of 6.65 (range 3.94 to 13.73) mm, 5.39 (range 0 to 9.44) mm, 7.27 (range 4.04 to 16.00) mm to a postoperative mean of 5.15 (range 2.93 to 7.30) mm, 7.21 (range 2.15 to 10.30) mm, and 4.25 (range 2.97 to 5.71) mm. No statistically significant difference was found between the 2 techniques. Both suture-button and metal screw fixation are effective treatment methods for an ankle fracture accompanied by syndesmosis injury. However, a long-term and prospective analysis is needed.

Intraoperative Three-Dimensional Imaging in Calcaneal Fracture Treatment.

BACKGROUND: To compare the effectiveness of intraoperative three-dimensional (3D) image and conventional two-dimensional (2D) fluoroscopic images, which are used in the treatment of acute calcaneal fractures. METHODS: We retrospectively analyzed 40 patients who suffered calcaneal fracture and underwent surgery at Inje University Busan Paik Hospital. The patients were divided into two groups. Only 2D fluoroscopy was used to evaluate 20 patients of group 1. On the other hand, 3D fluoroscopy was performed on the remaining 20 patients of group 2; 3D fluoroscopy was performed on these patients after they were extensively evaluated by 2D fluoroscopy during surgery. We reviewed the radiographic and clinical outcomes of these patients, whose average follow-up period was 42.6 months. RESULTS: In group 2, 3D fluoroscopy detected four cases (20%) of articular incongruence and screw misplacement. All these complicated cases were corrected during surgery. At the final follow-up session, the mean American Orthopedic Foot and Ankle Society (AOFAS) hind foot score was 78.3 (range, 65 to 95) in group 1 and 82.3 (range, 68 to 95) in group 2. CONCLUSIONS: Intraoperative 3D imaging of calcaneal fractures is considered to be useful in evaluating the congruence of joints and the placement of implants.

Clinical results comparing transtibial technique and outside in technique in single bundle anterior cruciate ligament reconstruction.

PURPOSE: To compare the clinical results of single-bundle anterior cruciate ligament (ACL) reconstruction using the conventional transtibial technique and the anatomical outside-in technique for femoral tunneling. MATERIALS AND METHODS: From 2007 to 2011, 89 patients who received ACL reconstruction were followed for ≥1 year were enrolled in the study. The conventional transtibial technique was used in 41 patients and the outside-in technique, in 48 patients. Femoral tunnel angle measurement and three-dimensional computed tomography (3D CT) were used for radiologic assessment of the location of femoral tunnel and Lysholm score and other tests were used for clinical assessment. RESULTS: Both techniques did not reveal statistical differences in the clinical assessment. However, in International Knee Documentation Committee subjective knee evaluation, the sum of two questionnaire items regarding instability showed a statistically significant difference (p=0.01). In the pivot shift test, the anatomical outside-in technique showed outstanding rotational stability over the transtibial technique (p=0.04). The mean femoral tunnel inclination in coronal plane were 69.2° and 30.3°, respectively, for both techniques, and 21.6° and 50.8°, respectively in sagittal plane, showing statistically significant differences on simple radiography (p=0.04, 0.05). A 3D CT was performed in 17 patients with the conventional transtibial technique and 25 patients with the outside-in technique. Coefficients of variation were 0.33 and 0.13, respectively, from dorsal border of the condyle and 0.67 and 0.24, respectively, from the roof of intercondylar notch. CONCLUSIONS: Femoral tunnels created with the outside-in technique have superior knee joint rotational stability compare to the transtibial technique. Therefore, the outside-in technique could be considered as a valuable technique in single-bundle ACL reconstruction.

Posterior lumbar interbody fusion using compressive bone graft with allograft and autograft in the pyogenic discitis.

STUDY DESIGN: This is a retrospective study. PURPOSE: To evaluate the advantages and effects of posterior lumbar interbody fusion (PLIF) using allograft and posterior instrumentation in the lumbar pyogenic discitis, which are resistant to antibiotics. OVERVIEW OF LITERATURE: To present preliminary results of PLIF using a compressive bone graft with allograft and pedicle screw fixation in the lumbar pyogenic discitis. METHODS: Fifteen patients who had lumbar pyogenic discitis were treated by posterior approach from May 2004 to July 2008. The mean follow-up duration was 27.2 ± 18.68 months. The standing radiographs of the lumbar spine and clinical results were compared and analyzed in order to assess the bony union, the changes in the distance between the two vertebral bodies and the changes in the lordotic angle formed between the fused bodies immediately after surgery and at the final follow-up. RESULTS: Fifteen solid unions at an average of 15.2 ± 3.5 weeks after operation. The mean preoperative lordotic angle of the affected segments was 14.3 ± 15.1°, compared to 20.3 ± 12.3° after surgery and 19.8 ± 15.2° at last follow-up. For the functional result according to the Kirkaldy-Willis criteria, the outcome was excellent in 9, good in 5, fair in 1, and there were no poor cases. The average visual analogue scale score was decreased from 7.4 before surgery to 3.4 at 2 weeks postoperative. CONCLUSIONS: The main advantage in the procedure of PLIF using compressive bone graft with allograft and post instrumentation is early ambulation. We believe that this is another good procedure for patients with poor general condition because a further autograft bone harvest is not required.