Arthroscopic findings associated with the unstable ankle.

Before lateral ankle stabilization, arthroscopic surgery was performed on 54 patients (55 ankles) with chronic ankle instability. All patient charts, x-rays, operative reports, and surgical videotapes were reviewed. A detailed questionnaire was answered by all patients. The study population included 31 males and 23 females, with a mean age of 31 years (range, 14-64 years). The right ankle was involved in 64% of cases. Average follow-up was 9.6 months. Arthroscopic surgery was performed using small joint instrumentation including 30 degrees and 70 degrees 2.7-mm arthroscopes and a 30 degrees 1.9-mm arthroscope. At surgery, 51 ankles (93%) had intra-articular abnormalities including loose bodies (12), synovitis (38), osteochondral lesions of the talus (9), ossicles (14), osteophytes (6), adhesions (8), and chondromalacia (12). The most common arthroscopic procedures were synovectomy, removal of loose bodies and ossicles, excision and drilling of osteochondral lesions, debridement of the lateral gutter, excision of osteophytes, and removal of adhesions and scar tissue. There was a 25% incidence of chondral injuries, which differs considerably from the results of Taga et al., who found chondral injuries in 95% of ankles with lateral instability. Overall, there were excellent or good results in 96% of ankles. The incidence of excellent results was lower in the worker's compensation patients because of a greater incidence of complaints of pain with activity. There was no correlation between the presence of osteochondral lesions or amount of talar tilt and results.

A new modified technique for harvest of calcaneal bone grafts in surgery on the foot and ankle.

Reported sites for retrieval of cancellous bone for grafts include the iliac crest, greater trochanter, proximal tibia, and distal tibia. A new lateral technique for retrieval of cancellous bone from the calcaneus is evaluated through anatomic review, quantitative analysis, and retrospective clinical assessment. Of 22 patients managed with this technique over a 2-year period, 17 returned for an evaluation by questionnaire, physical examination, and radiographic follow-up at an average of 7 months after surgery (range, 4-16 months). Complaints/complications were minor: three had minor incisional symptoms, five had medial heel pain (3 caused by plantar fasciitis), and one had unchanged preoperative heel pain secondary to clubfoot deformity. Compared with more extensive bone-grafting procedures, this procedure offers the advantages of bone harvested under local anesthesia using a readily accessible ipsilateral extremity and producing minor complications.

Results of arthrodesis of the tarsometatarsal joints after traumatic injury.

We retrospectively reviewed the records of thirty-two patients who had had an arthrodesis of the tarsometatarsal joints for intractable pain after a traumatic injury of the midfoot. The arthrodesis was performed at a mean of thirty-five months (range, six to 108 months) after the injury. All of the procedures were performed with use of rigid internal fixation, and twenty-four patients, in whom a defect had been created by debridement of the joints, were managed with an autogenous bone graft. Nine patients had at least one concomitant procedure, including a claw-toe procedure (eight patients), a reconstruction of the posterior tibial tendon (three patients), an excision of an interdigital neuroma (three patients), an arthrodesis of the calcaneocuboid joint (one patient), and an arthrodesis of the ankle (one patient). Complications included neuritis in three patients; metatarsalgia in two; malunion in two; and asymptomatic non-union, wound slough, superficial infection, and reflex sympathetic dystrophy in one each. The patients were evaluated at a mean of fifty months (range, twenty-four to 105 months) after the arthrodesis. The evaluation included a physical examination, radiographs, and use of the rating scale of the American Orthopaedic Foot and Ankle Society for the evaluation of the midfoot. The mean postoperative score of 78 (of a possible 100) points was significantly better than the mean preoperative score of 44 points (p = 0.02). With the numbers available, we could not show that the extent of the arthrodesis, the involvement of other joints in the hindfoot or the forefoot, the mechanism of injury, or whether the injury was work-related significantly affected the functional outcome.

Results of hallux varus correction using an extensor hallucis brevis tenodesis.

We have used an extensor hallucis brevis tenodesis procedure to treat symptomatic hallux varus in six patients (five women and one man). Indications for this procedure include the presence of flexible metatarsophalangeal and interphalangeal joints and the absence of arthritis. In this group (mean age, 47 years; range, 18-65 years), hallux varus followed correction of hallux valgus deformity in five patients and traumatic dislocation of the hallux in one patient. Excellent correction was noted and maintained in all patients at a mean interval of 28 months (range, 24-32 months) after surgery. Despite a slight decrease in dorsiflexion following surgery (average, 10 degrees), there were no additional complications noted, and the mean American Orthopaedic Foot and Ankle Society rating score improved from 61 to 85 after surgery.