Low prevalence of osteoarthritis in patients with congenital clubfoot at more than 60 years' follow-up.

We investigated 60 patients (89 feet) with a mean age of 64 years (61 to 67) treated for congenital clubfoot deformity, using standardised weight-bearing radiographs of both feet and ankles together with a functional evaluation. Talocalcaneal and talonavicular relationships were measured and the degree of osteo-arthritic change in the ankle and talonavicular joints was assessed. The functional results were evaluated using a modified Laaveg-Ponseti score. The talocalcaneal (TC) angles in the clubfeet were significantly lower in both anteroposterior (AP) and lateral projections than in the unaffected feet (p < 0.001 for both views). There was significant medial subluxation of the navicular in the clubfeet compared with the unaffected feet (p < 0.001). Severe osteoarthritis in the ankle joint was seen in seven feet (8%) and in the talonavicular joint in 11 feet (12%). The functional result was excellent or good (≥ 80 points) in 29 patients (48%), and fair or poor (< 80 points) in 31 patients (52%). Patients who had undergone few (0 to 1) surgical procedures had better functional outcomes than those who had undergone two or more procedures (p < 0.001). There was a significant correlation between the functional result and the degree of medial subluxation of the navicular (p < 0.001, r2= 0.164), the talocalcaneal angle on AP projection (p < 0.02, r2 = 0.025) and extent of osteoarthritis in the ankle joint (p < 0.001). We conclude that poor functional outcome in patients with congenital clubfoot occurs more frequently in those with medial displacement of the navicular, osteoarthritis of the talonavicular and ankle joints, and a low talocalcaneal angle on the AP projection, and in patients who have undergone two or more surgical procedures. However, the ankle joint in these patients appeared relatively resistant to the development of osteoarthritis.

Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy.

We retrospectively analyzed 26 shoulders in 24 patients 16 to 20 years (mean, 17.5 years) after a Bankart repair and compared these with a prospective series of 30 shoulders in 28 patients 15 years (mean, 15.1 years) after a Bristow-Latarjet repair for recurrent anterior dislocation of the shoulder. At follow-up one patient in each group had undergone revision surgery for recurrent instability. Two patients in the Bankart group had spontaneous stabilization of postoperative instability. Further, one patient in this group had had one subluxation during the follow-up period. In the Bristow group one patient reported 3 recurrences 3 years postoperatively. This patient has had no further redislocations during the past 12 years. Subluxations occurred occasionally several times in 2 patients in the Bristow group, but these patients were satisfied with the procedures at follow-up. No patient in the Bankart group had apprehension at follow-up. Eight patients in the Bristow group had subjective and/or objective apprehension. Throwing ability after surgery in the dominant shoulder was considered normal in 8 of 12 patients in the Bristow series and in 1 of 11 patients in the Bankart series. In the Bankart group 17 patients were "very satisfied" with the operative result, 7 were "satisfied," and 1 was "dissatisfied." The corresponding figures for the Bristow group were 24 who were very satisfied and 5 who were satisfied. Dislocation arthropathy was found in 16 of 26 Bankart shoulders (14 mild and 2 moderate) and in 9 of 30 Bristow shoulders (5 mild, 3 moderate, and 1 severe). The Bankart procedure seemed to be more successful than the Bristow-Latarjet repair when stability at follow-up was considered. However, when other criteria, as well as the patients' assessment of the operative result, are included, both methods can be recommended without any major differences.

Arthroscopic lavage speeds reduction in effusion in the glenohumeral joint after primary anterior shoulder dislocation: a controlled randomized ultrasound study.

Recent studies have shown that arthroscopic lavage of the glenohumeral joint within 10 days following a primary anterior dislocation significantly lowers the recurrence rate when compared with a nonoperative regime. We hypothesize that the lavage reduces distension in the joint and thereby facilitates adaptation and healing of the soft tissue lesion. Using ultrasound, we assessed the hemarthrosis in the glenohumeral joint weekly in 16 consecutive patients after traumatic primary anterior shoulder dislocation. The patients were randomized into two groups for treatment with either arthroscopic lavage or a nonoperative regime. Except for the lavage the two groups followed an identical rehabilitation program. Transversal dorsal ultrasound of the glenohumeral joint was performed, in which the joint effusion was assessed as the distance between the humeral head and the glenoid. Prior to the lavage the two groups had a similar amount of excessive joint effusion. The effusion declined to a steady state level within 3-7 weeks. The joint effusion decreased more rapidly (33%) in the group treated with arthroscopic lavage (P = 0.02) than in the nonoperated group.