Technique and clinical evaluation of arthroscopic ankle arthrodesis.

Arthroscopic ankle arthrodesis has recently been shown to be an effective procedure with significant advantages when properly indicated. We report on the results of arthroscopic ankle fusion in 16 patients with idiopathic or posttraumatic osteoarthritis and rheumatoid disease. We used standard ankle arthroscopic technique and simple noninvasive distraction with hanging weights. All 16 patients had a successful fusion at an average of 9.5 weeks postoperatively. Complications included 1 lateral cutaneous neuroma, and 1 patient who required removal of screws because of superficial pain. Postoperative evaluation showed complete resolution of pain in 14 of 16 patients and significant improvement in gait. Fourteen of 16 patients were completely satisfied with the result and cosmesis, and only 1 patient required shoe modification. These results substantiate previous reports that arthroscopic ankle arthrodesis is successful, and where indicated, has significant advantages over the open technique.

Chronic and recurrent ankle sprains.

Persistent symptoms such as pain, swelling, or giving way after lateral ligament injuries of the ankle are not uncommon. The treating orthopedist must first decide whether the symptoms are related to the ankle instability. Intra-articular or extra-articular injury may occur concomitantly with either a stable or unstable ankle, and careful diagnostic evaluation must be undertaken. Arthroscopy of the unstable ankle in which there is significant pain without demonstrable intra-articular injury by bone scans, CT scans, and MRI studies is indicated, as intra-articular lesions do occur that may result in chronic pain after the ankle has been rendered stable. An arthroscopic lateral ankle capsulodesis procedure has been described with promising early results. Arthroscopic management of an intra-articular pathologic condition in the stable ankle involves removal or excision of offending bone and/or soft tissue. Patients' symptoms can be improved significantly by these approaches, after which there can be a return to a more normal level of function.

Treatment of hallux valgus in adolescents by the chevron osteotomy.

Between 1978 and 1984, 20 adolescent patients underwent 35 chevron osteotomies of the first metatarsal for correction of painful hallux valgus. After an average follow-up of 64 months, 85% of the patients expressed overall satisfaction. The cosmetic effect was the most satisfactory result (90%), followed by relief of pain (85%) and lack of limitations in footwear (65%). Radiographic evaluation did not seem to correlate with the final clinical result. The chevron osteotomy is a reasonable operative procedure for correction of hallux valgus in adolescents.

Subtalar dislocations.

Subtalar dislocations are uncommon injuries. In an effort to obtain accurate information, eight recent major series (more than five patients) were summarized, including the experience at the authors' institution between 1975 and 1985 (12 patients). Medial dislocations predominated (79.5%), lateral injuries accounted for 17% of cases, and posterior (2.5%) and anterior (1%) dislocations were infrequent. Associated fractures with medial (55%) and lateral (72%) dislocations were common. Open injuries with lateral dislocations (25%) were more common, and avascular necrosis was uncommon (4%-5%). Males predominated (81%). It was evident that symptomatic subtalar instability occurred in younger patients treated with shorter periods of immobilization.