[Show abstract][Hide abstract] ABSTRACT: Background
We have conducted a retrospective review of 19 patients for whom 20 separated ossicles of the lateral malleolus were excised arthroscopically. We examined the operating methods, findings, and overall results.
The patients’ indications for this procedure were as follows. The main complaints were pain alone; ossicle sizes were small and ankle instability was minimal. There were 12 ankles of 12 males and eight ankles of seven females. The patients’ average age was 17.6 years. A 2.7-mm, 30° arthroscope was inserted into the ankle joint through the anterolateral portal. Instruments were inserted through the accessory anterolateral portal, and ossicles were removed piece by piece. Talar tilt angles and anterior displacements were examined and compared before and after surgery by use of stress radiographs. Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scales were assessed pre and postoperatively.
All patients recovered their original levels of activity. The mean talar tilt angle changed from 6.1° ± 2.4° preoperatively to 6.0° ± 1.8° postoperatively (p = 0.93), and the mean anterior displacement changed from 5.9 ± 1.7 mm preoperatively to 6.1 ± 2.0 mm postoperatively (p = 0.42). Average JSSF ankle/hindfoot scale improved from 77.6 ± 2.6 points preoperatively to 97.2 ± 5.2 points postoperatively (p < 0.01).
Arthroscopic excision of separated ossicles of the lateral malleolus achieved good results with minimum incisions, and relatively early resumption of daily and sports activity was possible. However, when the ossicles were embedded within the fibers of the anterior talofibular ligament, it was impossible to avoid cutting of ligament fibers. To reduce the possibility of ligament dysfunction, we believe postoperative treatment should conform to the accepted method for treatment of acute ankle sprains.
[Show abstract][Hide abstract] ABSTRACT: We treated 12 cases of posterior ankle bony impingement in 12 athletes arthroscopically, and examined the operating methods, findings, and postoperative physical therapy and overall results.
The patients' average age was 21.4 years. The mean duration of postoperative followup was 33.8 months. A 2.7-mm, 30 degree arthroscope was inserted into the subtalar joint using posterolateral and accessory posterolateral portals. When the impinged fragment was visualized, it was carefully excised from the surrounding soft tissues. The operation was completed once the entire flexor hallucis longus tendon was seen. No cast immobilization was applied postoperatively, and physical therapy including limited weight bearing and range-of-motion exercises commenced within 24 hours after surgery. Beginning 3 weeks after surgery, the patients were permitted to gradually resume sports under the guidance of a physiotherapist. The AOFAS ankle-hindfoot score, the postoperative range of motion of the ankle and the time to recover were determined.
The average postoperative AOFAS ankle-hindfoot score improved from 68.0 to 98.3 points. The mean preoperative range of motion of the ankle joint was improved from 59.2 degree to 68.4 degree. The average period to return to sports was 5.9 weeks. All patients reached full activity within 13 weeks after surgery. The surgical time ranged from 40 minutes to over 2 hours and was affected by the impingement condition.
Arthroscopic treatment for posterior ankle bony impingement syndrome was minimally invasive and suitable for athletes who desire an early return to sports activity.
[Show abstract][Hide abstract] ABSTRACT: The progress of diagnostic imaging technology, including CTs, MRIs, and ankle arthroscopy has encouraged more detailed descriptions of osteochondral lesions of the talus. These lesions can vary from chondral fragments separated from the subchondral bone with or without bone sclerosis or cysts in the subchondral layers. Isolated lesions of the cartilage, defined as chondral-separated types, as opposed to the osteochondral-separated types which were osteochondral fragments, were retrospectively evaluated in this study.
Seventy-three osteochondral lesions of the talus in 69 patients were treated. There were 29 chondral-separated types in 29 patients confirmed by examining CT, MRI, and arthroscopic findings.
The average age at onset of the chondral-separated type was 30.7 years. CT findings (29 ankles) showed sclerosis in seven ankles, micropores in nine, honeycombs in seven, and cysts in six. MRI T2-weighted image findings (28 ankles) showed micro to large pore high signals in the subchondral layers in 18 ankles, low to high mixed signals with poor margins in six, and high signals on the articular surfaces in four. Arthroscopic findings (29 ankles) showed softening of the articular cartilage in two ankles, fissures in 16, bulging and fissures in six, and detachment of the articular cartilage in five.
The onset of these lesions occurred in adults after bone maturity with involvement of the chondral and subchondral layers. Each layer seemed to have experienced different degenerative and reparative processes.
[Show abstract][Hide abstract] ABSTRACT: To determine what factors correlate with values for tested anterior drawer (AD) sign, we investigated stress radiographs in 71 patients with severe chronic lateral instability of the ankle as well as 320 normal controls. We found no correlation between AD and talar tilt (TT), but measurement of the anterior tip ratio (ATR) (ATR=tanA x 100) demonstrated a link of ATR with AD (r=0.74, p<0.001). The posterior tip ratio (PTR) (PTR=tanP x 100) was not correlated with AD (r=0.34, p=0.16). The ankle mortise angle (AMA) (the anterior opening of the lateral ankle mortise) was also not correlated with AD (r=0.27, p=0.23). Investigation of 320 normal ankles revealed a mean ATR of 9.1%+/-1.4%. The ATR in patients was 7.6%+/-1.7%, significantly lower than in the control patients. The values in female patients with chronic lateral instabilities were significantly less than the values in the females in the control group. But values for male patients were not different from the control group. Thus the anterior tip of the lateral tibial plafond, as it affects the ATR, may influence instability in anterior drawer function, especially in female patients with chronic lateral ligamentous instability of the ankle.
Foot & Ankle International 02/2002; 23(2):118-22. · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of lengthening on muscle metabolism was measured and correlated to the percent lengthening at early and late time points. Using the rabbit tibial lengthening model, the authors examined the effects of lengthening on the tibialis anterior muscle using phosphorus-31 magnetic resonance spectroscopy. Thirty-six rabbits were divided into five groups, four groups by percent lengthening (0%, 15%, 20%, and 25%), with each group divided into subgroups of early (end distraction) and late (12 weeks after end distraction), and the fifth group using the opposite untreated leg as control. Several parameters measuring metabolism of muscle using phosphorus-31 magnetic resonance spectroscopy analysis were compared. No changes occurred to 15% lengthening, but significant decreases were measured at 20% and 25% lengthening. After a 25% lengthening, the decreased metabolism persisted at 12 weeks after distraction, indicating the possibility of permanent damage. After 20% lengthening, the same parameters improved but never to normal levels. The authors conclude that lengthening to 15% is safe for muscle, but 20% to 25% lengthening may result in permanent metabolic damage. The current study also suggests that phosphorus-31 magnetic resonance spectroscopy may provide a viable clinical method for evaluating muscle damage during lengthening.
Clinical Orthopaedics and Related Research 07/1998; 351(351):214-21. DOI:10.1097/00003086-199806000-00026 · 2.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This case report describes arthroscopic findings of the effect on articular distraction of
ankle joint by means of external fixator for the patient with chondrolysis. Arthroscopy
showed fibrocartilage tissue lying between the talus and tibia to protect damaged articular
surfaces although apparent repair of surface cartilage failed to find.
Diagnostic and Therapeutic Endoscopy 02/1997; 4(2):101-5. DOI:10.1155/DTE.4.101
[Show abstract][Hide abstract] ABSTRACT: Sixty ankles of 59 patients with symptomatic ossicles of the lateral malleolus were studied. All patients underwent clinical and radiographic examinations. Stress arthrography was performed on 58, arthroscopy on 48, operative treatment on 52, and histologic examination on 23. The ossicles were classified into 3 sizes (small, medium, and large) and 2 levels (A and B) by location. The relationship between the ossicle and fibular tip was classified into 3 grades according to arthrography results (Grade 1, little inflow [< 1 mm] of the contrast medium; Grade 2, an apparent space [1-2 mm]; Grade 3, a large gap [> 2 mm]) and to operative and arthroscopic findings (Type A, a fibrous union; Type B, a partial continuity; Type C, a lax thin scar tissue; Type D, no continuity). There were significant differences in talar tilt angles on stress radiography between the 3 grades. Chronic symptoms had a tendency to increase from Grade 1 to Grade 3 and from Type A to Type C or D, with instability occurring more than pain. The size and level did not correlate with instability. Acute or chronic inversion forces may act on the connection between the ossicle and fibular tip, and damage to this structure may cause symptoms.
Clinical Orthopaedics and Related Research 10/1996; 330(330):157-65. DOI:10.1097/00003086-199609000-00019 · 2.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors report a case of entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis. This entrapment neuropathy was found distal to the inferior retinaculum that causes the anterior tarsal tunnel syndrome. Surgical decompression of the deep peroneal nerve that was entrapped by the extensor hallucis brevis relieved the symptoms. This condition, like the anterior tarsal tunnel syndrome, deserves attention.
The Journal of Foot and Ankle Surgery 11/1995; 34(6):560-2. DOI:10.1016/S1067-2516(09)80078-1 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Second look arthroscopy was performed on 46 of 137 consecutive patients who underwent arthroscopic meniscal repair. All tears were of the vertical type. Thirty-two tears were located in avascularized areas. Thirty-one patients had associated anterior cruciate ligament insufficiencies. Anterior cruciate ligament reconstructions were performed simultaneously on 26 patients. The double-needle cannula method was used in all the patients. An additional transplantation of a vascularized synovial pedicle flap to the suture site was performed on 7 tears in avascularized areas. Second look arthroscopy showed no healing in 8 patients and healing in 38. Four of the 8 unhealed tears were located in avascularized areas, and 4 had unreconstructed anterior cruciate ligament injuries respectively. All 7 patients with synovial pedicle flaps showed healing. All patients with anterior cruciate ligament reconstructions showed healing, and the healing rate was significantly higher than that of the other patients (p < 0.005). Patients with anterior cruciate ligament insufficiencies showed a significantly lower healing rate than the others (p < 0.005). In patients with tears in avascularized areas, the conventional meniscal repairs showed a lower healing rate than did the repairs with a synovial pedicle transplantation or an anterior cruciate ligament reconstruction (p < 0.005). These results suggest that the most important factors influencing meniscal healing are the presence of anterior cruciate ligament tears, ligamentous reconstruction, and vascularity of the tear site.
Clinical Orthopaedics and Related Research 05/1995; 314)(314):185-91. · 2.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A fracture through the posterior medial tubercle of the talus is quite rare. Although excision of the bone fragments has been reported previously in this fracture, cases of internal fixation of the posterior medial tubercle of the talus have not been reported. Two patients are described who presented with a fracture through the posterior medial tubercle of the talus which was treated with internal fixation. Our patients appeared normal on physical examination and returned to work, with no evidence of avascular necrosis of the fragments.
[Show abstract][Hide abstract] ABSTRACT: Treatment of abnormal mobility of the popliteal tendon area of the lateral meniscus is described. Twenty-seven patients who exhibited an abnormally mobile posterior segment with no obvious ruptures in the lateral meniscus were directly examined by us after an average of 4 years and 3 months from the time of the arthroscopic procedure. The main complaints associated with this condition before the surgery were pain and locking during deep knee flexions. The patients were divided into three groups according to surgical method: partial meniscectomy, subtotal meniscectomy, or meniscal repair. The subtotal meniscectomy and repair groups showed significantly higher scores than the partial meniscectomy group. A locking phenomenon recurred in one case of the meniscal repair group. In this case, the menisco-femoral coronary ligament posterior to the popliteal tunnel could not be sutured.
Arthroscopy The Journal of Arthroscopic and Related Surgery 02/1992; 8(4):424-7. DOI:10.1016/0749-8063(92)90002-S · 3.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An arthroscopic and anatomical investigation was performed to define the abnormal conditions of the popliteal tendon area in a lateral meniscus. Arthroscopic findings for 100 patients and anatomical observations of 10 amputated knees were analyzed. Five of the 10 dissected menisci were also examined histologically. Menisco-tibial coronary ligaments were classified into two types, as follows: type I--a coronary ligament covering an entire popliteal tendon beneath the meniscus; type II--a popliteal tendon visible beneath the meniscus through defects of the coronary ligament. Twenty-one of 100 cases were classified as type I, and 79 were classified as type II. Three of the 10 anatomical dissections were type I, and the remaining 7 were type II. Menisci in which the type I coronary ligaments were thought to be torn and menisci with type II coronary ligaments showed a rather marked mobility, but no conclusion could be reached.
Arthroscopy The Journal of Arthroscopic and Related Surgery 02/1992; 8(4):419-23. DOI:10.1016/0749-8063(92)90001-R · 3.19 Impact Factor