Arthroscopic handlebar technique for the treatment of posterior malleolar fractures.

Treating posterior malleolar fractures of the ankle remains a challenge. The arthroscopic handlebar technique is our novel surgical method used for reduction and fixation of posterior malleolar fractures and involves the restoration of posterior malleolar fractures under anterior arthroscopic guidance and the use of Kirschner wires that penetrates the fractured posterior malleolus. Arthroscopy enables visualization of the intra-articular fracture of the posterior malleolus, and a handlebar reduction bar is used to control the fractured posterior malleolus. The arthroscopic handlebar technique is a promising procedure for reduction and internal fixation of the posterior malleolar fractures.

Arthroscopic excision of separated ossicles of the lateral malleolus.

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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications.

PURPOSE: The objective of the study was to retrospectively compare the clinical outcomes of anatomic double-bundle anterior cruciate ligament reconstruction via hamstring tendons with single-bundle reconstruction between April 2002 and March 2004. METHODS: We retrospectively reviewed 123 consecutive patients, 71 of whom underwent double-bundle reconstruction and 52 of whom underwent single-bundle reconstruction. The same postoperative rehabilitation protocol was used for all patients. The patients were followed up for a mean of 33 months. We evaluated manual knee laxity, anterior knee laxity as measured with the KT1000 arthrometer (MEDmetric, San Diego, CA), range of knee motion, isokinetic peak torque of knee extension and flexion strength adjusted for body weight as determined by Cybex testing (Lumex, Ronkonkoma, NY), and Lysholm score. RESULTS: The Lachman test was negative in 64 cases (90%) and the pivot-shift test was negative in 62 cases (87%) in the double-bundle group. The Lachman test was negative in 45 cases (86%) and the pivot-shift test was negative in 42 cases (81%) in the single-bundle group. There was an extension deficit of greater than 5 degrees in 19 cases (26%) in the double-bundle group and 6 cases (10%) in the single-bundle group (P < .05). The side-to-side difference in anterior tibial translation measured with the KT1000 arthrometer was 1.7 +/- 2.0 mm in the double-bundle group and 1.9 +/- 2.2 mm in the single-bundle group. The isokinetic peak torque of knee extension and flexion strength was 90% and 89%, respectively, in the double-bundle group and 87% and 86%, respectively, in the single-bundle group. The Lysholm score averaged 96.8 +/- 5.1 in the double-bundle group and 92.8 +/- 6.9 in the single-bundle group postoperatively. CONCLUSIONS: No significant difference was found between the 2 procedures with regard to manual knee laxity, anterior knee laxity measured by the KT1000 arthrometer, knee extension and flexion strength, and Lysholm score. In contrast, there was a significant difference in the range of knee motion between the 2 groups. The findings of our study do not support the routine adoption of double-bundle reconstruction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

8-O-cinnamoylneoline, a new alkaloid from the flower buds of Aconitum carmichaeli and its toxic and analgesic activities.

From flower buds of Aconitum carmichaeli Debx., a new alkaloid, 8- O-cinnamoylneoline, was isolated. The structure of the new alkaloid was determined by spectral analysis, and the alkaloid was examined for its toxic and analgesic activities. Its LD50 value was 11.89 mg/kg (s.c.) in mice: the toxicity was 1/30 times that of mesaconitine and 20 times that of benzoylmesaconine. Its ED50 value was 0.86 mg/kg (s.c.) in mice using the tail pressure method: its analgesic effect was 1/40 times that of mesaconitine and 45 times that of benzoylmesaconine. Its safety margin (= LD50/ED50) was higher than that of benzoylmesaconine but lower than that of mesaconitine.