Safety of posterior ankle arthroscopy portals in different ankle positions: a cadaveric study.

PURPOSE: To investigate anatomic relation of standard and coaxial ankle arthroscopy portals with neurovascular structures during different degrees of ankle motion. METHODS: Twenty posterior ankles of ten fresh cadavers were assessed. Posteromedial, posterolateral and coaxial (transmalleolar) portals were created using 4-mm Steinmann pins in accordance with the defined technique in neutral position. The ankles were then dissected, and the distance from the portals to the peroneal tendons, short saphenous vein and sural nerve was measured laterally and that from the tibial nerve, flexor hallucis longus tendon and posterior tibial artery was measured medially. Changes in the distance between these structures were noted in neutral positions, 15° of dorsiflexion and 30° plantar flexion. RESULTS: In the neutral position, the mean distance of the conventional posterolateral portal to the sural nerve was 6 mm (SD 2.9, range 2.7-14.5). The mean distance of the posterolateral coaxial portal to the peroneal tendon was 1.6 mm (SD 0.55, range 1.1-2.9). The mean distance of the posteromedial portal to the FHL was 2.11 mm (SD 1.1, range 0-4.7). The mean distance of the posteromedial coaxial portal to the posterior tibial artery was 6 mm (SD 1.4, range 3.9-9.5). Although not statistically significant, the distance between the portal and neurovascular structures increased in dorsiflexion for the portals placed posteriorly to the neurovascular structures and increased in plantar flexion for the portals placed anterior to the neurovascular structures. CONCLUSIONS: In comparison with the portals made in the neutral position, the distance between neurovascular structures and portals changes with portal placement in plantar flexion and dorsiflexion. In clinical practice, therefore, it might be safer to place the posteromedial-posterolateral portals in dorsiflexion and posterolateral-posteromedial coaxial portals in plantar flexion. The tibial nerve is closer to the posteromedial coaxial in dorsiflexion and could be in danger if making this portal with the foot in this position.

The microfracture technique for the treatment of full-thickness articular cartilage lesions of the knee: midterm results.

PURPOSE: The purpose of this study was to determine the effectiveness of the microfracture technique in the treatment of full-thickness articular cartilage lesions of the knee. METHODS: In this study the midterm results of 90 patients (47 women and 43 men) with focal full-thickness articular cartilage lesions who had been managed with the microfracture technique are presented. The mean age of our patients was 34.5 years (range, 20 to 58), and 51 right and 39 left knees were treated. All of the articular lesions involved medial femoral condyles. RESULTS: On the basis of follow-up at a mean of 68 months (range, 24 to 108 months), mean improvements in Lysholm knee scores (from 54.2 to 84.6 points), Tegner activity scale scores (from 2.6 to 5.2 points), and Oxford knee interrogation scores (from 23.1 to 44.8 points) were observed (P < .0001). Moreover, there was a strong and significant correlation between functional results and age younger than 35 years, size of defect less than 2 cm(2), non-weight-bearing surface, and body mass index lower than 25 kg/m(2), respectively (P < .001). CONCLUSIONS: According to our midterm results, the microfracture technique is quite effective with regard to the improvement of daily activities with a favorable impact on pain relief and better functional results. Furthermore, we found that there was a correlation between functional results and age, size of defect, location of defect, and body mass index as prognostic parameters. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

[A case of acromioclavicular dislocation without coracoclavicular ligament rupture accompanied by coracoid process fracture]. / Bir olguda korakoklaviküler ligamanlarin saglam kaldigi akromiyoklaviküler eklem çikigi ve korakoid çikinti kirigi.

Acromioclavicular joint dislocation with intact coracoclavicular ligaments accompanied by fracture of the coracoid process is a rare injury. The patients are treated with conservative and/or surgical methods. A 30-year-old male patient developed type 3 acromioclavicular dislocation and coracoid process fracture due to a fall in the right shoulder. Both injuries were treated surgically. Following open reduction, the acromioclavicular joint was fixed with a Knowles pin, and the coracoid process was fixed with a 4.0-mm malleolar screw. Active-assisted rehabilitation of the shoulder was initiated a week after surgery. The patient returned to office work with a long arm splint at three weeks. Pain-free, active, and complete shoulder movements were seen in the fifth week. The Knowles pin in the acromioclavicular joint was removed under local anesthesia seven months postoperatively. A year after surgery, he resumed full shoulder functions without pain and there were no signs of complications such as heterotopic ossification.