History of the Association of Bone and Joint Surgeons.

The concept of another orthopaedic organization began 50 years ago by a few charter members. From this concept developed the Association of Bone and Joint Surgeons which in turn organized the journal Clinical Orthopaedics and Related Research. This history explains how the organization and the journal developed. It also pays tribute to some of the great leaders who developed the organization and journal.

Office carpal tunnel release with wrist block and wrist tourniquet.

Carpal tunnel release is usually performed in a hospital setting with regional anesthesia. The cost for use of the hospital operating room, anesthesia, and surgeon's fee is quite excessive. Over the past 5 years we have performed carpal tunnel releases in the office setting using wrist block anesthesia and a wrist tourniquet. There have been no complications, and the 20 patients interviewed and examined for this article preferred the office procedure over the hospital procedure. Carpal tunnel release can be performed safely in the office, and is less expensive than when done in a hospital setting.

Don't forget the Bristow-Latarjet procedure.

The authors have been disturbed by a number of reports appearing in the past 5 years condemning the Bristow procedure because of difficulties with screw failure and misplacement, nerve damage, and tethering of the subscapularis. A retrospective study was performed comparing the Bankart and Bristow procedures as performed by the authors during a 10-year period. Complications, rate of recurrence, presence of subluxation, range of motion, return to activity, strength, pain, and overall satisfaction were evaluated. There were 85 patients in the study, of which 61 had the Bristow operation and 24 were treated with the Bankart procedure. The minimum followup was 2 years. Very little difference was found between the 2 operations in any of the parameters studied, and in the authors' opinion, the Bristow procedure remains a reasonable alternative to the Bankart operation. The range of abduction, external rotation, and strength compared favorably with the Bankart group. The authors have encountered instances wherein capsular deficiency rendered the accomplishment of the Bankart procedure difficult or unreliable. Four such cases are reported. Under these circumstances, the Bristow served as a reliable alternative. Technical recommendations for avoiding the difficulties that have led to the condemnation of the Bristow procedure are described in detail.

Difficulties with bearing dislocation and breakage using a movable bearing total knee replacement system.

In 1980, the low contact stress, or New Jersey, system was introduced with movable high-density polyethylene bearings between the metallic femoral and tibial components. This system was developed to deal with two principal concerns of conventional knee replacement systems: loosening and wear. A federal Drug Administration review was required, and the study was performed in two phases. From 1981 until 1984, components were cemented in 40 knees, which then were evaluated for an average of seven years after surgery. From 1984 until 1986, 16 knees were selected for cementless fixation and were followed for an average of five years. The cemented group had a failure rate of 10% (four knees), two from tibial component loosening, one from bearing dislocation, and one from infection. Failure was determined by the necessity for revision. The uncemented group had a failure rate of 31% (four knees from bearing fracture and one from knee pain of uncertain source). Bearing failure was attributable to the entrapment of the subluxed lateral bearing. Sacrifice of the anterior cruciate ligament predisposes the system to bearing subluxation and failure.

Ankle pain following total knee arthroplasty. A case report.

The authors present their experience with four cases of ankle pain occurring in the immediate postoperative period after total knee arthroplasty. In a 40-month period, the authors performed 87 total knee arthroplasties. In the first 28 cases, an extramedullary alignment rod was used and there were no instances of ankle pain (0%). In the next 30 cases, an intramedullary alignment rod was employed and there were three cases of moderate to severe ankle pain (10%). In the last 29 cases, the medullary canal was decompressed, irrigated, and aspirated prior to insertion of the alignment rod. In this group there was only one case of mild ankle discomfort (3.5%). An extensive investigation was made into one of the cases in which the intramedullary alignment rod was used but the canal was not aspirated. Information from this case investigation, observation of the three subsequent cases, and the notation of a decrease in the incidence of ankle pain once aspiration was routinely used are reported. The unproven hypothesis that ankle pain may result from compression of the marrow contents into the bone interstices is presented for consideration. Three of the four cases of ankle pain reported here were spontaneously resolved within 9 months after surgery.

Patellofemoral arthritis resulting from malalignment. A long-term evaluation of treatment options.

This study examines and compares three treatment options for patellofemoral arthritis resulting from patellofemoral malalignment: longitudinal semipatellectomy, total patellectomy, and a modified Trillat procedure. Patients returned for examination in a 3- to 12-year follow-up period. Results from longitudinal semipatellectomy were unsatisfactory, with a reoperation and failure rate of 70%. Good long-term effects were found with total patellectomy (87% good or excellent). The modified Trillat procedure was effective in preventing recurrent dislocation (94%); however, the procedure was less effective in relieving anterior knee pain (65% good or excellent). A satisfactory solution remains to be found.

Acute surgical repair of the skier's thumb.

Complete ulnar collateral ligament tears incurred during the period fall 1977 through spring 1979 were treated under regional anesthesia by a single group of surgeons in an identical fashion as outpatients. Of 123 thumbs repaired, 69 (59%) were available for follow-up examination. There were 34 women and 35 men with an average age of 34.5 years (range, 16-61 years). The follow-up period averaged 31.6 months (range, 16-46 months). Weakness of pinch was described as none or mild in 66 (96%) and significant in only three (4%). Stiffness was described as none or mild in 66 (96%), moderate in two (3%), and severe in one (1%). Pain was described as none or mild in 68 (99%) and moderate in one (1%). Sixty-two patients (90%) preferred outpatient surgery with regional anesthesia whereas only seven (10%) did not. Forty-five (65%) of the 69 patients who required surgery had used traditional poles with straps, suggesting the pole as the causative factor. However, only 20% of noninjured skiers during the 1981-1982 season were using traditional poles with straps, and the total number of complete ulnar collateral ligament repairs did not decrease with the same number of skiers. Therefore, the change in pole design has not decreased the incidence of total ulnar collateral ligament tears. The results of acute surgical repair as an outpatient with regional anesthesia are excellent; 96% of the patients were pleased with the results. If the lesion is overlooked, the results of secondary construction are not nearly as good.

Long-term follow-up of metacarpal phalangeal arthroplasty with silicone Dacron prostheses.

Sixteen patients who had eighty-nine metacarpal phalangeal arthroplasties with silicone Dacron prostheses (Niebauer type), were followed for an average of 11 1/2 years. Evaluation for palmar subluxation, ulnar drift, range of motion (ROM), pain relief, and stability showed it was satisfactory for relief of pain and correction of ulnar drift but it was eventually poor for range of motion and stability. If the arthritis was not controlled, the function of the hand decreased progressively, in spite of prosthetic replacements of the joints.

Entrapment of the posterior interosseous nerve by a fibrous band in the dorsal edge of the supinator muscle and erosion of a groove in the proximal radius.

An unusual case of transient, reversible entrapment of the PIN has been described. The entrapment was due to a fibrous band at the distal edge of the body of the supinator muscle, not at the level of the arcade of Frohse. The transient paralysis was exacerbated by pronation and alleviated by supination. Release at operation alleviated all symptoms. A radiograph showed erosion in the proximal radius, presumably due to the posterior interosseous nerve. One must consider such an entrapment of the PIN when there is weakness of muscles innervated by the radial nerve distal to its course through the supinator muscle.