Arthroscopic treatment of Mycobacterium massiliense septic arthritis outbreak after intra-articular injection: A case-series report and literature review.

ABSTRACT: Non-tuberculous mycobacteria (NTM) comprise mycobacteria, with the exceptions of Mycobacterium (M.) leprae and the M. tuberculosis complex. Septic arthritis caused by NTM is so rare that there is no standardized treatment.Between April and September 2012, 27 patients were infected with M. massiliense in a single clinic following injection of steroid in the knee joint. Clinical data of 9 patients who received arthroscopic treatment in Seoul Hospital of Soonchunhyang University were analyzed retrospectively.Arthroscopic irrigation and debridement were performed average 2.6 times (1-3 times). As 6 out of 9 cases (67%) had joint contracture of the knee joint, arthroscopic adhesiolysis, and brisement were performed. After surgical procedures, Hospital for Special Surgery and Lysholm knee score showed improvement compared before the surgery, but a radiographic result evaluated by Kellgren-Lawrence revealed that 6 cases got deteriorated to stage 4 in the 4-year follow-up.NTM septic arthritis had a higher recurrence and a higher contracture incidence than septic arthritis caused by tuberculous mycobacteria or other bacteria. Treatment was possible with repeated arthroscopic debridement and intravenous antibiotics.

Prevalence and associated factors of intra-articular lesions in acute ankle fractures evaluated by arthroscopy and clinical outcomes with minimum 24-month follow-up.

BACKGROUND: Acute ankle fractures can lead to high rate of concomitant intra-articular lesions which may compromise clinical results. The purpose of this study was to evaluate the incidence of concomitant intra-articular lesions in acute ankle fractures with arthroscopy. We also sought to analyze the relationship between intra-articular lesions and the fracture type, as well as the severity of the fracture. METHODS: It was a retrospective cohort study. From April 2014 to December 2015, we have chosen arthroscopy-assisted open reduction and internal fixation (AORIF) for the treatment of unstable acute ankle fractures. All concomitant intra-articular lesions were assessed and documented carefully and prospectively, such as ligament injuries, osteochondral lesions, and tibiofibular syndesmosis injuries. All fractures were classified according to the Lauge-Hansen classification system. The American Orthopedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale was used to assess post-operative function. Statistical comparisons between the intra-articular lesions, the fracture type, and the severity of the presenting fracture were performed using a Chi-squared analysis. RESULTS: Data of 36 patients were analyzed in the study, including 23 supination-type fractures and 13 pronation-type fractures. The incidence of tibiofibular syndesmosis injuries, chondral lesions, and loose bodies were 92%, 72%, and 39%, respectively. Avulsion fractures of the anterior tibiofibular syndesmosis were more commonly found in supination-type fractures than pronation-type fracture (45% vs. 15%, χ = 5.78, P = 0.02), which would cause mechanical blocking in the anterior portion of the ankle. On the contrary, chondral lesions were more commonly found in the more severe fractures than mild fractures (86% vs. 53%, χ = 4.57, P = 0.03). A mean 41.7 months (range, 33.0-51.0 months) of follow-up was achieved. A mean AOFAS's ankle-hindfoot scale was 96.9, and 97.2% of the patients were satisfied with the procedure. CONCLUSIONS: Acute ankle fractures have a high incidence of concomitant intra-articular lesions. Avulsion fractures of the anterior tibiofibular syndesmosis are more commonly found in supination-type fractures. Chondral lesions are related to the severity of the fractures, but not with the classification of the fractures. AORIF can be one reliable solution in dealing with the associated injuries seen with acute ankle fractures.

Arthroscopic Assessment of Intra-Articular Lesion after Surgery for Rotational Ankle Fracture.

BACKGROUND: The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. METHODS: A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. CONCLUSIONS: Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes.

[Treatment of acute ankle fractures with arthroscopy-assisted open reduction and internal fixation].

OBJECTIVE: To explore the clinical results of arthroscopy-assisted open reduction and internal fixation for the treatment of acute Lauge-Hansen stage IV ankle fractures. METHODS: A prospective cohort of study was done in 42 patients of acute ankle fractures treated with arthroscopy-assisted open reduction and internal fixation from January 2008 to December 2009. According to Lauge-Hansen classification, there were 26 supination-eversion stage IV fractures, including 11 females and 15 males; with an average age of (36.8 +/- 11.7) years; and there were 16 pronation-eversion stage IV fractures, including 6 females and 10 males, with an average age of (37.6 +/- 11.2) years. All the patients were treated with arthroscopy-assisted open reduction and internal fixation,and intra-articular disorders were observed. Syndesmotic diastasis was treated with three-cortices syndesmotic screw, and osteochondral injuries were disposed by Cheng-Ferkel staging system. The clinical effects were evaluated according to AOFAS scores. RESULTS: All the patients were followed up for 1 year. At the final review,the mean AOFAS score was (92.00 +/- 9.32). Twenty-eight patients got an excellent result, 11 good, 3 fair. Lesions of the cartilage were found in 31 cases. The AOFAS scores of patients with osteochondral lesions were higher than those of patients without osteochondral lesions. The AOFAS scores of patients with osteochondral lesions below C grade were higher than those of patients with osteochondral lesions above C grade. The AOFAS scores of patients with osteochondral lesions were higher than those of patients with osteochondral lesions above C grade. The AOFAS scores of patients with syndesmosis fixation were lower than those of patients without syndesmosis fixation. CONCLUSION: Intra-articular disorders are common in Lauge-Hansen stage IV ankle fractures, and osteochondral lesion and sydesmosis diastasis are the most important prognostic factor that leads to unsatisfactory ankle functions. Arthroscopy-assisted open reduction and internal fixation for the treatment of acute ankle fractures is not only helpful to anatomical reduction of the articular surface, but also can improve the clinical results with effective diagnosis and treatment of combined intra-articular disorders.

Arthroscopic assessment of occult intra-articular injury in acute ankle fractures.

PURPOSE: To arthroscopically assess the pattern and extent of intra-articular damage associated with ankle fractures. TYPE OF STUDY: Prospective case series. METHODS: From 1989 to 1998, 48 consecutive patients with acute unstable ankle fractures underwent ankle arthroscopy followed by reduction and internal fixation. In addition, all injuries were categorized by specific osseous, ligamentous, and articular pathology, based on clinical and arthroscopic examination. Whenever possible, the fractures were classified according to Lauge-Hansen and Danis-Weber schemes. RESULTS: Traumatic articular surface lesions (TASLs), including chondral defects and osteochondral lesions measuring greater than 5 mm in diameter, were identified in 30 of the 48 ankles (63%), with 11 lesions localized to the tibia and 19 noted on the talus. The tibial lesions were at the posterior syndesmotic ligament insertion in 6 cases, at the anterior capsule origin in 3 cases, and at the central articular surface in 2 cases. Of the 19 talar lesions, 15 involved the medial dome and 4 involved the lateral articulation. TASLs of the talus in this series were uniformly unstable or displaced and virtually devoid of subchondral bone, precluding satisfactory internal fixation. Of the 10 pronation-external rotation fractures, 7 had articular surface defects with 5 involving the medial and 2 the lateral dome. Ten of the 24 supination-external rotation or Danis-Weber B fractures were found to have TASLs of the talus, 9 medial and 1 lateral. Nine of 12 fractures with syndesmosis disruptions sustained full-thickness damage to the talar chondral surface (P =.01). CONCLUSIONS: Ankle fractures have a high incidence of concomitant intra-articular pathology with syndesmosis disruption portending a particularly high risk of articular surface injury to the talar dome. Arthroscopy is a valuable tool in identifying and treating intra-articular damage that would otherwise remain unrecognized and may provide prognostic information regarding the functional outcome of these injuries.