Neurological complications of ankle arthroscopy.

A retrospective review of the first 612 patients undergoing consecutive ankle arthroscopy in the practices of two experienced arthroscopists was under-taken. All inpatient records, outpatient charts, and operative reports were reviewed. Indications for surgery included pain, swelling, locking, and instability that failed to respond to nonoperative management. The results of our investigation revealed an overall complication rate of 9.0% (55 complications). There were 27 neurological complications (4.4% of all arthroscopies) accounting for 49.1% of the complications noted. Specifically, the superficial peroneal nerve was injured in 15 cases, the sural nerve in 6, the saphenous nerve in 5, and the deep peroneal nerve in 1. All nerve injuries occurred through direct injury by portal or distractor pin placement. No cases of neurological injury caused by tourniquet compression or compartment syndrome were seen. Also, 1 case of reflex sympathetic dystrophy was identified.

Ankle arthroscopy in industrial injuries of the ankle.

Industry-related injuries to the foot and ankle are not uncommon. These cases are often difficult to evaluate with respect to degree of damage and even more difficult to quantitate with regard to functional impairment. This article represents an attempt to determine the role of ankle arthroscopy in the evaluation of ankle injuries that involve compensation or liability. A retrospective review was conducted. The study group consisted of 40 patients who underwent a total of 42 arthroscopic procedures. The patients were evaluated with regard to the mechanism of injury and clinical manifestations. Pain and swelling were the most common preoperative symptoms. The majority of patients had pain localized to the lateral and anterolateral ankle. There were a high percentage of positive bone scans that correlated well with bone pathology but poorly with soft-tissue pathology. Computed tomography (CT) scans were equivalent to tomograms in the demonstration of bone pathology. Follow-up was obtained in 24 patients. At least 50% of the patients had some improvement in their symptoms. Thirty-three percent believed there was no change, and 17% said they were worse. Over 70% of the patients were able to return to work, although 20% had to change their occupation. Fifteen percent were considered disabled. In patients without a specific diagnosis, ankle arthroscopy was helpful in establishing a diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Meniscoid lesions of the ankle.

The frequent use of arthroscopy has increased the orthopedic community's awareness of meniscoid lesions of the ankle and its ability to treat these lesions. This article defines the pathologic lesion and reviews the literature and case reports.

New concepts (distraction) in ankle arthroscopy.

Because of the problems inherent in arthroscopic visualization of the ankle, a new distraction technique has been devised to help overcome them. This technique has been used on 131 cases with few and relatively minor complications. It has greatly facilitated visualization of the ankle, and it is now possible to perform certain surgical procedures effectively and safely.

New techniques for arthroscopic surgery of the ankle: preliminary report.

The history of the development of techniques for arthroscopy of the ankle up to the 1980s was reviewed. The author's early experience with ankle arthroscopy and surgery is analyzed and illustrated to show how the need for better access to this joint, particularly posteriorly, led to the development of these methods. Laboratory work was done to prove their safety. Materials and methods are shown. Steps for performing both techniques are described in detail. A protocol has been developed for study and analysis of a series of patients to be reported at a later date. This should further verify the safety of the above. The end results with the employment of these techniques and of the final operative long-term results will be submitted. Methods for the prevention of complications were developed. This study, therefore, should establish better indications, as well as safer and far better means of performing diagnostic and operative arthroscopy of the ankle joint.

Arthroscopy and arthroscopic surgery of the elbow.

Arthroscopy and arthroscopic surgery of the elbow were performed in 45 cases of 3,300 arthroscopic procedures between 1974 through 1984. The indications established are: loose body removal, treatment of osteochondritis dissecans, synovectomy for non-specific and rheumatoid synovitis, treatment of some selected fractures, debridement of specific cases of degenerative arthritis, excision of osteophytes and for evaluation and treatment of the undiagnosed painful elbow. The choice of two different methods is described; one with the arm on an arm table as for hand surgery, and the other with the arm suspended overhead for easier access to the medial side. Normal arthroscopic anatomy of the elbow joint is described. The instruments have been classified as those most commonly used, those of special use, those instruments rarely or never used, and some special instruments introduced more recently. Eight approaches to the elbow joint for viewing and instrumentation are illustrated. The technique for entering the joint, distending and placing the scope, establishing drainage, probing and instrumentation is shown and illustrated. Immediate postoperative care and complications are shown. Seven representative cases are presented. Results of this small number of cases clearly indicate that there is a need for diagnostic and operative arthroscopy of the elbow.

Update in the treatment of osteochondritis dissecans.

During the early part of this century, various treatments for osteochondritis dissecans were recommended. A conservative program consisting of immobilization and non-weightbearing was advocated by many surgeons, particularly for children under 1 5 years of age. Later, fragments were pinned or removed in children's knees, while various methods of bone grafting were suggested for the adult.With the development of arthroscopic surgery in the 1970s, these methods were reevaluated. Various treatments were suggested, including drilling, drilling and pinning, reconstruction of craters, replacement of lesions, and methods of grafting. Although conservative management is still indicated for some patients, arthrotomy may be necessary under certain conditions.In the early 1980s scintigraphy has become helpful in following cases treated conservatively, as well as identifying those that require surgery. Also, methods of electrical stimulation are being applied and their results are being evaluated. The concept of early motion has gained more attention. Over a period of nine years, 1975 to 1984, arthroscopic surgery has been further modified. With this in mind, an update of all methods is here recorded and presented for consideration.

Unicompartmental knee arthroplasty for single compartment disease. Clinical experience with an average four-year follow-up study.

Unicompartmental knee arthroplasty using the Marmor modular knee prosthesis or, later, the Richards Modular II prosthesis in a series of 72 knees (60 patients) is reviewed, with an average follow-up period of four years (minimum, 2 years). Pain relief was rated as excellent in 90% of the knees. The average range of motion was improved after operation. No deep infections were encountered. Only one knee in the series has required further surgery, for patellofemoral disease.

Evolution and development of operative arthroscopy 1974 to present.

This discussion illustrates the history and development of operative arthroscopy, as well as the present state of the art, and also attempts to make some predictions. The information is based on the author's experience gained in his practice and the knowledge obtained as a faculty member in many courses on operative arthroscopy. Technological improvements in instrumentation along with the development of new portals of approach are described, as well as their application in many new procedures. Numerous pathological entities of the knee nave subsequently become amenable to arthroscopic surgical treatment. These techniques are discussed along with their indications. The application of future principles, procedures and research in the field of operative arthroscopy of the knee and other joints is expressed.

The use of bovine knees in operative arthroscopy.

The bovine knee is proposed as a practice model for developing arthroscopic surgical skills. Its similarity to the human knee is evaluated, and preparation and usage are discussed.

Arthroscopic treatment of osteochondritis dissecans.

Forty-nine knees with osteochondritis dissecans were evaluated and in many cases, treated by arthroscopic means. The lesions were classified as to location and degree of separation. Arthroscopic treatment involved drilling, pinning, reduction of fragments, removal and replacement of fragments, and bone grafting. Of the cases, 90% had healed in an average period of approximately five months. The mean follow-up was three years.

Ankle arthroscopy. Technique and indications.

The technique and indications for ankle joint arthroscopy have been presented. The keys to successful ankle arthroscopy include (1) a knowledge of extra-articular anatomy, (2) a systematic approach to the evaluation of the various compartments arthroscopically, (3) constant joint distention, and (4) muscle relaxation so the joint can be easily manipulated and distracted.

Operative arthroscopy.

In a period of 20 months, over 200 patients (age ranged from high school students to middle-aged persons) with knee injuries were treated by operative arthroscopy. The majority of the injuries were incurred while the patients had been participating in athletic events, either competitive or recreational. Operative arthroscopy offers the advantage of shortened hospital stay, rapid rehabilitation, lack of disfiguring scar, and reduced costs. Patients are followed yearly after the first postoperative year. Improved long-term results from diagnostic and operative arthroscopy, as compared to conventional surgical procedures, are expected. The proof of those expectations will be determined in the next several years as this group of patients requiring partial meniscectomies or procedures for pathologic and degenerative conditions is reevaluated.