The Impact of Dorsal Root Ganglion Stimulation on Pain Levels and Functionality in Patients With Chronic Postsurgical Knee Pain.

BACKGROUND: Chronic postsurgical pain is a considerable source of disabling neuropathic pain. Rates of knee replacement surgeries are increasing, and many patients report chronic postsurgical pain in their wake. When conventional therapies prove ineffective, neuromodulation options such as dorsal root ganglion stimulation (DRGS) may be used. However, little is known about the effect of DRGS on improvements in quantitative functional outcome parameters. MATERIALS AND METHODS: In a prospective observational study at two pain centers, patients with chronic postsurgical knee pain underwent implantation with a DRGS system after an interdisciplinary multimodal pain program. Ratings of pain, mood, quality of life, and function were captured at baseline and through 12 months of treatment. Quantitative measures (range of motion, walking distance, and pain medication usage) were also recorded. RESULTS: Visual analog scale ratings of pain decreased from 8.6 to 3.0 (p < 0.0001; N = 11), and other pain measures agreed. Quality of life on the 36-Item Short Form Health Survey questionnaire improved from 69.3 to 87.6 (p < 0.0001), whereas the improvement in depression ratings was nonsignificant. International Knee Documentation Committee questionnaire ratings of function improved from 27.7 to 51.7 (p < 0.0001), which aligned with other functional measures. On average, knee range of motion improved by 24.5°, and walking distance dramatically increased from 125 meters to 1481. Cessation of opioids, antidepressants, and/or anticonvulsants was achieved by 73% of participants. CONCLUSIONS: Both subjective-based questionnaire and quantitative examination-based variables were in broad agreement on the value of DRGS in improving functionality and chronic postsurgical pain in the knee. Although this finding is limited by the small sample size, this intervention may have utility in the many cases in which pain becomes problematic after orthopedic knee surgery.

One-year efficacy and safety of single or one to three weekly injections of hylan G-F 20 for knee osteoarthritis: a systematic literature review and meta-analysis.

The aim of this study was to evaluate the long-term efficacy and safety of single or 1-3 weekly injections of hylan G-F 20 at 1 year following the first injection for knee osteoarthritis (OA). Searches were conducted in PubMed/MEDLINE, Embase, and CENTRAL and included relevant conference proceedings (January 1, 1995-August 17, 2020). Randomized controlled trials (RCTs), non-randomized trials, and observational studies investigating 1-year efficacy and safety of 1-3 weekly injections or single hylan G-F 20 injection for knee OA were included. Primary outcomes were WOMAC pain, physical function, and stiffness. Meta-analyses of RCTs and non-randomized studies were conducted separately. Our search identified 24 eligible studies. Hylan G-F 20, in the meta-analyses of RCTs, showed statistically significant improvement in WOMAC pain (SMCC - 0.98, 95% CI - 1.50, - 0.46), physical function (SMCC - 1.05, 95% CI - 1.28, - 0.83), and stiffness (SMCC - 1.07, 95% CI -1.28, -0.86). Improvement was also seen for VAS pain, SF-36 MCS (mental component summary), and SF-36 PCS (physical component summary). Analyses of non-randomized studies showed similar efficacy estimates. There were no significant differences in efficacy based on injection schedule, nor between RCT and non-randomized studies. Rates of adverse events (AEs) were low for most types of AEs. Hylan G-F 20 (either as single or 1-3 weekly injections) showed improvement in 1-year efficacy outcomes in comparison to baseline and was generally well tolerated. While further research will inform the medical field regarding viscosupplementation treatment options for knee OA, these findings show that hylan G-F 20 at both frequencies/dosages are efficacious and generally well tolerated for long-term use.

Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHipTM).

AIM: To evaluate the clinical and radiological outcome nine and ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHipTM system. METHODS: In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem (MiniHipTM, Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years (range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score (OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score (HOOS) was assessed pre- and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker. RESULTS: The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc., (P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected. CONCLUSION: Regarding these first long-term results on the MiniHipTM, the implant performed exceedingly well with a high rate of survivorship for aseptic loosening. Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal, more physiological load transfer. This might minimize or exclude a stress shielding which might be associated with thigh pain, proximal bone loss and an increased risk of aseptic loosening. The MiniHipTM is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.

Effective patellofemoral joint stabilization and low complication rates using a hardware-free MPFL reconstruction technique with an intra-operative adjustment of the graft tension.

PURPOSE: Even if medial patellofemoral ligament (MPFL) reconstruction is a proven method, complications such as implant loosening, patella fractures, recurrent luxations, knee pain or knee stiffness are frequently described. Besides a correct tunnel positioning and implant-specific complications, this might be caused by difficulties with an appropriate graft tensioning. The study presented here is a necessary first step in exploring our technique of a double-limbed, hardware-free MPFL reconstruction, which provides another way to test and adjust the graft tension before permanent fastening. METHODS: Thirty consecutive patients (m/f = 18/12) with recurrent dislocations were evaluated after a mean follow-up of 24 months. Patients who had additional procedures such as a trochleoplasties, tibial tubercle transfers and derotational osteotomies were not included. Besides a standardized clinical examination, different scorings and possible complications were evaluated. RESULTS: The mean Kujala score improved significantly from 57 ± 15 to 92 ± 10. The Lysholm and IKDC score increased significantly from 59 ± 11 to 95 ± 6 and from 49 ± 9 to 89 ± 9, respectively. No patient reported a re-dislocation, subluxation or showed a positive apprehension. A total of 23 patients were engaged in regular physical activities. All but one, who lost interest, returned to the same sports. Because some did not follow our recommendation to return to sports after a rehab of at least 10-12 weeks, the period for a return was relatively short (median of 12 weeks, range 3-25 weeks). Four patients reported a moderate anterior knee pain only occurring after increased loads such as longer runs or workouts. One of these showed a slight flexion deficit of less than 20°. A severe motion deficit or stiffness was not noticed. CONCLUSIONS: Even if a larger, clinical outcome study is needed to ensure the efficacy and safety of our method, it seems to provide a good clinical outcome, a correspondingly high satisfaction and a low incidence of complications. The possibility to adjust graft tension might help in minimizing complications caused by difficulties with an appropriate graft tension. LEVEL OF EVIDENCE: IV.

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty.

AIM: To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system. METHODS: Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. RESULTS: Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring. CONCLUSION: TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning.

AIM: To evaluate our modified deepening trochleoplasty combined with a balanced medial patellofemoral ligament (MPFL) reconstruction for soft tissue alignement. METHODS: Thirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients (m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients' return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee (IKDC) and Lysholm scoring were evaluated. Moreover, patients' satisfaction with the general outcome, the cosmetic outcome, the pre- and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales. RESULTS: There were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points (P < 0.0001). Two of 26 cases (92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases (94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions. CONCLUSION: Our technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction.

Periprosthetic bone density changes after MiniHipTM cementless femoral short stem: one-year results of dual-energy X-ray absorptiometry study.

INTRODUCTION: The purpose of the current study was to investigate the reaction of the femur to the implantation of the MiniHipTM in terms of: (1) bone density change during one year; (2) correlations between stem length, CCD (caput-collum-diaphyseal), femoral offset, T-value, and bone density; (3) other co-variables that influence the change of bone density. PATIENTS AND METHODS: MiniHipTM implant was performed for 62 patients. The age range of the patients who underwent treatment was 25-78 years. Periprothestic bone density was determined within two weeks postoperatively, after three, six, and twelve months utilizing the DEXA scan. RESULTS: The highest change was observed in the first three months post-implantation, while significant decrease in density was recorded at proximal Gruen zones 1, 2, and 7, and at distal Gruen zone 4. The decrease in density reached a plateau between the third and sixth months after operation. Afterwards, bone density recovered up to the 12th postoperative month. The correlation analysis showed significant difference between Gruen zone 1 and stem size and CCD. The same significant trend was not reached for Gruen zone 7. Femoral offset showed no correlation. Covariance analysis was unable to establish connection of the results with diagnosis, pairings, or gender. DISCUSSION: MiniHipTM densitometric results are promising and comparable to good results of the other representatives of the femoral neck partially-sustaining short stem prostheses with a lower proximal bone density reduction. Periprosthetic bone resorption is a multifactorial process where stem size, CCD angle, and patient-specific variables such as T-value have an impact on the periprosthetic bone remodeling. In particular, this applies to Gruen zone 1.

Short-term results of the reverse Total Evolutive Shoulder System (TESS) in cuff tear arthropathy and revision arthroplasty cases.

INTRODUCTION: The aim of this study was to evaluate the clinical and radiological outcome of the Total Evolutive Shoulder System (TESS) in patients with cuff tear arthropathy and patients in need of a revision arthroplasty. METHODS: In this sequential study, 67 patients (56 non-stemmed, 11 stemmed) were evaluated after a mean follow-up of 17.5 months. The relative Constant and DASH scores, radiological joint geometry changes, complications and postoperative problems, which are not likely to affect the outcome, were evaluated. RESULTS: A significant increase was noticed for the relative Constant (11.3 vs. 78.8 %) and DASH scores (73.7 vs. 31.8) without significant differences between both etiology groups. Complication rates were similar to previous studies. An aseptic loosening of the non-stemmed humeral component was not noticed in the cuff tear arthropathy group, whereas one case with a loosening was noticed in the revision arthroplasty group. With nine cases (13.4 %), scapular notching rates were very low. On average, the acromiohumeral distance increased by 17 mm and the humeral offset by 13.9 mm; the height of the center of rotation decreased by 4.6 mm and the lateral glenohumeral offset by 6.1 mm, p < 0.05, respectively. CONCLUSION: Regarding the joint geometry, surgery with the TESS system provided adequate distalization and medialization of the humerus and the center of rotation. This corresponds to a good clinical outcome. The use of the surgical opportunity to implant the prosthesis with a relatively low neck-shaft angle might explain the low rates of scapular notching in our series. Regarding the case with a loosening of the humeral component, the surgeon should carefully indicate a stemless version for metaphyseal press-fit fixation in patients with revision arthroplasty.

Endoscopic calcaneoplasty.

Opinions differ regarding the surgical treatment of posterior calcaneal exostosis. After failure of conservative treatment, open surgical bursectomy and resection of the calcaneal prominence is indicated by many investigators. Clinical studies have shown high rates of unsatisfactory results and complications. Endoscopic calcaneoplasty (ECP) is a minimally invasive surgical option that can avoid some of these obstacles. ECP is an effective procedure for the treatment of patients with posterior calcaneal exostosis. The endoscopic exposure is superior to the open technique and has less morbidity, less operating time, fewer complications, and the disorders can be better differentiated.

Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients with rotator cuff tear arthropathy and preserved subscapularis muscle function: preliminary report and short-term results.

PURPOSE: Humeral resurfacing arthroplasty represents an alternative option to hemiarthroplasty for treatment of cuff tear arthropathy (CTA), with the advantages as follows: suitability for relatively young and high-demand patients because of preservation of bone stock and no loss of length, less invasive surgery, shorter operation time, no risk of periprosthetic stem fractures, and revision surgery can be undertaken easily. In the current study, resurfacing arthroplasty in combination with latissimus dorsi tendon transfer for CTA was performed. Three hypotheses: first, humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer would improve the overall functional outcome in patients with CTA. Second, this combination would improve humeral external rotation. Third, this combination would improve abduction and shoulder elevation. METHODS: Study was conducted as an observational case series. Fourteen patients (nine ♀ and five ♂) having CTA were included. Follow-up was carried out at the end of the 28th month for all patients. Constant Score was used for follow-up evaluation. Dorso-axillary approach was used for latissimus dorsi tendon transfer and ventral deltopectoral approach for Copeland resurfacing. Tendons were fixed to the greater tuberosity with two anchors. RESULTS: The absolute Constant Score significantly improved from 34 preoperatively to 69 postoperatively, relative Constant Score from 42 to 91%, elevation from 95° to 138°, abduction from 88° to 147°, and external rotation from 16° to 22° (not significant). CONCLUSION: Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients having CTA with preserved subscapularis function has satisfactory short-term functional clinical outcome. LEVEL OF EVIDENCE: IV.

Mid-term results following arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis.

PURPOSE: The purpose of this study was to assess the effectiveness of arthroscopic capsular release carried out for refractory cases of both primary and secondary adhesive shoulder capsulitis that were not responsive to at least 6 months of prior conservative therapy. METHODS: Arthroscopic 360-degree capsular release was performed on 167 patients (173 shoulders) with adhesive shoulder capsulitis. Ninety-one shoulders (52.6%) had primary and 82 shoulders (47.4%) secondary adhesive capsulitis. The median follow-up period was 36 months (range 14-67 months). RESULTS: All patients were evaluated according to the constant score. Both groups (primary and secondary adhesive capsulitis) experienced a significant improvement for all ranges of motion immediately postoperative, as well as at the time of follow-up. The median preoperative constant score was 41 (range 18-61) points and increased significantly to a median of 83 (range 27-100) at the time of follow-up. In the group of primary adhesive capsulitis, median preoperative score was 42 points (range 19-58) and increased to 85 points (range 36-100) at follow-up. In the group of secondary adhesive capsulitis, the preoperative mean increased from 41 points (range 18-61) to 74 points (range 27-100) at the time of the follow-up. The constant score component for pain and the visual analogue scale (VAS) score were also significantly increased. CONCLUSION: Arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis represents a valuable therapeutic choice with minimal complications, to effectively reduce pain and improve movement in all planes of motion. LEVEL OF EVIDENCE: Therapeutic retrospective case series study, Level IV.

The stop screw technique--a simple and reliable method in treating flexible flatfoot in children.

PURPOSE: The purpose of this study was to evaluate the stop screw method inserted with a minimal invasive technique in the treatment of flexible flatfoot in children. MATERIALS AND METHODS: We evaluated the results in a series of 21 flat feet in the age group ranging from 8 to 14 years between 1999 and 2007. The correction was evaluated clinically by assessment of heel valgus angle, range of motion of the ankle joint, and the photopodographic grading. The radiological assessment was performed by measuring the talonavicular angulation (Meary's line). RESULTS: At time of follow-up there was significant improvement in the heel valgus angle during rest and during tiptoe standing, significant improvement in the dorsiflexion from neutral position, and in podographic grading. Radiologically talonavicular angulation improved significantly from 162+/-8.9 degrees preoperatively to 174+/-5.8 degrees postoperatively. CONCLUSION: We can conclude that subtalar arthroereisis is relatively simple, effective, and minimally invasive procedure in treating flexible flatfoot in pediatric age.

A prospective multi-centre, open study of the safety and efficacy of hylan G-F 20 (Synvisc) in patients with symptomatic ankle (talo-crural) osteoarthritis.

BACKGROUND: To evaluate the safety and efficacy of hylan G-F 20 in patients with ankle osteoarthritis. METHODS: A prospective, open study in patients with symptomatic (>or=50 mm and

Foreign body reaction due to polyethylene's wear after implantation of an interspinal segment.

Different interspinous implants are used as minimal invasive intervention in the management of degenerative disorders of the lumbar spine. We present a case with foreign body reaction due to polyethylene's wear after a device for intervertebral assisted motion (DIAM) implantation. We conclude that the polyethylene interspinous devices can cause biological response, therefore; the surgeons and the companies should carefully watch their patients following application of such devices.

Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund's syndrome.

Posterior calcaneal exostosis treatment modalities showed many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimal surgical invasive technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. We operated on 81 patients with an age range between 25 and 55 years, 40 males and 41 females. The radiologic examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had neither clinical varus of the hind foot nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 35.3 months (12-72). According to the Ogilvie-Harris-Score, 34 patients presented good and 41 patients excellent results, while three patients showed fair results, and three patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. Only minor postoperative complications were observed. ECP is an effective and of minimal-invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve, the endoscopic exposure is superior to the open technique has less morbidity, less operating time, and nearly no complications; moreover, the pathology can better be differentiated.

Tendoscopic management of peroneal tendon disorders.

Endoscopic procedures at the hind foot have become more and more popular over the last few years. However, endoscopy of the peroneal tendon sheath is still not commonly done. We present our experience of scoping the peroneal tendon sheath to help establish more precise diagnosis of the pathology of the peroneal tendons and its associated structures and to treat it in a less invasive way.

Chondrolysis of the glenohumeral joint following arthroscopic capsular release for adhesive capsulitis: a case report.

This is a case of glenohumeral chondrolysis, following arthroscopy for adhesive capsulitis of the shoulder, during which, capsular release has been performed using a bipolar radio frequency energy probe. Heat produced during the procedure by the radio frequency energy probe, probably was the reason behind the occurance of such a rare pathological entity. Chondrolysis has to be put on the top of the list of complications that may occur following arthroscopy, whenever radio frequency energy tools are used. This is not because it is a common one, but because of the difficulty in managing it.

Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement.

The purpose of this study was to document the effect of arthroscopic management in patients with knee stiffness after total knee replacement. We present a case series study, in which 32 patients have been treated for moderate arthrofibrosis of the knee after total knee replacement, with the same regimen. We have excluded all cases of stiffness, because of infection, mechanical mal-alignment, loosening of the implants and other obvious reasons of stiffness of the knee, rather than pure arthrofibrosis. All patients first underwent a trial of conservative treatment before going for arthroscopic management. A pain catheter for femoral nerve block was inserted just before anesthesia for post-operative pain management. Arthroscopic arthrolysis of the intra-articular pathology was performed in a standardized technique with release of all fibrous bands in the suprapatellar pouch, reestablishing the medial and lateral gutter, release of the patella, resection of the remaining meniscal tissue or an anterior cyclops, if needed. Intensive physiotherapy and continuous passive motion were to start immediately post-operatively. All the patients were available for the follow up and they were evaluated using the knee society rating system. A total of 25 of the 32 procedures resulted in an improvement of the patients knee score. All the knees operated upon had intra-articular fibrous bands, hypertrophic synovitis and peri-patellar adhesions. A total of eight patients suffered from an anterior cyclops lesion and six patients showed pseudomenicus. In 19 cases a medial and lateral relapse of the patella was performed; only 5 patients got an isolated lateral release. The mean knee flexion was 119 degrees (100-130) at the end of arthroscopy and was 97 degrees (75-115) at the last follow up. The eight patients with extension lags decreased from 27 degrees (10 degrees-35 degrees) pre-operatively to 4 degrees (0-10) at time of follow up. The average knee society ratings increased from 70 points prior to the arthroscopy to 86 at time of follow up, which was found to be statistically significant (P < 0.01, student's t test). The average function score also showed improvement from 68 points pre-operatively to 85 at the time of final follow up. The average pain scores improved from 30 points pre-operatively to 41 at the time of final follow up. Our results showed that arthroscopic management of knee stiffness following total knee replacement is a safe and efficient method of treatment. Pain and functional knee scores can improve markedly.

Endoscopic resection of a symptomatic os trigonum.

The purpose of this study was to describe our technique and results of arthroscopic resection of a symptomatic os trigonum via two posterior portals in 10 cases. Between 1999 and 2005 we treated 10 patients with endoscopic resection of a symptomatic os trigonum. The age ranged between 19 and 32 years (average 25.9). The average follow-up was 25 months (6-61 months). Time interval between the onset of pain and endoscopic resection of the os trigonum was 20 months. Of the 10 patients, 9 were symptom free for activities of daily living (ADL) within 4 weeks after surgery. They resumed their professional sport activities in a period of 8 weeks. The average AOFAS ankle/hindfoot scale increased from 43 preoperative to 87 postoperatively. We observed no complication in these 10 patients. Endoscopic resection of the symptomatic os trigonum yields good results with minimal surgical morbidity and short recovery time.

The angle velocity reproduction test (AVRT) as sensorimotor function of the glenohumeral complex.

BACKGROUND: The purpose of the present study was to develop and evaluate the angle velocity reproduction test (AVRT) in the glenohumeral joint. METHODS: In 46 volunteers with healthy shoulders, a test was devised in order to record the angle velocity perception in the shoulder. One arm was moved passively by means of a Cybex 6000 unit. The subjects were asked to perform the same movement as precisely as possible with the contralateral arm without visual control. The movement was recorded with a contact-free motion analysis system with a digital infrared camera and evaluated by aid of a movement analysis program. Starting at -20 degrees, the movement was an anteversion (anterior flexion) of 110 degrees. The sector between 20 degrees and 90 degrees was analyzed in detail. Different parameters were documented which represented different aspects of the sensorimotor function. The predetermined angle velocity of the Cybex setting on the contralateral arm amounted to exactly 53 degrees /s. In order to observe validity and reliability, 10 additional measurements with visual control as well as 21 double measurements were performed. RESULTS: The comparison of the measurements with and without visual control yielded highly significantly better results for those courses with visual control with regard to all those parameters which represent the perception of velocity. The values which describe the evenness of the movements were weak and/or insignificant. CONCLUSION: The introduced AVRT appears suitable to test dynamic sensorimotor abilities.