Determining the Feasibility of Arthroscopic Anterior Talofibular Ligament Repair Utilizing a Novel Classification System.

The purposes of this study were to classify anterior talofibular ligament injuries (ATFL), to find out the feasibility of arthroscopic ATFL repair according to injury type and to investigate the diagnostic validity of magnetic resonance imaging (MRI) of ATFL injuries by comparing MRI and arthroscopic findings. The 197 ankles (93 right, 104 left, and 12 bilateral) of 185 patients (90 men and 107 women; mean age, 33.5 years, range: 15-68 years) were treated by arthroscopic modified Broström procedure after a diagnosis of chronic lateral ankle instability. ATFL injuries were classified according to their grade and location (type P: partial rupture, type C1: fibular detachment, type C2: talar detachment, type C3: midsubstance rupture, type C4: absence of ATFL, type C5: os subfibulare). Among the 197 injured ankles, according to ankle arthroscopy, 67 were type P (34%), 28 were type C1 (14%), 13 were type C2 (7%), 29 were type C3 (15%), 26 were type C4 (13%), and 34 were type C5 (17%). The kappa value for the agreement between the arthroscopic findings and MRI findings was also high (0.85; 95% confidence interval, 0.79-0.91). Our results also supported the use of MRI for diagnosing ATFL injuries and showed that it is an informative tool during the preoperative period.

Open procedure vs. arthroscopic débridement for chronic medial epicondylitis.

BACKGROUND: This retrospective study compared the outcomes after open and arthroscopic treatment of chronic medial epicondylitis (ME). METHODS: The study included 44 elbows in 38 patients: 25 (29-72 years) in the open group and 19 (27-70 years) in the arthroscopy group. The indications for ME surgery were failed conservative therapy for more than 3 months, symptom duration exceeding 6 months, and persistent severe pain. We used radiography, ultrasonography, and magnetic resonance imaging assessments. The clinical assessment included operating time, range of motion, grip strength, visual analog scale (VAS) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and complications. RESULTS: The mean follow-up was 20.2 (12-58) months. The mean operating time was significantly longer in the arthroscopy group (32.5 vs. 23.5 minutes; P = .029). In both groups, all outcome measures improved significantly after surgery and there were no significant differences between the DASH scores (preoperative 44.8 vs. 43.9, postoperative 12.5 vs. 13.2), grip strength (preoperative 72.2 vs. 66.8, postoperative 84.8 vs. 83.6), and VAS scores (preoperative 8.5 vs. 8.2, postoperative 1.0 vs. 1.1) in the open and arthroscopy groups. The outcomes were excellent or good in 20 patients (80%) in the open group and 16 (84%) in the arthroscopy group. The only complication was 1 case of transient ulnar neuropathy in the open group. CONCLUSION: Open and arthroscopic techniques were very effective and comparable for treating chronic ME. The surgeon can choose either technique for treating chronic ME.

Differential Diagnosis between Child Abuse and Infantile Cortical Hyperostosis: A Case Report and Literature Review.

Child abuse is a major public health problem that can lead to critical consequences for the child and family. However, early identification of abuse may be difficult. An 8-month-old boy presented with extensive periosteal reaction in both upper and lower long bones. There was no specific history of injury. Caffey disease was initially considered as the diagnosis because the patient displayed fever and hyperostosis of multiple bones with elevated erythrocyte sedimentation rates and C-reactive protein and alkaline phosphatase levels. However, we suspected child abuse based on the clinical and radiological features. We eventually found out that the child had been injured through child abuse and were able to treat him. We report this case because child abuse cases may be confused with Caffey disease. This case report can, therefore, help distinguish between Caffey disease and child abuse.