Background: Several studies have addressed the issue of the feasibility of arthroscopic surgery in older patients, usually by choosing an arbitrary age limit.
Hypothesis: Patient age is not associated with poor clinical outcome after arthroscopic surgery for osteochondral lesion of the talus (OLT), and other patient variables are the major determinants of clinical success/failure.
Study Design: Cohort study; Level of evidence, 3.
Methods: Between 2001 and 2008, 173 ankles underwent arthroscopic marrow stimulation treatment for OLT and were stratified into 6 age groups (<20, 20-29, 30-39, 40-49, 50-59, and ≥60 years). Bivariate and multivariate analyses were performed to determine the effect of age on clinical outcome.
Results: There were no significant differences among the 6 age groups in the preoperative and postoperative visual analog scale (VAS) for pain or the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was a significant increase in the duration of symptoms (P < .001) and a significant decrease in the incidence of trauma (P = .01) in the older group. Both the size of the osteochondral defect and the number of associated intra-articular lesions independently predicted a poor clinical outcome (P < .001).
Conclusion: In contrast to some of the previous studies on this topic, we found that increased age was not an independent risk factor for poor clinical outcome after arthroscopic treatment for OLT. We did find that older patients were less likely to have a history of trauma and had a longer duration of symptoms, had smaller osteochondral defects, and had more associated intra-articular lesions.
Background: Lateral ankle sprains account for 85% of ankle lesions.
Hypothesis: Combined open and arthroscopic procedures could improve the diagnosis and management of intra-articular lesions and allow surgeons to perform minimally invasive anatomic reconstruction of the lateral ligament complex.
Study Design: Case series; Level of evidence, 4.
Methods: Forty consecutive patients underwent ankle arthroscopy for recurrent (2 or more episodes) lateral ankle instability unresponsive to nonoperative measures. The clinical diagnosis of mechanical instability was confirmed at imaging (plain radiographs and magnetic resonance imaging [MRI]) and arthroscopic assessment. All patients underwent arthroscopic Broström-Gould repair for management of lateral ankle instability; secondary lesions were also managed. Postoperatively, the American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status; clinical examination and conventional radiographs were performed in all patients.
Results: Thirty-eight patients were reviewed at an average postoperative follow-up of 9.8 years. The mean AOFAS score was 90 (range, 44-100) at the last follow-up. No significantly different outcomes were found in patients who had undergone microfractures for management of grade III to IV cartilage lesions compared with patients with no cartilage lesions. Postoperative AOFAS scores were graded as excellent and good in almost all patients (94.7%). Concerning failure rate, 2 patients (5.3%) reported a low AOFAS score: one patient underwent soft tissue removal for anterior impingement, and one received simultaneous medial ankle instability repair.
Conclusion: The arthroscopic Broström-Gould–assisted technique could be a viable alternative to the gold-standard Broström-Gould procedure for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. Prospective randomized controlled trials are needed.
Background: There has been no attempt to correlate the type and number of intra-articular lesions with the results of ligament reconstruction for chronic lateral ankle instability.
Hypothesis: Certain intra-articular lesions affect the clinical outcome of ligament reconstruction.
Study Design: Case series; Level of evidence, 4.
Methods: Sixty-five ankles from 64 patients underwent a modified Broström operation for chronic lateral ankle instability with a mean follow-up of 28.7 months (range, 12–67). The results were assessed according to the Karlsson-Peterson Ankle Score. The type of intra-articular lesions and the association of clinical outcome were investigated using Pearson’s correlation coefficient and multivariate logistic regression analysis.
Results: The average Karlsson-Peterson Ankle Score was improved from 53 ± 14.63 preoperatively to 85.21 ± 11.97 at final follow-up (P < .001). Five different intra-articular lesions were described in 63 ankles (96.9%), and the ankle score negatively correlated with the number of lesions (r = –.604; P < .001). Multivariate logistic regression showed that syndesmosis widening (odds ratio, 11.1; 95% confidence interval: 2.2–55.4; P = .003), osteochondral lesions of the talus (odds ratio, 8.5; 95% confidence interval: 1.7–42.3; P = .008), and ossicles (odds ratio, 4.5; 95% confidence interval: 1.0–20.2; P = .046) are significant predictors of unsatisfactory results after ligament reconstruction.
Conclusion: Arthroscopic diagnosis and treatment of intra-articular lesions associated with chronic lateral ankle instability is a safe and effective method. The presence of any combination of associated intra-articular lesions can result in a poor outcome.
Background: Chronic exertional compartment syndrome is an entity that typically fails nonoperative management and requires operative treatment with fasciotomies for return to activity. Fasciotomies performed through single or multiple incisions may fail to totally release the fascia of the afflicted compartment(s) and may result in injury to neurovascular structures that cannot be visualized.
Purpose: The authors report results of endoscopic compartment release with the assistance of a balloon dissector in the treatment of chronic exertional compartment syndrome.
Study Design: Case series; Level of evidence, 4.
Methods: The clinical outcomes of 14 cases of chronic exertional compartment syndrome in 9 patients treated with endoscopic release were assessed with a retrospective chart review and the results of mailed questionnaires.
Results: Fourteen legs in 9 patients (4 male and 5 female; average age, 24 years) were treated with endoscopic compartment release for chronic exertional compartment syndrome. Eight of 9 patients were able to resume preoperative activities, including collegiate athletics in 5 cases and recreational sport in 3 cases. No neurovascular injuries occurred. Complications were isolated to postoperative hematomas that resolved in 2 patients. Seven patients completed questionnaires an average of 3.75 years after surgery. There were no recurrences of symptoms.
Conclusion: Endoscopic compartment release is a cosmetic, safe, and effective means of treating chronic exertional compartment syndrome.
