Page 11 - ISAKOS 2020 Newsletter Volume 2
P. 11

At a median of 3.7 years postoperatively, the Foot and Ankle Outcome Scores for pain, symptoms, activities of daily living, sports, and quality of life had all significantly improved as well. The authors concluded that hindfoot endoscopic release of the posterior ankle structures, including the posterior fibulotalocalcaneal ligament, is an effective technique for improving ankle dorsiflexion range in patients with painful limitation of ankle dorsiflexion.
Posterior Arthroscopic Treatment of Ankle Osteochondral Lesions
Jorge Pablo Batista, Hélder Miguel Duarte Pereira, C. Niek van Dijk, Jorge Javier Del Vecchio
Prospective Case Series
The aim of this study was to describe the clinical results of debridement and bone marrow stimulation by means of posterior ankle arthroscopy for the treatment of posterior osteochondral lesions of the talus. The authors hypothesized that posterior ankle arthroscopy is an effective and safe procedure to treat lesions <10 to 15 mm in size and <5 mm in depth located in zones 7, 8 and 9 of the Raikin and Elias grid. In this prospective analysis of the outcomes for 36 patients, the average American Orthopaedic Foot and Ankle Society clinical score improved from 42.3 preoperatively to 89.29 postoperatively. All patients were satisfied with the surgical outcome and stated that they would choose this procedure again. Three minor and transitory postoperative complications (5.55%) were observed: pain at the portals, ecchymosis, and hypoesthesia of the heel. The average VAS score improved from 7.75 preoperatively to 1.54 postoperatively, with an average improvement of 6.21 points. The majority (75%) of patients were able to resume their preinjury level of physical activity level. The authors concluded that the posterior arthroscopic approach with bone marrow stimulation is technically simple and is a safe and effective procedure for the treatment of posterior talar osteochondral lesions, with a low rate of complications, thereby reducing time to return to sports and/or work activity.
Endoscopic FHL Transfer to Augment Achilles Disorders
Jorge Pablo Batista, Jorge Javier Del Vecchio, Niek van Dijk, Helder Pereira
Technical Note
Many procedures have been described for the operative treatment of chronic Achilles tendon ruptures (CATR) and insertional calcific achilles tendinosis (ICAT). This technical note describes a novel technique for the treatment of such lesions. Fifteen patients who had undergone an endoscopic flexor hallucis longus (FHL) transfer to augment Achilles disorders between 2015 and 2016 were retrospectively identified. After an average duration of follow-up 11.27 months the overall success rate was 93.3%.
The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 62.27 points preoperatively and 91 points postoperatively. The average VAS score for pain was 6.93 preoperatively and 0.8 postoperatively. Only one patient (6.7%) required revision surgery. The advantages of FHL transfer are that it utilizes vascularized tendon with a strong viable muscle, has low morbidity, and is reproducible. On the basis of their findings, the authors concluded that this option may indicated for primary surgery in cases of CATR and non- insertional tendinopathy as well as for revision surgery in cases of ICAT.
Shoulder MRI in Asymptomatic Elite Volleyball Athletes Shows Extensive Pathology
Christopher Sy Lee, Nicole Hamilton Goldhaber,
Shane M. Davis, Michelle L Dilley, Aaron Brock, Jill Wosmek, Emily H. Lee, Robert K. Lee, William B. Stetson
Observational Study
Elite overhead athletes, such as volleyball players, are predisposed to shoulder injuries due to repetitive overhead movement and overloading of the shoulder joint and surrounding muscles and ligaments. Returning to play at an elite level following shoulder surgery is often not possible. The authors hypothesized that MRI of the dominant shoulders of elite volleyball players would demonstrate extensive asymptomatic shoulder pathology that does not prevent the athlete from competing. To test this hypothesis, they evaluated the history, physical examination findings, and MRI findings for 26 asymptomatic elite volleyball players (14 mean and 12 women with mean age of 25.5 years) to determine the incidence of asymptomatic shoulder pathology. VAS pain scores, range of motion, strength, and UCLA and ASES outcome scores were measured and recorded. All MRIs showed abnormal pathology. Specifically, 23 athletes (88.5%) had rotator cuff tendinosis; 17 (65.4%) had partial rotator cuff tears involving the supraspinatus, infraspinatus, or subscapularis; 6 athletes (23.1%) had a labral tear; and 6 athletes (23.1%) had labral fraying. These findings support the notion that elite-level volleyball players can have asymptomatic shoulder abnormalities in their dominant arm that do not limit their ability to participate. The authors suggested that this knowledge will improve outcomes following the treatment of shoulder pain in overhead athletes and will prevent unnecessary surgical procedures.

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