Arthroscopic Ulnar Nerve Decompression (SS-54)

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ABSTRACTS

mediate pos operative the elbow is immobilized in a removable cast or with an orthesis at the desired profit position for 6 weeks, being removed 4 to 6 times a day for movement and physiotherapy, which lengths 6 months. After that the patients were evaluated with the Mayo elbow score and manual analog goniometry. Results: The study group was composed by 15 men and 9 women, 14 right and 10 left elbows and the mean age 34,58 (18 to 62). The follow up varied from 18 to 62 months with average of 38,41. The ROM increased about 43,3 degrees (10 to 90) and the Mayo elbow score was 85,4 (25 to 100). We did not have any definitive iatrogenic injury, with one temporary paralysis of the posterior interosseus nerve. Conclusion: The surgery for release of the stiff elbow is a well established procedure, with the open and the arthroscopic methods following the same principles. Against the closed way we have the longer learning curve, the costs and when muscles allonge is necessary and favourable is the aesthetic and lesser soft tissue aggression. Both modalities have the same possible complications. Concluding, the arthroscopic release for elbow stiffness besides providing ROM earning, gives great satisfaction rates and good cosmetic aspect. Each case must be individually evaluated and adjuvant procedures may be necessary. Take care with the surgical technique is always mandatory to avoid neurovascular injuries and with the correct indication it is a secure and effective procedure. Arthroscopic Management of Mason Type II- Radial Head Fractures Using Percutaneous K-wires (SS-53) HARI K. ANKEM, M.S.(ORTH), D.N.B.(ORTH), M.R.C.S.(EDIN), PRESENTING AUTHOR VENKATESWARA RAO GORTHI, M.S.(ORTH) SRINATH KAMINENI, F.R.C.S.(TR&ORTH) Introduction: We propose that good to excellent final functional outcome is possible following arthroscopic management of acute radial head fractures (Mason type II) even with minimal fixation. Methods: 15 patients with acute radial head fractures (Mason Type II) who attended our out-patient department prospectively during the period 2008-2010 were enrolled in the study. There were 11 males and 4 females, average age being 33 years (range 21-54). All the patients were taken up for surgery within the first 72 hrs from injury, after thorough clinical and radiologic exam. Patients with co-existing distal humeral fractures, high grade medial collateral ligament tears and fracture dislocation of elbows were excluded from this study. With the elbow in 90 degrees flexion, Arthroscopic debride-

ment of radio-capitellar joint is performed, followed by arthroscopic assisted reduction of radial head fracture fragments which are then fixed by passing 1.6mm Kwires (Synthes) percutaneously (1-2 nos). Postoperatively the elbow is immobilized in a posterior pop slab for 3-4 weeks in 90 degrees, Indomethacin (75 mg) is given once daily for 3 weeks to prevent heterotopic ossification. The K-wires were removed between 3-4 weeks and full range of elbow motion is actively pursued. Results: The average postoperative follow-up is for 24 months (range 10-36 months) and the average MEPS (Mayo Elbow Performance score) being 85 (range 8090). There is no heterotopic ossification in any of these cases. All the fractures have fully united and there were no nerve related complications or infections either acute or delayed. Conclusion: Excellent final functional outcome is possible following arthroscopic management of acute radial head fractures (Mason type II) even with minimal fixation. Arthroscopy not only allows for debridement of osteochondral loose fragments, fracture fragment reduction but also verifies the integrity of collateral and annular ligaments. Arthroscopic Ulnar Nerve Decompression (SS-54) CHRISTOPHER CHUINARD, M.D., M.P.H., PRESENTING AUTHOR KAREN MILLER, A.T.C., OTC Introduction: To report our results with an arthroscopic technique for ulnar nerve decopression. Methods: A retrospective review of a single surgeon series of arthroscopic ulnar nerve releases associated with other arthroscopic elbow procedures. From April of 2007 to January of 2011, fifty nine elbow arthroscopies were performed by the surgeon; sixteen patient hand an arthroscopic ulnar nerve decompression as part of the surgery; no isolated arthroscopic nerve decompressions were performed. All patients were available for clinical and radiographic follow-up at an average of 16 months (range 3-24). Results: Average preoperative range of motion was 25.4o of extension to 112.3o of flexion. Average postoperative range of motion was 9.6o of extension to 130o of flexion, a gain of 15.8o and 17.7o respectively. Thirteen patients remain very satisfied with their elbow surgery. Three patients underwent a subsequent elbow surgery: one total elbow (in a rheumatoid), and two formal ulnar nerve transpositions. Conclusion: Arthroscopic ulnar nerve decompression can be performed successfully. The technique is demanding and revision demonstrates significant scaring around the nerve. One case had a significant neuroma as a result

ABSTRACTS of the arthroscopic procedure. With the ease of an isolated decompression through a small incision, the arthroscopic approach may not be the procedure of choice.

Osteochondral Lesions of the Talus: A Ten-Year Prospective Clinical Experience (SS-55) BRIAN D. DIERCKMAN, M.D., PRESENTING AUTHOR SAMEH A. LABIB, M.D. MICHAEL SMITH, M.D. Introduction: Treatment of osteochondral lesions of the talus (OLT) remains controversial, especially for high-grade lesions with involvement of subchondral bone. The purpose of this study was to compare outcomes of microfracture and osteochondral autologous transplantation (OAT) for treatment of full thickness cartilage lesions i.e. international cartilage research society (ICRS) grade III (bone intact) and IV (bone involved) lesions. Methods: During a ten-year period, a prospective investigation was undertaken for all patients identified with ICRS grade III and IV lesions treated with either microfracture or OAT. Any cystic lesion deeper than 3mm or any lesion refractory to previous microfracture by the senior author was treated with OAT. All other lesions were treated with microfracture. Patient outcomes were measured with use of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHS), Visual Analog Scale (VAS) for Pain and Function, and overall satisfaction rating. Results: Nineteen patients were treated with OAT, with seventeen of these completing a minimum of twelve months’ follow-up (mean 31 months, range 12-124). Thirty-three patients were treated with microfracture, with thirty-one completing a minimum of twelve months’ follow-up (mean 30 months, range 12-63). There were no significant differences between the two groups in regards to sex, age, BMI, pre-operative AHS score, VAS pain and function, lesion size, chronicity of symptoms or need for follow-up procedures. Despite having had significantly more prior surgeries (76.5% vs 22.6%, p⬍0.01) and a higher percentage of ICRS grade IV lesions (88.2% vs 32.3%), patients in the OAT group had higher post-operative AHS scores (88 vs 80, p⫽0.02). Conclusion: Our results demonstrate treatment of highgrade OLTs with OAT leads to improved functional outcomes when compared to microfracture, despite the OAT group predominately involving patients with grade IV lesions that failed previous microfracture.

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Arthroscopic Normal and Pathologic Posterior Ankle Ligament Anatomy (SS-56) RANDALL FARAC, M.D., PRESENTING AUTHOR RICHARD D. FERKEL, M.D. MARK PINTO, M.D. NADER FAHIMI, M.D. SCOTT RAHHAL, M.D. JAY MARUMOTO, M.D. Introduction: To document the normal arthroscopic appearance of the posterior capsular structures, posterior inferior tibiofibular ligament (PITFL), and the transverse tibiofibular ligament (TTFL), as well as variations in their anatomical relationships. We also wanted to determine the incidence and nature of tears of the TTFL as visualized arthroscopically. Methods: In Part I, 222 consecutive ankle arthroscopies were performed and videotaped at our institution over a three year span. These videotapes were reviewed, paying particular attention to the posterior capsuloligamentous structures. Videotapes that did not give adequate visualization to assess these structures were discarded from this study. The remaining 102 ankle arthroscopies were evaluated for the configuration of the posterior capsuloligamentous structures. Part II involved review of our ankle arthroscopy database to locate all patients with tears of the TTFL and identify associated diagnoses and treatment. Results: All patients in Part I had evidence of both a PITFL and TTFL, which formed a labrum or meniscuslike addition to the posterior distal tibia. No patients demonstrated disruption of the PITFL, while three patients had tears of the TTFL. We noted four distinct patterns of the PITFL and the TTFL. Thirty-four patients (33%) had a type III pattern with a sizable gap of ⬎2 mm between the two ligamentous structures. Nine patients (9%) had a type IV pattern, which demonstrated a sizable gap between the two ligaments, but the TTFL appeared as a cord-like structure, resulting in an overall thinner posterior labrum. Thirty three patients (32.4%) had a type II pattern with a gap ⬍2 mm between the PITFL and TTFL. Twenty-six patients (25.5%) had a type I pattern with the confluence of the two ligaments without a gap. The presence of a “vertical band” was documented in 30% of the arthroscopies reviewed. In 60 patients (59%), the flexor hallucis longus (FHL) tendon was not discernible, usually secondary to synovial proliferation in the area. The review of all ankle arthroscopies at our institution revealed forty patients with tears of the TTFL for an incidence of 1.7%. Conclusion: To our knowledge, this is the first paper to describe an arthroscopic classification of the normal pos-