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Great toe arthroscopy: Indications, technique and results
317
ABSTRACTS All 12 of the ankles have fused solidly. The final position of the foot was considered excellent in all but one case. In this case, there was a considerable deformity preoperatively. She has remained in approximately 5” of equinus, which has been no functional problem to this patient. The hospital stay required for this procedure was significantly less than that for the standard open fusion techniques and can be performed as an outpatient procedure. Postoperatively, the pain has been significantly less, with a number of patients requiring no narcotic drugs postoperatively. Arthroscopic ankle fusion using demineralized bone matrix and bone marrow aspiration to stimulate a rapid fusion is shown to be effective. This procedure allows a high, rapid fusion rate along with very low morbidity and an excellent postoperative functional position of the foot. Great Toe Arthroscopy: Indications, Technique and Results. Richard D. Ferkel and Kent Van Buecken. Van Nuys, California, U.S.A. Previously, there have been no detailed reports on great toe arthroscopy. The purpose of this study was to develop the indications and technique for great toe arthroscopy and to analyze our results in the first 12 patients. The diagnostic indications for great toe arthroscopy were pain, swelling, stiffness, and locking. The dorsomedial, dorsolateral, and straight medial portals were determined through anatomical dissections and distances measured from the neurovascular structures. A 2.7-mm short scope was used with a sterile suspension system, small joint instruments, and video documentation. Postoperatively, all patients wore a sterile compression dressing with a wood-soled shoe and were discharged the day of surgery. Normal anatomy was established with five cadaver specimens. Great toe arthroscopy was performed on 12 patients (9 female, 3 male). Average age was 28 years, and average follow-up was 12 months. The normal anatomy of the great toe can be seen in its entirety by using all three portals. The most difficult areas to visualize are the dorsal gutter and the lateral sesamoid. Postoperative diagnoses on the 12 patients included chondromalacia (3), synovitis (4), osteochondritis dissecans (l), osteophytes (2), and loose bodies (2). Results were graded 83% good (lo), 17% fair (2), with no poor results. No complications occurred in this study. Great toe arthroscopy appears
to be a reasonable alternative to arthrotomy in the diagnosis and treatment of selected pathologic conditions. As our experience and technique improve, therapeutic indications will increase. Arthroscopic Assessment of Glenoid Loosening Following Total Shoulder Arthroplasty. Peter M. Bonutti and Richard J. Hawkins. Effingham, Illinois, U.S.A., and London, Ontario, Canada. We conducted a retrospective study of eight patients to evaluate arthroscopy as an adjunct in the assessment of glenoid loosening after total shoulder arthroplasty. Eight patients with pain after a total shoulder arthroplasty underwent a physical examination and had plain radiographs. Three of the patients had arthrograms. All eight patients underwent diagnostic arthroscopy. Open exploration of each shoulder was subsequently performed, so arthroscopic findings could be correlated with surgical findings. Five patients were found at open surgery to have a loose glenoid component and underwent glenoid revision. All five of these components had been determined to be loose arthroscopically. Radiographs suggested possible loosening in two of the five. Arthrograms had been obtained in two of the five, but in neither did it indicate loosening. Three of the patients were found at open surgery to have a well-fixed glenoid. Arthroscopically, only one of the three was thought to be well-fixed, whereas the other two were incorrectly thought to be loose. Radiographs correctly indicated all three to be well fixed. An arthrogram was obtained in one case and was thought to be equivocal. Arthroscopy was the most sensitive indicator of glenoid loosening in our series. It correctly predicted loosening in all components ultimately found to be loose at surgery. Unfortunately, we were not as good at predicting which glenoids were well fixed. We believe that arthroscopy is an important adjunct in the assessment of glenoid loosening. It is likely to be especially valuable in the early stages of loosening, before migration and subsidence, when plain radiographs and arthrograms may still be normal. Operative Elbow Arthroscopy: Long-Term FollowUp. Champ L. Baker, William W. Peterson, and Robert DaSilva. Columbus, Georgia, U.S.A. We reviewed the cases of 42 patients who underwent operative elbow arthroscopy. Fifteen had a Arthroscopy.
Vol. 7. No. 3, 1991
ABSTRACTS All 12 of the ankles have fused solidly. The final position of the foot was considered excellent in all but one case. In this case, there was a considerable deformity preoperatively. She has remained in approximately 5” of equinus, which has been no functional problem to this patient. The hospital stay required for this procedure was significantly less than that for the standard open fusion techniques and can be performed as an outpatient procedure. Postoperatively, the pain has been significantly less, with a number of patients requiring no narcotic drugs postoperatively. Arthroscopic ankle fusion using demineralized bone matrix and bone marrow aspiration to stimulate a rapid fusion is shown to be effective. This procedure allows a high, rapid fusion rate along with very low morbidity and an excellent postoperative functional position of the foot. Great Toe Arthroscopy: Indications, Technique and Results. Richard D. Ferkel and Kent Van Buecken. Van Nuys, California, U.S.A. Previously, there have been no detailed reports on great toe arthroscopy. The purpose of this study was to develop the indications and technique for great toe arthroscopy and to analyze our results in the first 12 patients. The diagnostic indications for great toe arthroscopy were pain, swelling, stiffness, and locking. The dorsomedial, dorsolateral, and straight medial portals were determined through anatomical dissections and distances measured from the neurovascular structures. A 2.7-mm short scope was used with a sterile suspension system, small joint instruments, and video documentation. Postoperatively, all patients wore a sterile compression dressing with a wood-soled shoe and were discharged the day of surgery. Normal anatomy was established with five cadaver specimens. Great toe arthroscopy was performed on 12 patients (9 female, 3 male). Average age was 28 years, and average follow-up was 12 months. The normal anatomy of the great toe can be seen in its entirety by using all three portals. The most difficult areas to visualize are the dorsal gutter and the lateral sesamoid. Postoperative diagnoses on the 12 patients included chondromalacia (3), synovitis (4), osteochondritis dissecans (l), osteophytes (2), and loose bodies (2). Results were graded 83% good (lo), 17% fair (2), with no poor results. No complications occurred in this study. Great toe arthroscopy appears
to be a reasonable alternative to arthrotomy in the diagnosis and treatment of selected pathologic conditions. As our experience and technique improve, therapeutic indications will increase. Arthroscopic Assessment of Glenoid Loosening Following Total Shoulder Arthroplasty. Peter M. Bonutti and Richard J. Hawkins. Effingham, Illinois, U.S.A., and London, Ontario, Canada. We conducted a retrospective study of eight patients to evaluate arthroscopy as an adjunct in the assessment of glenoid loosening after total shoulder arthroplasty. Eight patients with pain after a total shoulder arthroplasty underwent a physical examination and had plain radiographs. Three of the patients had arthrograms. All eight patients underwent diagnostic arthroscopy. Open exploration of each shoulder was subsequently performed, so arthroscopic findings could be correlated with surgical findings. Five patients were found at open surgery to have a loose glenoid component and underwent glenoid revision. All five of these components had been determined to be loose arthroscopically. Radiographs suggested possible loosening in two of the five. Arthrograms had been obtained in two of the five, but in neither did it indicate loosening. Three of the patients were found at open surgery to have a well-fixed glenoid. Arthroscopically, only one of the three was thought to be well-fixed, whereas the other two were incorrectly thought to be loose. Radiographs correctly indicated all three to be well fixed. An arthrogram was obtained in one case and was thought to be equivocal. Arthroscopy was the most sensitive indicator of glenoid loosening in our series. It correctly predicted loosening in all components ultimately found to be loose at surgery. Unfortunately, we were not as good at predicting which glenoids were well fixed. We believe that arthroscopy is an important adjunct in the assessment of glenoid loosening. It is likely to be especially valuable in the early stages of loosening, before migration and subsidence, when plain radiographs and arthrograms may still be normal. Operative Elbow Arthroscopy: Long-Term FollowUp. Champ L. Baker, William W. Peterson, and Robert DaSilva. Columbus, Georgia, U.S.A. We reviewed the cases of 42 patients who underwent operative elbow arthroscopy. Fifteen had a Arthroscopy.
Vol. 7. No. 3, 1991