Faculty Bibliography

The role of arthroscopic procedures in the management of glenohumeral stability continues to evolve. Arthroscopic transglenoid suture capsulorrhaphy, as described, is an effective alternative for correcting the pathology of anterior and anteroinferior shoulder instability. The procedure avoids the morbidity associated with open repairs as a result of anterior soft tissue dissection and division of the subscapularis. The procedure, however, is technically demanding. To achieve predictable and reproducible results that approach those seen in comparable patient populations undergoing open Bankart stabilization, recognition of, and addressing, the responsible pathology is essential, as is appropriate patient selection. Based upon experience to date, arthroscopic transglenoid suture capsulorraphy is best indicated for traumatic anterior dislocators with a Bankart lesion and good quality glenohumeral ligaments. Arthroscopic suture capsulorrhaphy is not recommended for patients involved in upper extremity collision sports, those with a large glenoid rim defect, habitual luxators, patients younger than 18 years of age, and for surgeons whose experience with operative arthroscopy of the shoulder is limited. The procedure has an unresolved role, due to lack of sufficient long-term data in acute dislocations, multidirectional instability, those with previously failed open or arthroscopic repairs, and those with generalized joint hyperlaxity. The eventual role of arthroscopic transglenoid suture capsulorrhaphy in the treatment of anterior shoulder instability awaits further studies and technological innovation

Twenty-nine cases of operative arthroscopy of the ankle were done between 1985 and 1989 for synovial impingement of the ankle. The average age of the patients was 37 years. All patients (17 men, 12 women) reported an earlier history of injury, with 24 of the patients (83%) noting chronic ankle pain after an inversion injury and 5 of the patients (17%) reporting a previous ankle fracture. Physical examination elicited anterolateral tenderness at the ankle in all cases with associated anteromedial pain in 4 patients. A demonstrable 'click' was evident in 6 of the patients (21%) on forced dorsiflexion of the ankle. All patients failed conservative treatment including physical therapy and nonsteroidal antiinflammatory drugs. Surgery was performed at an average of 36 months postinjury. Ankle arthroscopy revealed extensive hypertrophic synovial thickening and scar tissue anterolaterally, indicating synovial impingement in all patients. Associated chondromalacia of the distal tibia was seen in 21% of the patients. Operative arthroscopy included partial synovectomy and debridement of the hypertrophic tissue and partial shaving chondroplasty of the tibia when indicated. Postoperatively, patients were weightbearing as tolerated. Results were assessed subjectively and objectively. At 25-month followup 26 patients had excellent or good results and 3 had fair results; there were no poor results. There were no major complications, including infection or neurovascular compromise. The 3 patients with associated ankle instability comprised the 'fair' result group and eventually required lateral ankle reconstruction. Thus, chronic ankle pain due to synovial impingement can be safely, predictably, and effectively treated by operative ankle arthroscopy

Eleven asymptomatic patients 1-9 months after arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with autogenous semitendinosus and gracilis tendons as a 'neoligament' were studied by MR. Each neoligament was clinically intact. Examinations were performed at 1.5 T with T1- and T2-weighted sagittal and oblique spin echo images in the plane of ACL repair. On MR in 9 of the 11 patients (82%) the ACL neoligament appeared as a smooth well-defined band of low signal intensity along its entire course. In two patients (18%) the integrity of the neoligament could not be determined by MR. Ligaments in which integrity could not be determined demonstrated irregularity or a wavy contour, high signal intensity change within the ligament, or discontinuity of the ligament. We conclude that, contrary to previous reports, MR can demonstrate an intact ACL reconstruction

A case of synovial chondromatosis of the shoulder is reported in a 28-year-old man with long-standing shoulder pain after a remote episode of trauma. Although plain roentgenograms were normal, arthrograms revealed the characteristic findings of synovial chondromatosis. Treatment consisted of arthroscopic removal of multiple cartilaginous loose bodies and partial synovectomy. Synovial chondromatosis of the shoulder treated with arthroscopic debridement and synovectomy rather than traditional open arthrotomy seems not to have been reported previously

Sixty patients (eighty hips) who had slipped capital femoral epiphysis were treated by epiphyseodesis with a cannulated-screw technique. Forty-nine patients (sixty-seven hips) were available for follow-up, forty-four (sixty hips) of whom were followed for a minimum of two years. Thirty-five patients (forty-six hips) were followed until the hardware was removed. Of seventy-two hips in which contrast medium was injected, arthrographic results were obtained in three. In these three hips, there was evidence of pre-existing narrowing of the joint space. Four patients (six hips) who did not have evidence of penetration by a screw or guide-wire had evidence of either pre-existing chondrolysis or osteoarthrosis. Chondrolysis did not develop postoperatively in any patient who had no evidence of it preoperatively

An instrument is described which is capable of collecting fractions from a capillary zone electrophoresis apparatus. The fraction collector is characterized in terms of discretely collecting the separated components of a multi-component sample. In addition, the fraction collector permits the study of the effect of capillary zone electrophoresis on the biological activity of alpha-chymotrypsin

A 23-year-old man sustained an isolated popliteus tendon rupture while pushing a car. The diagnosis was established with the use of arthroscopy, electromyography, and Cybex testing. After the patient failed to respond to conservative therapy, the tendon rupture was surgically repaired. The patient had an uneventful recovery and returned to his preinjury level of athletic activity. Although popliteus tendon tenosynovitis as well as injury to the popliteus in association with other ligamentous knee injuries has been described, neither an isolated popliteus tendon rupture nor an arthroscopic evaluation of a popliteus tendon rupture has been reported

Ganglion cysts of the cruciate ligaments of the knee are rare. A case is presented of a ganglion cyst of the anterior cruciate ligament diagnosed arthroscopically

A technique that utilizes a newly designed cannulated screw with injection of radiographic dye through the screw cannula provides a reliable and practical method for detection and avoidance of pin penetration when operating on slipped capital femoral epiphyses. Adoption of this method minimizes the possibility of poor results occurring as a consequence of internal fixation.

An unusually high incidence of talocalcaneal coalition is reported in a group of patients with arthrogryposis multiplex congenita with resistant talipes equinovarus deformities.