Faculty Bibliography

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

Methods of non-invasive monitoring of training status for prevention of staleness in athletes and dancers need to be developed and evaluated. In order to monitor physiologic and psychologic changes which may result from overstraining, we measured urinary excretion of free norepinephrine (NE) and epinephrine (E) and mood states over 5 weeks of an intensive ballet season in 12 (6 men, 6 women) professional dancers. First morning urine voids (AM) were collected at the start of the season and following the only off-day each week with final collection on the last day of the season. Additional urine samples were collected before (pre) and after (post) each dancer's subjectively-rated single most difficult performance. Profile of Mood States (POMS) was completed by and collected from each dancer at the same time as the AM urine samples. NE and E excretions (nanograms per mg creatinine) increased significantly with time (r = 0.91, p less than 0.02, and r = 0.94, p less than 0.01, respectively) from beginning to end of season, and pre to post (51.1 +/- 7.3 to 115.6 +/- 19.7, p less than 0.001 and 19.3 +/- 3.2 to 37.7 +/- 4.2, p less than 0.001, respectively). Women had a significantly higher excretion of NE than did men (F = 9.33, p = 0.014) and no gender differences existed in the excretion of E (F = 0.57, p = 0.484).(ABSTRACT TRUNCATED AT 250 WORDS)

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