To investigate intraarticular lesions producing persistent postoperative pain, we arthroscopically examined 31 ankles in 31 patients (15 women and 16 men) with lateral ligament injury. The patients ranged in age from 15 to 33 years, with a mean of 20 years. Nine patients were freshly injured, and 22 patients had chronic injuries. All of the patients underwent arthroscopic examination immediately before the ligament operation. Chondral lesions were found in 89% of the freshly injured ankles and 95% of the ankles with chronic injuries. Most of these lesions were in the medial half of the ankle joint, especially in the anteromedial edge of the tibial plafond. After followup for 1 year postoperatively, persistent pain was noted in 4 patients who had chondral lesions of greater than one-half the thickness of the articular cartilage. Pain and tenderness were localized at the anteromedial joint line, corresponding to the location of the chondral lesions. Chondral lesions of greater than one-half the thickness of the articular cartilage were found in 8 ankles in the chronic injury group, but there were none in the fresh injury group. Thus, in lateral ligament injuries of the ankle, the longer the time elapsed from the initial injury, the more severe the associated chondral lesions became. These chondral lesions appear to cause persistent pain.

Fresh frozen allogeneic tendon was used to reconstruct the lateral ligaments in 17 ankles. Two or more years later, 13 returned for follow-up examination. The mean age at operation was 23 years (range 15 to 39); the interval between injury and operation varied from six months to 20 years. There were no infections and no immunological rejections, and according to Sefton's criteria, nine patients were excellent and four good. No patient complained ofinstability ofthe ankle and stress radiography

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Although free tissue transfer following limb-saving wide resection has become increasingly necessary in the treatment of sarcomas of the extremities, the side effects of adjuvant chemotherapy on the microvascular structure are not yet known. There may be significant effects, especially with intra-arterial administration. In order to study the time-dependent manifestations of possible effects, experimental microvascular anastomoses in the rat femoral artery were performed at various intervals, after intra-arterial injection of Adriamycin. This drug was used because of its popularity as an adjuvant chemotherapeutic agent. Vessels were examined at varying intervals for macroscopic changes affecting patency and for histologic changes. Anastomoses done at three weeks after Adriamycin injection resulted in the worst patency rate. Histologically, thrombotic occlusion was associated with widespread and profound disruption of the internal elastic lamina, thought to be thrombogenic trauma: the vessel was presumed to have been made fragile by preoperative Adriamycin treatment. Five weeks or longer after injection, this effect was reduced, according to patency rates and histologic findings. Endothelial damage was minimal and appeared insignificant.

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