Posterior calcaneal exostosis treatment modalities showed many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimal surgical invasive technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. We operated on 81 patients with an age range between 25 and 55 years, 40 males and 41 females. The radiologic examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had neither clinical varus of the hind foot nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 35.3 months (12-72). According to the Ogilvie-Harris-Score, 34 patients presented good and 41 patients excellent results, while three patients showed fair results, and three patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. Only minor postoperative complications were observed. ECP is an effective and of minimal-invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve, the endoscopic exposure is superior to the open technique has less morbidity, less operating time, and nearly no complications; moreover, the pathology can better be differentiated.

The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch has to be strictly avoided.

No abstract

No abstract

The purpose of this study was to present the technique of arthroscopic capsule release in patients with early and midstage degenerative joint disease of the hip. In 22 patients we performed an arthroscopic capsular release of the hip joint capsule with simultaneous synovectomy and percutaneous drilling of areas of bone edema. The age of the patient ranged from 28 to 65 years (mean 52 years). There were 14 male and 8 female patients. All patients had suffered from a significant reduction of quality of life. In 15 of the 22 patients hip arthroplasty was already indicated in another institution. The preoperative Harris hip Score of 12 patients was below 69 points, 8 patients had a score between 70 and 79 points and 2 patients had a score between 80 and 89 points. At the time of follow-up (mean 26 months after surgery) 1 patient scored below 69 points, 3 patients scored between 70 and 79 points in the Harris hip score. Two patients scored between 80 and 89 points and 16 patients reached a score between 90 and 100 points. Subjective and objective 18 of 22 patients showed clinical relevant improvement. There was no complication in this series. Four patients underwent hip arthroplasty between 6 months and 2 years after the arthroscopic procedure. Minimal invasive arthroscopic treatments seem to decrease the subjective and objective complaints in early and midstage degenerative arthritis of the hip.