Purpose Anatomic reconstruction of the anterior talofibular ligament and calcaneofibular ligament is a valid treatment of chronic hindfoot instability. The purpose of this study was to investigate the outcomes of this procedure performed by an all-inside endoscopic technique. Methods This study is a retrospective evaluation of a prospective database. Subjects were all patients who underwent an endoscopic lateral ligament reconstruction between 2013 and 2016. All patients had symptoms of ankle instability with positive manual stress testing and failed nonoperative treatment during at least 6 months. At final follow-up the outcome was assessed using the visual analogue score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Karlsson-Peterson scores. Results After an average follow-up of 31.5 ± 6.9 months, all patients reported significant improvement compared to their preoperative status. The preoperative AOFAS score improved from 76.4 ± 15 to 94.7 ± 11.7 postoperatively (p = 0.0001). The preoperative Karlsson-Peterson score increased from 73.0 ± 16.0 to 93.7 ± 10.6 postoperatively (p = 0.0001). The VAS score improved from 1.9 ± 2.5 to 0.8 ± 1.7 (p < 0.001). Two patients had complaints of recurrent instability. Conclusion Endoscopic ligament reconstruction for chronic lateral ankle instability is a safe procedure and produces good clinical results with minimal complications. In addition, the endoscopic approach allows an assessment of the ankle joint and treatment of associated intra-articular lesions. Level of evidence II.

Purpose To evaluate return to sport and clinical outcomes with at least 2 years followup after arthroscopic reconstruction ACL in population over 50 years-old. Methods: eighty-one patients aged 50 years or older underwent isolated, primary ACL reconstruction with hamstring autograft between 2014 and 2016. In all patients, a period of conservative treatment had failed (minimum 6 months), and they complained of functional instability and/or limitation during daily activity. Patients were assessed preoperatively and at the latest follow-up with a physical examination, return to sports activity, the Lysholm score, the International Knee Documentation Committee scoring system, the Knee injury and Osteoarthritis Outcome Score, and the Tegner activity scale. Data regarding complications and revision surgeries were collected at 2-year follow-up. Results At the last follow-up, significant improvement in outcome scores from pre-to postoperative assessments was found. The mean overall IKDC score increased from a preoperative mean of 54.4-82.9 (p < 0.001). Mean preoperative Lysholm score increased from a preoperative mean of 67.4-90.4 (p < 0.001). The mean overall KOOS score increased from a preoperative mean (p < 0.001). Median preoperative Tegner score was 5 (range 2-8) and median postoperative score was 5 (range 1-7). 86% of patients returned to the sport, 51% to their preinjury sports level. Tegner score, before accident, was the only positive influencing factor a return to pre-injury level of the sport. Conclusion Arthroscopic reconstruction ACL in patients over 50 years-old resulted in excellent functional outcomes, with most patients returning to sport and at the same level they had before the injury. Level of evidence Level IV.

Chronic patellar tendon rupture is a rare injury; extensor mechanism impairment leads to great disability in daily life. The delayed diagnosis and reconstruction of chronic patellar tendon ruptures are technically challenging. Numerous surgical procedures have been described with bone-tendon-bone graft, hamstring graft, artificial ligament, and allograft. We describe safe, reproducible anatomic reconstruction of the patellar tendon using hamstring tendon and adjustable suspensory fixation. After harvesting of the hamstrings, the graft is prepared with 2 adjustable suspensory fixation devices. Then, a complete tibial tunnel and a patellar tunnel with a socket are drilled with the appropriate diameter, and the graft is pulled through the tunnels. Finally, the suspensory fixation devices on the tibial and patellar sides are tensioned. The aim of this procedure is to obtain complete mobility of the knee, using a procedure similar to anterior cruciate ligament reconstruction in graft preparation.

No abstract

No abstract