Ankle intra-articular pathology after acute injury is common and often under-diagnosed. While the majority of soft tissue injuries improve with rehabilitation, up to 40% of patients experience chronic pain, stiffness or instability. MRI is increasingly used in the investigation of such patients; however interpretation of MRI findings requires specialist expertise. The aim of this study was to determine the diagnostic potential of magnetic resonance imaging (MRI) compared to ankle arthroscopy. Forty consecutive patients presenting with ankle pain of at least three months duration were included in the study. This cohort of patients underwent magnetic resonance imaging (MRI) and then arthroscopy. Pre-operative MRI reported findings were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative predictive value of MRI for diagnosing ankle pathology was then assessed. The 2 senior authors reviewed the MRI scans and their findings correlated. The average time between injury and presentation to our service was 2.2 years. This interval ranged from 3 months to 10 years. 51% of patients gave history of inversion and/or plantar flexion injuries. 14 % had symptoms, which persisted following an ankle fracture. At arthroscopic evaluation 23 patients had osteochondral defects and 37 had evidence of synovitis. MRI identified 50% of the osteochondral defects with sensitivity 50% and specificity 100%. Synovitis was not identified in any of the patients on preoperative MRI but 33% of the preoperative MRI did demonstrate a joint effusion. Despite the high rate of discordance between MR imaging and arthroscopy in our study MRI still remains a useful adjunct in the investigation of ankle pain. The implications for practice and further study are discussed.
Ankle intra-articular pathology after acute injury is common and often under-diagnosed. While the majority of soft tissue injuries improve with rehabilitation, up to 40% of patients experience chronic pain, stiffness or instability. MRI is increasingly used in the investigation of such patients; however interpretation of MRI findings requires specialist expertise. The aim of this study was to determine the diagnostic potential of magnetic resonance imaging (MRI) compared to ankle arthroscopy. Forty consecutive patients presenting with ankle pain of at least three months duration were included in the study. This cohort of patients underwent magnetic resonance imaging (MRI) and then arthroscopy. Pre-operative MRI reported findings were compared with the arthroscopic findings. The sensitivity, specificity, positive and negative predictive value of MRI for diagnosing ankle pathology was then assessed. The 2 senior authors reviewed the MRI scans and their findings correlated. The average time between injury and presentation to our service was 2.2 years. This interval ranged from 3 months to 10 years. 51% of patients gave history of inversion and/or plantar flexion injuries. 14 % had symptoms, which persisted following an ankle fracture. At arthroscopic evaluation 23 patients had osteochondral defects and 37 had evidence of synovitis. MRI identified 50% of the osteochondral defects with sensitivity 50% and specificity 100%. Synovitis was not identified in any of the patients on preoperative MRI but 33% of the preoperative MRI did demonstrate a joint effusion. Despite the high rate of discordance between MR imaging and arthroscopy in our study MRI still remains a useful adjunct in the investigation of ankle pain. The implications for practice and further study are discussed.
Total Elbow arthroplasty can be a valuable treatment option in the painful or stiff elbow but outcomes have been disappointing previously. The history of total elbow arthroplasty has been disappointing in the past. Implants initially were a coupled articulation and were a rigid hinge. There was then a move to resurfacing type of designs although there was an issue with instability postoperatively with these implants. The semiconstrained coupled implant was developed in the mid 1970s by Coonrad. The idea behind the implant was that the loose polyethylene coupling provides inherent stability while decreasing the amount of loosening that was seen with the rigid hinge implants previously. We are reporting our results of our experience with a single type of semiconstrained implant that has been used in our unit since 1999. A semiconstrained total elbow arthroplasty was performed in thirteen patients over a period of 7 years period in our unit. Mean age at time of surgery was 60 years (44–70) M:F ratio 11:2. The aetiology of the joint pathology was Rheumatoid Arthritis (n= 10), psoriatic arthritis (n= 2) &
posttraumatic (n =1). The patients were followed up for a mean duration of 4.5 years. They were assessed for range of motion, Mayo elbow function scores and radiographic evaluation and complication rate. 9 of the 13 elbows had a good to excellent result. There were 5 complications overall. There was two ulnar neuropathies that eventually resolved and one ulnar component that had to be revised 2 weeks after initial insertion. 3 had condylar fractures none of which required further operation. One patient had evidence of radiographic loosening but was asymptomatic. In our experience the semiconstrained total elbow replacement is a valuable option in the treatment of painful stiff the elbow.
Injection of the plantar fascia under general anaesthesia is a safe and effective method for the relief of conservatively unmanageable heel pain due to plantar fasciitis. A larger patient population and a greater than 1 year follow up would be helpful to determine the long term benefits &
outcomes of this treatment.
