Reconstruction of the lateral ligaments of the ankle has been performed for many years, but few reports are available regarding the outcome after 10 years or longer, and there are no such reports on reconstruction with the more recently developed artificial ligaments. I report the clinical outcome and radiological findings.

Materials and results: The subjects are 62 feet in 57 patients (male 28 feet, female 34 feet). All patients were followed up by direct examination and stress roentgenography for 10 years or longer. Mean follow-up period is 11 years and 9 months.

On stress X-ray taken at the final examination, TTA improved preoperatively 19 degrees to 4 degrees postoperatively, and ADT improved from 12 to 5 mm. There was no marked development or progression of arthropathic changes. No allergic reaction to the artificial ligament material occurred in any patient. postoperatively and no patient had instability that became severe enough for reoperation to be required. As for arthropathic changes, in 3 patients with a TTA of 10 degrees or more postoperatively, progression of mild osteoarthritic changes was observed.

Discussion: There have been few studies involving long-term follow-up for 10 years or more. This procedure is not happened OA changes and ADL limitation because reconstruction at anatomical position of ATFL and CFL. It has not been happened pathological rupture of artificial ligament because lateral ligaments are not intra-articular ligament but periarticular ligament.

Conclusion: Reconstruction with artificial ligament is anatomical procedure and can be expected the prolonged effectiveness.

Aims: Arthroscopic drilling for the treatment of osteo-chondral lesion (OCL) of talus has been able to return earlier to social life resulting from less invasive operation. However, long term results of drilling have not been clear. Results of arthroscopic drilling for OCL which have passed 5 years or longer are reported. Methods: Subjects were 54 feet in 52 patients who had passed more than 5 years who underwent arthroscopic drilling. Age ranged 21 to 52 years with an average of 34 years. Classiþcation based on Berndt & Harty was as follows: 1 foot for stage?, 38 feet for stage?, 8 feet for stage?and 7 feet for stage?. Resdults: No patients showed limited range of motion at the þnal examination. With pain, 2 patients developed pain in the lesion, while no patients showed disturbance in gait, either. With sports, all the patients returned to initial sports, however, in patients with extensive lesion (3 patients), there remained pain causing a decrease in sports level. X-ray þndings revealed osteoarthritic change in three patients. Conclusions: In the present study, in patients of 90 percent or greater, there were no new developed or deterorated pains. However, osteoarthritic change was observed in the cases with lateral ligaments tear or subchondral bone cyst. Thus, it may suggest the limit in the indications of drilling. Furthermore, since there remained pain in the patients with complicated injuries or extensive lesion, it may be difþcult to obtain excellent results with use of arthroscopic drilling alone.

Aims: To clarify correlation between magnetic resonance imaging (MRI) and pathology of pain in posterior aspect of the ankle in ballet dancers. Methods: Twenty feet of þfteen patients, who underwent surgery with the average age of 19.2 years, were retrospectively analyzed. They were diagnosed as ßexor hallucis longus (FHL) tendon injury or posterior ankle impingement (PAI) syndrome mainly based on physical signs. MRI þndings of FHL tendon were classiþed with the classiþcation of posterior tibial tendon dysfunction presented by Conti et al., and were compared with macroscopic changes of the tendon. FHL injuries were classiþed as follows; paratendinitis as grade-1, superþcial injury (< 1/2 thickness) as grade-2, and deep injury as grade-3. MRI þndings of PAI syndrome were also compared to surgical and histological þndings. Results: Correlation of FHL tendon injury with MRI þndings was presented on the table. There was a case with a ganglion cyst of FHL tendon presented on MRI. There were, however, two cases with ganglions on þbro-osseous tunnel MRI could not reveal. In four feet of three patients, bone marrow edema in os trigonum or posterior part of the talus was observed. Conclusion: MRI was useful to investigate the pathology of pain in posterior aspect of the ankle.

Purpose: Pain occasionally develops in the posterior tibial tendon after chronic sprains, whose pathology is not known yet. We inserted an endoscope (tendoscope) into the tendon sheath of the tibialis posterior and treated based on the observation of its pathology.

Subjects and methods: Subjects were patients who had complained pain in the posterior tibial tendon after ankle sprain. The interval from the injury to the tendo-scope ranged from one month to one year and 8 months with an average of 9 months. There were 18 patients (11males, 7females). The age ranged from 18 to 33 years with an average of 24 years. For initial treatment, cast fixation, and orthoses were employed in 10 patients. Other 8 patients were left with bandage alone. For these patients, a 2.4mm-diameter endoscope was inserted into the tendon sheath.

Results: Synovia proliferation was found in all the cases, and vicula in the tendon sheath disappeared. Synovia proliferation was found in all patients and erosion of the tendon was observed in 8 patients. In other 3 patients, injured sliding floor of the posterior tibial tendon was found. For treatment, synovectomy and smoothing of the sliding floor were performed. All the patients had improvement of pain and returned to sports with the former level.

Discussion: It has been known that, in some cases, pain emerges in the posterior tibial tendon after ankle sprain. Its pathology has remained unknown. It is suggested that injuries in the tendon sheath of the tibialis posterior, sliding floor of the tendon, and deltoid ligament associated with the sprain may have caused inflammations, which has developed synovia proliferation. It is thought posterior tibial tendon is often injured after ankle sprain.

Purpose: Severe trauma in the mid-foot induces various foot deformities, causing pain. The mechanism and treatment of foot deformities following mid-foot trauma were evaluated.

Materials: We evaluated feet showing dislocation and/or fracture of 2 or more joints or 2 or more tarsal bones encountered at our department between 1983 and 1996. The subjects were 24 males (26 feet) and 8 females (8 feet) aged 21–58 years (mean, 37 years). The injury that caused foot deformities was navicular bone fracture in 1 case, Chopart dislocation in 3, Lisfranc dislocation in 23, and fracture dislocation of the cuneiform in 5, The follow-up period was 2 years and 4 months _ 8 years (mean, 4 years and 9 months). Deformities occurred in these cases and associated factors were evaluated.

Results: Flat foot deformity occurred in the 1 case of navicular bone dislocation and 2 of fracture dislocation of the cuneiform. Cavovarus deformity occurred in the 6 cases of Lisfranc fracture dislocation. Other deformities were observed in 3 feet. All patients complained of pain and fatigability during walking and were treated by corrective osteotomy and arthrodesis. Though the pain reduced, discomfort in the foot persisted, making heavy labor impossible in 3 cases.

Discussion: In the mid-foot, there are many small tarsal bones, to which many tendons and ligaments are attached, forming the foot arch. Even though injury of one joint or one ligament (tendon), foot deformity can be induced. It is also possible that intraarticular injury was already severe at the time of injury, inducing secondary deformity. In trauma of the mid-foot involving multiple joints, the injured area should be adequately evaluated by preoperative stress X-P or MRI.