Midshaft Clavicle Fractures: When Is Surgical Management Indicated and Which Fixation Method Should Be Used?

For displaced midshaft clavicle fractures, operative treatment either with open reduction and plate fixation or with intramedullary fixation has been shown to provide earlier return to work and sport, improved functional outcomes, greater patient-reported satisfaction with appearance, and significantly decreased incidence of nonunion and malunion when compared with conservative treatment. Operative intervention is not without risks associated with surgery. Shared decision-making with the patient and understanding patient goals allows surgeons to recommend a management option that the patient will be comfortable with and will follow to achieve a satisfactory outcome.

Imaging of Patellofemoral Instability

Patellar instability is a broad term that encompasses patellar dislocation, patellar subluxation, and patellar instability. Although both functional and anatomic considerations contribute to symptoms of patellar instability, the most important are thought to be patella alta, trochlear dysplasia, and lateralization of the tibial tubercle. In patients with a history suspicious for prior patellar dislocation, careful evaluation of MRI and radiographic studies can reveal characteristic findings. The most common methods to address patellofemoral instability are medial patellofemoral ligament reconstruction and tibial tubercle osteotomy with either anteromedialization or medialization. Less commonly trochleoplasty is indicated as well. Patients may be treated with one of or a combination of these techniques, each of which has specific indications and complications.

Reconsidering Reciprocal Length Patterns of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament During In Vivo Gait

BACKGROUND

Some cadaveric studies have indicated that the anterior cruciate ligament (ACL) consists of anteromedial and posterolateral bundles that display reciprocal function with regard to knee flexion. However, several in vivo imaging studies have suggested that these bundles elongate in parallel with regard to flexion. Furthermore, the most appropriate description of the functional anatomy of the ACL is still debated, with the ACL being described as consisting of 2 or 3 bundles or as a continuum of fibers.

HYPOTHESIS

As long as their origination and termination locations are defined within the ACL attachment site footprints, ACL bundles elongate in parallel with knee extension during gait.

STUDY DESIGN

Descriptive laboratory study.

METHODS

High-speed biplanar radiographs of the right knee joint were obtained during gait in 6 healthy male participants (mean ± SD: body mass index, 25.5 ± 1.2 kg/m²; age, 29.2 ± 3.8 years) with no history of lower extremity injury or surgery. Three-dimensional models of the right femur, tibia, and ACL attachment sites were created from magnetic resonance images. The bone models were registered to the biplanar radiographs, thereby reproducing the in vivo positions of the knee joint. For each knee position, the distances between the centroids of the ACL attachment sites were used to represent ACL length. The lengths of 1000 virtual bundles were measured for each participant by randomly sampling locations on the attachment site surfaces and measuring the distances between each pair of locations. Spearman rho rank correlations were performed between the virtual bundle lengths and ACL length.

RESULTS

The virtual bundle lengths were highly correlated with the length of the ACL, defined as the distance between the centroids of the attachment sites (rho = 0.91 ± 0.1, across participants; P < 5 × 10^-5). The lengths of the bundles that originated and terminated in the anterior and medial aspects of the ACL were positively correlated (rho = 0.81 ± 0.1; P < 5 × 10^-5) with the lengths of the bundles that originated and terminated in the posterior and lateral aspects of the ACL.

CONCLUSION

As long as their origination and termination points are specified within the footprint of the attachment sites, ACL bundles elongate in parallel as the knee is extended.

CLINICAL RELEVANCE

These data elucidate ACL functional anatomy and may help guide ACL reconstruction techniques.

Patients with depression and anxiety symptoms from adjustment disorder related to their shoulder may be ideal patients for arthroscopic rotator cuff repair

BACKGROUND

Mood symptoms may be due to shoulder-related depression or anxiety or clinical anxiety/depression. The objective of this study was to evaluate the relationship of shoulder-related and pre-existing diagnosis of depression or anxiety with changes in American Shoulder and Elbow Surgeons (ASES) score after rotator cuff repair.

METHODS

A retrospective review of prospectively collected data on subjects undergoing arthroscopic rotator cuff repair was reviewed. Preoperative and postoperative ASES, questions from the Western Ontario Rotator Cuff index questions directed to feelings of depression/anxiety related to the shoulder, and pre-existing diagnoses of depression and/or anxiety were recorded. The Wilcoxon rank sum test was used to compare changes, and Spearman's correlation was used to correlate changes in mood and ASES between male and female subjects and those with and without anxiety and/or depression.

RESULTS

One hundred seventy-one subjects (53 female; mean age, 58.0 years; standard deviation [SD], 8.5) who underwent arthroscopic rotator cuff repair were evaluated with the mean follow-up of 36.6 months (SD, 17.5). Forty-six subjects (mean age, 58.8 years; SD, 8.2) had pre-existing diagnoses of depression and/or anxiety and 125 subjects (mean age, 57.7 years; SD, 8.7) did not. Patients showed improvement in Western Ontario Rotator Cuff shoulder-related depression (Δ 22.3) and anxiety (Δ 24.7). There was a strong correlation between the change in mood symptoms and the change in ASES score, for depression (r = 0.74) and anxiety (r = 0.71). Patients with and without clinical diagnosis of anxiety or depression experienced similar changes in mood symptoms related to the shoulder and ASES scores (P = .65, P = .39). Patients' ASES scores were less correlated with changes in shoulder-related mood symptoms; however, if patients had clinical depression/anxiety compared with those without (r = 0.68 vs. 0.75, P < .0001 for depression; r = 0.56 vs. r = 0.74, P < .0001 for anxiety).

CONCLUSIONS

After rotator cuff repair, symptoms of depression/anxiety related to the shoulder improved dramatically with or without pre-existing clinical diagnosis of depression or anxiety. As the patient-reported functional outcomes of those with pre-existing clinical diagnosis of anxiety/depression improved, they did not experience as strong as an improvement in their mood symptoms as those without prior diagnoses and may benefit from directed treatment of these symptoms. Patients with shoulder-related mood symptoms only, conversely, experience a strong relationship between their improvement in function with their mood symptoms and may be ideal candidates for rotator cuff surgery. It is important for clinicians to separate mood symptoms related to adjustment disorder from the rotator cuff injury from clinical depression and anxiety.

The Effect of Preexisting and Shoulder-Specific Depression and Anxiety on Patient-Reported Outcomes After Arthroscopic Rotator Cuff Repair

BACKGROUND

Few studies have considered the potential effect of depression or anxiety on outcomes after rotator cuff repair.

PURPOSE

To evaluate the effect of a preexisting diagnosis of depression or anxiety, as well as the feeling of depression and anxiety directly related to the shoulder, on the American Shoulder and Elbow Surgeons (ASES) score.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

This study is a retrospective review of prospectively collected data on patients who underwent arthroscopic rotator cuff repair and were evaluated by the ASES score preoperatively and at a minimum 12 months postoperatively as part of the senior author's shoulder registry. Preexisting diagnoses of depression and/or anxiety were recorded, and questions from the Western Ontario Rotator Cuff Index directed at feelings of depression or anxiety related to the shoulder were also evaluated. The Wilcoxon rank sum test was used to compare ASES scores between patients with and without anxiety and/or depression. Spearman correlation was used to correlate questions on depression and anxiety with ASES scores.

RESULTS

A total of 187 patients (63 females, 124 males; mean age, 58.6 years, SD, 8.7 years) undergoing arthroscopic rotator cuff repair were evaluated with a mean follow-up of 47.5 months (SD, 17.4 months; range, 12-77 months). Fifty-three patients (mean age, 60 years; SD, 8.6 years) had preexisting diagnoses of depression and/or anxiety and 134 patients (mean age, 58.1 years; SD, 8.7 years) did not. Patients with depression and/or anxiety had significantly lower preoperative and postoperative ASES scores (60.7 vs 67.8, P = .014; and 74.6 vs 87.1, P = .008, respectively). The change in ASES scores from preoperative to postoperative, however, was not significantly different (18.0 vs 14.9). A higher score of depression or anxiety related to the shoulder had a negative correlation with the preoperative (r = -0.76, P < .0001; and r = -0.732, P < .0001, respectively) and postoperative (r = -0.31, P = .0001; and r = -0.31, P = .0003, respectively) ASES scores, but a positive correlation (r = 0.50, P < .0001; and r = 0.43, P < .0001, respectively) with the change in ASES scores.

CONCLUSION

Patients with a history of depression and/or anxiety have lower outcome scores preoperatively and postoperatively; however, they should expect the same amount of relief from arthroscopic rotator cuff repair as those without a history of depression or anxiety. Stronger feelings of depression or anxiety directly related to the shoulder correlated with lower preoperative and postoperative outcome scores, but a greater amount of improvement from surgery. The results from this study suggest that a preexisting diagnosis of depression or anxiety, as well as feelings of depression or anxiety directly related to the shoulder, should be considered during the management of patients with rotator cuff tears.

Correlation of Single Assessment Numerical Evaluation Score for Sport and Activities of Daily Living to Modified Harris Hip Score and Hip Outcome Score in Patients Undergoing Arthroscopic Hip Surgery

BACKGROUND

The Single Assessment Numerical Evaluation (SANE) is a single-question outcome score that has been shown to be a reliable measure of outcomes for shoulder and knee injuries but has not been compared with other validated outcome scores in hip pathology managed arthroscopically.

PURPOSE

To correlate SANE Activities of Daily Living (ADL) and Sport subscales with the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) ADL and Sport subscales before and after arthroscopic hip surgery.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 3.

METHODS

A retrospective review of a prospectively filled database of patients undergoing arthroscopic hip surgery by a single surgeon was conducted. Inclusion criteria included patients scheduled for arthroscopic hip surgery for femoroacetabular impingement, labral tear, or gluteus medius tear. Exclusion criteria included previous surgery to the hip. Outcome scores, including the mHHS, HOS ADL and Sport, and SANE ADL and Sport, were measured preoperatively and postoperatively at 3 months, 1 year, and then annually. Pearson correlation coefficients between preoperative SANE ADL and Sport and the mHHS, HOS ADL, and HOS Sport were calculated. Pearson correlation coefficients between postoperative SANE ADL and Sport and the mHHS, HOS ADL, and HOS Sport were also calculated.

RESULTS

Eighty-five patients (mean age, 37.9 years; range, 14-66 years; 57 females, 28 males) underwent arthroscopic hip surgery for assorted pathology. Mean follow-up was 8 months (range, 3-64 months). Based on the Pearson correlation coefficient, preoperative SANE ADL and Sport had a moderate correlation with the mHHS (r = 0.66; 95% CI, 0.47-0.79; P < .0001; r = 0.54; 95% CI, 0.31-0.71; P < .0001, respectively). Preoperative SANE ADL and Sport had a moderate correlation with HOS ADL (r = 0.60; 95% CI, 0.39-0.75; P < .0001) and HOS Sport (r = 0.65; 95% CI, 0.45-0.79; P < .0001). Postoperative SANE ADL and Sport had a strong correlation with the mHHS (r = 0.69; 95% CI, 0.50-0.82; P < .0001; r = 0.78; 95% CI, 0.61-0.88; P < .0001). Postoperative SANE ADL and Sport had a strong correlation with HOS ADL (r = 0.79; 95% CI, 0.65-0.88; P < .0001) and HOS Sport (r = 0.88; 95% CI, 0.78-0.94; P < .0001).

CONCLUSION

This study showed a significant correlation between SANE and mHHS in patients undergoing arthroscopic hip surgery both pre- and postoperatively. SANE ADL and Sport had a strong correlation with HOS ADL and Sport preoperatively and short-term postoperatively. SANE scores are more highly correlated with traditional subjective outcome measures during the short-term postoperative period than they are preoperatively. The SANE score provides an efficient method of assessing outcomes after hip arthroscopy.

Clinical and Radiographic Outcomes of the Simpliciti Canal-Sparing Shoulder Arthroplasty System: A Prospective Two-Year Multicenter Study

BACKGROUND

Stemmed humeral components have been used since the 1950s; canal-sparing (also known as stemless) humeral components became commercially available in Europe in 2004. The Simpliciti total shoulder system (Wright Medical, formerly Tornier) is a press-fit, porous-coated, canal-sparing humeral implant that relies on metaphyseal fixation only. This prospective, single-arm, multicenter study was performed to evaluate the two-year clinical and radiographic results of the Simpliciti prosthesis in the U.S.

METHODS

One hundred and fifty-seven patients with glenohumeral arthritis were enrolled at fourteen U.S. sites between July 2011 and November 2012 in a U.S. Food and Drug Administration (FDA) Investigational Device Exemption (IDE)-approved protocol. Their range of motion, strength, pain level, Constant score, Simple Shoulder Test (SST) score, and American Shoulder and Elbow Surgeons (ASES) score were compared between the preoperative and two-year postoperative evaluations. Statistical analyses were performed with the Student t test with 95% confidence intervals. Radiographic evaluation was performed at two weeks and one and two years postoperatively.

RESULTS

One hundred and forty-nine of the 157 patients were followed for a minimum of two years. The mean age and sex-adjusted Constant, SST, and ASES scores improved from 56% preoperatively to 104% at two years (p < 0.0001), from 4 points preoperatively to 11 points at two years (p < 0.0001), and from 38 points preoperatively to 92 points at two years (p < 0.0001), respectively. The mean forward elevation improved from 103° ± 27° to 147° ± 24° (p < 0.0001) and the mean external rotation, from 31° ± 20° to 56° ± 15° (p < 0.0001). The mean strength in elevation, as recorded with a dynamometer, improved from 12.5 to 15.7 lb (5.7 to 7.1 kg) (p < 0.0001), and the mean pain level, as measured with a visual analog scale, decreased from 5.9 to 0.5 (p < 0.0001). There were three postoperative complications that resulted in revision surgery: infection, glenoid component loosening, and failure of a subscapularis repair. There was no evidence of migration, subsidence, osteolysis, or loosening of the humeral components or surviving glenoid components.

CONCLUSIONS

The study demonstrated good results at a minimum of two years following use of the Simpliciti canal-sparing humeral component. Clinical results including the range of motion and the Constant, SST, and ASES scores improved significantly, and radiographic analysis showed no signs of loosening, osteolysis, or subsidence of the humeral components or surviving glenoid components.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison Between Sexes of Bone Contusions and Meniscal Tear Patterns in Noncontact Anterior Cruciate Ligament Injuries

BACKGROUND

Valgus load has been linked to female predominance and mechanism for noncontact anterior cruciate ligament (ACL) injuries. Magnetic resonance imaging (MRI) studies reporting frequent medial contusions in noncontact ACL injuries suggest anterior translation rather than a valgus mechanism.

HYPOTHESIS

Bone contusion and meniscal tear patterns differ between sexes.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

This study included a review of clinic notes, operative reports, and MRI of patients younger than 20 years who underwent acute primary ACL reconstruction for a noncontact injury between January 1, 2005, and January 1, 2010. A blinded musculoskeletal MRI radiologist reported the incidence of medial and lateral femoral and tibial bone contusions on MRI, as well as the severity of medial versus lateral tibial contusions. The location of the bone contusions and meniscal tears and the maximal tibial contusion severity were compared through chi-square analysis (statistical significance, P < .05).

RESULTS

A total of 73 patients met inclusion criteria: 28 males, 45 females; mean age, 16.1 ± 1.7 years (males), 16.5 ± 1.7 years (females). No significant differences were noted between sexes for location of tibial contusions (P = .32), femoral contusions (P = .44), or meniscal tears (P = .715). The most common tibial contusion pattern was to have both medial and lateral tibial contusions, in both male (57%) and female (60%) patients. The most common femoral contusion pattern was lateral only in females (62%) and both medial and lateral in males (50%). The percentage of female (29%) and male (29%) patients with isolated medial meniscal tears was nearly identical. More males (29%) than females (18%) had isolated lateral meniscal tears (P = .72). No significant difference in the relative severity of the tibial contusions was noted (P = .246). The lateral tibial contusion was rated as being more severe than the medial in the majority of females (64%) and males (57%).

CONCLUSION

No significant differences were detected between sexes with noncontact ACL injuries for location of tibial or femoral contusions or meniscal tears or for severity of medial versus lateral tibial contusions. The MRI data were not consistent with the valgus collapse mechanism of injury.

Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator

BACKGROUND

Several virtual reality simulators have been developed to assist orthopaedic surgeons in acquiring the skills necessary to perform arthroscopic surgery. The purpose of this study was to assess the construct validity of the ArthroSim virtual reality arthroscopy simulator by evaluating whether skills acquired through increased experience in the operating room lead to improved performance on the simulator.

METHODS

Using the simulator, six postgraduate year-1 orthopaedic residents were compared with six postgraduate year-5 residents and with six community-based orthopaedic surgeons when performing diagnostic arthroscopy. The time to perform the procedure was recorded. To ensure that subjects did not sacrifice the quality of the procedure to complete the task in a shorter time, the simulator was programmed to provide a completeness score that indicated whether the surgeon accurately performed all of the steps of diagnostic arthroscopy in the correct sequence.

RESULTS

The mean time to perform the procedure by each group was 610 seconds for community-based orthopaedic surgeons, 745 seconds for postgraduate year-5 residents, and 1028 seconds for postgraduate year-1 residents. Both the postgraduate year-5 residents and the community-based orthopaedic surgeons performed the procedure in significantly less time (p = 0.006) than the postgraduate year-1 residents. There was a trend toward significance (p = 0.055) in time to complete the procedure when the postgraduate year-5 residents were compared with the community-based orthopaedic surgeons. The mean level of completeness as assigned by the simulator for each group was 85% for the community-based orthopaedic surgeons, 79% for the postgraduate year-5 residents, and 71% for the postgraduate year-1 residents. As expected, these differences were not significant, indicating that the three groups had achieved an acceptable level of consistency in their performance of the procedure.

CONCLUSIONS

Higher levels of surgeon experience resulted in improved efficiency when performing diagnostic knee arthroscopy on the simulator. Further validation studies utilizing the simulator are currently under way and the additional simulated tasks of arthroscopic meniscectomy, meniscal repair, microfracture, and loose body removal are being developed.

MRI Determination of Knee Effusion Volume: A Cadaveric Study

Background

There is currently limited literature on quantitative determination of knee effusion volume using magnetic resonance imaging (MRI).

Purpose

To describe a method of knee effusion volume determination using MRI generated models and to demonstrate accuracy of this technique.

Materials and methods

Using axial T2-weighted turbo spin echo and sagittal SPACE sequences, MRIs of three cadaver knees with multiple saline loads were obtained. Effusions models were created and effusion volumes were estimated using the Rhinoceros software. Estimated and known effusion volumes were compared using a bivariate correlation analysis.

Results

The SPACE sequence and T2WTSE estimates were highly correlated with the known volumes (R = 0.996 and 0.993 respectively, p < 0.001).

Conclusion

MRI-generated models of knee effusions provide accurate estimates of knee effusion volumes.

Clinical relevance

MRI determination of knee effusion volume may provide a useful clinical outcomes tool.

Wittstein J, Spritzer C, Garrett WE. MRI Determination of Knee Effusion Volume: A Cadaveric Study. The Duke Orthop J 2013;3(1):67-70.

Aberrant origin of the long head of the biceps: a case series

BACKGROUND

Variants of the origin of the long head of the biceps have been described intraoperatively. It is unclear whether these variants contribute to shoulder pathology. Our purpose was to describe an anatomic variation of the origin of the long head of the biceps and associated clinical presentations of 2 subjects and to review existing reports of other variants.

METHODS

We present the history and physical examination, imaging, and arthroscopic findings of 2 cases of an abnormal variant of the origin of the long head of the biceps.

RESULTS

In 2 subjects, the long head of the biceps was noted to have a Y-shaped origin with 1 limb coming from the rotator cable and the other limb taking origin medial to the superior glenoid tubercle. A 42-year-old male weightlifter presented with distal clavicle osteolysis confirmed by diagnostic injection and had resolution of symptoms after a distal clavicle excision. A 38-year-old female retired military officer presented with subcoracoid impingement confirmed by magnetic resonance imaging findings and a diagnostic injection and did well after subcoracoid decompression. In neither case did the biceps tendon appear diseased or related to shoulder pathology.

CONCLUSIONS

In rare cases, the long head of the biceps takes origin from the rotator cable and has a second origin medial to the supraglenoid tubercle. This variant does not appear to contribute to shoulder pathology because standard treatment of concomitant diagnoses resulted in resolution of symptoms.

Chronic tears of the reflected head of the rectus femoris: results of operative treatment

BACKGROUND

While the majority of quadriceps muscle strains can be managed nonoperatively, rare cases remain symptomatic despite nonoperative treatment.

PURPOSE

The purpose of this study is to report on results of surgical treatment of a limited number of cases of persistently symptomatic tears of the reflected head of the rectus femoris.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The records of 5 patients with chronic tears of the rectus femoris treated with excision of the reflected head were reviewed. A telephone interview regarding return to sport and current limitations was completed if patients were available for further follow-up.

RESULTS

A review of 5 cases of surgical treatment of chronic tears of the reflected head of the rectus was completed. Patients included 1 woman and 4 men with an average age of 21 years (range, 18-24 years). Three patients played football (2 kickers) and 2 played soccer at a collegiate level. All 5 reported a significant decrease in pain during sport and activities of daily living and were able to return to collegiate athletics. Two patients had a late recurrence of pain with kicking that resolved with nonoperative treatment, 1 had residual thigh pain with intense play, 1 had no pain but noted decreased kicking accuracy, and 1 patient returned to play without symptoms.

CONCLUSION

Strain injuries to the reflected head of the rectus femoris can benefit from delayed excision in rare cases that fail nonoperative management. High-level kicking athletes are likely to experience significant reduction in pain, but may have some residual or recurrent symptoms that limit competitive level of play postoperatively.

Hamstring graft preparation using a needleless suture loop

Placement of running, locking stitches during the harvest and preparation of hamstring tendons can be time consuming and requires placement of suture in the most distal and proximal 2 to 3 cm of the tendons. The authors have regularly used a needleless suture loop technique to both harvest and prepare autograft gracilis and semitendinosis tendons and to tension quadrupled hamstring tendon grafts during anterior cruciate ligament reconstruction. This cost-effective technique reduces exposure to needles, the time required to harvest and prepare the grafts, and the amount of suture in the tibial tunnel, while providing adequate fixation to tension the tendons as needed.

Isokinetic testing of biceps strength and endurance in dominant versus nondominant upper extremities

BACKGROUND

The strength and endurance of the contralateral biceps muscle can serve as a useful comparison for the operative limb following distal biceps repairs, mid-substance repairs, or tenotomy or tenodesis of the long head. There are limited data available on the effect of handedness on biceps strength and endurance.

HYPOTHESIS

The dominant upper extremity has greater elbow flexion and supination peak torque and endurance.

MATERIALS AND METHODS

Subjects with no history of prior upper extremity injury or limitations completed isokinetic testing of biceps flexion and supination peak torque and endurance on a Biodex machine. A paired student t test was used to compare peak torque and endurance for both supination and flexion for the dominant and nondominant upper extremities. The results were analyzed for the entire group, and for male and female subjects separately as well.

RESULTS

A power analysis revealed that 5 subjects were needed to achieve 80% power. Twenty subjects (10 male, 10 female) were tested. No significant difference was detected for peak torque or endurance for supination or flexion between the dominant and nondominant upper extremities. No difference was detected when the group was analyzed as a whole, nor when men and women were analyzed separately.

CONCLUSIONS

The dominant and nondominant upper extremities demonstrate similar peak torque and endurance for supination and flexion. The normal contralateral upper extremity can be used as a matched control in the evaluation of post operative biceps isokinetic strength and endurance without adjusting results for handedness.

Endoscopic compartment release for chronic exertional compartment syndrome: surgical technique and results

BACKGROUND

Chronic exertional compartment syndrome is an entity that typically fails nonoperative management and requires operative treatment with fasciotomies for return to activity. Fasciotomies performed through single or multiple incisions may fail to totally release the fascia of the afflicted compartment(s) and may result in injury to neurovascular structures that cannot be visualized.

PURPOSE

The authors report results of endoscopic compartment release with the assistance of a balloon dissector in the treatment of chronic exertional compartment syndrome.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

The clinical outcomes of 14 cases of chronic exertional compartment syndrome in 9 patients treated with endoscopic release were assessed with a retrospective chart review and the results of mailed questionnaires.

RESULTS

Fourteen legs in 9 patients (4 male and 5 female; average age, 24 years) were treated with endoscopic compartment release for chronic exertional compartment syndrome. Eight of 9 patients were able to resume preoperative activities, including collegiate athletics in 5 cases and recreational sport in 3 cases. No neurovascular injuries occurred. Complications were isolated to postoperative hematomas that resolved in 2 patients. Seven patients completed questionnaires an average of 3.75 years after surgery. There were no recurrences of symptoms.

CONCLUSION

Endoscopic compartment release is a cosmetic, safe, and effective means of treating chronic exertional compartment syndrome.

Traumatic subchondral fracture of the femoral head: a case report

Subchondral insufficiency fractures of the femoral head have been described in elderly, osteoporotic patients and most commonly occur at the superolateral aspect of the femoral head. This case report describes an insufficiency fracture that involves the posterior inferior aspect of the femoral head in a thin, elderly woman.

Endoscopic compartment release for chronic exertional compartment syndrome

Chronic exertional compartment syndrome is a condition that typically fails conservative management and requires a fasciotomy for the patient to return to activity. Fasciotomies performed through single or multiple incisions may fail to fully release the fascia of the afflicted compartment(s) and also may result in injury to neurovascular structures that cannot be visualized. Endoscopic assistance may minimize the intraoperative and postoperative complications associated with compartment release and offer improved cosmesis. This article describes an endoscopically assisted technique using a balloon dissector designed to address the shortcomings of open and semi-blind techniques.