Late results of surgical repair in recent ruptures of the lateral ligament of the ankle

Between 1979 and 1994, 75 patients underwent primary repair of a Grade III rupture of the lateral ligament of the ankle. The operation was indicated after the demonstration of ankle instability on stress X-rays by anterior displacement of the talus by more than 8 min or/and a talar tilt of move than 10 degrees. The patients were either young or engaged in sports activities or physically demanding jobs. An end-to-end suture of the torn ligament was undertaken under general anaesthesia. A non-weight-bearing cast was used for the first 2 weeks, followed by a walking cast until 6 weeks postoperatively. Sixty-one patients were followed up for 1-15 years (mean 10.3 years). At follow-up all but one patient had returned to their pre-injury level of activity without complaint or restriction. (C) 1997 Elsevier Science Ltd. All rights reserved

Talar tilt : a prognostic criterion of post-operative outcome in bi-malleolar fractures [L'inclinaison de l'astragale, critère pronostique de l'évolution post-opératoire après fracture bi-malléolaire]

Eighty patients with bi-malleolar fractures treated operatively between 1977-1984, formed the basis of this study. Twenty-six of the patients were male and 53 female, aged from 16-76 years (means av. 45 years). Talar tilt was measured on the anteroposterior radiograph of the ankle, as a difference between two angles. The first is the angle which formed by the line who joins the tips of the medial and lateral malleoli and the parallel to the talar surface and the second one is the angle which is formed by the former line and the parallel to the distal tibial surface. The results were as follows : a) Talar tilt 0° - (+ -) 1° in 32 patients (40 %), b) Talar tilt < ( - ) 1° (talus in valgus) in 36 patients (45 %), c) Talar tilt > ( + ) 1° (talus in varus) in 12 patients (15 %). The immediate postoperative X-Ray findings and the long term radiographic and clinical evaluation (F.U. : painswelling-motion-X-Rays) correlated with symptoms in : a) 9,37 % of the patients of the first group, b) 62,5 % of the patients of the second group, c) 100 % of the patients of the third group. On the basis of this study it would appear that talar tilt is a safe prognostic index of the postoperative outcome in patients with bi-malleolar fractures. © 1993 Springer-Verlag

Traumatic dislocation of the knee

Sixteen patients with traumatic dislocation of the knee were treated during the period 1977-1995. The average period of follow up was 7 years. The mean age was 39.07 years for men and 45.6 years for women. One patient sustained a rupture of the popliteal artery and peroneal nerve at the same time, while two others sustained peroneal nerve neurapraxia. Fourteen out of 16 patients underwent surgical treatment for various combinations of ligamentous injuries, and the following techniques were used: suturing, pullout, reconstruction by using the semi-tendinosus tendon or the iliotibial band or the patellar tendon, and finally reattachment. Simple peripheral menisceal tears were sutured, while partial meniscectomy was performed only in extensive tears of the posterior horn of the meniscus. Postoperatively all the patients had a long backslab applied for 3 weeks and from the first postoperative day commenced isometric quadricep exercises and mobilised on elbow crutches non weight bearing on the injured side. After the backslab was removed, all started active knee exercises. The postoperative results were satisfactory regarding the knee stability, the pain and the patient's level of activity despite the seriousness of the injury. ß Springer-Verlag 1998