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Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 333 - 333
1 Jul 2008
Hassouna HZ Bendall SP
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Objective: The purpose of this study is to evaluate the prognosis of arthroscopic ankle treatment. Also we will formalise the relationship between the arthroscopic treatment and time for a further major ankle surgery

Patients and Methods: Consecutive Case Series study using prospectively gathered database. Between January 1997 to December 2000, Eighty consecutive patients (80 ankles) having ankle arthroscopy with the finding of Osteoarthritis (OA) or impingement were identified and their outcome at five years ascertained.

Arthroscopic procedure involved pre operative skin markings. Ankle distraction is used. An anterior approach used with standard Anteromedial and antero-lateral portals.

Treatment: debridement of osteochondral lesions, removal of loose bodies, curettage, drilling, synovec-tomy, and abrasion of the subchondral bone. All ankle joints had wash out.

Results: Results were examined using Kaplan Meier survival analysis. Statistical analysis of the results was done using Chi squared test.

Fifty five (69%) patients had soft tissue impingement, and 25 (31%) patients had osteoarthritic degenerative changes.

Seven (9%) patients had further major surgery and 6 (8%) had repeat arthroscopy.

The surgery was required for 7 arthritic ankles (7/25).

Survivorship: Survival analysis

28% of osteoarthritic patients progress to major ankle surgery, within 5 years of arthroscopic treatment. None of patients with impingement symptoms required further major surgery.

No statistical significance between those under 50 and those over 50 years in OA group

Conclusion: Arthroscopically treated impingement Ankles has an excellent prognosis, while osteoarthritic ankles have less favoured prognosis, with high proportion requiring further major surgery. Age does not affect prognosis in O.A group. Arthroscopy for OA, is likely to fail within 18 months.


The Journal of Bone & Joint Surgery British Volume
Vol. 86-B, Issue 2 | Pages 279 - 281
1 Mar 2004
Redfern DJ Coleridge SD Bendall SP

We present a case of Mycobacterium avium-intracellulare (MAI) infection of the ankle joint in a patient with HIV infection. The patient presented with a painful, destructive arthropathy of the ankle. Initial microbiological studies were negative but infection with MAI was later identified from biopsies taken during hindfoot fusion. Antibiotic triple therapy was given and the patient remains pain-free without evidence of active infection. To our knowledge, this is the first case of MAI infection of the ankle reported in the literature. A high index of suspicion of (atypical) Mycobacterial infection should be maintained in patients with HIV infection presenting with an indolent but destructive arthropathy of the ankle joint.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 3 | Pages 330 - 333
1 Apr 2003
Molloy S Solan MC Bendall SP

Inversion injuries of the ankle are common and most are managed adequately by functional treatment. A significant number will, however, remain symptomatic.

Synovial impingement is one cause of continuing pain. This condition is often difficult to diagnose because the physical signs and investigations are non-specific. If the diagnosis is made, treatment by arthroscopic debridement has been shown to be highly effective. Our aim was to describe a new physical sign to help in the diagnosis of anterolateral synovial impingement in the ankle.

A cadaver dissection demonstrated the anatomical basis for the physical sign and a prospective clinical study involving 73 patients showed that the lateral synovial impingement test had a sensitivity of 94.8% and a specificity of 88%.

We describe the test and conclude that this physical sign will be of use to practitioners treating patients with chronic pain in the ankle after injury.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 5 | Pages 706 - 708
1 Jul 2001
Solan MC Calder JDF Bendall SP

Manipulation of the metatarsophalangeal joint and injection with steroid and local anaesthetic are widely practised in the treatment of hallux rigidus, but there is little information on the outcome. We report the results of this procedure carried out on 37 joints, with a minimum follow-up of one year (mean, 41.2 months). Patients with mild (grade-1) changes gained symptomatic relief for a median of six months and only one-third required surgery. Two-thirds of patients with moderate (grade-2) disease proceeded to open surgery. In advanced (grade-III) hallux rigidus, little symptomatic relief was obtained and all patients required operative treatment. We recommend that joints are graded before treatment and that manipulation under anaesthetic and injection be used only in early (grades I and II) hallux rigidus.


The Journal of Bone & Joint Surgery British Volume
Vol. 83-B, Issue 2 | Pages 250 - 252
1 Mar 2001
Solan MC Lemon M Bendall SP

Most techniques described for the correction of hallux valgus require exposure of the distal aspect of the first metatarsal. A dorsomedial incision is often recommended. Texts counsel against damaging the dorsal digital nerve, as a painful neuroma is an unwelcome surgical complication.

Our study on cadavers aimed to investigate the anatomy of the dorsomedial cutaneous nerve in the metatarsophalangeal region, with special reference to surgical incisions. A constant, previously unrecognised branch of the nerve was identified. This branch is likely to be damaged if a dorsomedial approach is used. It is recommended that a mid-medial incision be used instead, i.e. at the junction of the plantar and dorsal skin.


The Journal of Bone & Joint Surgery British Volume
Vol. 81-B, Issue 4 | Pages 663 - 666
1 Jul 1999
Sawant MR Bendall SP Kavanagh TG Citron ND

In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united.

A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.