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We reviewed 22 patients who had arthroscopic evalu ations and preoperative magnetic resonance imaging studies of their ankles because of chronic anterolateral ankle pain after sprains. The ability of surgeons to use the initial clinical examination to predict arthroscopi cally confirmed anterolateral ankle impingement was compared with the ability to predict this condition using preoperative magnetic resonance imaging. The patient population consisted of 15 men and 7 women who had an average age of 28 years. Five patients (23%) were intercollegiate athletes and 17 patients (77%) were recreational athletes. All patients reported previous traumas to the involved ankles, and all were seen with chronic ankle pain. Clinical examinations were used to assess ankle pain, swelling, range of motion, and sta bility. Anterolateral ankle impingement was confirmed in 18 patients (82%) with arthroscopic examination. Clinical examinations had a sensitivity of 94% and a specificity of 75% for predicting impingement, and magnetic resonance imaging had a sensitivity of 39% and a specificity of 50%. The results of this study suggest that preoperative magnetic resonance imag ing examination is not beneficial or cost-effective in the diagnosis of anterolateral ankle impingement; further more, its use may cause further delay in treatment.

We studied 54 patients with shoulder pain secondary to anterior instability or glenoid labral tears refractory to 6 months of conservative management with no evidence of rotator cuff lesions. All patients had sufficient preoperative clinical data, magnetic resonance imaging, and shoulder arthroscopy results for analysis. The ability to predict the presence of a glenoid labral tear by physical examination was compared with that of magnetic resonance imaging (conventional and arthrogram) and confirmed with arthroscopy. There were 37 men and 17 women (average age, 34 years) in the study group. Of this group, 64% were throwing athletes and 61% recalled specific traumatic events. Clinical assessment included history with specific attention to pain with overhead activities, clicking, and instances of shoulder instability. Physical examination included the apprehension, relocation, load and shift, inferior sulcus sign, and crank tests. Shoulder arthroscopy confirmed labral tears in 41 patients (76%). Magnetic resonance imaging produced a sensitivity of 59% and a specificity of 85%. Physical examination yielded a sensitivity of 90% and a specificity of 85%. Physical examination is more accurate in predicting glenoid labral tears than magnetic resonance imaging. In this era of cost containment, completing the diagnostic workup in the clinic without expensive ancillary studies allows the patient's care to proceed in the most timely and economic fashion. Glenoid labral tears have been associated with overhead throwing activities, trauma, and shoulder instability. Assessment of an athlete with shoulder pain should take into account a careful history of clicking sounds or catching, symptoms with overhead activities, reports of instability, or previous trauma. On physical examination, patients with labral tears often demonstrate objective instability with or without clicking or catching during glenohumeral rotation. Plain radiographs have not been helpful, and radiologists have relied on techniques from arthrogram to arthrotomogram, CT arthrogram, magnetic resonance imaging (MRI), and MR arthrogram to assist in the diagnosis. Various sensitivities and specificities have been reported for these tests. However, a large degree of intra- and interobserver variability has been demonstrated, and the degree to which these studies are helpful in preoperative planning has been questioned. No previous study to our knowledge has involved MRI in a direct comparison of other diagnostic modalities. Therefore, the purpose of this study is to investigate the accuracy of MRI and physical examination in the diagnosis of glenoid labral tears.

A direct blow to the leg resulted in fibular shaft fractures in three elite college athletes participating in contact sports. None of the athletes had prior symptoms sug gestive of a stress fracture. All three athletes had benign-appearing fractures and were treated nonopera tively. Ultimate healing was delayed, occurring on av erage at 23 weeks, and each case was complicated by refracture. Fractures of the fibular shaft in athletes may require more aggressive treatment than other simple fractures to allow sufficient healing to withstand the rigors of athletics.

Open rotator cuff repair has shown reliable results in terms of pain relief and improved shoulder function. Re cently, however, arthroscopically assisted rotator cuff repair has shown promising preliminary results. We compared the results of these two procedures with re gard to pain, function, range of motion, strength, patient satisfaction, and return to previous activity. Thirty-seven rotator cuff repairs were evaluated in 36 patients with a minimum followup of 2 years. The open repair group comprised 20 shoulders with an average followup of 3.3 years; the arthroscopically assisted repair group com prised 17 shoulders with an average followup of 3.2 years. Overall, the open repair group had 80% good- to-excellent results and 88% patient satisfaction, and the arthroscopically assisted repair group had 85% good-to-excellent results and 92% patient satisfaction. Shoulder flexion and abduction strength, the size of the tear repaired, and the functional outcome did not differ significantly between the two groups. In general, how ever, small and moderate-sized tears (

The static restraints of various surgical procedures for chronic lateral ankle instability were compared. Forty cadaveric ankles were divided equally into the follow ing five groups: 1) ankles with intact anterior talo fibular and calcaneofibular ligaments, 2) ankles with incised anterior talofibular and calcaneofibular liga ments, 3) ankles with Chrisman-Snook procedure, 4) ankles with Watson-Jones procedure, or 5) ankles with modified Broström procedure. All ankles were placed in a mechanical apparatus for anterior drawer stress and inversion stress tests. After each applica tion of force, a radiograph of the ankle joint was taken, and the anterior talar displacement and the ta lar tilt angle were measured. All procedures reduced anterior drawer and talar tilt when compared with the ankles with incised anterior talofibular and calcaneofibular ligaments. Significant differences were found among the groups for both in version and anterior drawer stress at all forces, except for the third and fourth groups. The modified Broström group had the least amount of anterior talar displace ment and talar tilt angle at all forces. There were no significant differences between the Watson-Jones and the Chrisman-Snook procedures in anterior talar dis placement and talar tilt. The modified Broström proce dure produced a greater mechanical restraint than either of the other procedures.