Background: Management of high grade acute acromioclavicular (AC) joint dislocation is considered a surgical dilemma. Open methods of fixation are the gold standard but the morbidities are frequent. The goal of this study was to evaluate the results of arthroscopic fixation of acute high grade (AC) joint dislocation. Methods: A series of 24 patients with acute high grade acromioclavicular joint dislocation were fixed arthroscopically using TightRope device. The study was done between February 2013 and February 2017. The functional outcomes were assessed using Constant-Murley score and University of California at Los Angeles shoulder (UCLA) scale. The preoperative and postoperative means of coraco-clavicular distance were calculated and used for radiological assessment. P-value < o.o5 was statistically significant. Results: The mean followed up time was 23.25 ± 7.1 (12-35) months. There was highly significant improvement in the Constant-Murley score and (UCLA) scale at the end of the follow up period. The coraco-clavicular distance was improved from 21.7 ± 3.1 mm preoperative to 10.17 ± 2.3 mm postoperative. There were two complications, one case had over correction and the other had mild transient post-operative burning pain along the course of ulnar nerve. Conclusion: Arthroscopic fixation of acute high grade (AC) joint dislocation is safe, minimally invasive technique with satisfactory functional outcomes and low morbidities provided that it is done by surgeons skilled in shoulder arthroscopy.

Osteotomy-sparing technique using TightRope device is effective in the management of moderate hallux valgus provided that proper patient selection, adequate surgical technique, and proper postoperative protocol are followed.

Background. Haglund’s syndrome is a posterosuperior calcaneal prominence with posterior heel pain causing functional disability to the patient. Operative treatment is indicated after failure of conservative measures and includes resection of the bony hump along with retrocalcaneal bursectomy. This study aimed to evaluate the functional outcome and degree of patient satisfaction after endoscopic resection of Haglund’s deformity with assessment of correlation with the length of bony exostosis. Methods. Seventeen patients (21 feet) with a mean age of 44.7 ± 5.1 years were included in this study. Six females and 11 males underwent endoscopic calcaneoplasty. Clinical outcome evaluation included the assessment of the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society score (AOFAS). The preoperative and postoperative lengths of bony exostosis were measured radiologically. The paired t test and the Wilcoxon signed-rank test compared the preoperative and final postoperative means. P < 0.05 was considered statistically significant. Results. The mean follow-up period was 56.4 ± 5.1 months. Statistically significant improvements in the preoperative mean of AOFAS (from 55.7 ± 9.3 to 94.3 ± 7.1) and VAS (from 8.1 ± 1.4 to 0.7 ± 1.04) at the final follow-up were noted P < 0.0001 . There was a statistically significant correlation between clinical scores (AOFAS and VAS) and the final postoperative length of the bone above parallel pitch lines (PPLs). The patients were satisfied and returned to their previous activities without reporting major morbidities except one patient who had mild pain with exertion. Conclusion. Endoscopic calcaneoplasty is a safe, less invasive surgical procedure for the management of Haglund’s syndrome after failure of conservative treatment. It provided a satisfactory clinical result without serious complications at a minimum 4-year follow-up.

Background: Anterior cruciate ligament (ACL) tear is a common knee injury with various manual tests used for clinical diagnosis. The aim of this prospective study was to evaluate the lever sign test sensitivity as a new clinical test for diagnosis of ACL disruptions compared to other manual diagnostic tests. Methods: One hundred patients with chronic ACL tears were included in this study between January 2017 and March 2018. The mean age was 29.1±8.2 yr. Four clinical tests (anterior drawer, Lachman test, pivot shift, and lever sign) were obtained in all patients by two different clinicians. The contralateral uninjured knees were used as controls for comparison. The sensitivity of these tests was estimated with recording of the interobserver reliability for lever sign test. Statistically significant differences between the lever test and other clinical tests were assessed using chi-square analysis. Results: The recorded sensitivities of anterior drawer, pivot-shift, and Lachman tests were 82%, 88%, and 91%, respectively. The sensitivity of the lever sign test was much lower (34%) with 100% interrater reliability. There was a statistically significant difference between the lever sign test and other physical tests (P-value<0.05). Conclusions: The lever sign test has much lower sensitivity than other clinical diagnostic tests in patients with chronic ACL lesions. More biomechanical studies should be carried out to prove the validity of this test for the diagnosis of ACL injuries. Level of evidence: Level III.