314 ABSTRACTS

toxic threshold. The effects of epinephrine and tourniquet were significant, with p values of 0.026 and 0.002, respectively. The presence of epineph- rine lowered serum bupivacaine levels by 0.16 p&ml and that of tourniquet lowered it by 0.23 pg/ml. In conclusion, this study demonstrates that intraarticular injection of 20 ml of 0.25% bupiv- acaine is a safe technique. Peak serum concentra- tions occur between 10 and 30 min and do not change significantly over time. Addition of epineph- tine to bupivacaine and injecting it after the tourni- quet is inflated decrease the peak concentrations to 0.09 p&ml.

Arthroscopic Ankle Arthrodesis Utilizing a Sot? Tis- sue Distraction Technique. James P. Tasto. San Di- ego, California, U.S.A.

The objective of this study was to assess the ef- fectiveness of operative ankle fusion performed ar- throscopically. A review of 10 cases during a lVz-year period was done.

A soft-tissue distraction technique was used. Ar- throscopic debridement was done down to sub- chondral bone and percutaneous screw fixation was performed. Cast immobilization was for 3 weeks followed by an AFO until union.

Ten patients underwent arthroscopic ankle ar- throdesis. Nine went on to uneventful union. One case of delayed union probably represents avascu- lar necrosis of the talus. Average time to union was 8% weeks. Three patients required screw removal.

Arthroscopic ankle arthrodesis offers a safe and effective surgical technique to the orthopedist. Length of hospitalization, time of immobilization, complications, and morbidity are reduced. Length of time to union appears to be improved.

This technique appears to be less invasive and therefore preserves the blood supply and may be responsible for the rapid union. It is cost effective, averaging 1 hospital day and return to light duty in 2-3 weeks.

Usage of an Electrocautery Loop Probe for Arthro- scopic Meniscectomy: A Five Year Experience with Results, Indications and Complications. Jack M. Bert. St. Paul, Minnesota, U.S.A.

An electrocautery loop probe has been used ex- clusively in the past 5 years for arthroscopic men- iscectomy in more than 800 surgical cases.

Arthroscopy, Vol. 7, No. 3, 1991

The electrocautery loop probe is designed with Teflon polymer surrounding the wire to prevent ar- titular surface damage to the hyaline cartilage when using this instrumentation system. Two polymer projections at the top of the probe prevent end-on injury to the articular cartilage by the exposed cut- ting portion of the wire loop.

Inadvertent injury to the articular surface can oc- cur if the generator settings are too high, resulting in polymer failure with resultant exposure of the wire loop.

Biopsies of the meniscus up to 1 year postopera- tively when performing additional procedures have shown no evidence of thermal necrosis, which can occur up to a depth of 1,100 km when performing meniscal resection with electrocautery.

The electrocautery loop probe can be used in pa- tients with flap tears, bucket-handle tears, horizon- tal cleavage tears, radial tears, vertical horn tears, or complex posterior horn tears of the meniscus. Use of the electrocautery loop probe device results in safe, effective, efficient meniscal resection with- out fear of damage to the articular surface of the joint if used properly. Furthermore, there is no ev- idence of long-term damage to the meniscus subse- quent to the use of this arthroscopic cutting tool.

The Effect of Cold Therapy on Morbidity Subsequent to Arthroscopic Lateral Retinacular Release. Jack M. Bert, John G. Stark, and Cay Chock. St. Paul, Min- nesota, U.S.A.

The procedure with the greatest morbidity when performed arthroscopically is lateral retinacular re- lease. Complication rates have been reported to be as high as 7.2% secondary to intraoperative and postoperative hematoma formation.

A prospective study was undertaken in which 110 patients were randomly assigned to one of two groups treated with or without cold therapy for 24 h postoperatively subsequent to arthroscopic lateral retinacular release using electrosurgery.

These patients were reviewed 1 week postopera- tively and were graded based on extent of effusion, narcotic use, use of external aids, extent of pain (graded subjectively), range of motion, and ability to straight leg raise.

Seventy-four percent of the patients treated with cold therapy had good-to-excellent results 1 week postoperatively and had no significant complica- tions .

ABSTRACTS 315

Thirty-two percent of the patients treated without cold therapy had good-to-excellent results 1 week postoperatively, and two significant complications occurred in this group.

Arthroscopic Repair of Peripheral Triangular Fibro- cartilage Detachments. A. Lee Osterman, Todd Lip- schultz, and John Bednar. Philadelphia, Pennsylva- nia, U.S.A.

Triangular fibrocartilage injuries have been clas- sified into central and peripheral tears. Currently, arthroscopic debridement seems a worthwhile pro- cedure for the central repairs. Peripheral detach- ments either from the ulnar styloid or from the ul- nocarpal ligaments, because of their vascularity, have the ability to heal if repaired.

The diagnosis, arthroscopic treatment, and post- surgical results in a series of patients were pre- sented.

Nineteen patients underwent arthroscopic repair of a peripheral detachment. The diagnosis was made most commonly by distal radial ulnar joint arthrography, magnetic resonance imaging, and the observation on arthroscopy of the loss of the nor- mal “trampoline tautness” of the cartilage on ar- throscopy.

The repair was accomplished using a modified meniscal suturer with the scope in the 6R portal, and the sutures passed from the 3-4 portal. Postop- eratively, patients were immobilized for between 4 and 6 weeks in a Munster-type cast. Average fol- low-up was 17 months, with a range of 9-29 months. More than 80% had returned to full work and avo- cational activities. No instability of the distal radial ulnar joint was noted, and pain decreased in all pa- tients.

In summary, arthroscopic repair of peripheral tri- angular fibrocartilage detachments is possible and seems to be of benefit.

Arthroscopic Stabilization of the Chronic Subluxlng or Dislocating Shoulder Without the Use of Internal Fixation. Joel H. Eisenberg, Michael R. Redler, and Paul J. Hecht. Bridgeport, Connecticut, U.S.A.

Various surgical measures have been described to treat the patient with a chronic subluxing or dis- locating shoulder. The greatest experience has been

with open procedures; however, new arthroscopic procedures have been described. These include procedures that use either sutures or staples to help stabilize the anterior portion of the glenohumeral joint. We present an arthroscopic surgical stabiliza- tion procedure that does not require the use of hard- ware or sutures. In the first 12 patients of this pilot study, arthroscopic stabilization was done by burr- ing the anterior portion of the glenoid neck, debrid- ing the adjacent area of the subscapularis, and al- lowing normal scarring to take place. The patient was then kept in a shoulder immobilizer. No inter- nal fixation or sutures were used. In a 1-3-year fol- low-up, no recurrent subluxation or dislocation has occurred. The patients were able to return to their preinjury activity level and all stated they were pleased with the outcome of their surgery.

Arthroscopic burring of the anterior glenoid neck and debridement of the adjacent subscapularis re- gion can provide an acceptable means for anterior stabilization in the patient with chronic subluxation or dislocation of the shoulder. Long-term follow-up with a greater number of patients is needed before comparisons can be made with other stabilization procedures.

Analysis of Failed Arthroscopic Subacromial Decom- pression. Richard J. Hawkins, Stephen R. Saddemi, and John T. Mor. London, Ontario, Canada, To- ledo, Ohio, and Lakeland, Florida, U.S.A.

The purpose of our study was to analyze our failed arthroscopic acromioplasties to determine whether the failure was due to surgical technique, incorrect diagnosis, or due to other causes.

Nineteen patients were included in the study. All patients underwent an arthroscopic subacromial decompression/acromioplasty for presumed im- pingement syndrome. Because of continued pain, all patients then underwent a subsequent open sub- acromial decompression/acromioplasty. All proce- dures were performed by the same surgeon. Twelve patients returned for an examination and completed a questionnaire for the study. The other seven pa- tients underwent chart review only. All operative notes were examined to determine whether there were technical problems at the time of arthroscopy. Operative notes from the open procedures were ex- amined to determine whether an adequate subacro- mial decompression had been performed arthro-

Arthroscopy, Vol. 17s No. 3, 1991