Ankle

Definition

Impingement between anterior distal tibial osteophyte and sulcus of the talus in dorsiflexion

Epidemiology

Seen in athletes with repetitive dorsiflexion

Football / soccer / ballet / gymnasts

Pathology

Anterior osteophytes

Soft tissue impingement - scar tissue in anterolateral gutter from recurrent ankle sprains

Bassett's ligament - thickened fascicle of the AITFL

Results 

90% fusion rates

Lose70% sagittal plane ROM

Disadvantages of Arthrodesis 

Non union rates up to 12%

Decreased gait speed

Poor mobility over uneven surfaces

History

First generation (late 70s early 80s) 

Results

Definition

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

Epidemiology

Age: 20 - 50

Sex: M > F

Types

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

Definition

Chondroid Metaplasia of synovium affecting large joints

Nodules of hyaline cartilage

- formed in the subsynovial layer of joint capsules

Epidemiology

Rare lesion

Most common in 20's and 30's

Sex: M > F (2:1)

Monoarticular

Site

AKA

Diaphyseal Aclasis / Multiple Osteochondromas

Definition

Heritable skeletal dysplasia

Epidemiology

AD with variable penetrance (96%)

Malignant Transformation

Incidence of malignant transformation much higher 

- 10% overall

- 1 % / year

Chondrosarcoma (CS) > Osteosarcoma (OS)

Look

Aids

Shoes - raises / wear patterns

Stigmata generalised disease

Hands - RA, CMT

Front

Knee alignment

Forefoot - Hallux & Lesser toes 

Scars

Circulatory changes

Medial Side

Turn affected side away & ask to step foot forward

Flexed attitude of knee

Medial arch - planus / cavus