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Background: Ankle arthroscopy has evolved as a diagnostic and therapeutic tool. Traditionally, it is performed with traction because of the tight ankle joint space. Original traction techniques were invasive but have progressed to the commonly used noninvasive modalities. Recent reports have suggested traction may be unnecessary. The purpose of this study was to compare prospectively ankle arthroscopy with and without traction in terms of ease of visualization of anatomic structures according to the Ferkel's ankle arthroscopy criteria. Methods: Under Institutional Review Board approval, 103 patients received ankle arthroscopies, first with noninvasive traction and subsequently without traction. An independent observer scored each arthroscopy based on the 21-point Ferkel's criteria. For each structure adequately visualized, one point was given. Inadequate visualization was defined as excessive force or as visible cartilage scuffing. The maximum possible score was 21 points and the lowest was zero. Fifty-five females and 48 males, average age 35 (range, 16 to 71) years, participated in the study. Results: Noninvasive traction facilitated visualization of all structures of the anterior ankle in more than 90% of cases except for the anterior compartment and lateral gutters, which were better visualized without traction with the ankle in dorsiflexion. No difference was seen when visualizing the talus. Traction arthroscopy performed better when evaluating the central and posterior ankle. The mean score difference was statistically significant, 11.2 versus 18.5 points, favoring noninvasive traction arthroscopy. The complication rate was 4%. Conclusion: Noninvasive traction facilitated complete ankle arthroscopy. Dorsiflexion improved visualization of the anterior compartment and lateral ankle gutter. The authors recommend noninvasive traction when performing ankle arthroscopy. Level of Evidence: II, Diagnostic, Prospective Study

Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18–100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0–91), and the average CES-D score was 10 points (SD, 8; range, 0–42). Fourteen of the 30 items of the DASH demonstrated correlation greater than r=0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p

Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18–100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0–91), and the average CES-D score was 10 points (SD, 8; range, 0–42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p