SLAP lesions of the glenoid labrum: CT arthrographic and arthroscopic correlation.

Tears in the superior part of the glenoid labrum in the anterior and posterior directions (SLAP, superior labrum anterior, posterior) result from injuries that place excessive stress on the tendon of the long head of the biceps brachii muscle. The intimate relationship of the tendon and the superior glenoid labrum promotes injury to the latter structure. Four types of SLAP lesions are seen at arthroscopy. Images from 17 patients with surgically proved SLAP lesions who had undergone preoperative computed tomographic (CT) arthrography were retrospectively reviewed to evaluate the value of CT arthrography in the detection and accurate depiction of these labral injuries. The authors compared the findings at videotaped arthroscopic surgery with those from CT arthrography and found that abnormalities of the labral-capsular apparatus could be detected with CT arthrography in 16 of the 17 patients. Furthermore, the CT arthrographic criteria developed during this review helped determine the type of tear in 15 of the 17 patients. CT arthrography appears to be useful in the evaluation of patients with suspected SLAP lesions.

Multiple epiphyseal fractures in an athlete.

Avulsion fractures occur in the adolescent population at apophyseal locations in the lower extremities. Well-developed adolescents seem to be more prone to these than leaner counterparts. Physicians and coaches should be aware of this factor and the possibility of multiple avulsion fracture in the same individual.

Lateral reconstruction for anterolateral rotatory instability of the knee.

Sixty patients underwent surgery for correction of anterolateral rotatory instability using an extraarticular approach. Forty procedures were performed utilizing Hughston's technique which is outlined. This approach is shown to provide effective control of pivot shift and anterolateral rotatory laxity.

Posterior problems in the knee. Posterior cruciate insufficiency and posterolateral rotatory insufficiency.

During a recent three-year period, 39 patients underwent surgical procedures for lesions of the posterior complex of the knee. The results in 28 followed for greater than six months (average followup, 16 months) are reported; eight are presently in the early rehabilitative phase and three have been lost to followup. In reconstruction for chronic laxity, a semitendinosus replacement of the posterior cruciate ligament with anterior advancement of the lateral arcuate complex is recommended. Use of the medial gastrocnemius tendon is still advised in selected cases. Reconstruction for posterolateral rotatory laxity with an intact posterior cruciate is performed with anterior advancement of the popliteus tendon and the arcuate complex. Pes anserinus transfer, imbrication of the posterior oblique ligament, and biceps tenodesis may be performed as supplemental procedures.

Suprapatellar plica: a study of their occurrence and role in internal derangement of the knee in active duty personnel.

Over the past two years, 380 knee procedures have been reviewed to determine the number of suprapatellar plicas that were observed as contributing factors in the patello-femoral derangement problems of active duty personnel seen at the Naval Regional Medical Center in Charleston. Fiftyeight cases with a follow-up of greater than six months were found in which a suprapatellar plica was considered to be pathological, and was removed. The surgical cases involving a plicectomy, a plicectomy and partial chondrectomy of the patella, a plicectomy and menisectomy, or a plicectomy and extensor reconstruction of the patella were followed to determine whether the patients with these conditions returned to full active duty. It was felt that because of the rigors required for shipboard activities, a return to full active duty was considered a good result. One hundred percent of the cases treated by plicectomy and menisectomy were able to return to full active duty after six months. Eighty percent of the cases treated by plicectomy, extensor reconstruction, and partial chondrectomy of the patella were able to return to full shipboard activities.A more detailed look at the knees that had a plicectomy alone, with a pathologic plica as its only internal derangement, showed that 40% had an excellent result with a return to full active duty and unlimited sports activities. Another 44% had a good result with a return to their full shipboard responsibilities.