[An adolescent with knee pain]. / Een jongen met een pijnlijke knie.

A 16-year-old male presented with acute knee pain due to focal periphyseal oedema of the distal femur. This is a physiological reaction during skeletal maturation.

[A female runner with a painful knee]. / Een hardloopster met een pijnlijke knie.

A 36-year-old, healthy woman presented with pain in her left knee. The X-ray of this knee showed a lytic tumour. The MRI scan also revealed this lesion, which was highly suspicious for a giant cell tumour of the distal femur. She was treated in a specialised centre.

[A man with an abnormal dimple in his upper leg]. / Een man met een abnormale delle in zijn bovenbeen.

A 29 year-old man presented with muscle weakness and an abnormal dimple near his hamstrings after a complicated anterior cruciate ligament reconstruction of his right knee. MRI demonstrated atrophy of the semitendinosus muscle. He received physiotherapy after which he functionally recovered.

[A woman with knee locking after a partial knee arthroplasty]. / Een vrouw met slotklachten na een hemi-knieprothese.

A 57-year-old woman presented with knee locking and lateral knee pain after a partial knee arthroplasty. Consequently, during knee arthroscopy 2 cement particles were found and removed.

Leg alignment and tibial slope after minimal invasive total knee arthroplasty: a prospective, randomized radiological study of intramedullary versus extramedullary tibial instrumentation.

The purpose of the study was analysis of leg alignment and tibial slope comparing intramedullary versus extramedullary tibial instrumentation in the Genesis II MIS-TKA (Smith & Nephew, Memphis, USA). A prospective randomized study was performed according to the CONSORT guidelines. All patients (56 patients) for MIS-TKA were included, if the pre-operative standing long leg X-ray demonstrated the tibia eligible for use of both intra- and extramedullary MIS tibial instrumentation. Randomization was performed by envelope selecting intra- or extramedullary tibia MIS instrumentation. All patients were operated by, or under supervision of, one experienced knee surgeon (RJ). Measurements of leg alignment and tibial slope were made on standardized long leg standing X-rays and lateral knee X-rays performed pre-operatively and 4-12 months post-surgery. Leg alignment was defined as being within or outside the range of 3° varus-valgus on the mechanical leg. The tibial slope was compared pre- and post-surgery. In the present study, there was no difference in leg alignment after MIS-TKA comparing intramedullary versus extramedullary tibial instrumentation. Restoration of tibial slope was significantly better with use of the extramedullary tibial instrumentation.

[Diagnostic image A woman with a painful wrist]. / Een vrouw met een pijnlijke pols.

A 70-year-old woman had a painful wrist after a fall from her bike, due to a carpometacarpal luxation.

Conventional versus invaginated stripping of the great saphenous vein: a randomized, double-blind, controlled clinical trial.

BACKGROUND: An invaginated strip of the great saphenous vein (GSV) may be associated with diminished blood loss and less discomfort compared to conventional stripping in patients with unilateral primary GSV varicosis. METHODS: Ninety-two patients were randomized for conventional (CON) or invaginated (INVAG) stripping and were followed for 26 weeks postoperatively. RESULTS: Both groups (n = 46) were well balanced for age, gender distribution, and body mass index. The CON group lost twice as much blood compared to the INVAG group (CON: 28 +/- 4 g, INVAG: 15 +/- 2 g, p < 0.001). Infragenual incision length following a conventional strip was twice as long (CON: 16 +/- 1 mm, INVAG: 8 +/- 1 mm, p < 0.001). Pain as measured with a visual analog scale (minimal 0, max 10) decreased in both groups in a similar fashion from 3.2 +/- 0.3 preoperatively to 0.6 +/- 0.2 after 26 weeks (p < 0.001). Saphenous nerve damage after one month was observed in four CON patients compared to no patients following invagination. Return to work was not different (CON: 13 +/- 2 days, INVAG: 11 +/- 2 days). CONCLUSION: Invagination of the GSV in uncomplicated primary varicosis may be associated with less surgical trauma compared to a conventional stripping technique.