Medial Plica Syndrome of the Knee: Arthroscopic Plica Resection versus Structured Physiotherapy-A Randomized Controlled Trial.

Background Medial plica syndrome is a commonly overlooked cause of anterior knee pain. A consensus on diagnosis and treatment is yet to be found. This study compares the clinical outcome of arthroscopic plica resection with structured physiotherapy for patients with isolated medial plica syndrome in a prospective randomized controlled trial with a 2-year follow-up. Methods Forty-eight patients have been included in this prospective randomized controlled trial presenting medial plica syndrome. Patients were randomly assigned to either arthroscopic plica resection or structured physiotherapy. The primary outcome was the change in the average score of the Lysholm knee scoring scale from baseline to 2-year follow-up. Results Mean baseline Lysholm score for patients assigned to arthroscopic plica resection and physiotherapy was 65.8 and 66.3, respectively. No significant difference was seen between the two groups. Thirty-three patients were assessed at 2 years follow up. The mean Lysholm score was 89.7 for patients assigned to arthroscopic plica resection and 74.6 for patients assigned to structured physiotherapy. A statistically significant difference was seen between the two groups (p = 0.007). Conclusions Arthroscopic plica resection was associated with significantly greater clinical improvement compared with physiotherapy at 2-year follow-up.

[The Masquelet procedure used after an open femur fracture with infection and osteomyelitis]. / Masquelets teknik anvendt efter åben femurfraktur med infektion og osteomyelitis.

The treatment of patients with larger bone defects due to infections, trauma or tumours is a challenge in orthopaedic surgery. In 1986 Alain Charles Masquelet introduced a new technique using a two-step procedure, in which cement and bone-graft is used to reconstruct the defect. The Masquelet procedure is an effective alternative to methods formerly used in Denmark, but is still rarely used and unknown by many. In this case report we present a young woman with a large bone defect due to infection after an open femur fracture, who was successfully treated using this method.

Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial.

PURPOSE: Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration analgesia is a simple technique that has proven effective in postoperative pain management after total knee arthroplasty. Further, local infiltration analgesia covers the donor site and is associated with few complications. It was hypothesised that local infiltration analgesia at the donor site and wounds would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft. METHODS: Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating scale, and use of opioid, range of motion and adverse effects were assessed at the postoperative recovery unit (0 h), 3, 24 and 48 h, postoperatively. RESULTS: There were no significant differences between the groups in pain intensity or total opioid consumption at any of the follow-up points. Further, there were no differences between groups concerning side effects and range of motion. CONCLUSIONS: Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated femoral nerve block combined with infiltration at the donor site, we recommend local infiltration analgesia in ACL reconstruction with hamstring tendon graft.

[Complete proximal hamstring tendon rupture can be misinterpreted as muscle rupture]. / Total ruptur af hasemusklerne proksimalt på låret kan forveksles med fibersprængning.

Complete proximal hamstring tendon rupture is a rare injury which untreated can lead to reduced strength, pain and dysaesthesia corresponding to the sciatic nerve. We report a case of complete hamstring tendon rupture in a 50 year-old woman who was treated with surgical reinsertion of the tendon to the ischial tuberosity. Surgical repair should be considered in active patients, who desire a high level of physical activity. Surgery should preferably be performed in the first 2-3 weeks after injury, as delayed surgery is complicated by scar tissue in close relation to the sciatic nerve.

[Magnetic resonance imaging of the scaphoid bone]. / Magnetisk resonans-skanning af os scaphoideum.

INTRODUCTION: Can junior doctors in orthopaedic surgery interpret magnetic resonance imaging (MRI) scans of the scaphoid bone and thereby avoid that patients undergo unnecessary immobilization and repeated controls? MATERIAL AND METHODS: Patients suspected of having a fracture of the scaphoid bone and with a negative x-ray were included in the study. The MRI was performed within a few days, and the patient received the results of the MRI the same day in the ambulatory. The junior doctor had received training in MRI diagnosis and was not allowed to confer with another doctor. Subsequently, the junior doctor's medical opinion was reviewed by a radiologist, and the treatment was adjusted if there was a discrepancy concerning the diagnosis. Among the 98 eligible patients, 13 had their MRIs reviewed by the junior doctor in tandem with a specialist; therefore, only 85 patients were included in the study. RESULTS: Junior doctors found three out of five scaphoid fractures and misinterpreted six. Specificity reached 92.5% and the sensitivity 60%. The junior doctors as well as the radiologists found 11 fractures of the distal radius that had not been detected prior to the MRI. CONCLUSION: We cannot recommend that junior doctors in orthopaedic surgery interpret MRI scans. Since studies have showed that is it cost-effective to offer early MRI, we will continue doing so, but will wait for the final report from the radiologists before initiating treatment.