Chondromalacia and chronic anterior instabilities of the knee.

In this study, we surveyed a consecutive series of 500 patients who had undergone an open procedure for chronic anteromedial and/or anterolateral instabilities. Those patients who had an open arthrotomy were separated for analysis. All of the patients were examined before and during surgery. A knee sheet, based on the kind used at the Hughston Orthopaedic Clinic in Columbus, Georgia, was used to record all clinical findings. Chondromalacia of the articular surface of the femur was detected at surgery in 161 patients (32%). A statistical analysis showed that the variables directly influencing degenerative changes of the cartilage are: a previous surgery that did not sufficiently restore joint kinematics (chi square = 20.238, P less than 0.001) and a time lapse of more than 30 months between first trauma and surgery (chi square = 21.736; P = 0.001). A higher score on dynamic (jerk or pivot shift) and static (internal and external anterior drawer) tests, indicating instability, or a meniscal tear alone do not statistically correlate with chondromalacia, but together they influence degenerative changes of the cartilage.

[Chronic anteromedial and anterolateral instability of the knee in athletes. Results of treatment with peripheral surgery]. / Les laxités chroniques antéro-médiales et antéro-latérales du genou chez les athlètes. Résultats du traitement par plastie périphérique.

The authors have treated 48 unstable knees by lateral and medial ligament plasties using the Hughston technique. 36 patients were athletes who had to cease their sport because of anteromedial or anterolateral instability. 8 had previously had a menisectomy. Forty-three patients were reviewed with a follow up of 15 to 60 months. 30 patients who had both an active and a passive ligament plasty were able to undertake sporting activities but only 12 at top level. There were 13 failures.

Pathogenesis of Legg-Calvé-Perthes disease.

After reviewing the most widely accredited theories on pathogenesis advanced up to now, the authors report the results of a histological histochemical and ultrastructural study of the upper femoral epiphysis in Legg-Calvé-Perthes disease. They conclude that the primary lesion is probably a dysplastic change in the epiphyseal cartilage.

The pathology of the rotator cuff of the shoulder.

The pathology of the rotator cuff of the shoulder, which is often regarded as synonymous with the condition known as peri-arthritis of the shoulder, comprises: calcified tendinopathy, tendinosis, the acromio-humeral friction syndrome and rupture of the rotator cuff tendons. The authors analyse the various aspects of these pathological conditions in the light of recent physiopathological and clinical findings.

A new approach to the pathology, clinical features and treatment of stress tendinopathy of the Achilles tendon.

On the basis of clinical, anatomical, surgical, histological and pathological investigations, the authors propose a classification of the tendinopathies of the Achilles tendon associated with stress. These are particularly common in the field of sport. Three syndromes are identified: a) pure peritendinitis; b) peritendinitis associated with tendinosis; c) pure tendinosis. The symptoms and possible complications are described and the problem of treatment is discussed. In pure peritendinitis tenolysis is recommended, but in peritendinitis associated with tendinosis it should be combined with extensive scarification of the tendon in order to promote revitalisation.

Femoral metastases from carcinoma of the breast. Pathological and clinical aspects.

In long bone metastases from breast carcinoma, the femur is the bone most frequently involved. Osteolysis is brought about by the osteoclasts, by the neoplastic cells themselves, and to some extent by autolysis of the osseous tissue adjacent to the metastasis. When the metastases are asymptomatic, radiotherapy and antiblastic chemotherapy are indicated, but with symptomatic metastases and spontaneous fractures surgical intervention is indicated. This consists either of prosthetic replacement or of intramedullary fixation complemented by chemotherapy and radiotherapy.

Early development of patella infera after knee fractures.

The condition referred to as patella infera is characterized by a permanent shortening of the patellar ligament and is associated with a severely limited range of motion of the knee joint. Patella infera is a common complication of injury or surgery to the knee joint, and it is generally considered a condition that presents after a variable, albeit considerable time after injury. A review of the knee roentgenograms of patients with arthrofibrosis and patella infera showed this condition to be an immediate complication of knee fractures. Therefore, in order to better define the development of patella infera, the patellar height was studied during treatment of 146 knee joint fractures (46 supracondylar fractures, 50 patellar fractures and 50 tibial plateau fractures). Using the Caton-Deschamps method patella infera was detected in eight cases (17.39%) immediately after supracondylar fractures, in six cases (12%) after patellar fractures, and only in two cases (4%) after tibial plateau fractures. The patellar ratio remained unchanged or worsened further after treatment, and its incidence was unaffected by the type of treatment. These observations rule out etiologies such as inflammatory or algodystrophic phenomena and quadriceps inhibition, because the reduction of patellar height was evident immediately and persisted at follow-up examinations.

Conversion of the arthrodesed hip to a total hip arthroplasty. Indications and limitations.

Arthrodesis of the hip is thought to achieve satisfactory clinical and functional results in the adult despite the loss of articular mobility involved (Santori et al., 1986; Russel, 1987; Weber, 1987). Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and knees due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires further intervention. Surgery on these joints may yield satisfactory short-term results, but these will not last if the arthrodesed hip is not converted to total hip arthroplasty either prior to or at the same time as such operations.