Incidence, location and classification of glenoid labrum meniscoid folds.

INTRODUCTION: The purpose of the present study was to arthroscopically investigate the incidence and location of labral meniscoid folds of the shoulder joint, as well as to classify them into types and detect any possible correlation with gender, side and age of patients. MATERIALS AND METHODS: The shoulder joint of 59 patients who underwent arthroscopic surgery for different reasons was examined for meniscoid folds. We classified all meniscoid folds into slim or thick and large or small. The location and area of labral folds were assessed according to o'clock position and were defined by the center of the fold. RESULTS: The incidence of labral meniscoid folds in shoulder joint was 62.7 %. Meniscoid folds were more frequently found at 2-o'clock position in right shoulders and at 10-o'clock position in left shoulders. Most of them were located in anterior and superior rim of labrum. Statistically significant difference (p = 0.018) was only detected between location of meniscoid folds and gender. In male patients meniscoid folds were mostly located in a more anterior position than women, whose meniscoid folds were found more superiorly. Older patients presented a higher rate of meniscoid folds. CONCLUSION: Meniscoid folds are quite common in shoulder joint. Labral meniscoid folds are located more often at an anterosuperior position of shoulder joints and their incidence tends to be higher in older patients, while in male ones they are located in a more anterior position in comparison to female patients where they are located more superiorly.

Posterior tibial subluxation and short-term arthritis resulting from failed posterior cruciate ligament reconstruction.

Posterior tibial subluxations because of combined or isolated posterior cruciate ligament (PCL) injuries require detailed evaluation. PCL reconstructions are difficult procedures because of the low rate of such injuries and the complex anatomy of the ligament. We report on 2 cases of failed PCL reconstruction because of malpositioned femoral tunnels. These 2 cases support the existing biomechanical evidence that the correct placement of the tunnels, especially in the femur, is a major factor in defining the outcome. It seems that the drilling of the tunnels, especially in the femur, during PCL reconstruction must be performed with accuracy and always be evaluated in cases of graft failure. In addition, failed PCL reconstructions are usually accompanied by a short-term excessive arthritis that results in poor functional outcome.

The diagnostic dilemma created by osteoid osteoma that presents as knee pain.

PURPOSE: Osteoid osteoma is a rare benign bone lesion with a high incidence in adolescents and young people. The objective of our study was to illustrate the difficulties in diagnosis of osteoid osteoma in patients presenting with atypical knee pain. TYPE OF STUDY: Retrospective case series. METHODS: In 10 patients who presented to our department with atypical knee pain between 1984 and 1999, the diagnosis of an osteoid osteoma was delayed. Retrospective review of these 10 cases was performed using interviews and re-evaluation of medical histories, radiographs, computed tomography (CT) scans, isotope bone scan, and magnetic resonance imaging (MRI). RESULTS: Initial radiographs showed features of osteiod osteoma in only 2 cases. In addition, in 1 case, not only initial but also repeated radiographs of the knee joint were still normal 10 months after the delineation of the nidus using MRI. Four unnecessary arthroscopies were performed on 4 of the 10 patients and the final diagnosis was established using MRI, CT, and isotope bone scan. The mean time interval between arthroscopy and osteiod osteoma diagnosis was 11.5 months. CONCLUSIONS: Osteoid osteoma must be included in the differential diagnosis of persistent unexplained knee pain, especially when objective findings of the knee are vague. The presence of the lesion juxta-articular to the knee joint or in the midshaft or upper end of the femur may be referred as pain to a nearby joint. Plain radiographs have a low diagnostic value in the detection of the lesion whereas isotope bone scan and MRI are reliable imaging techniques. The evaluation of the ipsilateral hip joint should not be overlooked.