Treatment of acromioclavicular separations. A retrospective study.

A retrospective study of 134 patients with Types I, II, and III acromioclavicular separations was carried out. The average followup was 6.3 years, with the longest being 19 years, and the shortest being 1 year. The mechanism of injury was a direct blow in 92% of the patients. The average age of the patients was 30.1 years, with a range from 13 to 68 years. All patients were evaluated using a standard rating system for the shoulder and humerus, the total for perfect recovery being 100. Twenty-four patients with Type I separations were immobilized 19.5 days, with a disability period of 6 weeks, and rated 94 points. Twenty-five patients with Type II separations were immobilized 27 days for the conservative groups, had a disability period of 6 weeks, and rated 90 points. Eighty-five patients with Type III acromioclavicular separations were followed. Seven patients had conservative treatment, were immobilized an average of 22 days, with a disability period of 13 weeks, and rated 82. Of those patients who underwent surgical repair, excluding Dacron graft substitution, the immobilization period was 6 weeks, with a disability period of 12 weeks, and a rating of 80. Fifty-eight patients underwent repair with double velour Dacron prosthetic substitution for the coracoclavicular ligaments, combined with distal clavicular resection in all but two patients. The average immobilization period was 1 week, with the average disability period being 3 weeks. The average rating was 96, with 24 patients rating 100. The major cause for a rating less than 100 was light to moderate pain that persisted in a few cases, which was only occasional and associated with a particular activity. One infection occurred requiring graft removal 5 months after surgery. Calcification in the area of the coracoclavicular ligaments did not affect the final rating and recurrence of deformity was not noted.

Natural history of anterior cruciate tears.

An evaluation of 361 patients with documented anterior cruciate tears was carried out with analysis of mechanisms, symptomatology, physical findings, and limitations. At the time of injury, patients generally heard a loud pop and felt their knee "slide apart" with a subsequent hemarthrosis. Internal tibial rotation was described as the principal mechanism of iniury in 81.6% of the patients. Less than 20% had a triad type injury. A "crossover" test enabled reproduction of the mechanism. On a 100 point scale, those with "no repair" scored a mean of 55.4, direct repairs 56.7, pes transfers 59.6, and modified MacIntosh 88.9 points. The natural course of a patient can often be projected. A Continuing comparative study of results from treatment regimens and procedures is indicated.

Profiles of skin test reactivity to antigens of various mycobacterial species in a human population and in experimental infections.

Sensitivity profiles to 6 mycobacterial skin test antigens prepared from Mycobacterium tuberculosis, M. kansasii, M. scrofulaceum, M. intracellulare, M. avium and M. fortuitum were obtained in 6 groups of guinea pigs, each infected with one of the 6 mycobacterial species. Each group of animals showed the greatest sensitivity towards the homologous antigen. A second infection with a different species was super-imposed two months after the skin tests; the sensitivity towards the second species usually became dominant. Sensitivity profiles with the 6 antigens in a large random sample of the population of a district of Haiti resembled closely the sensitivity profiles for all the guinea pigs infected with two mycobacterial species. This suggested that the Haitian population consisted of a mixture of persons infected with one or more mycobacteria. Haitians with the largest to an antigen, which was at least 6 mm in diameter and at least 2 mm larger than the reaction to any other antigen, were assumed to be infected with the corresponding mycobacterial species. Sensitivity profiles of these persons resembled closely the sensitivity profiles of guinea pigs infected with the same species. In the Haitian population prevalence of infection with other mycobacterial species was much more common than infection with M tuberculosis. In spite of this, after 15 years of age only the tuberculosis infection rates increased with age, suggesting that allergy produced by M. tuberculosis infection was stronger and subject to much less waning than allergy produced by other mycobacterial infections.