[Aseptic osteonecrosis of the femoral condyle after meniscectomy by the arthroscopic approach]. / Ostéonécrose aseptique du condyle fémoral après méniscectomie par voie arthroscopique.

Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prothesis, the other 7 patients were treated medically.

Nine cases of osteonecrosis in elderly patients following arthroscopic meniscectomy.

We report nine cases of osteonecrosis of the knee after arthroscopic meniscectomy between 1992 and 1996. In five women and four men aged between 58 and 82 years (mean 69 years), magnetic resonance imaging (MRI) demonstrated a meniscal tear for which arthroscopic meniscectomy was performed. MRI was done between 3 days and 72 weeks after the onset of symptoms. Signs of osteonecrosis were not present on the initial MRI scan. Postoperatively, all patients experienced persistent knee pain and joint effusion. A repeat MRI scan 6-48 weeks after meniscectomy confirmed the diagnosis of osteonecrosis. In eight patients osteonecrosis was located on the medial, in one patient on the lateral femoral condyle. Our report supports the results of recent studies which have related osteonecrosis to arthroscopic meniscectomy. Further studies need to be undertaken to determine the aetiology of the osteonecrosis related to this procedure in the elderly. Until the results of these studies are available, we recommend considering carefully before performing arthroscopic procedures in the elderly.

A simple suture shuttle in rotator cuff repairs: a technical note.

In rotator cuff repairs, it is often necessary to pass 2 tails of 2 sutures through 1 transosseous hole to maximize the number of sutures per hole. We report on a simple technique with a double-loop suture thread that allows the passing of more than 1 suture limb through the same hole. This simple device, the simple suture shuttle, used in cuff repairs in combination with the modified Mason-Allen suture technique, significantly reduces the difficulty of passing more than 1 suture tail through a single bone tunnel. By reducing the number of bone tunnels, the weakening of a bone that might not be very strong is kept to a minimum. The Simple Suture Shuttle can also be used to pass more sutures through a given number of transosseous holes.

Treating tibial fractures with a modified Sarmiento method.

There is still no unanimous agreement on the appropriate primary treatment of tibial fractures. One fraction advocates conservative treatment, and another advocates open reduction and internal fixation. Between these extremes is the functional treatment developed by Augusto Sarmiento. The authors adopted Sarmiento's method in 1976 and present a prospective study of 317 cases treated between 1976 and 1988 in which the union rate was 98.7%. They describe the Sarmiento method as ideal for closed, spiroid (whether comminuted or not) tibial fractures resulting from low-energy forces.

Humeral retrotorsion and glenohumeral relationship in the normal shoulder and in recurrent anterior dislocation (scapulometry).

The authors' roentgenographic technique provides precise assessment of the glenohumeral relationship on the basis of two-plane examination. A group of 50 normal male subjects serve as the basis for determining normal values for the following angles or lines: projected and corrected cephalodiaphyseal angle, projected and corrected humeral retrotorsion, glenoid inclination, angle of attack, glenoid retroversion, dimension of glenoid, width of humeral head, and contact index. Two groups of patients suffering from recurrent anterior dislocation (RAD) are compared with the normal group. The shoulders with RAD do not differ significantly from the normal ones. Humeral retrotorsion, in particular, is identical. Significant differences are found between affected and unaffected sides in unilateral RAD. The diameter of the glenoid and the contact index are smaller on the dislocated side. Because the projected values seldom differ by more than 10 degrees from the calculated values, if the authors' roentgenographic technique is used, the figures can generally be accepted without correction.