Painful medial knee compartment syndrome in over-45 year-olds: I--medical or surgical management: a series of 174 patients.

INTRODUCTION: There is at present no consensus on the management of degenerative medial meniscus lesions in patients aged over 45 years without proven osteoarthritis, especially given that the causal relation between degenerative meniscal lesion and osteoarthritis remains controversial. A prospective multicenter non randomized study was therefore performed. The principal objective was to assess surgeons' practice in the management of degenerative medial meniscus lesions. The secondary objectives were to identify predictive and prognostic factors and to compare medical versus surgical attitudes so as to draw up an adapted treatment strategy. PATIENTS AND METHOD: One hundred and seventy-four patients were included between September 2008 and February 2010, and distributed between a surgical (n=104) and a medical group (n=70). Minimum follow-up was 6 months. Patient satisfaction and health-related quality of life on the SF-36 questionnaire were assessed at 6 months. RESULTS: No difference emerged between the surgical and medical groups. However, predictive factors for poor results were identified: overweight (p=0.005), cartilage lesions (p=0.035) and meniscus extrusion (p=0.006). DISCUSSION: Results clarified the relation between degenerative meniscus lesions and osteoarthritis, in terms of meniscal incompetence. Meniscal extrusion should be seen as an arthrogenic degenerative meniscus lesion. We recommend a management strategy based on terrain and imaging data (X-ray and MRI), with the aim of providing patient relief while conserving cartilage.

[Evaluation of 5 years of nucleolysis treatment in 150 cases of radiculalgia and 10 cases of lumbago of disk origin]. / Bilan de cinq années de traitement pars nucléolyse de 150 radiculalgies et 10 lombalgies discales.

The action of chemical nucleolysis on lumbar disc/root problems was assessed on the basis of 4 parameters: root pain, neurological deficit, residual lumbar pain and spinal mobility evaluated by the Shöber test, at 4 months, 1 year, 2 years, 3 years and more. With time, mean results concerning root pain disappeared; neurological deficit and root pain progressed in parallel with good or excellent results of the order of 75 percent; residual lumbar pain remained stable, null in 30 percent of cases and very troublesome in 15 per cent of cases. Mobility increased with time: when good or excellent, nor poor results were seen in terms of lumbar pain or root pain.