Anteromedial meniscofemoral ligament of the knee: CT and MR features in 3 cases.

We report 3 cases of AnteroMedial MeniscoFemoral Ligament (AMMFL) fortuitously demonstrated during knee imaging in three patients. This rare normal variant of insertion of the anterior horn of the medial meniscus consists of an anomalous fibrous band distinctly covering the whole length of the anterior cruciate ligament to attach the anterior horn of the medial meniscus to the posterolateral wall of the femoral intercondylar fossa. AMMFL was diagnosed during arthro-CT in two patients and clearly identified during knee MR imaging in a third patient. The two cases demonstrated during arthro-CT--one prospectively and the other retrospectively--were confirmed during therapeutic arthroscopy. We illustrate the anomaly, discuss its controversial clinical significance and review the literature.

[Arterial false aneurysm after total hip arthroplasty. A case report]. / Faux anévrysme artériel sur arthroplastie de hanche. A propos d'un cas.

Vessel damage during implantation of a total hip arthroplasty is exceptional (0.2-0.3% incidence). We observed a case of false aneurysm of the common femoral artery diagnosed in a pauci-symptomatic patient seven months after total hip arthroplasty. The vessel was damaged by a fragment of cement in contact with the artery. Treatment consisted in extraction of the cement fragment and insertion of a vascular prosthesis after dissection and ligature of the pseudoaneurysm. A review of the literature of vascular complications after prosthetic hip surgery was undertaken. Early complications include acute bleeding or ischemia while late complications include pseudoaneurysm or arteriovenous fistulization. Predisposing factors are: infection, repeated contact between the implants and arterial walls, overly medial reaming of the acetabulum, intrapelvic cement spikes, and use of Hohmann retractor. We detail here the clinical signs, diagnostic approach, and natural course of arterial false aneurysm resulting from intra-pelvic cement leakage.

[Os odontoideum. A neurologic syndrome after orthopedic reduction of a C1-C2 subluxation]. / Os odontoideum. Syndrôme neurologique après réduction orthopédique d'une subluxation C1-C2.

A case of os odontoideum associated with a C1-C2 subluxation is described. During the reduction procedure by external manipulation, bulging of the membrana tectoria resulted into medullary compression followed by a neurological syndrome. An occipito-C2 arthrodesis was performed later on when the neurological status recovered back to normal. The case reported underlines the possibility of neurological damage following closed reduction of a C1-C2 subluxation, while the surgical procedure should not be incriminated. The pathogenic mechanism may not be properly understood if closed reduction is followed by surgical treatment during the same session.

[A unicompartment knee prosthesis: the effect of the positioning of the tibial plate on the functional results]. / Prothèses unicompartimentales de genou: influence du positionnement du plateau tibial sur les résultats fonctionnels.

The authors analyse the results of 51 unicompartmental knee prostheses with 1 to 12 years follow-up (mean follow-up: 5 years). The results were evaluated using the scoring system of the "Knee Group" of the SO.B.C.O.T. (Société Belge de Chirurgie Orthopédique et de Traumatologie). This analysis demonstrates that the quality of the results depends on implant positioning. The authors suggest positioning the tibial implant parallel with the healthy plateau and slightly distal, i.e. to position the tibial implant perpendicular to the epiphyseal axis and not to the mechanical axis, as is systematically done with the usual tibial cutting guides. When this ideal positioning was respected, 77.5% of the patients had a score above 90 points (out of a possible maximum of 100 points) and 12.5% had a score between 75 and 89 points. When this condition was not respected, none of the knees obtained more than 75 points. The difference was statistically significant (p = 0.0001).

[Complete knee prosthesis in severe genu valgum. Retrospective review of 90 knees surgically treated through the anterio-external approach]. / Prothèse totale du genou sur grand genu valgum. Revue rétrospective de 90 genoux opérés par abord antéro-externe.

The authors have made a retrospective study of 90 total knee arthroplasties performed through a lateral approach in knees with a valgus deformity superior or equal to 10 degrees. The mean function score increased from 35.9 to 73.2 postoperatively; the mean knee score increased from 60.2 to 93.6. Radiological evaluation of the mechanical angle (HKA) showed 16 degrees of valgus deviation preoperatively versus only 1.5 degrees of valgus post-operatively. A strict operative technique using a lateral approach in severe valgus knee deformity makes it possible to reproducibly achieve joint stability with good mobility and a neutral mechanical axis in total knee arthroplasty.

[Intra-osseous and intra-articular cyst of the knee. Apropos of a case associated with osteochondritis dissecans]. / Kyste synovial intra-osseux et intra-articulaire du genou. A propos d'un cas associé à une ostéochondrite disséquante.

Subchondral bone cyst, intraarticular synovial cyst, and osteochondritis dissecans arising together are analyzed: this association has so far not been reported. If we accept the theory of a mechanical origin for subchondral bone cysts (leakage of joint fluid or intrusion of the synovial membrane through a breach in the cartilage), then the osteochondritis certainly provided the port of entry that allowed formation of the intraosseous synovial cyst in this patient.

[Primary rhabdomyosarcoma of bone. Apropos of a spinal localization]. / Rhabdomyosarcome osseux primitif. A propos d'une localisation vertébrale.

The authors describe one case of rhabdomyosarcoma of the second thoracic vertebra. The primitive osseous nature is discussed through an analysis of the case and a review of the literature.

[Upper tibial osteotomy for gonarthrosis in genu varum. Apropos of a series of 193 cases reviewed 6 to 10 years later]. / Ostéotomie tibiale haute de valgisation pour gonarthrose sur genu varum. A propos d'une série de 193 cas revus après 6 à 10 ans de recul.

The authors have analyzed the results of 193 tibial osteotomies with varus deviation reviewed after an average 8 year follow-up. There were 71 per cent of good results. 14 patients (7.2 per cent) were reoperated for unsuccessful osteotomy. The optimal postoperative tibio-femoral axial alignment was obtained between 3 degrees and 5 degrees valgus. The analysis of the series illustrates clearly the criteria of good results thus providing a guide to surgical indication. It is a question of the preoperative height of medial tibio-femoral space being higher or equal to 50 per cent of the normal, a constitutional tibial varus over 5 degrees, a preoperative mechanical axis of less or equal to a 10 degrees varus, the absence of subluxation of the tibial eminences. Statistically the most important factor (p = 0.0004) was the height of the medial tibio-femoral space of which the decrease illustrates the stage of development of A.O. Finally, in the case of arthritic genu varum, the painful patello-femoral syndrome progresses favorably in the case of good surgical indication on the medial tibio-femoral compartment.

[Old-fashioned combined intra- and extra-articular surgery of the knee for chronic lesions of the anterior cruciate ligament. Intermediate results. Indications]. / "Old fashion" plasties mixtes intra-et extra-articulaires du genou pour lésion chronique du ligament croisé antérieur. Résultats à moyen terme. Indications.

The authors studied the results of a homogeneous group of 60 knees on which were performed intra- and extraarticular ligamentoplasty for chronic anterior laxity. The MacIntosh technique as described by Imbert was used. This consisted of a continuous transplant taken from the extensor apparatus. The patients were operated by the same surgeon but questioned by another. The results were analyzed for stability, pain and resumption of sports (kind and level). Certain parameters were currently found to be unfavorable, such as relatively small transplant diameter, arthrotomy, 3 or more weeks of postoperative plaster immobilization, total discharge, period of 6 or more weeks, lack of extension tolerated until the 16th week, a very slow rate reeducation allowing competition at the prior level only after a year following surgery in particular, do not seem to influence the results. Only 76.6% of the patients had a result considered to be very good or good, and the analysis of average (16.6%) and poor (6.5%) results showed preoperative factors which indicated the prognosis. These included meniscus conservation, age, sports activities, preoperative degenerative lesions, type of accident and the patient's motivation.

[Surgical treatment of isthmic spondylolisthesis. A comparative study of 3 types of arthrodesis]. / Traitement chirurgical du spondylolisthésis isthmique. Etude comparative de 3 types d'arthrodèse.

The authors present a series of 186 cases of spondylolisthesis treated using 3 different types of arthrodesis: 84 by anterior arthrodesis, 35 by postero-lateral arthrodesis and 67 by combined arthrodesis. Slippage reduction was sought only in combined arthrodesis. The elimination of pain or a significant improvement were noted in 95 per cent of cases treated by anterior arthrodesis, in 74 per cent of those treated by postero-lateral arthrodesis and in 97 per cent of those treated by combined arthrodesis. The work resumption or professional rehabilitation rate was 89 per cent for anterior arthrodesis, 46 per cent for postero-lateral arthrodesis and 90 per cent for combined arthrodesis. Analysis of the clinical results according to the criteria of Stauffer and Coventry shows that good results were noted in 69 per cent of cases treated by anterior arthrodesis, in 43 per cent of those treated by postero-lateral arthrodesis and in 74 per cent of those treated by combined arthrodesis. A fusion rate of 86 per cent was achieved after anterior arthrodesis, 69 per cent after postero-lateral arthrodesis and 95 per cent after combined arthrodesis. Reduction had no effect on either clinical results or spinal statics in spondylolisthesis of less than 50 per cent. In the reduction of spondylolisthesis of more than 50 per cent, better results were obtained with the R. Louis technique than the Harrington technique in the restoration of spinal statics and maintenance of long-term clinical results.

[Angiosarcoma after total knee prosthesis. Apropos of a case]. / Angiosarcome après prothès totale de genou. A propos d'un cas.

The authors describe the case of an angiosarcoma associated with a knee prosthesis. The appearance of a malignant tumour in the area of the implantation of a metallic prosthesis is rare. The pathogenesis of this association is still unknown. The authors make an analysis of the problem on the basis of a review of the literature.