Painful medial knee compartment syndrome in over-45-year-olds. II--technical note: Biomechanical considerations: theoretic analysis of load distribution in the knee according to plane and to gait phase.

Varus deviation as defined by Thomine is the basis for understanding load distribution between the medial and lateral tibial plateau; it was originally defined in the frontal plane. Analysis in the sagittal and horizontal planes leads to a concept of varizing area. Varizing area sheds light on how, during gait, load predominates in the medial and posteromedial knee. It also accounts for the following two findings: (a) degenerative lesions are mainly medial, even when the mid-knee axis is normal; (b) degenerative lesions are mainly posterior.

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.

[Varus osteotomy in severe arthrosis of the hip--a long-term study (author's transl)]. / Résultats des ostéotomies de varisation pour coxarthroses évoluées: analyse statistique d'une série de 141 hanches revues à plus de 10 ans.

141 hips were reviewed more than 10 years after operation. The average follow-up was 13.5 years. A close relationship between the pre-operative functional state and the final result was established. The improvement was due to a decrease of pain in most cases, especially severe ones. Mobility and walking ability were little changed. Some worsening of the condition of patients was noted at about the 10th post-operative year. The aetiology, the degree of dysplasia, or degree of displacement of the osteotomy, had little influence on the final result. The degree of post-operative hip congruence was unimportant. The best results were seen in excentrated hips with severe radiological involvement. It is concluded that varus osteotomy is a valuable procedure in severe arthrosis of the hip. The hazards of the procedure are small, and it is indicated in young or middle-aged patients.