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.

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.

[Tibial valgus osteotomy]. / Ostéotomie tibiale de valgisation.

The tibial valgus osteotomy whatever its technique has a survival rate of about 85 % to 10 years, if we consider the reoperation as a criterion of failure, with a confidence index at 78%. The age, weight, sex and functional signs have no impact on the outcome. We have found no evidence in the preoperative radiographic assessment, neither the medial pinch, or varus epiphyseal neither varisant gap, which could be a failure and a reoperation before the tenth year. Good results were observed significantly when there is an over-valgus at least 3 degrees of global axis of the lower limb. This corresponds to a valgus epiphyseal by more than 2 degrees . The substantial reduction in the gap varisant that lowers the overall time varisant below 200 kg cm provides the same positive results. The outcome will depend directly on the accuracy of the calculation of the preoperative correction performed and the quality of surgical achievement. Because of the need for precision, navigation technique appears as reliable, simple which makes it also possible to monitor the front slope and tibial rotation induced. The osteosynthesis must be stable and rigid to avoid postoperative loss of correction.