Distal biceps ruptures. A followup of Boyd and Anderson repair.

Twenty-one distal biceps ruptures in 20 patients were treated during a 10-year period. All patients were men with an average age of 47 years (range, 37-70 years). Long term results (average, 44 months) were assessed using the American Academy of Orthopaedic Surgeons Disabilities of the Arm, Shoulder, and Hand outcomes questionnaire, isokinetic testing of elbow flexion and supination (strength and endurance), and patient satisfaction. Measurements of range of motion revealed diminished forearm rotation in four of 21 (19%) elbows and diminished flexion in one of 21 (5%). Isokinetic testing revealed 10 of 21 (48%) elbows had weakness of supination versus three of 21 (14%) for flexion. Deficits in endurance included eight of 21 (38%) elbows for supination and seven of 21 (33%) for flexion. Seven complications occurred in seven patients for a 35% complication rate. Heterotopic ossification was the most common complication, occurring in three patients. One of these patients also had a synostosis. All patients completed the Disabilities of the Arm, Shoulder, and Hand outcomes questionnaire. Twelve patients had an excellent outcome, eight had a good outcome, and no patient had a fair or poor outcome. These results correlated closely with the patients' own subjective assessments of their satisfaction with the procedure. Despite diminished strength and endurance and a high rate of complications, patient satisfaction was excellent and functional outcome was good.

[Patellar imbalance and external rotary instability of the knee]. / Déséquilibre rotulien et instabilité rotatoire externe du genou

The importance of external hyperrotation and external rotary instability in patellar imbalance is examined. In view of the progressive nature of patellar imbalance and of the predominant part played by the muscular and capsulo-ligamentous elements in the stability of the extensor apparatus, the authors advocate an earlier and more radical surgical approach with a view to improving the patellar medialization forces (transplantation of the intermediate great muscle and retension of the lateral patellar retinaculum) as well as the elements of active internal rotation of the tibia (modified version of Slocum's operation and transfer of the internal third of the patellar tendon).