Does an abnormal infrapatellar plica increase the risk of chondral damage in the knee.

PURPOSE: the aim of this study was to evaluate abnormal infrapatellar plicae that cause chondral lesions on the patellofemoral sulcus and superior aspect of intercondylar notch. METHODS: in this study, 133 abnormal infrapatellar plicae were evaluated. The abnormal infrapatellar plicae may lead to chondral lesions on the superior portion of intercondylar notch and on the inferior portion of the patellofemoral sulcus with striking, friction, and compression forces during knee motion. RESULTS: the chondral lesions that were caused by abnormal infrapatellar plicae were more severe than the chondral lesions that were caused by normal infrapatellar plicae. The width of the plica did not affect the severity of chondral lesions. CONCLUSION: abnormal infrapatellar plicae might be one of the causes of chondral lesions on the superior portion of intercondylar notch and on the patellofemoral sulcus. The width of the plica did not affect the severity of chondral lesions.

Full arthroscopic lateral retinacular release with hook knife and quadriceps pressure-pull test: long-term follow-up.

The most important causes of anterior knee pain include patellofemoral malalignment which causes patella-condyle contact anomalies at the patellofemoral joint, excessive patellar lateral pressure increase, trauma and overuse. In this article, besides presentation of late clinical results of 169 lateral retinacular release cases which were surgically treated between January 1995 and December 2002 with the help of a hook knife from the anterolateral portal due to lateral compression syndrome and patellar maltracking, we also described quadriceps tendon pressure-pull test which strongly indicates patellofemoral pain during physical examination of a patient with anterior knee pain. In addition to radiological patellofemoral imaging methods, we describe dynamic arthroscopic patellofemoral joint examination which is applied perarthroscopically to all of our surgically treated patients. We divided the patients into two groups: group 1 was the younger group with age 16-40 years; group 2 was the older group with age >41 years. Preoperative mean Lysholm scores for group I was 67.6 and 98.6, postoperatively, whereas it was 62.3 preoperatively and 91.4 postoperatively in group 2. This improvement of Lysholm scores postoperatively was statistically significant for each of the two groups (p=0.001). For group 1 preoperative IKDC scores were A in 8 patients, B in 61 patients and C in 11 patients, whereas it was A in 78 patients and B in 2 patients postoperatively. For group 2 preoperative IKDC scores were A in 2 patients, B in 43 patients, C in 36 patients and D in 8 patients, whereas it was A in 78 patients and B in 11 patients. This improvement of IKDC scores postoperatively was also statistically significant for each of the two groups (p=0.001). Preoperative and postoperative congruent angles of all patients were also measured. Preoperative mean congruent angle was +16.4 in group 1 while mean congruent angle was -7.1 postoperatively. For group 2 preoperative mean congruent angle was +18.7 preoperatively and -6.9 postoperatively. This improvement was statistically significant for each of the two groups (p=0.001). The overall number of patellar lateral compression syndrome cases were 51 (24 in group 1, 27 in group 2), patellar lateralization cases were 64 (28 in group 1, 36 in group 2) and patellar subluxation cases were 54 (28 in group 1, 26 in group 2). At the evaluation of arthroscopic lateral patellar facet and lateral femoral condylar chondral pathologies, we statistically showed that patellar chondral pathologies were more severe than the femoral chondral pathologies (p=0.001). In our opinion, the severity of patellar lateral facet chondral lesions, although it has a thicker layer of cartilage, is due to distribution of load to a larger contact area of lateral femoral condyle. Statistically increasing severity of femoral (Kendall's tau-b: 0.248, p=0.001) and patellar chondral lesions (Kendall's tau-b: 0.444, p=0.0001) with age is compatible with our arthroscopic and clinical observations. The most important complication seen in our cases was fibrosis at the site of lateral release, seen in three patients. They were healed without any sequela with local corticosteroid injection into the fibrosis tissue. We did not see any hemarthrosis or haematoma as a complication.

Deltoid (triangular)-shaped anterior cruciate ligament that caused notch impingement: a report of two cases.

In this article, we present 2 previously unreported cases of anterior cruciate ligaments (ACL) that had a wide deltoid (triangular)-shaped tibial insertion in the coronal plane that caused impingement at the intercondylar notch, inferior parts of patellofemoral sulcus, and the posterior cruciate ligament (PCL). Ligamentoplasty was used in both cases. Inferomedial and inferolateral parts of the ACL that caused impingement were excised, and the normal width of the tibial insertion of the ACL was provided.

Clinical evaluation of ulnar nerve repair at wrist level.

INTRODUCTION: In this study, the results of ulnar nerve repair were analyzed. The relation between the functional outcome scores and clinical findings were investigated to find out whether any clinical finding could be predictive of the outcome. MATERIALS AND METHODS: Seventeen patients who underwent ulnar nerve repair formed the study group. Average follow-up lasted 45.5 months (range 39-48 months), and average age of the study group was 31.7 years (range 26-42 years). The same operative technique was applied to all patients by one of the authors (HG). Follow-up checks were done at 3, 6, and 12 months postoperatively. The patients who did not attend the last follow-up were excluded from the study group. The Seddon classification was used as the functional scoring system. Wound healing, Tinel sign, interosseous atrophy, atrophy of the first web space, clawing, and protective sensation were the clinical findings examined at the follow-ups. Wound healing was classified as either normal scar formation or hypertrophic scar-keloid (HsC) formation. RESULTS: Good results in 4 and fair results in 13 were obtained according to the Seddon classification. Statistically, there was no difference between the clinical findings at the 3, 6, and 12 month follow-ups. CONCLUSION: Presence of HsC and clawing can be regarded as a predictive sign for fair results in nerve repairs.

United unresorbed medial and lateral plicae as anterior mesenchymal synovial septal remnant.

Mesenchymal tissue that forms compartments in the knee joint begins to be resorbed in the 8th week of embryologic life. Unless these mesenchymal tissues are totally resorbed, they remain as septal remnants, and are termed mediopatellar, infrapatellar, suprapatellar, and lateral plicae. We report a case of united anterior plica; the inferior part of the anterior mesenchymal septum at the back of the patellar tendon was unseparated and unresorbed, and one-half of the superior part of the septum beginning from the inferior pole of the patella formed the V-shaped medial and lateral plicae such that their opening looked upwards.