Superior Patellar Dislocation Reduced by Intra-articular Injection: A Case Report and Review of Literature.

CASE: A 53-year-old woman presented with a locked knee after an atraumatic hyperextension episode. Imaging showed an anterior tilt of the patella hinging over the superior trochlear margin, consistent with a superior patellar dislocation. The patella spontaneously reduced on an intra-articular injection with 15 mL of lidocaine in normal saline, after which she was able to actively range her knee. CONCLUSION: Superior patellar dislocations are rare and usually result from a sudden forced contraction of the quadriceps, trapping the patella over superior trochlear osteophytes. Reduction is possible through an intra-articular local anesthetic injection, without manipulation of the patella.

Aneurysmal bone cysts: do simple treatments work?

BACKGROUND: Primary aneurysmal bone cysts (ABCs) are benign, expansile bone lesions commonly treated with aggressive curettage with or without adjuvants such as cryotherapy, methacrylate cement, or phenol. It has been reported that occasionally these lesions heal spontaneously or after a pathologic fracture, and we observed that some ABCs treated at our center healed after biopsy alone. Because of this, we introduced a novel biopsy technique we call "curopsy," which is a percutaneous limited curettage at the time of biopsy, obtaining the lining membrane from various quadrants of the cyst leading to consolidation (curopsy = biopsy with intention to cure). QUESTIONS/PURPOSES: We asked whether (1) a curopsy results in comparable likelihood of healing of the ABC compared with more aggressive approaches involving curettage, (2) the two approaches differ in terms of the likelihood of recurrence after treatment, and (3) the two approaches differ in terms of complications after surgery. METHODS: Between January 1, 1999 and June 30, 2012, 221 patients with a diagnosis of primary ABC were registered in our oncology database. Patients presenting with a pathologic fracture and those seeking a second opinion were excluded. One hundred ninety patients were included in the study. One hundred two (54%) were treated with curopsy and 88 (46%) were treated with curettage after a core needle biopsy. Complete followups were available for 88% (90 of 102) and 93% (80 of 88) of patients in those groups, respectively. During that period, a curopsy was performed for all patients with benign bone lesions with imaging suggestive of classic primary ABCs and for whom the core needle biopsy simply showed blood with no solid component. Curettage after a core needle biopsy was reserved for histologically confirmed primary ABCs, lesions with impending fractures, large lesions, if the ABC was thought to be a secondary disorder, and patients for whom the curopsy failed. All patients were followed up until consolidation of the lesion (mean, 9.6 weeks, range, 3-25 weeks, 95% CI, 8.32-10.9 for curopsy; mean, 11.4 weeks, range, 8-32 weeks, 95% CI, 10.6-12.3 for curettage). The median followup for all patients was 14 months (range, 6-36 months). RESULTS: Of the 102 patients who had curopsy and observation, 83 (81%) required no additional treatment and the lesion resolved. Of the 88 patients who underwent curettage (with or without adjuvant therapy) after core needle biopsy, the success rate was 90% (79 of 88). Local recurrences in both groups (curopsy or curettage) were treated successfully with additional curettage in all but one case. Curopsy in comparison to curettage provided a mean shorter healing time (9.6 versus 11.4, p = 0.01) but there was a higher local recurrence and need for additional intervention rate (18.6% versus 10.2%, p = 0.04). There were no differences in the complications between the treatment groups. CONCLUSIONS: A curopsy is a novel biopsy technique that was successful in resolving ABCs in 81% of the patients in our study. Curopsy, as a biopsy technique, for ABCs needs consideration as it potentially minimizes the number of patients needing a second procedure (a core needle biopsy being the first) as is the current practice. Furthermore, it does not disadvantage the patient or surgeon should additional intervention be needed in the form of curettage with or without adjuvants. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Does the Oxford Knee Score complement, concur, or contradict the American Knee Society Score?

The American Knee Society Score (AKSS) and the Oxford Knee Score (OKS) are commonly used outcome assessment tools following total knee arthroplasty. The literature is sparse with regard to direct correlation between the AKSS and the OKS. The present study aimed to elucidate any direct correlation between these two scoring systems. Preoperative and 1-year postoperative AKSS and OKS from 379 patients were analyzed statistically. Regression equations were developed based on curve fit models. The study found a good correlation between the two scoring systems. The OKS can be used as a screening tool to identify which patients need to be assessed clinically in the short term (<2 years) following total knee arthroplasty (TKA). This will have significant cost-benefit implications. It is also possible to predict the AKSS from OKS using mathematical equations developed for this study. This method of predicting the AKSS from the OKS has not previously been described.