[Legg-Calve-Perthes treatments and relation between type of treatment and duration of the disease]

Legg-Calve-Perthes disease is one of the most common disabling diseases of childhood and if not managed appropriately is truly disabling. Severity of disease and duration of disease onset are main determinants of choosing treatment strategy of either conservative management or surgical treatment. This study was designed to determine Legg-Calve-Perthes treatments and relation between type of treatment and duration of the disease. This descriptive study was carried out on 50 patients with Legg-Calve-Perthes disease admitted in Ghaem Hospital in Mashhad, North East of Iran from 1995-2005. According to age of patients and severity of disease, the subjects allocated to conservative [11 patients] and surgical treatment [39 patients]. Clinical improvement signs include pain reduction, range of joints motion, which were evaluate by physical examination and taking medical history of patients. In conservative group, only 4 patients assumed to be successfully treated with mean age of 7.25 years and the mean interval between disease onset and beginning of treatment was 2.25 months. Surgical group had mean age of 10.85 years and mean interval between onset of disease and initiation of treatment was 18 months. Conservative group showed less sever form of disease [lateral pillar group A and group B with age less than 8 years], but patients treated surgically were more severely involved [lateral pillar group B with age more than 8 years and group C]. This study showed that age and severity of disease [lateral pillar classification] are main elements in treatment strategy [choosing conservative VS surgical treatment]. The interval between onset of disease and onset of treatment strongly affects treatment success

[Patella femoral joint pain due to degenerative joint disease, conservative and surgical treatment]

Degenerative joint disease in patella femoral joint causes disabling pain in knee motion. When conservative treatment fails, surgery is indicated. In advanced stage those operations that release the stresses on the patella femoral joint by correcting the biomechanics of the joint may be more useful for patients. In this study, we analyzed the clinical outcomes following conservative methods and surgical treatment with tibial tuberosity transfer. Fifty patients, who had severe patella femoral arthritis, after true clinical and radiographic evaluation, were treated with conservative methods. For those patients that did not have improvement after three months and were agree with surgical treatment, tibial tuberosity transfer was done. Patients were followed for one year and were asked about decrease of pain and improvement in daily living function. Altogether, 12 patients [24%] had improvement with conservative methods and in 34 patients after conservative treatment failure who agreed to have surgical treatment had 13 acceptable results [38.2%]. In advanced DJD of patella femoral joint, patients not responding to conservative treatment, may have surgical treatment. Anterior transfer of tibial tuberosity can be considered as a last choice of surgery before TKA and can be accepted and considered

[Comparison of the clinical examination and arthroscopic Findings in internal derangements of knee]

It' s assumed that, while tear of meniscus and ligament causes joint line tenderness; locking or giving way and instability of the knee joint may have other reasons too. In this study, clinical and arthroscopic findings in knee internal derangements were compared. This descriptive study was done in the year 2004 - 2005 On 92 patients [100 knees] refered to knee clinic of Ghaem Hospital with signs and symptoms of meniscus and ligament tear of knee, and admitted in orthopedics ward. All patients were re-examined clinically [with and without GA] and with arthroscopic method, and were managed definitely. Patients with intra - articular fractures and chronic synovitis excluded from the study. Individual, clinical and arthroscopy data were gathered in a questionnaire and processed by Excell software, descriptive statistics, and frequency distribution tables. The age of patients was between 13-71 [mean of 32.1] years, and duration of symptoms was from 15 days to 2 years [with mean of one year]. 60% of patients had stable and 40% unstable knee. Common findings with arthroscopic examination of these patients were: Meniscus tear [75%], degenerative changes [23%], synovial hypertrophy [4%], loose body [4%], osteochondral fractures [2%]. In 16% of the knees, no pathological finding was noted. Thirty seven persent of patients who had knee locking in clinical examination, had normal meniscus in arthroscopy and 34% of patients who had giving way had normal meniscus arthroscopically. Only 27% of patients who had joint line tenderness had tear of the meniscus in knee arthroscopy. In clinical examination 57% of patients had positive Mac Murray test. Only 33% of false negative results for this test was found after arthroscopy. Arthroscopy of the knee is the best method for diagnosis and treatment of the meniscal injuries, but clinical examination is a reliable method to detect these knee injuries