ABSTRACT
In athletes with anterior cruciate ligament (ACL) tears combined with meniscal and cartilage injuries, the goals are to restore knee laxity and relieve symptoms, while long-term goals are the return to pre-injury sport activity and to prevent onset of degenerative changes. We compared the post-operative (minimum 5 years) clinical and radiological outcomes of 50 patients, similar for ACL rupture and meniscal tears, but different for the grade of cartilage lesion. The patient population was divided into two groups similar for ACL reconstruction and surgical meniscal management. Group 1 included 25 patients undergoing microfracture management of grade III-IV cartilage lesions, while Group 2 included 25 patients with grade I-II cartilage lesions, managed by radiofrequency. Comparing pre- and post-operative status, Lachman test, pivot shift values and KT 1000 side to side difference measurements improved significantly (<.001) in both groups, with NS difference between the two groups (>0.05) at the intermediate and latest assessments. At both post-operative appointments, in both groups, the average Lysholm score and IKDC ranking rates improved significantly (<0.001) compared to pre-operative values, but slight worsening was observed in Group 1 patients at the latest review. At the latest assessment, 10 knees (40%) in Group 1 and 3 knees (15%) in Group 2 demonstrated degenerative changes according to Fairbank grading. Concerning the WOMAC index score and sport activity level rating, Group 1 patients had significantly lower scores than Group 2 patients (P < 0.05). In patients with symptomatic ACL instability combined to grade III-IV cartilage lesions, microfractures give excellent short-term clinical and functional improvement but do not prevent the evolution of degenerative changes.
Subject(s)
Anterior Cruciate Ligament/surgery , Knee Injuries/surgery , Menisci, Tibial/surgery , Plastic Surgery Procedures/methods , Range of Motion, Articular/physiology , Adult , Anterior Cruciate Ligament Injuries , Arthroscopy/methods , Athletic Injuries/diagnostic imaging , Athletic Injuries/surgery , Cartilage, Articular/injuries , Cartilage, Articular/surgery , Cohort Studies , Debridement/methods , Female , Follow-Up Studies , Humans , Injury Severity Score , Knee Injuries/diagnostic imaging , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Multiple Trauma/surgery , Radiography , Recovery of Function , Risk Assessment , Sprains and Strains/surgery , Statistics, Nonparametric , Tibial Meniscus Injuries , Time Factors , Treatment Outcome , Young AdultABSTRACT
We report on a case of an osteolytic lesion of the femur in a patient with previous prostate cancer, affected by hip osteoarthritis. Computed tomography of the femur demonstrated the presence of fat in the lesion. Computed tomography-guided fine needle aspiration biopsy revealed mature adipose tissue along with hematopoietic precursor cells. Surgical management consisted of curettage and packing with allograft, followed later by total hip arthroplasty. This is the third case of intraosseous myelolipoma reported in the literature.
