The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation.

In a prospectively randomized study including 68 patients, the results of inside-out horizontal meniscus suturing were compared to meniscus repair using the meniscus arrow. 96% of the patients underwent re-arthroscopy after 3-4 months. Only lesions in the red/red or red/white areas were included. Patients were treated with a hinged brace for 9 weeks. 30 patients had an isolated bucket-handle lesion. In 19 cases the repair was done in conjunction with an ACL reconstruction and in 19 cases the repair was performed in an ACL-insufficient knee. The two groups were comparable. Operating time in the arrow group was one half that of the suture group. Of 65 re-arthroscopies, 91% of the patients had healed or partially healed in the arrow group compared to 75% in the suture group (P = 0.11). In only 50% of the non-healed cases was this clinically suspected prior to control arthroscopy. The difference between healing in ACL-reconstructed and ACL-insufficient knees was not significant. Two patients in the suture group had a deep infection. There were no serious neurovascular injuries. Five patients in the suture group and two patients in the arrow group had symptoms in the saphenous nerve area. All patients had some synovial irritation at control arthroscopy but no severe reactions to suture or arrows were seen. Short-term results with meniscus arrows, based on healing and evaluated by second-look arthroscopy, seem promising.

Subcapital fracture of the femoral neck following internal fixation with a dynamic hip screw.

A case of subcapital femoral neck fracture following osteosynthesis of a trochanteric fracture is described. The implant used was the dynamic hip screw. This kind of fracture is very rare, and has to our knowledge never been described with the use of the dynamic hip screw.

[Cervical dilatation with Lamicel in gravida I women applying for termination of pregnancy]. / Cervikal dilatation med Lamicel til abortsøgende gravida I.

Thirty primigravidae referred for termination of pregnancy in the first trimester participated in a prospective randomised investigation. The object of this investigation was to determine the extent of cervical dilatation obtainable employing a new osmotic cervical dilator, Lamicel. In fifteen patients, a 3 mm Lamicel rod was introduced four hours prior to abortion by suction and fifteen patients functioned as the control group. In the treated group, dilatation of the cervix was commenced with a cervical diameter of 7 mm compared with 3 mm in the control group (p less than 0.01). Four patients stated that they experienced transient pain on introduction of Lamicel. No differences in the nature and frequencies of complications were observed between the groups. Employment of Lamicel provides gentle and effective dilatation of the cervical canal and the method is thus considered as suitable for termination of pregnancy.

Nine-year follow-up of the cementless Ring hip.

Because of the revived interest in cementless hip prostheses, 238 Ring prostheses from the period 1968 to 1979 were reviewed; 127 hips with a median follow-up of 9 years were available for examination. Two thirds of the hips were rather painless, and 90 percent of the patients graded their result as excellent or good. Six hips had had a deep infection requiring removal of the prostheses in two hips, and 37 prostheses were removed because of loosening. By actuarial analysis the overall probability of survival and the average annual probability of removal were found to be 81 and 1.7 percent, respectively, after 12 years. The long-term survival of the Ring prosthesis seems to be comparable to the survival of some commonly used cemented prostheses.

Rupture of the knee capsule from articular hyperpressure. Experiments in cadaver knees.

We used 10 cadaver knees to estimate the safe pressure during arthroscopy by measuring the volumes and pressures of irrigation fluid at different flexion angles. Maximum volumes could be contained at 35 degrees of flexion. Pressures of 200 to 450 mmHg were measured, and all the knees ruptured by extension or flexion after they were filled to 100 mmHg at 35 degrees of flexion. Fifty milliliters of irrigation fluid had to be removed if the pressure remained constant when extending from 35 degrees and 70 ml when flexing to 90 degrees. Totally, 100 ml irrigation fluid had to be removed when flexing from 35 degrees to 120 degrees. Our investigation indicates that a pressure of 150 mmHg can be tolerated by all knees. Both flexion and extension from the 35 degrees position must be done gently and slowly using a large bore, wide-open inflow and outflow tubes allowing egress of irrigation fluid to prevent capsular rupture, extravasation of irrigation fluid, vascular compromise, or compartment syndrome.

Displacement of lidocaine from human plasma proteins by disopyramide.

Displacement from human plasma proteins of lidocaine by disopyramide was investigated in serum from nine patients receiving lidocaine treatment because of severe ventricular arrhythmias. From each patient disopyramide in concentrations of 5.9 and 14.7 mumol/l was added to three different serum concentrations of lidocaine and the displacement was examined. At a serum concentration of disopyramide of 14.7 mumol/l the percentage of unbound lidocaine increased from 30.4 +/- 0.2 to 36.3 +/- 0.2% (mean +/- S.E.M., P less than 0.001) at an average total serum concentration of lidocaine of 22.7 mumol/l. The study implies a stronger binding affinity of disopyramide than lidocaine to alpha-1-acid glycoprotein. We recommend caution when using disopyramide immediately after an infusion of lidocaine. With the dosage regimen used serum concentrations considerably above the suggested therapeutic level were achieved in the majority of patients.