Patellofemoral arthroplasty. A 2- to 18-year followup study.

Sixteen patellofemoral arthroplasties in 13 patients were evaluated to assess long term results. Preoperative diagnoses included 10 patients with primary patellofemoral osteoarthritis, 2 patients with posttraumatic osteoarthritis secondary to patellar fracture, and 1 patient with recurrent patellar subluxation/dislocation. The average patient age at surgery was 64 years (range, 42-84 years) and average length of followup was 5.8 years (range, 2-18 years). A modified Hungerford and Kenna knee rating system was used for evaluation, and serial radiographs were assessed for mechanical failure of the components or progressive arthritic deterioration of the knee compartments. Fourteen (88%) of 16 patellofemoral arthroplasties in 11 (85%) of 13 patients were rated as excellent or good. One revision was required at 18 months for persistent patellar malalignment and subluxation, and now is rated as excellent at more than 16 years of followup, modifying the final results to 94% successful patellofemoral arthroplasties in 92% of the study patients. No mechanical failure has occurred, and no patient has required patellofemoral arthroplasty conversion to total knee arthroplasty. Patellofemoral arthroplasty is a viable surgical option for selected patients with isolated patellofemoral arthritis when additional factors, such as extraarticular disease and multicompartment arthritic degeneration, are considered.

Diagnostic and counselling difficulties using a fully comprehensive screening protocol for families at risk for tuberous sclerosis.

Tuberous sclerosis (TS) results from an autosomal dominant gene which exhibits variable expression and reduced penetrance. Although there are well established diagnostic criteria for TS, examination of first degree relatives can cause diagnostic criteria for TS, examination of first degree relatives can cause diagnostic problems with consequent difficulties in genetic counselling. Using an extensive, non-invasive protocol consisting of skin examination with Wood's lamp, cranial CT scan, specialist ophthalmological and dental examination, skeletal survey, and echocardiography, we have examined 56 first degree relatives of persons with TS. These consisted of 40 parents and seven sibs from 25 sporadically affected families and nine persons from seven multigeneration families. In seven of the apparently sporadically affected families, three mothers had echocardiographical findings consistent with one or more rhabdomyoma. In another, the mother's renal ultrasound showed evidence of single cysts in both kidneys. In a fifth family, the father had suggestive but not diagnostic features of TS on the cranial CT scan and skeletal survey. In the sixth family, the mother was found to have atypical calcification on CT scan. In a seventh instance a sib from a two generation family had echocardiographical evidence of a rhabdomyoma. Even though the proband in three of the sporadically affected families presented with fits, developmental delay, and depigmented patches, and therefore did not strictly fulfil the diagnostic criteria for TS, two mothers were found to have evidence of rhabdomyomata on echocardiography and the brother of the third had typical depigmented patches. Although the presently accepted diagnostic criteria for TS may not allow one to make a definitive diagnosis of TS in these relatives, we recommend that an extensive screening protocol be used to examine first degree relatives and that caution be used in counselling apparently unaffected members of families at risk for TS.

Osteochondrosis dissecans occurring in the knee and ankle of the same patient.

Osteochondrosis dissecans is a disease that is known to present in multiple joints. A literature search revealed no reports of this lesion appearing in the knee and ankle of the same patient. Such a clinical presentation is the basis for this report, which is intended to alert clinicians to include osteochondrosis dissecans in their differential diagnosis of knee and ankle pain. A short review of the literature and treatment alternatives is included.

Treatment of acromioclavicular separations. A retrospective study.

A retrospective study of 134 patients with Types I, II, and III acromioclavicular separations was carried out. The average followup was 6.3 years, with the longest being 19 years, and the shortest being 1 year. The mechanism of injury was a direct blow in 92% of the patients. The average age of the patients was 30.1 years, with a range from 13 to 68 years. All patients were evaluated using a standard rating system for the shoulder and humerus, the total for perfect recovery being 100. Twenty-four patients with Type I separations were immobilized 19.5 days, with a disability period of 6 weeks, and rated 94 points. Twenty-five patients with Type II separations were immobilized 27 days for the conservative groups, had a disability period of 6 weeks, and rated 90 points. Eighty-five patients with Type III acromioclavicular separations were followed. Seven patients had conservative treatment, were immobilized an average of 22 days, with a disability period of 13 weeks, and rated 82. Of those patients who underwent surgical repair, excluding Dacron graft substitution, the immobilization period was 6 weeks, with a disability period of 12 weeks, and a rating of 80. Fifty-eight patients underwent repair with double velour Dacron prosthetic substitution for the coracoclavicular ligaments, combined with distal clavicular resection in all but two patients. The average immobilization period was 1 week, with the average disability period being 3 weeks. The average rating was 96, with 24 patients rating 100. The major cause for a rating less than 100 was light to moderate pain that persisted in a few cases, which was only occasional and associated with a particular activity. One infection occurred requiring graft removal 5 months after surgery. Calcification in the area of the coracoclavicular ligaments did not affect the final rating and recurrence of deformity was not noted.

Anatomical and physiologic characteristics to predict football ability. Report of study methods and correlations, University of Arkansas, 1976.

In a prospective study of 56 scholarship players at the University of Arkansas in 1976, 14 anatomical and physiologic measurements were carried out on each of the 56 players, to include certain orthopaedic strength, power, and balance tests, and compared to the coaches' subjective ratings of football ability in an effort to determine which characteristics best correlate to the athlete's true performance. The correlation matrix for the criterion measure and the predictor variables of selected anatomical strength, balance, and power measures are presented, and the results of the study indicate that genu varum (0.445) and tibial torsion (-0.33) had the highest correlation with the coaching criterion variable. The average tibial torsion was 42.6 for these scholarship athletes, while normal average tibial torsion among a nonscholarship group was 27.40 degrees. Other anatomical characteristics measured, as well as strength and power measure, could not reach the critical level of +/- 0.263 to be significant at the 0.05 level, although horsepower was close (0.255). The Margaria-Kalamen power test was significantly related to the 40-yard dash, and a moderately good measure of football ability.

Natural history of anterior cruciate tears.

An evaluation of 361 patients with documented anterior cruciate tears was carried out with analysis of mechanisms, symptomatology, physical findings, and limitations. At the time of injury, patients generally heard a loud pop and felt their knee "slide apart" with a subsequent hemarthrosis. Internal tibial rotation was described as the principal mechanism of iniury in 81.6% of the patients. Less than 20% had a triad type injury. A "crossover" test enabled reproduction of the mechanism. On a 100 point scale, those with "no repair" scored a mean of 55.4, direct repairs 56.7, pes transfers 59.6, and modified MacIntosh 88.9 points. The natural course of a patient can often be projected. A Continuing comparative study of results from treatment regimens and procedures is indicated.

Traumatic lesions of the metatarsophalangeal joint of the great toe in athletes.

In the 1972, 1973, and 1974 football seasons at the University of Arkansas, 74 players sustained sprains of the ankle, producing a total of 152 missed practices and 6 missed games. Although only 18 injuries of the first metatarsophalangeal joint complex were seen, these later resulted in 92 missed practices and 7 missed games. This injury has been a significant problem for both the university and for most other major institutions, judging from a 70% response to 94 questionnaires sent to trainers of 94 large colleges and universities throughout the United States. It is the researchers opinion that the artificial turf surface, particularly as it ages, the shoes, and shoe fitting are all possible contributors to the incidence of the problem. Nonoperative treatment, whose hallmark is rest, is the treatment of first choice. Taping and splinting with a 0.51-mm spring steel splint with reinforcement, both pre- and postinjury, are beneficial. Injections of steroids or any other attempt to return the still painful athlete to activity are contraindicated. Late surgery, particularly in the event of capsular ruptures, as well as early repair, can be of benefit. The need to re-evaluate the shoes and playing surfaces in the light of this and other injuries is emphasized.