ABSTRACT
INTRODUCTION: A prospective arthroscopic study on 140 knees to discover the etiopathogenic mechanism responsible for idiopathic patellar syndrome (IPS) was carried out. MATERIALS AND METHODS: Patients were grouped into two categories: One group with idiopathic patellar syndrome (76 patients, 53 male and 23 female), the other group (control group) presenting no patellar pathology in clinical, radiological and arthroscopic examinations (64 patients, 55 male and 9 female). The author analyzed the statistical differences using 9 clinical and morphometric parameters in the IPS group and the control group. The morphometric index PTO/LNPL (PTO: distance between the medial upper end of the tibia and the inferior border of the pes anserinus. LNPL: width of medial tibial surface) seems to be a valid reference index (p = 0) for the diagnosis of IPSI caused by internal rotatory muscle deficiency. RESULTS: The X2 test showed significative correlation (p < 0.05) between sex and IPS. The incidence of IPS was 1/1 in males and 2.5/1 in females. The PTO/LNPL value in this syndrome was higher than 1.1. No patient in the IPS group had spontaneous recovery, nevertheless, 86.8 per cent of patients has a good result after 6 months of physical therapy of the internal rotatory muscles. DISCUSSION: The high distance between the medial upper end of the tibia and the inferior border of the pes anserinus in knees with IPS as well as the good results obtained by physical therapy of the internal rotatory muscles leads the author to suggest a new etiopathogenic mechanism for IPS: some idiopathic patellar syndromes may be caused by an isolated internal rotatory muscle deficiency of the leg. CONCLUSION: The author concludes with two therapeutic suggestions: 1. physical therapy of the internal rotatory muscles should be used in patellar syndromes caused by deficiency of internal rotatory muscles. 2. Methods which sacrifice internal rotatory muscles in knee ligament surgery should be avoided as these could lead to a possible patellar syndrome by deficiency of internal rotatory muscles.
Subject(s)
Joint Diseases/etiology , Knee Joint , Pain/etiology , Patella , Adolescent , Adult , Arthroscopy , Child , Data Interpretation, Statistical , Female , Humans , Joint Diseases/diagnosis , Joint Diseases/physiopathology , Joint Diseases/therapy , Knee Joint/physiopathology , Male , Middle Aged , Pain/physiopathology , Prospective StudiesABSTRACT
A posterior cruciate ligament avulsion fracture (PCLAF) of the knee can be repaired through a large approach. A new technique based on internal fixation under arthroscopic control employed a posterolateral puncture. The fracture was reduced and the osseous fragment transfixed using a new forceps guide. The osseous fragment was stabilized through a tunnel drilled from the proximal anterior aspect of the tibial metaphysis by means of a cortical screw and an intraarticular nutwasher. The technique was made in eight undamaged normal fresh knees from distal ischemic amputated lower limbs. In six knees the technique was successful. In two knees the presence of hypertrophic synovium impeded a good visualization and the technique failed. In the hands of arthroscopic surgeons, this technique could be an effective alternative to arthrotomy in the treatment of PCLAF.
Subject(s)
Ligaments, Articular/injuries , Tibial Fractures/surgery , Aged , Aged, 80 and over , Arthroscopy , Bone Screws , Female , Humans , Ligaments, Articular/surgery , Male , Orthopedic EquipmentABSTRACT
Synovial oedema is a frequent complication in arthroscopic procedures performed with normal saline as the irrigating fluid. The authors have studied the effect of saline solution, Ringer lactate, 5% Dextran and 10% Dextran in normal saline on 12 specimens of human synovial membrane. They found that 10% Dextran in normal saline decreases the water content of the synovium without causing damage, and recommend this solution for procedures lasting longer than 30 minutes.
Subject(s)
Arthroscopy , Dextrans/therapeutic use , Edema/prevention & control , Isotonic Solutions/therapeutic use , Sodium Chloride/therapeutic use , Synovial Membrane , Therapeutic Irrigation , Arthroscopy/adverse effects , Dextrans/administration & dosage , Dextrans/pharmacology , Edema/etiology , Humans , Hydrogen-Ion Concentration , Isotonic Solutions/pharmacology , Joint Diseases/diagnosis , Knee Joint , Osmolar Concentration , Ringer's Lactate , Sodium Chloride/pharmacology , Solutions , Synovial Membrane/anatomy & histology , Synovial Membrane/drug effectsABSTRACT
A 20-year-old heroin user developed staphylococcus septic arthritis of the manubrium joint. The diagnosis was established by a culture of the infected tissue and blood culture. The clinical impression was aided by 99mTc radionuclide scintimetry. Early diagnosis localized the infection. Immediate antibiotic therapy solved a problem in the sternum that seems not to have been reported in the English literature.
Subject(s)
Arthritis, Infectious/etiology , Heroin Dependence/complications , Manubrium , Staphylococcal Infections/etiology , Sternum , Adult , Arthritis, Infectious/diagnostic imaging , Humans , Male , Manubrium/diagnostic imaging , Radiography , Radionuclide Imaging , Sternum/diagnostic imaging , TechnetiumABSTRACT
Synovial oedema is a frequent complication in arthroscopic procedures performed with normal saline as the irrigating fluid. The authors have studied the effect of saline solution, Ringer lactate, 5% Dextran and 10% Dextran in normal saline on 12 specimens of human synovial membrane. They found that 10% Dextran in normal saline decreases the water content of the synovium without causing damage, and recommend this solution for procedures lasting longer than 30 minutes.
