Relevancy and reproducibility of magnetic resonance imaging (MRI) interpretation in multiple-ligament injuries and dislocations of the knee.

INTRODUCTION: After multiple-ligament injuries and dislocations of the knee, clinical assessment of the soft tissues is difficult and MRI is generally performed. HYPOTHESIS: MRI is a reliable examination, providing a precise and reproducible assessment of soft-tissue lesions after multiple-ligament injuries or dislocations of the knee. MATERIALS AND METHODS: Forty patients presenting multiple-ligament lesions of the knee were included in this multicenter prospective study. All had an MRI of the knee in the 48 h following their accident. Thirty-four patients were treated surgically. A 17-item standardized interpretation guide was created. Intraobserver reproducibility was assessed by comparing the interpretations of five surgeons at two different times 3 weeks apart. Interobserver reproducibility was evaluated by comparing the results of the interpretations of 40 MRIs performed by three pairs of surgeons. The relevance of the MRI interpretations was determined by comparing the results of the surgeons to those of a radiologist and with the data from the surgical reports. RESULTS: The overall intraobserver and interobserver agreement was low. Comparing the surgeon's results with the radiologist's results and the surgical data, the agreement was low. DISCUSSION: After multiple-ligament injuries and dislocations of the knee, a precise diagnosis is necessary. This study provides an isolated demonstration of the lack of precision and reproducibility of MRI interpretations for the diagnosis of the lesion's topography. MRI should be integrated into a complete assessment with a precise clinical exam and stress X-rays. LEVEL OF EVIDENCE: Level IV, prospective case-control study.

[Urinary diversion to the augmented and valved rectum: simplified technique]. / Dérivation urinaire rectale à basse pression et anti-reflux: technique simplifiée.

OBJECTIVE: Description of the Ghoneim's low pressure rectal bladder, without colo-colic valve and colostomy. METHOD: Thirty-six patients underwent this simplified technique. RESULTS: The simplification of the technique did not increase the complication. The operating time has been lessened. The closing colostomy was avoided.

Cemented all polyethylene tibial insert unicompartimental knee arthroplasty: a long term follow-up study.

UNLABELLED: Unicompartimental knee arthroplasty outcome is sometimes compared to total knee arthroplasty but various implant parameters might greatly influence this outcome. The objectives of this study were to report the results of a consecutive series of 172 all-polyethylene unicompartmental knee arthroplasties (UKAs) and to detail possible factors of success and failure. HYPOTHESIS: It is possible to outline implant and technique factors determining success or failure in unicompartimental knee arthroplasty. MATERIALS AND METHODS: One hundred seventy-two HLS-type cemented resurfacing UKAs, with the femoral implant made of chrome-cobalt and the tibial implant tibial entirely in polyethylene (without anchorage studs) were consecutively implanted between 1988 and 2004 in 134 patients (111 females and 23 males) in our center according to the indications established in 1988, using the same technique for each surgery. The patients' mean age was 72.2 years (range, 25-90 years). The review rate was 83.7% (144 UKAs), with a mean follow-up of 62.3 months (range, 24-160 months). The series included 84 medial UKAs and 60 lateral UKAs. The clinical data were analyzed using the IKS criteria and the patients had a complete radiological evaluation before surgery and at the last follow-up. RESULTS: The rate of satisfied or very satisfied patients was 97.2%. No pain or slight pain was found in 81% of the cases. The mean flexion was 133 degrees (range, 85-150 degrees). The mean knee score varied from 63.6 before surgery to 91.5 (90.4 for medial UKAs and 92.9 for lateral UKAs) and the function score from 63.6 to 83.8 (84.7 for medial UKAs and 82.6 for lateral UKAs). The mean range of motion was 133 degrees (range, 85-150 degrees), better than the medial UKAs for osteonecrosis. The mean residual deformity was 4 degrees varus for the medial UKAs and 2 degrees valgus for the lateral UKAs. A radiolucency was found in 23% of the cases (20% tibial and 3% femoral), nonprogressive in all cases. In 87.2% of the cases, the opposite femorotibial compartment remained radiologically normal. No progression to osteoarthritis in the femoropatellar joint required additional surgery. Sixteen patients required revision surgery: in six cases, the implant was removed and a total prosthesis implanted (one late infection, one case of involvement of the opposite compartment, and four cases of tibial component loosening). In the other cases, one tibial baseplate was changed, five arthroscopies were done, and four unicompartmental knee replacements were done on the opposite compartment. The Kaplan-Meier survival rate (taking into account the revisions with implant change) was 95.6. The results of this series were very satisfactory and were similar to recent series in the world literature that showed survival rates between 90 and 98% at 10 years, rates that are equivalent to those found for total knee replacements. The mean flexion range of motion found was higher than the majority of other recent series, probably because of the precise patient selection in the present study, a minimally invasive approach, and the femoral implant design with an ascending condylar posterior cut. The deterioration of the contralateral compartment is frequently reported, but was perhaps prevented by the absence of overcorrection and patient selection. In this series, none of the UKAs was revised for wear. We explain this by the systematic preservation of a moderate undercorrection, particularly for medial UKAs, the quality of the polyethylene, and a selection based on patient weight and age. CONCLUSIONS: The option of an all-polyethylene tibial implant, with minimal bone cuts (femoral resurfacing), makes excellent long-term results possible.

Medial unicompartimental knee arthroplasty for osteonecrosis or osteoarthritis.

We report a prospective series of 33 unicompartmental knee arthroplasties (UKAs) operated for a spontaneous osteonecrosis of the knee (SPONK) compared with 35 UKAs operated for osteoarthritis (OA). The mean follow-up was 5 years. Preoperative functional score in the SPONK group was significantly lower than that in the OA group. The results were comparable in terms of pain, knee score and function. At the last follow-up, the survival rate was 92.8% for the SPONK group and 95.4% for the OA group. We found a higher rate of radiolucencies in the SPONK group, however, without any clinical symptoms. The UKA is a good option in the treatment of SPONK.

[Pseudosarcoma of the bladder. Apropos of a case of inflammatory tumor of the bladder]. / Pseudo-sarcome de la vessie. A propos d'une observation de tumeur inflammatoire de la vessie.

The authors report a case of benign pseudosarcoma of the bladder and emphasize the endoscopic features of the tumour, which were highly suggestive of malignancy, leading to the decision to perform cystectomy. The diagnosis was corrected by endoscopic resection and histology. Treatment usually consists of partial cystectomy, but can sometimes be limited to one or several endoscopic resections.

[Endoscopic treatment of uterine myoma]. / Traitement endoscopique des myomes utérins.

The technique and results of endoscopic resection of submucosal uterine myoma performed in a series of 42 cases are presented. Following hysterography and hysteroscopy, endoscopic resection is carried out through a dilated cervix and under glycol infusion. The technique is very simple and the duration of the operation never exceeds 30 minutes. The postoperative period is short, and the average length of stay in hospital varies from 24 to 48 hours. Resection of submucosal myoma usually enables treatment with progestins to be discontinued. Moreover, when the submucosal myoma is not very large and solitary this technique offers an alternative to hysterectomy.

[Fabian's spiral endoprostatic prosthesis]. / La prothèse endoprostatique spirale de Fabian.

This involves a supple metal prosthesis placed in the posterior urethra to relieve cervico-prostatic obstruction whilst allowing for normal function of the striate sphincter as well as satisfactory bladder drainage with normal continence. Easily inserted under local anesthesia and without morbidity, with a perfect functional result in the great majority of cases provided indications are complied with, i.e. essentially prostatic hypertrophy with retention. This prosthesis is designed for use in patients with temporary or permanent contraindications to surgery. Compliance with the very precise technique for insertion, under optical and televisual control, as well as with surgical contraindications (neurological bladder, cerebral arterial sclerosis, concomitant bladder lesion), ensures a good result. This prosthesis thus avoids the need for an indwelling catheter.

[Urokinase (in situ) in the case of acute ischemia of the lower limbs (author's transl)]. / L'urokinase in situ dans l'ischémie aiguë des membres inférieurs.

Eighteen patients with severe, acute ischemia of the lower limbs were treated with an arterial perfusion of the ischemic leg with Urokinase. This was associated, in thirteen patients, with a limited attempt of revascularization. The result of this treatment was an immediate improvement in twelve cases, which lasted, more than six months, in six patients. The authors insist on the interest of the arteriography performed after the fibrinolytic treatment in order to complete the revascularization.

[Acute duodenal ulcers complicating Listeria meningitis (author's transl)]. / Ulcères aigus duodénaux compliqués au cours des méningites à Listeria.

The authors report 3 cases of acute complicated duodenal ulcers occurring during the course of Listeria meningitis. These three adults (2 females and 1 male) suffered from localised neurological involvement and, in 2 cases neurovegatative disorders an altered level of consciousness. The ulcers were situated in the duodenal cap, and in each case there were at least 2 large excavated ulcers. These ulcers were the site of late complications on the 13th and 15th days after the onset of neurological disease. In two cases the major symptom was haemorrhage, whilst in the third it subsided leaving a syndrome of peritonitis due to perforation. Treatment in all three cases consisted of vagotomy with pyloroplasty (the ulcers being excised or sutured). All the patients recovered from their digestive complications without relapse despite the persistence 6 and 10 months later of the same neurological problems in two of them. All these facts would be in favour of a neurogenic aetiopathogenesis, via the vagal nerve. Thus acute late duodenal ulcers in patients with neurological disease from a separate enity within the context of stress lesions.

[Ttoal hip arthroplasty after arthrodesis (desarthrodesis)]. / Arthroplastie totale dans les hanches arthrodésées (désarthrodèses).

A report is given on 24 cases of desarthrodesis of the hip long after arthrodesis, in one case after 73 years, the patient being a woman of 84, and in several cases after 40 years. In all cases the results were satisfactory and recovery was excellent despite the long duration of the arthrodesis. Desarthrodesis is therefore a valuable operation which may be indicated in cases where position is poor or lumbalgia inhibits the function.