Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients.

SUMMARY: Between October 1991 and December 1995, a total of 22 patients (23 knees) underwent meniscal transplantation with nonirradiated, cryopreserved allografts. Implantation was arthroscopically assisted using bone plugs to prevent meniscal extrusion and maintain weight-bearing functional position. Patients were evaluated with an average follow-up of 40 months (range, 13 to 69 months) using the International Knee Documentation Committee, Lysholm, and Tegner scoring systems. The most significant finding was pain reduction after implantation. Lateral and standing anteroposterior radiographs were obtained on all patients at follow-up with an average joint space loss of 0.882 mm (range, 0 to 3 mm). Magnetic resonance imaging was preformed on both knees in 12 of the 22 patients at an average of 24.4 months postoperatively. On average, the allograft meniscus was 63% (range, 31% to 100%) the size of the normal meniscus. Clinical results showed improvement of preoperative pain in all patients. Although patients continue to have good pain relief following their meniscal allograft transplantation, the average shrinkage in the size of the meniscus as shown on magnetic resonance imaging is a concern.

Acute atraumatic compartment syndrome in an athlete: a case report.

OBJECTIVE: To present the case of a college football player with acute, atraumatic, exercise-induced compartment syndrome in the leg. BACKGROUND: Acute, atraumatic, exercise-induced compartment syndrome is an infrequently reported cause of leg pain in the athlete. If left untreated, acute compartment syndrome can cause muscle necrosis. DIFFERENTIAL DIAGNOSIS: Chronic exertional compartment syndrome, medial tibial syndrome, stress fracture. TREATMENT: Treatment consists of compartment fasciotomy. UNIQUENESS: This previously healthy, but unconditioned, athlete developed severe anterolateral left leg pain after two days of fall practice in which he was unable to run a mile in 7.5 minutes. Physical examination by the team physician revealed acute compartment syndrome, and an emergency anterolateral compartment fasciotomy was performed. Second-look débridement performed 48 hours later revealed no significant change in the necrotic appearance of the anterior compartment soft tissue. Therefore, the dead muscle was completely débrided, and a free-flap latissumus dorsi graft was used for coverage of the wound. With recovery, strength returned to normal in the lateral compartment but remained 0/5 in the anterior compartment. The patient had persistent sensory loss in the distributions of the superficial and deep peroneal nerves. CONCLUSIONS: Although much less common than the more frequent causes of leg pain (ie, chronic exertional compartment syndrome, medial tibial syndrome, stress fracture), acute compartment syndrome is potentially more devastating. When the increased intracompartmental pressure within a closed tissue space exceeds capillary perfusion pressure, tissue perfusion is decreased, the soft tissue becomes ischemic, and cells die. The most important clinical diagnostic signs of compartment syndrome are pain with passive stretching of the compartment and pain out of proportion to the results of the physical examination.

The value of the measurement from T5 to T12 as a screening tool in detecting abnormal kyphosis.

Because vertebral endplates above T5 are not consistently seen on standard lateral radiographs, we assessed the reliability of measuring from T5 to T12 to detect abnormal kyphosis in children. Sixty-nine subjects were included, with 43 normal controls. Propst-Proctor and Bleck reported the normal measurement of T5-T12 to be between 20 and 33 degrees. All 69 patients with abnormal kyphosis measured > 33 degrees from T5 to T12. Twenty-four normal subjects had measurements < or = 33 degrees, and 19 measured > 33 degrees. Sensitivity, specificity, and accuracy were 100, 56, and 83%, respectively, when using 33 degrees as the upper limit of normal. In conclusion, a measurement from T5 to T12 of > 33 degrees on lateral thoracolumbar radiographs as a screening for abnormal kyphosis had a sensitivity of 100%. For patients with a measurement > 33 degrees, additional lateral radiographs to visualize the entire thoracic spine above T5 would be warranted.