Bone-patellar tendon-bone graft via a single minimally-invasive approach versus a classical approach in anterior cruciate ligament reconstruction: a prospective study.

UNLABELLED: Harvesting the patellar ligament for anterior cruciate ligament reconstructions can be a source of anterior knee pain and hypoesthesia of the lateral side of the knee. We analyzed the feasibility of a minimally-invasive technique via a single patellar approach and postulate that it reduces anterior pain and limits the hypoesthesia area. PATIENTS AND METHODS: A prospective, comparative, non-randomized, single-center study was conducted on two groups: one undergoing surgery with the classical anteromedial approach, the other with the minimally-invasive approach. Each group included 20 patients. Both series were reviewed between the 6th and 8th month after surgery. The revision was clinical, radiological, and ultrasonographic. RESULTS: The grafts harvested via the classical approach in all 20 cases presented good characteristics, versus eight out of 18 for the grafts harvested via the minimally-invasive approach. A prominent anterior tibial tuberosity improved the quality of the tibial bone block. A hypoesthesia zone was found in 16 cases out of 18 in the classical approach group, it measured a mean 10.3 ± 5.6 cm(2). A surface area of 3 cm(2) was noted in one case from the minimally-invasive group. No significant difference was found for the subjective and objective IKDC and Lille patellofemoral scores between the two groups. Anterior pain was present in four patients in the classical group and six in the minimally-invasive group. DISCUSSION: The minimally-invasive technique reduces the risk of cutaneous hypoesthesia. It does not prevent anterior pain related to harvesting the patellar tendon and a good-quality transplant can be obtained if the anterior tibial tuberosity is prominent. LEVEL OF EVIDENCE: Level III: case-control study.

FDG-PET improves tumour detection in patients with paraneoplastic neurological syndromes.

To determine the usefulness of [18F]fluorodeoxyglucose (FDG) whole body FDG-PET in the diagnosis of tumours in patients with paraneoplastic neurological syndromes (PNS), we prospectively studied 20 patients with paraneoplastic antibodies in whom conventional imaging gave negative or inconclusive results for the presence of tumour. All 20 patients had neurological manifestations compatible with PNS and well-characterized paraneoplastic antibodies (12 anti-Hu, one anti-Hu and anti-CV2, one anti-CV2, four anti-Yo, one anti-Ri and one anti-amphiphysin). The mean delay between the onset of neurological symptoms and FDG-PET was 10 months (range 1-54). In these 20 patients, abnormal uptake was demonstrated in 18 patients, with some patients having abnormal signal in several areas. We observed abnormal uptake in the mediastinum (13 cases), lung (two cases), breast (two cases), parotid gland (one case), or the cervical, supraclavicular or axillary lymph nodes (seven cases). Following FDG-PET, the histological diagnosis of the tumour was made in 14 patients (small cell lung carcinoma in eight cases, breast adenocarcinoma in two, lung adenocarcinoma in two, axillary metastasis of ovary carcinoma in one, and malignant thymoma in one). Two other patients with abnormal FDG uptake showed radiological evidence of lung cancer, but a histological diagnosis could not be obtained. In two other patients, initial FDG-PET showed abnormal FDG uptake that was not confirmed a few months later by repeat FDG-PET. In the two patients with negative FDG-PET, peritoneal carcinomatosis was diagnosed in one and no tumour was found in the other. In our series, the sensitivity of FDG-PET for tumour detection was >83% demonstrating a clear role of this technique in the management of patients with PNS. However, in our series, the specificity of FDG uptake was only 25% due to unexplained abnormal FDG uptake in three patients and in abnormal FDG uptake due to a benign tumour in one patient. Over the study period, we saw 73 other patients with PNS and paraneoplastic antibodies. A tumour was demonstrated in 71 out of 73 by conventional techniques. Since false-positive and false-negative results are possible with FDG-PET and in most patients with PNS, the tumour is demonstrated by conventional techniques, we believe that FDG-PET should be reserved, at the moment, for patients with well-defined PNS antibodies when conventional imaging fails to identify a tumour or when lesions are difficult to biopsy.

Interstitial lung disease in amyopathic dermatomyositis, dermatomyositis and polymyositis.

This study investigated interstitial pneumonia associated with amyopathic dermatomyositis, dermatomyositis and polymyositis, paying particular attention to muscular and/or cutaneous manifestations and their chronology relative to lung involvement. Patients included four males and 13 females, aged 51.7+/-10.8 yrs, who had surgical lung biopsy. Diagnoses included dermatomyositis (10 patients), polymyositis (four patients) and amyopathic dermatomyositis (three patients). Solitary respiratory manifestations preceded the onset of any skin or muscle disease in four cases (24%). Reticular and ground glass opacities were the most frequent computed tomography (CT) findings. Pathological review showed nonspecific interstitial pneumonia (eleven, 65%; cellular, two; cellular and fibrotic, five; fibrotic, four), usual interstitial pneumonia (two), organising pneumonia (two), lymphocytic interstitial pneumonia (one), and unclassifiable interstitial pneumonia (one). Nonspecific interstitial pneumonia was the most common histological pattern of interstitial pneumonia in patients with amyopathic dermatomyositis (three of three) and in patients with respiratory symptoms as the initial clinical manifestation of the connective tissue disease (three of four). Survival at 5 yrs was 50%. This study shows the clinician should remain alert to potential muscular or cutaneous manifestations whenever a pathological diagnosis of nonspecific interstitial pneumonia is made.

[Posterosuperior glenoid rim impingement in athletes: the diagnostic value of traditional radiology and magnetic resonance]. / Il conflitto glenoideo postero-superiore dell'atleta: valore diagnostico della radiologia tradizionale e della risonanaza magnetica.

First described by Walch in 1991, the posterosuperior glenoid rim impingement syndrome is a major condition in the differential diagnosis of shoulder pain occurring in the athletes engaged in repetitive and loading movements of abduction and extra-rotation of the dominant upper limb. Thirty-eight athletes with these dynamic athletic characteristics, referred for unexplained shoulder pain and with a clinical diagnosis of posterosuperior glenoid rim impingement syndrome, underwent radiography and MR examinations, with excellent final results. Radiography was capable of depicting the abnormal skeletal features of this kind of impingement, thus allowing a preliminary diagnosis to be made. MRI excelled in diagnosing the lesions in the deep surface of the supraspinatus tendon and in the posterior labrum secondary to impingement. The static and the kinematic sequences with the arm in abduction and extrarotation proved to be the best ones to define the physiopathologic phases of impingement. Thus, we conclude that invasive diagnostic procedures are not necessary for the correct and unquestionable diagnosis of posterosuperior glenoid rim impingement syndrome.