Popliteus tendon tenosynovitis.

This case report highlights an unusual cause of anterolateral knee pain. The popliteus muscle arises from three origins--that is, the lateral femoral condyle, the fibula head, and the lateral meniscus--and inserts into the proximal tibia above the soleal line. It may be subjected to a number of pathologies including tenosynovitis, acute calcific tendonitis, rupture, and even avulsion. In this case, the diagnosis of popliteus tendon tenosynovitis was not made from magnetic resonance imaging findings, but was confirmed and successfully treated during arthroscopic examination.

Early dislocation after total hip arthroplasty: are postoperative restrictions necessary?

We studied prospectively 499 cases of primary total hip arthroplasty done through an anterolateral approach to establish the early dislocation rate when restrictions on postoperative mobilization were not imposed. There were 3 early dislocations (within 6 weeks of surgery). All were reduced closed, and every patient subsequently achieved a stable hip without further intervention. Our results suggest that a low early dislocation rate can be achieved using an anterolateral approach without the need to restrict patients' postoperative mobilization. It may not be appropriate, however, to remove these restrictions when using other surgical approaches to the hip.

Development of the hip in multiple epiphyseal dysplasia. Natural history and susceptibility to premature osteoarthritis.

We have determined the natural history of hip development in 42 patients with multiple epiphyseal dysplasia (MED). Premature osteoarthritis was a frequent outcome and was almost inevitable before the age of 30 years in those with incongruent hips. There were two types of immature hips: type I, the more severe form, had a fragmented and flattened ossific nucleus and acetabular dysplasia, was misshapen at skeletal maturity and osteoarthritic by 30 years of age; the milder type II hip had a small, rounded, uniformly ossified nucleus and a more normal acetabulum. Type II hips were well formed at maturity and were less prone to premature osteoarthritis. Considerable variations were noted in the manifestations of MED between families but not within families. The prognosis of a child's hip could be predicted; in sporadic cases from the type of immature hip, and in familial cases by also taking into account the outcome of affected relatives.

Maintenance of cell viability in stored bone.

Although stored autogenous bone is routinely used for bone grafting in spinal surgery, the cellular elements of this bone do not survive the period of storage under standard conditions. By the use of tissue culture techniques, the authors show that it is possible to keep bone cells alive for many weeks. The potential advantages of maintaining cellular viability in grafted bone is discussed.

Classification of congenital abnormalities of the sacrum. Patterns of associated dysfunctions.

Fifty-eight patients with a congenital abnormality of the sacrum were studied; a modified classification is suggested. Type 1a is characterized by an abrupt termination of the sacrum with an otherwise normal spinal column. Type 1b shows a similar sacral deficit, but with abnormalities evident higher in the spine. In Type 2 the terminal spine is malformed, and in Type 3 there is posterior sacral dysraphism. A high incidence of concomitant congenital abnormalities was found in Types 1 b and 2. Bladder dysfunction in the absence of typical clinical signs was often found in Types 1a and 1b.

Congenital absence of the scaphoid in the "VATER" association.

A rare carpal anomaly is reported in a patient with multiple congenital abnormalities. A literature search reveals few such cases, but a characteristic clinical picture emerges. Patients with this deformity should be carefully examined to exclude other congenital abnormalities.