Intercondylar notch encroachment following anterior cruciate ligament reconstruction: a prospective study.

Intercondylar notch impingement is a recognized cause of graft failure following anterior cruciate ligament (ACL) reconstruction and typically is attributed to anterior tibial tunnel placement or inadequate notchplasty. This prospective study assessed the incidence and nature of notch regrowth following initial ACL reconstruction. The study population was comprised of 36 patients who underwent ACL reconstruction using a patellar tendon-bone autograft. A 3- to 5-mm notchplasty was performed in all patients, and an intraoperative radiograph was taken confirming proper tunnel placement. Magnetic resonance imaging (MRI) was performed the first week following surgery and again at 6 months. The MRIs were reviewed by two skeletal radiologists to evaluate postoperative notch and graft changes. Of the 36 study patients, 28 (78%) knees showed no evidence of graft impingement as defined by graft indentation and intra-substance edema. The MRIs of 8 (22%) patients showed evidence of graft impingement. Four patients had clinical signs of graft impingement, namely persistent effusion or lack of full extension. Arthroscopically, 3 of these patients demonstrated graft encroachment and impingement by fibrocartilage with areas of immature bone. These results indicate that graft impingement from regrowth of the notch is a clinically relevant phenomenon that could potentially result in late graft demise in the ACL-reconstructed knee.

Meniscal repair in the goat model. The use of healing adjuncts on central tears and the role of magnetic resonance arthrography in repair evaluation.

We evaluated the effect of adjunctive healing measures on central tears of the adult goat medial meniscus and the role of magnetic resonance arthrography in the assessment of menisci that have undergone a repair. Peripheral tears were made unilaterally in the medial menisci of seven goats in Group I and repaired with nonabsorbable suture. Six Group II goats had central medial meniscal tears repaired as in Group I plus an exogenous fibrin clot. Eight Group III goats had central tears plus abrasion of the parameniscal synovium and tear edges. Six months after surgery, a magnetic resonance imaging scan and a magnetic resonance arthrogram were obtained and the menisci were examined grossly. Group I goats showed healing in all seven knees. Central tears repaired with a fibrin clot (Group II) showed healing in one of six knees (17%). Central tears repaired with abrasion (Group III) showed healing in seven of eight knees (87.5%). Magnetic resonance arthrography was 100% accurate in detecting the presence or absence of complete residual tears. This study supports the current trend of using adjunctive measures for repair of central tears. Furthermore, abrasion of the parameniscal synovium and the tear edges appears to be more effective than the use of an exogenous fibrin clot. Magnetic resonance arthrography is useful in the evaluation of menisci that have undergone repair.

MR imaging findings in anterior cruciate ligament reconstruction: evaluation of notchplasty.

OBJECTIVE: Notchplasty, resection of bone from the roof and lateral side of the inter-condylar notch, is frequently performed during anterior cruciate ligament (ACL) reconstruction to avoid abrasion or deflection of the ACL graft by the femur (graft impingement). Graft impingement can develop months after the initial reconstruction despite adequate notchplasty. Such impingement has recently been attributed to fibrocartilage overgrowth of the notchplasty site. The objectives of this study were to evaluate the MR appearance of the notchplasty site immediately after surgery and 6 months later and to investigate whether cartilage overgrowth of the notchplasty site can be detected with MR imaging. SUBJECTS AND METHODS: Thirty-three patients who underwent bone-tendon-bone autograft ACL reconstruction had MR scans of the intercondylar notch 6 months after surgery. Twenty-five of these patients also had MR scans in the immediate postoperative period. The appearance of the notchplasty site and evidence for cartilage overgrowth of the notchplasty site were evaluated. Arthroscopic correlation was available for six patients. RESULTS: On MR images, the margins of the notchplasty site were identified in all patients. Contour of the notchplasty site along the lateral notch wall was frequently concave toward the notch, a finding not commonly seen in an unoperated notch. Six months later, the shape of the notchplasty site had not changed, but evidence for recortication of the notchplasty site (seen as a layer of signal void 0.5-1.5 mm in thickness over the previously exposed cancellous bone) was seen in 94% of the patients. Additionally, a second layer of signal void, 1-5 mm in thickness with signal intensity identical to that of hyaline cartilage, was seen overlying the notchplasty site in 64% of patients. Arthroscopic correlation available in six patients suggested that this second layer represented fibrocartilage overgrowth of the notchplasty site. CONCLUSION: Characteristic changes of the intercondylar notch after notchplasty can be seen on MR images. This preliminary study also suggests that a thin layer of cortical bone forms over the notchplasty site in most patients within 6 months of surgery. Perhaps more significantly, overgrowth of the notchplasty site by fibrocartilage may also be detected in some patients. Further experience is needed to determine whether MR imaging is a useful method for identifying cartilage overgrowth after notchplasty.

Traumatic spondylopelvic dissociation. A case report and literature review.

STUDY DESIGN: A case of traumatic spondylopelvic dissociation and a method of fixation are described. OBJECTIVES: The treatment of this rare injury pattern required differentiation from less severe lumbosacral fracture-dislocations or bilateral sacroiliac joint dislocations. SUMMARY OF BACKGROUND DATA: Several case reports have described less severe fracture patterns, but only a handful have illustrated true spondylopelvic dissociation in which there is complete displacement of the lumbar spine into the pelvis. METHODS: After initial stabilization at an outside hospital, the patient was transferred to the authors' institution for definitive care. After computed tomography imaging with three-dimensional multiplanar reconstruction, the fracture was stabilized with a pedicle screw construct attached to the pelvis by means of the Galveston technique. Bilateral iliosacral screws were used to increase stability. RESULTS: At a 2-year follow-up, the patient was pain-free and ambulating in an ankle-foot orthosis. He had a persistent deficit involving the right L5 and S1 nerve roots but was continent of stool. CONCLUSIONS: The unique fracture pattern described in this patient is presented to offer better insight into management of this complex injury and to delineate it from simpler patterns of injury to the lumbosacral junction.

Anabolic steroid education and adolescents: do scare tactics work?

The opinions (level of agreement) of high school varsity football players with regard to reported effects of anabolic steroids were assessed before and after two different education interventions. Lectures and handouts of a balanced education program (potential risks and benefits) were compared with a risks-only (negative or "scare tactics") presentation, in a controlled manner. Those receiving the balanced review significantly increased their agreement with 5 of 10 targeted adverse effects, while no change occurred for any risks among those taught by the negative intervention. A teaching model that only emphasizes the untoward consequences of anabolic steroids is ineffective, even in the short-term. A balanced education approach can improve understanding of the potential adverse effects of these drugs. Additional strategies may be required to change young athletes' attitudes toward anabolic androgenic steroid use.

Effect of an anabolic steroid education program on knowledge and attitudes of high school football players.

Six varsity high school football teams were assessed by confidential questionnaire regarding anabolic steroids, before and 2 weeks after an education intervention. The education program used the American College of Sports Medicine's position on the "use of anabolic androgenic steroids in sports." Two teams received a lecture and a four-page handout, two teams were given the handout only, and two teams were controls. Self-report of current use was 1.1% but 38.8% claimed availability of these agents. Although increased awareness of the adverse effects of anabolic steroid was found after the education program, no differences in attitudes toward the use of anabolic steroids occurred as compared to controls. Strategies designed to dissuade adolescent athletes from considering these drugs need to be developed.

[Clinical course of 470 patients with mitral valve prolapse]. / Klinischer Verlauf bei 470 Patienten mit Mitralklappenprolaps.

The clinical relevance of the echocardiographic finding of mitral valve prolapse (MVP) is largely unclear. Therefore we made a prospective study of 470 patients with MVP established by M-mode echocardiography (63.7% holosystolic, 36.3% late systolic) over an average period of 2.7 years, corresponding to an observation period of 1,269 patient years. Patients with hemodynamically relevant mitral insufficiency were excluded from the study, as were patients with additional cardiac disorders. Three patients died, two of non-cardiac causes, but one probably in sudden cardiac death. 54.8% complained of angina pectoris, 15.6% of dyspnea. 14.4% suffered from non-orthostatic vertigo. 23.3% had one or more syncopes, 14.9% for the first time during the period of observation. 43.4% suffered from rhythm disturbances, 10.2% for the first time during the period of observation. Patients with rhythm disturbances experienced non-orthostatic vertigo (p less than 0.01) and syncopes (p less than 0.01) more frequently than patients without rhythm disturbances. During the study none of the patients developed endocarditis and none had an arterial embolism. Patients with late systolic MVP and a click experienced syncopes more frequently than those with holosystolic MVP without a click (p less than 0.05). Further correlations between the echocardiographic picture, auscultatory findings, age, sex and weight on the one hand and clinical progress on the other hand, were not found. Thus prognosis for MVP with regard to survival seems to be good. Nonetheless, complaints, even potentially threatening syncopes, are frequent. Neither clinical nor echocardiographic findings permit a prognostic statement.