[Course of recurrent dislocation of the patella, patellar syndrome without dislocation and femoropatellar osteoarthritis]. / Evolution de la luxation récidivante de la rotule, du syndrome rotulien sans luxation et de l'arthrose fémoro-rotulienne.

The frequency of recurrent dislocation of the patella is increased by the young age of onset, the presence of patella alta and permanent subluxation of the patella. The natural history of the patellar syndrome appears to be fairly favourable in everyday activities, but discomfort is often marked in the intermediate term in sports activities. Isolated femoropatellar osteoarthritis rarely causes major functional impairment of gait. Medial or lateral femorotibial osteoarthritis occurs secondarily. Painful cases often present with subchondral anomalies of the lateral patellar facet, lateral tibial osteophytosis and patella alta.

[Spontaneous course of femorotibial osteoarthritis]. / Evolution spontanée de l'arthrose fémoro-tibiale.

Medial femorotibial osteoarthritis (MFTO) is characterised by progressive deterioration resulting, in 6 out of 10 cases, in an inability to walk after 10 to 15 years. At the surgical stage, AP films show subchondral bone wear on the edge of the medial tibial plateau with lateral tibial dislocation and lateral films show obliqueness of the medial tibial plateau possibly exceeding 10 degrees and accompanied by anterior subluxation of the tibial or even rupture of the anterior cruciate ligament. Lateral femorotibial osteoarthritis (LFTO), more frequent in women, occurs an average of 7 years later than MFTO, at an average age of 70 years. Instability is often severe. 72% of cases develop clinical valgus deformity of 10 degrees to 20 degrees after an average of 13 years. Recurvatum is also possible. The combination of femoropatellar osteoarthritis, generally lateral, is observed in 23 to 41% of cases, depending on the author, while osteoarthritis of the hip is observed in 10% of cases and chondrocalcinosis is present in 20% of cases. These figures must be interpreted in relation to the usual ageing of the subjects.

[Age at the onset and incidence of chronic pain in knee osteoarthrosis]. / Age de début et fréquence des douleurs chroniques dans la gonarthrose.

The incidence and age of onset of daily knee pain for more than 3 months each year were determined in the various topographical varieties of knee osteoarthrosis (404 knees, 258 patients: 195 women and 63 men). Statistical calculation revealed no significant difference between the incidence of forms without chronic pain in the various topographical types of knee osteoarthrosis. In women, the mean age of onset of chronic pain in lateral femoro-patellar osteoarthrosis was 56.6 +/- 12, in medial femora-tibial osteoarthrosis was 62.7 +/- 12, in the combination of the two 65.2 +/- 10 and in lateral femoro-tibial osteoarthrosis was 69.2 +/- 10. In men, this age in lateral femoro-patellar osteoarthrosis was 60.5 +/- 10 and in medial femoro-tibial osteoarthrosis was 64 +/- 10. Thus lateral femoro-patellar osteoarthrosis caused chronic pain an average of 5 years before medial femoro-tibial osteoarthrosis, and the latter an average of 7 years before lateral femoro-tibial osteoarthrosis.

[Obesity and arthritis of the knee]. / Obésité et gonarthrose.

More than 45 p. cent of patients with degenerative knee arthritis are obese. The overweight is more marked when the medial tibio-femoral and the lateral femoro-patellar aspects are affected. With the same degree of weight gain, the relationship between obesity and degenerative knee arthritis is more marked in women than in men. The significance of the overweight increases the probability of developing degenerative knee arthritis, increasing its functional severity. The obesity precedes the arthritis, and is not its consequence. It is a mechanical effect by increase of the articular strains. It is unknown how long the obesity must be present in order to be pathogenic for the knee and what functional and anatomical improvement may be expected from a weight loss.

[A rheumatologist's point of view on lumbago]. / La douleur lombaire vue par le rhumatologue.

The rheumatologist has to be sure the low back pain of more than three months duration has a mechanical origin, i.e. that it is not due to a tumoral, infectious, metabolic or traumatic vertebral disease. He has to recognise a low back pain from visceral origin and, at the opposite, a functional disorder. The mechanical low back pain may arise from the intervertebral disk, the articular process, a spondylolisthesis, etc... The management includes various physical and medicamentous means; the surgical procedures must be exceptional and have to be done only in highly selected patients. There is a great amount of post-operative sources of low-back pain.

[Gonarthrosis and obesity]. / Gonarthrose et obésité.

Statistical comparison of the weight index of patients presenting arthritis of the knee with that of a control group of matching sex and age, has enabled to demonstrate a definite weight gain in the most frequent topographical varieties of knee arthritis in women: lateral femoro-patellar, medial femoro-tibial, combination of the two. In men, the excess weight was only demonstrated in medial femoro-tibial arthritis.

[Value of the femorotibial angle in 244 patients without knee arthrosis]. / Valeur de l'angle fémoro-tibial de 244 sujets exempts de gonarthrose.

Measurement of the femorotibial angle was performed in 244 patients (134 women and 110 men) without knee arthrosis with roentgenograms taken in the upright position. The values were grouped according to sex and to decade of life. The average value was approximately 0. As defined by the average upper and lower values of the two types of angulation, the normal value in women was 4 degrees of varus and 4 degrees of valgus. In men, the normal value of the right leg was 5 degrees of varus and 5 degrees of valgus; the left leg demonstrated up to 6 degrees of varus and 5 degrees of valgus. After sixty years of age, 5 percent of patients had angulation above these normal values in valgus and varus.

[Radiological study of painless knees in 50 men over 65 years of age. II. Axial projection and profile radiography (author's transl)]. / Etude radiologique des genoux indolores de 50 hommes de plus de 65 ans. II. Radiographies en incidence axiale et de profil.

Radiographs were taken in profile, and femoropatellar axial projection with 60 degrees flexion, in 50 men over 65 years of age who had never complained of symptoms related to their knees. Visible osteophytes of the patella are very frequently noted in profile radiography and were present in 35 subjects. Painless femoropatellar arthrosis is also frequent and this was noted on 60 degrees axial radiography in 7 subjects; unilaterally in 3 cases and bilaterally in 4 subjects. In 9 cases the femoropatellar arthrosis was external, while in 2 cases it was present both externally and internally. Detection of a patellar osteophyte on profile radiography does not necessarily imply the existence of femoropatellar arthrosis detectable radiologically on axial projection. This study was also able to define values for a certain number of the parameters of radiological morphology of the knee.

[Radiological study of painless knees in 50 men over 65 years of age. I. Teleradiography in the frontal position with the patient standing (author's transl)]. / Etude radiologique des genoux indolores de 50 hommes de plus de 65 ans. I. Téléradiographie de face en station debout.

Teleradiographic examinations of the lower limb, from the frontal position with the patient standing, were conducted in 50 men over 65 years of age who had never had painful knees. One knee (out of 100) was found to have an internal femoro-tibial arthrosis. The femoro-tibial angle in the arthrosis-free knees was -0.27" (+/- 2.83 degrees) on the right and -1.10" (+/- 3.05 degrees) on the left. The mean femoro-tibial angle was -0.68" (standard deviation 2.9 degrees), and normal values are therefore -5.5 degrees to +5.1 degrees. There was no evidence, therefore, of statistically significant physiological genu valgum in the population studied. Marginal osteophytes and tibial spines are frequently observed and have no pathological significance. A meniscochondrocalcinosis was present in 8 percent of the subjects.

[Radiological study of painless knees in 50 women more than 65 years old. I. Frontal teleradiography in an upright position]. / Etude radiologique des genoux indolores de 50 femmes de plus de 65 ans. I. - Téléradiographie de face en station debout.

Fifty women over 65 who had never suffered from knee problems had a frontal teleradiography of the lower limbs in a vertical standing position. Two knees (out of one hundred) were affected by an external femoro-tibial arthrosis. The femoro-tibial angle of the knees without arthrosis was very close to 0 (0.02). The typical difference was 2.46. The normal level is thus approximately -5 to +5 degrees, and there was thus no "physiological" genu-valgum in the population studied. Marginal osteophytosis and the tibial spines is very frequent and has no pathological significance. A menischondrocalcinosis was found in 14 per cent of subjects.

[Extensive bony condensation of the vertebrae in intervertebral disc degeneration. (Study of 25 cases)]. / Les condensations vertébrales étendues des discopathies dégénératives. (Etude de 25 cas)

The authors report 25 cases of extensive bony condensation of the vertebrae due to degeneration of the intervertebral discs, giving on lateral XRay a dome-shaped or helmet-shaped appearance. 19 cases occurred in women. Two-thirds of the patients were aged between 35 and 55 years, with an average of 45 years. The lesions were lumbar in 21 patients. They affected in 20 cases two adjacent vertebrae. All the clinical, radiological, pathological and discographic findings, together with the course, confirmed the degenerative origin of these bony condensations, the pathogenesis of which is still not perfectly understood.