Autologous chondrocyte implantation for traumatic full-thickness cartilage defects of the knee in 14 patients: 6-year functional outcomes.

BACKGROUND: Autologous chondrocyte implantation (ACI) was introduced in 1987 in Sweden by Brittberg and Peterson for the treatment of severe chondral defects of the knee. Here, our objective was to evaluate mid-term outcomes of ACI in young athletic patients with deep chondral defects of the knee after trauma. HYPOTHESIS: ACI is effective in filling full-thickness chondral defects of the knee. PATIENTS AND METHODS: We prospectively monitored 14 patients, with International Cartilage Repair Society grade III or IV lesions, who underwent ACI between 2001 and 2006. Standard evaluation measurements were used. Mean age at surgery was 37.7 years (range, 30-45). A history of surgery on the same knee was noted in ten (67%) patients. The defect was on the medial femoral condyle in 11 patients, lateral femoral condyle in two patients, and both femoral condyles in one patient. Mean defect surface area after debridement was 2.1cm(2) (1-6.3). RESULTS: After a mean follow-up of six years, improvements were noted in 12 (86%) patients, with an International Knee Documentation Committee (IKDC) score increase from 40 (27.6-65.5) to 60.2 (35.6-89.6) (P=0.003) and a Brittberg-Perterson score decrease from 54.4 (11.8-98.2) to 32.9 (0-83.9) (P=0.02), between the preoperative assessment and last follow-up. The visual analogic scale pain score decreased from 66.3 (44-89) to 23.2 (0-77) (P=0.0006). In two (14%) patients, no improvements were detectable at last follow-up. The remaining 12 patients were satisfied and able to resume sporting activities, albeit at a less strenuous level. Two ACI-specific complications occurred, namely, periosteal hypertrophy treated with debridement in one patient and transplant delamination in another. DISCUSSION: Our findings are consistent with previous reports but cover a longer follow-up period. Although the outcomes are promising, longer follow-ups are needed to confirm the long-term effectiveness of ACI. LEVEL OF EVIDENCE: IV, prospective therapeutic study.

[Functional range of motion of the hip joint]. / La mobilité fonctionnelle de l'articulation de la hanche.

PURPOSE OF THE STUDY: The functional mobility of a joint represents the range of motion healthy individuals require to fulfill everyday life tasks. Oscillation angle corresponds to the entire range of motion that can be achieved by the joint. Wedge opening and direction are the characteristic features. We describe the characteristics of functional mobility of the hip joint in healthy subjects. MATERIAL AND METHODS: Hip motion was analyzed in twelve healthy subjects aged 22 to 25 years. The three dimensional analysis used the Motion Analysis System (Motion Analysis Corporation, Santa Rosa, CA) at a frequency of 60 Hz. MatLab software was used to modelize a prosthesis and determine the oscillation angle and its direction as a function of implant position and head-to-neck ratio. After determining the hip center for each individual subject, the range of motion necessary to complete a task was given by the maximal angle along each anatomic axis needed to reach a given position in comparison with the resting position. The following tasks were studied: sit to stand motion, lifting weight from a squatting position, reaching the ground with both legs abducted in extension, walking, ascending and descending stairs, getting on a bicycle, sitting cross-legged, cutting toenails. Whether or not the task could be achieved with the prosthetic conformation was then determined. RESULTS: Each task was described as a combination of motion in the three anatomic axes. Lifting weight from a squatting position combined flexion (110 degrees), abduction (9 degrees) and external rotation (18 degrees) with a standard deviation of 9 degrees. For a given task, only a few combinations of femoral and acetabular orientations were compatible with completion of that task. Combining the motions required for several tasks diminished the possible orientations for prosthetic positioning. DISCUSSION: Analyzing the motion required for these tasks shows the maximal range of motion involved in each direction. There was very little variability among healthy subjects. These results are in agreement with other values determined with other methods. Compensatory mechanisms used by disabled people to complete different tasks were not taken into consideration. The effects of changing either the head-to-neck ratio or implant position are discussed in relation to completion of a given task.

[Iliopsoas bursal distension revealing complication of total hip arthroplasty: five cases]. / Masse inguinale révélatrice d'une complication d'une arthroplastie totale de hanche: A propos de 5 cas.

The iliopsoas bursa is situated immediately anterior to the hip joint. Communication can develop between a hip prosthesis and the iliopsoas bursa leading to distension and formation of an inguinal mass revealing complication of total hip arthroplasty. We report five clinical cases. The five patients with a total hip arthroplasty developed a mass in the Scarpa triangle which correlated with defective prosthesis function. We chose not to dissect the cystic mass but to treat the intra-articular cause. Symptoms resolved after the intervention in all cases. This rare condition should be envisioned if an inguinal mass develops or has a functional impact, particularly on the lymphovenous circulation. Anatomic relations can be distinguished with computed tomography. Prosthetic complications include infection, loosening or wear. The work-up should include search for infection and standard x-rays of the hip joint. Before surgery, duplex Doppler should be performed systematically to search for a thromboembolic complication.

Sleep apnoea syndrome secondary to rheumatoid arthritis.

A patient who developed severe sleepiness and sleep apnoea in association with adult acquired retrognathia and subluxation of the cervical spine at the level of C3-C4, both resulting from rheumatoid arthritis, is described. The possible causative factors of the association between sleep apnoea and rheumatoid arthritis include reduction of the size of the upper airway by temporomandibular joint destruction, brainstem compression due to rheumatoid arthritis affecting the cervical spine, sleep fragmentation, and drug effects.

[Sideroblastic anemia in a multiple myeloma treated by melphalan (author's transl)]. / Anémie réfractaire au cours d'un myélome multiple traité par melphalan.

A case of sideroblastic anemia arised in multiple myeloma is related. Eighteen cases of literature are studied. This evolution usually appears in old and remitted myeloma. The pathogeny of the sideroblastic anemia is unknown, and possibly related to leukemia complicating multiple myeloma.