Glued periosteal grafts in the knee.

Periosteal grafting was performed in 4 patients with osteochondritis dissecans of the medial femoral condyle and 1 patient with osteonecrosis of the lateral femoral condyle following prednisone therapy. The lesions were drilled out deep into the cancellous bone. The periosteal graft was taken from the medial facet of the tibia and fixed to the excavated bony defect by the tissue glue Fibrinkleber Human Immuno (Tisseel). The patients were followed clinically, by arthroscopic examination and by radiography at 3, 6, and 12 months. After 1 year the borderline between the new and surrounding cartilage was hardly visible.

Lateral and anterior instability in acute ankle distortion. A radiologic investigation.

In a prospective consecutive investigation radiologic tests for lateral and anterior instability in acute ankle distortion were found to be reliable indications of lateral ligament ruptures. Arthrography of the ankle joint was used as reference. Absence of instability, however, gives little information as to the ligamental status. The size of this group constitutes a clinical problem. Better results are achieved by combining lateral and anterior instability tests. If only one test is used, the anterior instability test should be preferred. The results of the two tests bare no relation to the degree of ligament ruptures found at operation.

Arthrography of the ankle. Value in diagnosis of rupture of the calcaneofibular ligament.

As part of a clinical prospective investigations 102 patients with fresh ankle injuries underwent ankle arthrography and surgery for rupture of the lateral ligaments of the ankle. Three hypotheses concerning the improvement of the arthrographic diagnosis of rupture of the calcaneofibular ligament were tested. Two were rejected. Improvement in the diagnostic specificity was possible by combining arthrography with a stress inversion test, but the sensitivity of this combination was low. It was demonstrated that absence of peroneus sheath filling was a better diagnostic sign with good rather than with poor recess filling.

Ruptures of the lateral ligaments of the ankle. Clinical diagnosis.

During the 11-month period 1 October 1977 to 31 August 1978 a total of 44 patients with acute supination trauma of the ankle were examined. The clinical findings were compared with the results of arthrography. This revealed that direct and indirect tenderness of the anterior talofibular ligament and calcaneofibular ligament respectively, combined with a greater than or equal to 4 cm swelling anteriorly and over the lateral malleolus, indicated a ligament injury with great likelihood. If some of the diagnostic signs are absent, most emphasis should be laid on the swelling over the lateral malleolus and on the direct and indirect tenderness of the calcaneofibular ligament. The talar-tilt test and examination for the drawer sign were of limited diagnostic value.

Rupture of the lateral ligaments of the ankle: operation or plaster cast? A propective study.

The material comprises 444 patients, aged 12-50 years, with acute sprain of the ankle, seen over an 11-month period (1.10. 1977 to 31.8. 1978). Clinical examination showed no rupture of the ligaments in 53. Arthrography in the remaining patients revealed rupture of the lateral ligaments in 209 (in two-thirds of the anterior talofibular ligament and in one-third of the anterior talofibular as well as calcaneofibular ligament). Conservative treatment with a below-knee plaster cast for 5 weeks was employed in 107 patients, while 102 were treated surgically by suture of the ruptured ligament(s) and subsequently wore a below-knee plaster cast for 5 weeks. The follow-up 1 year after the accident was attended by 63 per cent of the patients. Good results were found in 76 per cent of those treated by plaster cast only and in 81 per cent of those treated by surgery. The difference is not statistically significant.

Arthrographic diagnosis of ruptured calcaneofibular ligament. II. Clinical evaluation of a new method.

The validity of a new criterion for the arthrographic diagnosis of rupture of the calcaneofibular ligament is compared to that of other arthrographic criteria, in a clinical series. The new criterion is found to be more reliable than those previously used.