Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) in the Medial Sesamoid of the First Toe.

Bizarre parosteal osteochondromatous proliferation, or Nora's lesion, is a unique bony lesion that generally originates from the small bones of the hands and feet in young adults. We report a case of a bizarre parosteal osteochondromatous proliferation originating from the medial sesamoid of the first toe that was managed surgically by en bloc excision. At 5-year follow-up, there was no evidence of recurrence.

Rice body mass formation mimicking a neoplastic disease around the trochanteric bursae of the hip.

Multiple rice body formation is an uncommon inflammatory process. Sometimes it leads to a big mass in unusual locations. Although sometimes associated with bursitis and systemic diseases, such as rheumatoid arthritis, the pathophysiology of this rare entity is still obscure. We present a 29-year-old woman with multiple rice body mass formation in the trochanteric bursa of the left hip. She was operated, and had no recurrence at 18 months after the surgery.

Arthroscopic treatment of synovial chondromatosis of the ankle.

We report a case of synovial chondromatosis of the ankle joint, which has been successfully treated with arthroscopic removal of loose bodies and synovectomy, with the patient immediately returning to school and activities of daily living. Recovery after arthroscopic debridement and loose body removal is much shorter in comparison with arthrotomy, and there is no need of immobilization postoperatively.

[Other arthroscopic procedures for the treatment of chondral injuries of the knee joint]. / Diz eklemi kikirdak lezyonlarinda artroskopik cerrahi ile diger uygulamalar.

Cartilage injuries can be treated through conservative or surgical approaches upon evaluation of the lesion. In surgical approach, arthroscopic treatment has proven to be both very popular and efficient. Through arthroscopy, treatment options such as lavage, chondral shaving, debridement, microfracture, abrasion, and chondroplasty have been successfully performed in patients with appropriate indications.

Three-bundle popliteus tendon: a nonsymptomatic anatomical variation.

A 34-year-old man suffering from knee pain on the medial side of his right knee underwent knee arthroscopy. The arthroscopy revealed the popliteus tendon with an appearance of three bundles. Three-bundle popliteus tendon is a normal variant finding with no clinical significance.

A complete supra-patellar plica with an unusual presentation.

A suprapatellar plica is a persistent remnant of the embryologic synovial membrane between the suprapatellar pouch and the knee joint. Pathologic synovial plica is not a common entity, however, when present, it can mimic a variety of clinical situations. We describe here a case of pathologic suprapatellar plica that has a check-valve mechanism, which results in a clinical presentation as knee joint swelling.

Decrease in the numbers of mechanoreceptors in rabbit ACL: the effects of ageing.

It is proposed that there is a positive correlation between the numbers of mechanoreceptors and proprioceptive function. On the other hand, normal aging process is associated with deficits in proprioception. This study is designed to test the hypothesis that aging resulted in decreased numbers of mechanoreceptors. Anterior cruciate ligaments of 14 male rabbits (2 months, n=5; 12 months, n=4 and 60 months, n=5) were extracted and the total numbers of Ruffini, Pacini and Golgi tendon-like receptors were accounted. As a result, the numbers of mechanoreceptors, especially Ruffini receptors, decreased with aging (p<0.05). Increased age was associated with changes in the morphology of mechanoreceptors. In conclusion, aging results in both diminished numbers and changed morphology of mechanoreceptors.

Bilateral lipoma arborescens of the knee in a child: a case report.

We report a case of childhood lipoma arborescens of both knee joints who had been erroneously diagnosed to have initially acute rheumatic fever and subsequently oligoarticular juvenile rheumatoid arthritis. She had taken anti-inflammatory medication for 8 years without remission of the effusion. Magnetic resonance imaging (MRI) and synovectomy revealed the diagnosis of lipoma arborescens. Lipoma arborescens should be kept in mind in the differential diagnosis of refractory chronic joint effusion and synovial hypertrophy in the childhood period, and MRI yields the correct diagnosis in this setting.

The effects of menstrual cycle on the knee joint position sense: preliminary study.

The purpose of this study was to determine the effects of menstrual cycle on proprioception by using the active knee joint position sense test (JPST). The 19 healthy women (ages between 20 years and 27 years) who have normal regular menstrual cycle were included in the study. We applied JPSTs at two different directions throughout the three different phases of the menstrual cycle, i.e. menstrual, follicular, and early luteal in dominant knees. When we started from flexion (90 degrees ), target angles were 70 degrees , 50 degrees , and 30 degrees and we started from extension (0 degrees ), target angles were 20 degrees , 40 degrees and 60 degrees . The absolute reposition errors from the target angles have been evaluated. Results have shown that reposition errors from the target angle at 40 degrees , 50 degrees and 70 degrees of knee angles were higher in the menstrual phase than that of the follicular phase (P<0.05). In addition, higher value of reposition error from the target angle at 40 degrees was found in the menstrual phase compared to luteal phase (P<0.05). In conclusion, we have demonstrated that active JPST was significantly reduced in the menstruation period.

The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture.

PURPOSE: The purpose of this study was to compare the accuracy of clinical examination versus magnetic resonance imaging (MRI) in diagnosing meniscal and anterior cruciate ligament (ACL) pathology. TYPE OF STUDY: Prospective, longitudinal study. METHODS: Between August 2001 and December 2001, we prospectively evaluated 50 consecutive patients (37 male, 13 female) with 65 pathologies of medial meniscal tears, lateral meniscal tears, and/or ACL rupture. The average preoperative period for the patients was 5 weeks (range, 5 days to 5 months) and their mean age was 22 years (range, 12 to 42 years). After initial clinical examination, the same sports medicine fellowship-trained orthopaedic surgeon (10-year practice profile of 100% sports medicine) evaluated the MRI of the patients and performed their arthroscopic procedure. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated comparing clinical examination, MRI, and arthroscopic evaluation. RESULTS: There was no statistical difference between MRI or clinical examination in diagnosing medial or lateral meniscal tears or ACL tears ( P >.05). The accuracy of the clinical examination and MRI evaluation was equal for diagnosing meniscal tears and ACL ruptures. CONCLUSIONS: A well-trained qualified surgeon can safely rely on clinical examination for diagnosing meniscal and ACL injuries. Clinical examination is at least as accurate as MRI in the skilled orthopaedic surgeon's hand. MRI should be reserved for more complicated and confusing cases. The routine ordering of an MRI scan of the knee before examination by a well-trained orthopaedic surgeon is not recommended. LEVEL OF EVIDENCE: Level II, diagnostic.

The sole arch indices of adolescent basketball players.

OBJECTIVE: The aim of this study was to find out the difference between sole arch indices of adolescent basketball players and an age matched non-athletic group. METHODS: This study was carried out in the Sports Education, Health and Research Center, Ankara, Turkey, between November 1998 and December 1998. In junior (16-18 years) categories 48 male basketball players and 45 age matched controls were included in the study. Body mass index and podoscopic sole images of subjects were recorded, and the arch index was calculated for each group. RESULTS: The sole arch index has no difference between basketball players and controls. The right foot arch index of the control group was 59.62 +/- 23.26 and 56.74 +/- 17.21 in players (p=0.497). The left foot arch index was 54.54 +/- 23.72 in control groups and 55.13 +/- 17.33 in players (p=0.890). There was a significant negative correlation between sole arch index and training age in basketball players (r=-0.3312 for right sole arch index, p value is less than 0.05; r=-0.3056 for left sole arch index, p less than 0.05). CONCLUSION: These results have shown that basketball might result in specific adaptation on sole arches of adolescent players.

[Wrist injuries in children and adolescent athletes: macrotrauma and overuse]. / Cocukluk ve ergenlik döneminde el bilegi yaralanmalari: Makrotravma ve asiri kullanim.

Young children and adolescents are becoming increasingly involved in recreational and professional sports. This inevitably leads to an increase in the number of sports-related injuries involving the hand and the wrist. Hence, physicians should have a good insight into macro- and microtraumas affecting the hand and the wrist. Prevention of injuries, correction of muscle-tendon imbalances, and maintenance of strength and flexibility are important issues for the prevention of disabilities in this age group.

[Patellar instability: arthroscopic surgery, indications and techniques]. / Patellar instabilite: Artroskopik cerrahi, uygulama, endikasyon ve teknikler.

A significant incidence of knee pain and disability arises from patellofemoral disorders. An accurate diagnosis relies both on a comprehensive history and a careful physical examination; radiologic modalities also play an important part in the diagnosis and follow-up. Most patellofemoral disorders can be examined in three groups: pain due to soft tissue abnormalities, patellar instability, and patellofemoral osteoarthritis. Conservative therapy can be successful in many patellofemoral disorders. Surgical treatment consists of lateral release, medial plication and reconstruction of the medial patellofemoral ligament, proximal and distal realignments, patellar osteotomies, and patellectomy. In traumatic dislocations primary reconstruction or arthroscopy assisted medial stabilization can be performed.

Influence of irrigation solutions combined with colchicine and diclofenac sodium on articular cartilage in a rat model.

A two stage, controlled animal trial was designed to observe the effects on normal and manually damaged articular cartilage of the rat knee joint of colchicine (COL) and diclofenac sodium (DIC) added into washout solutions. In the first stage, 21 rats were randomized into three groups, and right knees of all groups were washed-out by either COL, DIC or physiologic saline (PS) solutions. The left side was kept as a paired control. After 18 months, all knees were evaluated macroscopically and microscopically for cartilage changes. In the second stage, 25 rats were randomized into four groups, and a 2 x 2 mm defect was created surgically on the medial condyle. The joints were washed out by either COL, DIC or PS solutions. At the end of the six months, macroscopic, microscopic and transmission electron microscopy (TEM) evaluations were performed to observe the changes to the defective area. The results showed that washout procedures with certain arthroscopic fluid modifications revealed macroscopically less fibrillation and surface changes for the COL and DIC groups in the first stage. Colchicine and diclofenac sodium solutions conducted a better effect on the thickness of the cartilage and gave better results according to Mankin's criteria for degeneration. In the second stage, COL and DIC groups showed better effects on the cartilage regeneration. The pharmacological agents added into the arthroscopic washout fluid may have an effect on the ultrastructure and biologic properties of the joint cartilage, and may improve the results of arthroscopic treatment in chondral pathologies, especially in secondary arthritis.

The efficacy of intra-articular ketamine for postoperative analgesia in outpatient arthroscopic surgery.

PURPOSE: The purpose of this study was to compare the postoperative analgesic effects of intra-articularly administered ketamine, neostigmine, and bupivacaine after outpatient arthroscopic surgery. TYPE OF STUDY: Prospective, randomized, double-blind, clinical study. METHODS: In this study, 60 patients undergoing arthroscopic surgery other than ligament reconstruction were evaluated for postoperative pain. Ketamine, neostigmine, and bupivacaine were administered intra-articularly. The period of effective analgesia, recorded in minutes, was measured between time 0 and first usage of patient-controlled anesthesia (PCA) by the patients. The visual analog scale (VAS) was used to describe the pain level of the patient. RESULTS: VAS values were lower for the 3 medication groups compared with the placebo at rest and 90 degrees knee flexion. Intra-articular administration of 0.5 mg/kg ketamine provided longer duration of analgesia as defined by the first PCA use time (P <.05). The total amount of pethidine and analgesia time were longer for the 3 medication groups. CONCLUSIONS: Our basic finding was reduction in postoperative pain and consumption of adequate analgesic drugs with intra-articular ketamine, bupivacaine, or neostigmine use. We have not seen any psychomimetic side effects, particularly as seen with higher doses or systemic use. This study may conclude that intra-articular administration of ketamine provides long-lasting and effective analgesia, similar to neostigmine but less effective than bupivacaine after knee arthroscopy without any adverse effects. LEVEL OF EVEIDENCE: Level I.

Cervical and lumbar spinal changes diagnosed in four-view radiographs of 732 military pilots.

BACKGROUND: Pilots who fly jet fighters or helicopters frequently experience vertebral problems due to acceleration and vibration, wearing helmets and other headgear, and sitting in suboptimal postures. METHODS: We looked for spondylarthritic or spondylitic changes in 4-view radiographs (AP, lateral, left and right oblique) of the cervical and lumbar vertebrae of 732 pilots and 202 non-flying controls. The subjects included 91 F-16 jet pilots, 363 other jet pilots, 119 transport pilots, and 159 helicopter pilots. RESULTS: The prevalence of cervical changes in helicopter pilots was 19%, significantly higher than those for other pilots (8-13%) or controls (10%). There was no difference among groups with respect to prevalence of lumbar changes. Among all pilots, compression fractures were more common in the lumbar region than in the cervical region. Age was the most important variable related to spondylarthritic or spondylitic changes in all subjects, whereas height was an important factor only among jet pilots. CONCLUSION: We found an increased prevalence of cervical changes, especially osteoarthritis, in helicopter pilots. Increasing age and tall stature were associated with an increased prevalence of vertebral spondylarthritic or spondylitic changes in jet pilots.

Biomechanical testing of hamstring graft tibial tunnel fixation with bioabsorbable interference screws.

PURPOSE: This study evaluated the failure mode, maximum load at failure, displacement at failure, and stiffness differences of quadrupled hamstring graft-tibial tunnel fixation using 28-mm, tapered 35-mm, or bicortical 17- and 20-mm bioabsorbable interference screws (Arthrex, Naples, FL). TYPE OF STUDY: Biomechanical study. METHODS: Nine matched pairs (18 specimens) of young cadaver tibias (mean bone mineral density [BMD] = 0.847 g/cm2, range, 0.689 to 1.11 g/cm2) were divided into 3 groups of 6 specimens. Kruskal Wallis analysis of variance and Mann-Whitney U tests post hoc comparisons were used to assess group differences (P <.05). RESULTS: Maximum load at failure for the 28-mm screw was 488.2 +/- 197 N, with a displacement of 18.4 +/- 7.5 mm and a stiffness modulus of 38.9 +/- 7.0 N/mm. Maximum load at failure for the tapered 35-mm screw was 844.8 +/- 121.4 N, with a displacement of 15.3 +/- 1.6 mm and a stiffness modulus of 70.5 +/- 21.1 N/mm. Maximum load at failure for bicortical screw fixation was 543.7 +/- 266.5 N, with a displacement of 17.7 +/- 6.6 mm and a stiffness modulus of 57.7 +/- 14.9 N/mm. Fixation using the tapered 35-mm screw displayed greater maximum load at failure than either 28-mm screw fixation (P =.015) or bicortical screw fixation (P =.037). Significant differences were not evident for displacement. Both tapered 35-mm (P =.016) and bicortical screw (P =.026) fixation displayed greater stiffness than 28-mm screw fixation. All constructs failed by pullout. CONCLUSIONS: Fixation using a single tapered 35-mm screw displayed increased maximum load at failure compared with the 28-mm screw or bicortical fixation. Both the tapered 35-mm screw and bicortical fixation showed greater stiffness than fixation using a 28-mm screw. Use of a single 35-mm screw for quadrupled hamstring graft-tibial tunnel fixation may be preferred for patients with poor tibial BMD.

Partial deficiency of the lateral meniscus.

We report an abnormally shaped lateral meniscus. As far as we know, the present case is the first description of partial deficiency of the lateral meniscus in the literature. Although it is a rare abnormality, arthroscopic surgeons should be familiar with this entity for the differential diagnosis of bucket-handle meniscal tears, not only for magnetic resonance imaging, but also for arthroscopic evaluation. This entity could also be an aggravating factor for instability symptoms of partial or total anterior cruciate ligament-deficient knees.