Objective assessment of the anterior tibial translation in Lachman test position. Comparison between three types of measurement.

The purpose of this study was to compare three types of objective measurement in Lachman test position and to validate a new measurement procedure. Twenty-three patients were evaluated after anterior cruciate ligament (ACL) reconstruction at 10 years' mean follow-up. The contralateral knee had a normal ACL. Both knees were compared using Lachman test, arthrometer, radiological drawer, and electromagnetic sensing device (EMS) measurements. The values were obtained by two trained orthopaedic surgeons independently. Arthrometer assessment was done with the Kneelax 3 (Biodex) at 88 and 132 N. Radiological drawer was measured with a load of 10 kg. EMS is composed of an electromagnetic transmitter and two sensors. Displacement of the sensors was measured along the three perpendicular axes of the transmitter. Data after processing give the displacement of the sensors perpendicular to the tibial axis. The load was applied on the calf perpendicular to the tibial axis with a 10-kg counter-weight. Metallic objects must be avoided around the set-up. No significant difference between examiners was observed in clinical (P = 0.45) or objective (P > 0.3) measurements. The best correlation was obtained between arthrometer and EMS measurements (R = 0.94). Arthrometric and radiological drawer were poorly correlated (R = 0.65). The values of the medial radiological drawer were quantitatively similar to the 132 N arthrometric values. The sensitivity of EMS to skin movements was tested. The correlation between the EMS drawer and the other movements was not significant (R < or = 0.37). Quantitative correspondence with Lachman grades was only 36% of the arthrometer and EMS values and 37% of the radiological measurements. The effectiveness of EMS to evaluate anterior tibial displacement in Lachman test position after ACL reconstruction is demonstrated in this study. This method is non-invasive and comfortable for the patient, but needs a careful set-up. This method can potentially be used to assess rotational laxities.

Double semitendinosus anterior cruciate ligament reconstruction: 10-year results.

In a series of 30 consecutive patients who suffered from chronic instability of the knee joint, reconstruction of the torn anterior cruciate ligament was performed with a looped semitendinosus tendon, reinforced by an extra-articular anterolateral procedure. Of these 30, 27 could be followed up 9-11 years after the operation. The evaluation included the International Knee Documentation Committee (IKDC) questionnaire and was completed by testing with a Kneelax arthrometer at 132 N and by anteroposterior standing X-ray, in order to evaluate the degenerative changes. At the time of the check-up: 96% of the study group considered that they had normal or nearly normal knees, and 81% had recovered to the same sports activity level as before their injury. The degenerative changes noted at the index operation did not progress notably, except in two cases. Laxities of 7 knees were normal, with a side-to-side difference of less than 2 mm; 15 were nearly normal, with a mean difference of 3.45 mm; and 5 were abnormal, with a mean difference of 6.2 mm. The study shows that the procedure is efficient in restoring a satisfactory stability for most patients and stabilises the evolution of the degenerative lesions as shown by standing X-ray.

Comparison between magnetic resonance imaging and arthroscopy in the diagnosis of patellar cartilage lesions: a prospective study.

A blind and prospective study was conducted to assess the accuracy of magnetic resonance imaging (MRI) for diagnosing patellar cartilage lesions. Thirty-three consecutive patients undergoing knee arthroscopy were examined by MRI prior to surgery. Imaging was performed in the axial plane on a 1.5-Tesla unit with spin-echo and gradient-echo T1 and T2 sequences. The MRI and arthroscopic data were compared using a four-grade classification and a patellar map which divided the patellar surface into four quadrants. The overall sensitivity of MRI was 84.7% and the specificity 97.2%. The same pit-fall led to two MRI false positives. A perfect correlation of grading was obtained in 76.5%. When discordance was found, the tendency with MRI was commonly to underestimate the grade of the lesions. The MRI accuracy was high in this study in spite of a high rate of low-grade lesions which are difficult to assess. Related criteria for cartilage assessment with MRI and arthroscopy are suggested for further studies.

[Pertrochanteric fracture in elderly subjects. Prospective non-randomized studies]. / Les fractures pertrochantériennes du sujet âgé. Etude prospective non randomisée.

During a two-year period 237 patients were admitted for intertrochanteric fracture of the femur. 196 patients were included in this study with an average age of 79 years. Surgery comprised 163 nailings (Ender-Kempf), 31 blade plates and 2 prostheses. In this study the mortality rate and general complications were essentially related to the age and general condition of the patient; the general complications did not differ between methods. Walking ability at 6 months chiefly depended on the patient's general condition before the fall. The techniques allowing immediate weight-bearing diminished the length of hospitalization. Reoperation was required in 4% of nailings and 6.5% of blade plates.

Campylobacter fetus subspecies fetus bacteremia.

Eight patients with Campylobacter fetus bacteremia, six of them with serious underlying diseases, were seen in a two-year period. Besides fever, which was observed in all cases, the most frequent clinical manifestation was lower extremity phlebitis and cellulitis (four patients). In one of these patients, it had the peculiar aspect of bilateral pretibial cellulitis. One patient had vertebral osteomyelitis, a complication, to our knowledge, not yet described. Two patients, both with advanced underlying diseases, died. The five patients who completed a two- to three-week course of erythromycin gluceptate, all had initial clinical improvement. However, one patient suffered a relapse at the end of treatment, and progression of vertebral osteomyelitis while on erythromycin therapy was observed in another patient. These clinical and bacteriologic failures occurred despite the in vitro sensitivity to erythromycin of the two strains. This suggests that erythromycin might not be adequate therapy for C fetus septicemia.

Influence of (+)-cyanidanol-3 on the leukocyte migration inhibition test carried out in the presence of purified protein derivative and hepatitis B surface antigen.

It has been shown that (+)-cyanidanol-3, therapeutically administered during the course of acute hepatitis B, is able to favor the elimination of hepatitis B surface antigen (HBsAg) from the blood. This observation suggests that (+)-cyanidanol-3 might stimulate the cell-mediated immune response, since it is known that this type of response is responsible for elimination of the virus. In the present study, the possible action of (+)-cyanidanol-3 on this type of immunity was investigated by adding the substance in vitro to leukocyte migration inhibition tests, performed with the antigens purified protein derivative (PPD) and HBsAg and with leukocytes from individuals sensitized to these antigens. In normal individuals sensitized to PPD, the addition of (+)-cyanidanol-3 amplified the inhibition of migration by 7.0% (P less than 0.05). In patients previously infected by hepatitis B virus and sensitized to HBsAg, the addition of (+)-cyanidanol-3 amplified the migration inhibition by 10.5% (P less than 0.05). A trend to a dose-response relation was observed with the antigen PPD. (+)-Cyanidanol-3 did not modify leukocyte migration in the absence of an antigen. (+)-Cyanidanol-3 therefore seems capable of amplifying the cell-mediated immune response as measured by the leukocyte migration inhibition test. It is thus possible that it favors the elimination of HBsAg in patients by this mechanism.