Desmoplastic fibroma of the ilium.

INTRODUCTION: The desmoplastic fibroma is a rare locally invasive bone tumour. Surgical resection with minimal margins is recommended. PRESENTATION OF CASE: A 15 year-old boy was referred with chronic left thigh pain. MRI revealed a bone lesion within the cavity of the inner table of the left iliac wing without invasion of the underlying bone marrow. A surgical biopsy revealed a desmoplastic bone fibroma. A partial resection of the inner table of the iliac wing sparing the outer table was performed. At the latest follow-up the initially spared iliac wing had needed further resection. The reason proposed for this is devascularisation by substantial periosteal stripping causing partial resorption initially, then necrosis and ultimately ulceration through the skin necessitating further surgical resection. DISCUSSION: The technique of resection of a pelvic desmoplastic fibroma sparing the outer table of the iliac wing has not previously been reported. The objective of a limited resection was to minimize the risk of a postsurgical limp caused by weakness of the gluteus medius muscle. However we report that this technique did not work in this case. A wider resection of the iliac wing as it is recommended for a malignant tumour would have yielded a similar final outcome. CONCLUSION: A partial resection of the iliac wing seemed an appealing technique for a benign tumour of the inner table of the iliac wing. However, considering the complications encountered, the authors advise a simple "en bloc" resection of the iliac wing for this type of tumour in this location.

Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction.

PURPOSE: Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the tibia at 20 degrees of knee flexion and also during the pivot shift test. METHODS: The data of 63 patients who had ACL reconstruction were prospectively collected. Thirty-two patients had single-bundle reconstruction (SB group), and 31 received double-bundle reconstruction (DB group). The per-operative navigation system (Praxim ACL surgetics System) helped to search for a minimal anisometry profile of the grafts, which was favorable (graft loosened with flexion) in the anatomic area of ACL insertion and preventing any conflict between the graft and the femoral notch. The system also evaluated anteroposterior (AP) rotational stabilities and pivot shift. The value of the pivot shift was calculated from the values of the maximum rotation and AP translation obtained when performing the manoeuver before and after ACL reconstruction, comparing SB and DB reconstruction. RESULTS: The post-operative AP displacement of the lateral compartment during the Lachman test was statistically reduced in DB group in comparison with SB group (5.1 ± 4.4 mm vs. 7.1 ± 3.2 mm, P = 0.04), whereas the AP displacements of the medial compartment were also reduced (3.4 ± 3.7 mm vs. 4.5 ± 2.6 mm, P = 0.15) but with no statistical significance. Internal and external rotations at 20° of knee flexion were lower in the DB group than in SB group with statistical significance (respectively, 13.2 ± 4.9° vs. 17.5 ± 4.0°, P < 0.001 and 9.1 ± 3.6° vs. 11.5 ± 3.5°, P = 0.01). During the pivot shift test, the post-operative AP maximal translation was statistically different in both groups: 4.5 ± 2.1 mm in DB group and 6.3 ± 2.7 mm in SB group (P = 0.01)), whereas the maximal rotation was not statistically different: 3.8 ± 2.5° in DB group and 3.4 ± 1.2° in SB group (n.s.). Therefore, Colombet's index was similar in DB group and SB group (respectively, 0.21 ± 0.16 and 0.17 ± 0.06, (n.s.)). CONCLUSIONS: This study shows a significant intraoperative advantage in anterior and rotational stability for four-tunnel DB ACL reconstruction compared with SB ACL reconstruction. LEVEL OF EVIDENCE: II.

Perilunate dislocations and transscaphoid perilunate fracture-dislocations: a retrospective study with minimum ten-year follow-up.

PURPOSE: Perilunate dislocations and transscaphoid perilunate fracture dislocations are associated with a high incidence of posttraumatic arthritis. According to the current literature, at medium-term follow-up, radiological signs of arthritis do not correlate with functional scores. The aim of this study was to evaluate patient hand function and the development of posttraumatic arthritis after perilunate dislocations (11 cases) and transscaphoid perilunate fracture dislocations (7 cases) at a minimum 10 years of follow-up. METHODS: A retrospective review was performed including 18 patients with a minimum 10-year (average, 13 y) follow-up. The clinical results were evaluated using the Mayo wrist score and the patient-rated wrist evaluation. Radiological abnormalities were stratified using the Herzberg classification. RESULTS: According to the Mayo wrist score, the authors found 5 excellent, 3 good, 7 fair, and 3 poor results. The mean Mayo wrist score was 76 (range, 60-90). There were 6 type A, 5 type A1, 6 type B1, and 1 type C, according to the Herzberg classification. Posttraumatic degenerative changes were observed in 12 cases. CONCLUSIONS: The presence of radiological arthritis and static carpal instability did not cause reduced function at our minimum follow-up of 10 years. Based on our findings and previously reported series, we conclude that signs of posttraumatic arthritis after perilunate dislocations and transscaphoid perilunate fracture dislocations increase progressively but are well tolerated at an average follow-up of 13 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty.

The purposes of this study were to investigate the mode of failure and survivorship of an independently performed series of medial Oxford unicompartmental knee arthroplasties. The study included 43 knees in 40 patients with a mean follow-up of 14.88 years: 13 knees (11 patients) had revision surgery (30%), and ten patients required conversion to total knee prosthesis. The mean International Knee Society (IKS) scores at the time of the revision were 145.52 [standard deviation (SD): 39.90, range: 167-200]. The overall alignment of the knee was restored to neutral, with a hip-knee-ankle (HKA) angle average of 178° (SD: 3.21°, range: 170-186°). Survivorship, as defined by an endpoint of failure for any reason, showed that the survival rate at five years was 90%, at ten years 74.7% and at 15 years 70%. Excluding inappropriate patient selection and surgeon-associated failures, our survival analysis plot is much improved: survivorship at five years is 94.5%, at ten years 85.7% and at 15 years 80.4%. The Oxford meniscal bearing arthroplasty offers long-term pain relief with good knee function. Unfortunately, we demonstrated a high complication rate, with some of the failures encountered indicating that the surgical technique is very demanding.

Pulsed radiofrequency applied to the suprascapular nerve in painful cuff tear arthropathy.

The purpose of this study was to assess the efficacy of pulsed radiofrequency (PRF) applied to the suprascapular nerve for pain relief in medically unfit patients with painful cuff tear arthropathy. Twelve patients with chronic shoulder pain due to cuff tear arthropathy were recruited. The mean age was 68 years (range, 60-83 years). The suprascapular nerve was targeted at the suprascapular notch with PRF. The patients were assessed with the Oxford score, Constant score, and visual analog scale (VAS) pain score before ablation and 3 and 6 months after ablation. Statistical analysis was undertaken by use of the Friedman test. Ten patients showed improvement in the VAS score (P = .24) and Constant score (P = .005) and eleven in the Oxford score (P = .001). There was a deterioration in the VAS scores between 3 and 6 months, suggesting that the benefits were starting to wear off with time (P > .05). We conclude that PRF may be a useful therapeutic adjunct in patients with painful, end-stage rotator cuff tear arthropathy who are medically unfit for surgery.