Medial collateral ligament of the knee: anatomy,management and surgical techniques for reconstruction

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. The incidence is reported to be 0.24 per 1000 per year, and twice as high in males. The majority of MCL injuries are isolated, occurring in young sportsmen and women. However, they can occur in association with other injuries of the knee, most commonly the anterior cruciate ligament. Most injuries to the medial supporting structures occur as a result of valgus forces; but in sports, these can be a result of skiing injuries or ‘cutting’ manoeuvres. The majority of MCL injuries heal well with non-operative management and rarely require surgery; but if acute injuries are insufficiently treated or missed, the result can be chronic laxity. This chapter reviews the existing literature on common history and examination findings in MCL injuries. There are a number of classification systems designed to grade the severity of injury, which are based on the amount of laxity and the ability of the assessor to feel an end-point. There has been significant advancement in the understanding of the anatomy and biomechanics of the different components of the MCL. The anatomical landmarks of the superficial and deep MCL as well as the posterior oblique ligament are discussed along with the function of these individual structures. Although most MCL injuries heal well with non-operative management, there are a number of indications for operative intervention. These include open and multi-ligament knee injuries, as well as chronic instability. Broadly these are divide into repair or reconstruction categories. Repair is best performed in acute cases, where surgery is indicated for other reasons such as a meniscal tear; whereas reconstruction is best reserved for chronic instability. The reconstruction techniques including the Lind and LaPrade are described.     

Primary actinomycotic lung abscess

A case of recurrent massive haemoptysis in whom primary actinomycotic lung abscess was diagnosed following right pneumonectomy is reported.     

Characteristics of rheumatoid arthritis patients with self-reported sicca symptoms: evaluation of medical, salivary and oral parameters

OBJECTIVES: To examine the prevalence of sicca symptoms in rheumatoid arthritis (RA)-patients, and to evaluate medical, salivary, and oral parameters in matched subgroups of patients with and without sicca symptoms as well as in healthy controls.
PATIENTS AND METHODS: The prevalence of self-reported sicca symptoms was examined by a postal questionnaire in a representative cohort of RA-patients (n = 105, aged 52–74 years, disease duration 10–20 years, 77% females, 56% RF-positive).Patient subgroups and controls (9–10 in each group) underwent examinations of disease activity, blood analyses, tests of tear and salivary secretion, and examination of oral mucosa and microflora. Analyses of salivary acidic proline-rich proteins (PRPs), statherin and histatins were performed.
RESULTS: One or more sicca symptoms were reported by 65% of RA-patientS. Sicca patients (having ≥4 sicca symptoms) had a more active and severe disease with higher scores for disability, fatigue and tender joints than patients without such symptomS. Other significant findings in the sicca group were lower values of unstimulated whole saliva, output of PRPs, statherin and histatins in submandibular saliva, and higher counts of oral Candida species.
CONCLUSIONS: Sicca symptoms were prevalent in RA.Qualitative and quantitative salivary tests distinguished between sicca and non-sicca RA-patients, though overlap was considerable for some parameters.