Knee instability after injury to the anterior cruciate ligament. Quantification of the Lachman test

We have measured anterior and posterior displacement in 563 normal knees and 487 knees with chronic deficiency of the anterior cruciate ligament (ACL). We performed stress radiography using a simple apparatus which maintained the knee at 20 degrees of flexion while a 9 kg load was applied. There was no significant difference in posterior translation dependent on the condition of the ACL. Measurement of anterior translation in the medial compartment proved to be more reliable than in the lateral compartment for the diagnosis of rupture of the ACL, with better specificity, sensitivity and predictive values. We have classified anterior laxity based on the differential anterior translation of the medial compartment and identified four grades in each of which we can further distinguish four subgrades for laxity of the lateral compartment. Within each of these subgroups, either internal or external rotation may dominate and sometimes there is a major translation of both compartments. Radiological evaluation of displacement of the knee in 20 degrees of flexion provides conclusive evidence of rupture of the ACL. A detailed study of pathological displacement is the basis for a classification of laxity. It is then possible to decide for each type of laxity, the surgical treatment which is specifically adapted to the lesion, and to define a reference value for judging outcome.     

Guidelines (short version) of the French Society of Otorhinolaryngology (SFORL) on cervical lymphatic malformation in adults and children: Diagnosis

Objectives

The authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for the diagnosis of cervical lymphatic malformation in adults and children.

Endosalpingosis or microcystic and proliferating glandular inclusion disease of the genital tract and peritoneum. Apropos of 6 cases

Endosalpingosis, defined by the presence in an ectopic site of epithelium comparable to that of the tubal mucosa, is not a well-known entity. In reference to 6 cases of our department, the authors have been able to assess this lesion. Clinical manifestations and laboratory tests offer no arguments. Cytology represents a diagnostic trap. The diagnosis may only be made histologically and is very often fortuitous. This benign lesion is often the result of a metaplasic process but, considering the difficulty of the diagnosis, the treatment is often surgical (total hysterectomy with castration). The course is uneventful.     

Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis

BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.     

Peritoneal amyloidosis in Waldenstr?m's macroglobulinemia. X-ray computed tomographic aspects

A 74 years old man, know to have Waldenstr?m's macroglobulinemia was hospitalized for intestinal obstruction. Upper gastrointestinal barium study revealed an extrinsic stenosis of duodenum. Ultrasonography and abdominal computed tomography revealed a diffuse mesenteric infiltration with medium level echoes and encasing of mesenteric vessels. Histologic examination of biopsies taken at exploratory laparotomy disclosed amyloidosis of the epiploon and mesentery. The review of amyloidosis in macroglobulinemia shows peritoneal amyloidosis to be a very rare event. Sonographic, computed tomographic and pathologic findings of this unusual case are discussed.     

Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery

BackgroundThe public health cost impact of complex regional pain syndrome type I (CRPS I) is considerable in both emergency and scheduled orthopaedic surgery. We proposed to assess the effectiveness of vitamin C in prevention of CRPS I in foot and ankle surgery.MethodsWe carried out a “before–after” quasi-experimental study comparing two chronologically successive groups without (Group I: July 2002–June 2003) and with (Group II: July 2003–June 2004) preventive 1 g daily vitamin C treatment. All patients having surgery on the foot or ankle were enrolled, with the exception of diabetic foot cases. Several factors were analysed: sex, age, type of pathology, history of CRPS I, psychological context, tourniquet time, and cast immobilisation time.Results420 feet (392 patients) were included in the study: 185 in Group I, 235 in Group II. CRPS I occurred in 18 cases in Group I (9.6%) and 4 cases in Group II (1.7%) (p < 10^?4), with history of CRPS I as a significantly correlated factor (relative risk = 10.4). The psychological context (anxio-depressive state) showed a (sub-significant) tendency to increase the risk of CRPS I (relative risk = 2.6).ConclusionVitamin C has been shown to be effective in preventing CRPS I secondary to wrist fracture, but few data are available with respect to foot and ankle cases. The present study demonstrates the effectiveness of vitamin C in preventing CRPS I of the foot and ankle—a frequent complication in our control group (9.6%). The authors recommend preventive management by vitamin C.     

Sagittal laxity after posterior cruciate ligament-retaining mobile-bearing total knee arthroplasty

Posterior cruciate ligament stretching after posterior cruciate ligament-retaining (CR) total knee arthroplasty (TKA) can lead to an increase in sagittal laxity, knee dysfunction, or accelerated damage to the tibial bearing surface. We conducted a prospective study on 74 consecutive mobile-bearing CR TKA to determine if knee laxity changed with time or if knees with large initial laxity experienced greater increases in laxity. Patients were studied with radiographic posterior and anterior drawer examinations at 3 and 23 months. Model-based shape-matching techniques were used to measure TKA kinematics. We found a 1-mm increase in posterior drawer. Knees with large postoperative drawers did not exhibit increased laxity at last follow-up. The use of a mobile-bearing CR TKA did not significantly modify the midterm knee sagittal laxity.