[Acute lesions of the anterior cruciate ligament of the knee. Apropos of 71 follow-up cases].
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Biomedical subjects
Publications and source records attributed to H Dejour.
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Division of the anterior cruciate ligament in dogs usually leads to degenerative arthrosis of the knee after a few weeks. The authors have replaced the anterior cruciate ligament in 7 dogs by an artificial ligament made of carbon fibre. The results were analysed after seven months. In all cases the artificial ligaments had been affected in spite of good clinical behaviour. The fibrous invasion of the carbon fibres was poor. Most of the knees had cartilaginous lesions of the arthrotic type, the synovium was the site of foreign body reaction surrounding deposits of carbon and some carbon deposits were found in lymph glands in the inguinal region.
A low patella is frequently a complication of a lesion of the knee but it can also present secondary symptoms of its own. The authors describe an original method for assessment of the vertical level of the patella. They have tried to establish a relationship between the low situation of the patella and pain of a certain type associated with limited flexion of the knee. Physiopathological and biomechanical evidence is taken into account. In most instances, a low patella is secondary either to a mechanical cause, natural or iatrogenic, or to an inflammatory cause such as algodystrophia. 29 patients out of 128 observed cases have been operated on. 17 of these were due to excessive transplantation of the anterior tibial tubercle. In most of the cases the tibial tubercle was transplanted upwards in association with a joint release. In only 3 cases a patellectomy was done. The results were excellent or good in half of the cases and unsatisfactory in the other half.
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In fractures of the tibial condyles, associated ligamentous tears may be discovered by the presence of additional bone fragments, by stress radiographs or by tomography. Two types of lesion were found among the 25 cases treated by the authors. In the first group there was a uni-condylar fracture associated with a tear of the medial or lateral ligament. In the second group, there was a uni-condylar fracture associated with a fracture of the tibial spine. After a review of their results, the authors consider that ligamentous lesion should be treated surgically as well as the bony lesions which must be repaired first. Post-operative immobilisation was continued for one month followed by rehabilitation. An arthrolysis may be done five months later if necessary.
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50 cases of genu recurvatum were classified into three types: osseous (malunion, epiphysiodesis), capsular and ligamentous (congenital hyper-extension, sequelae of old ligament rupture) and combination of the two types. The author's have analysed the results of 44 surgical procedures. The main procedure practised has been an opening wedge osteotomy of the upper end of the tibia above the level of the tibial tubercle with a graft to fill the gap. It is important to avoid distal displacement of the patella by detachment of the tibial tubercle and reattachment more proximally at the end of the surgical procedure. Osteotomy is always indicated but should be combined with a capsular repair or combined types. The results are satisfactory especially in cases due to premature closure of the growth plate.
On the basis of four personal cases of osteoid osteomas of the foot, the authors study their frequency, their localization, and their clinical and radiological manifestations. They insist on the special difficulties of diagnosing this condition due to its atypical and uncertain radiological outline, and also on methods of further investigation : arteriography and especially isotopic scintigraphy.
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In a prospective randomised trial, three groups of 20 patients each were compared. A first group served as a control, a second group received dipyridamole and acetylsalicylic acid and a third group received low doses of heparin. The incidence of deep vein thrombosis determined by the 125I-fibrinogen test was 40% in the first group, 50% in the second group, and 5% in the third group. The differences between the heparin group and the two other groups are statistically significant. No wound complication and no haematoma at the injection site occurred.
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