Purpose: The purpose of this work was to evaluate radiographically architectural changes in the knee caused by open medial tibial osteotomy fixed with a Puddu plate.

Material and methods: Forty-three patients (45 knees) operated on between 1999 and 2002 were reviewed retrospectively. Osteotomy was performed for femorotibial osteoarthritis of the medial compartment in 39 knees, laxity in three and both in three. There were 16 women and 27 men, mean age 55 years (22–73). Standard x-rays of the knee (AP, lateral 30° flexion) and telemetric films obtained preoperatively and at bone healing were analysed by two independent observers (a junior and a senior). We noted: mechanical axis (HKA), presence of epiphyseal varus and its correction, patellar height (Caton-Deschamps index), and tibial slope. The alpha risk was set at 5% for statistical analysis.

Results: Complications included two cases of non-union which required revision. Measures were reproducible between the two observers (p> 0.5). Mean HKA at bone healing was 183.53±2.28° for an expected correction of 184.14±0.93 (p=0.0112). Osteotomy achieved correction of constitutional varus in 25/36 knees (p=0.014). In the nine knees without constitutional varus, an oblique tibiotalar space was observed in five. Preoperative patella was 0.86±0.13 versus 0.69±0.16 postoperatively (p=0.021). The position of the plate on the medial aspect of the metaphysic was posterior in 28 knees and middle in 17 but with no impact on tibial slope related to plate position (p=0.175).

Discussion: Open medial tibial osteotomy with Puddu plate fixation enabled us to achieve the desired correction which persisted to bone healing and to correct constitutional varus when present, an important element for ligament balance in the event a secondary total knee arthroplasty would become necessary. In our series, we did not find any changes in the posterior slope related to the position of the plate as has been reported by others. Conversely, we did observe a decrease in patellar height.

Purpose: First described in 1699, hydatid cyst in a muscle is extremely rare today, even in endemic areas.

Material and methods: We report a retrospective series of nine cases of primary hydatid cyst observed between 1985 and 1998. The patients were predominantly women living in a rural area (mean age 37 years), who consulted for an isolated tumefaction of the thigh (left side in 7/9 cases) which had evolved for twelve months on the average without affecting the general health status. Ultrasonography was highly contributive, suggesting the diagnosis in all cases. Hydatic serology was positive in five cases. Computed tomography (n=3) and magnetic resonance imaging (n=2) provided supplementary information. Hydatid cysts were identified in the adductors (n=4), the quadriceops (n==3) and the three compartments (n=1).

Results: Surgical treatment was performed in eight patients; en bloc resection of the hydatid cyst with peripheral muscle tissue in six cases and subtotal pericystectomy in two. Clinical and anatomic results are presented at mean six years follow-up.

Discussion: We discuss the role of each radiographic examination for the diagnosis and search for extension of hydatid cysts as well as the therapeutic options depending on the clinical course and soft tissue involvement.

Purpose: Patellar tendinopathy is a frequent pathology which generally heals well after functional treatment if managed early.

Material and methods: We report a retrospective analysis of thirteen high-level athletes who underwent surgery for chronic patellar tendinopathy. The disease was demonstrated by ultrasound, MRI, and plain radiographs. Four patients had insertion tendiopathies and nine had tendinopathies involving the tendon body. Six patients also presented a femoropatellar impingement demonstrated by arthroscan. The indication for surgery was total sports disability (Blazina stage III-b) after failure of functional treatment. Surgery consisted in systematic combing of the tendon after resection of degenerative tissue. Resection of the patellar apex was performed in the four patients with insertion tendinopathy. Lateral release was performed in patients with femoropatellar impingement and one patient with severe impingement required advancement of the anterior tibial tuberosity.

Results: Outcome was very good in eight patients and good in five at 36 months (mean follow-up).

Discussion: Ultrasonography was often the only exploration performed for chronic patellar tendinopathy. It is essential for diagnosis and postoperative surveillance. MRI should be reserved for surgical cases or if the diagnosis is doubtful. The beneficial effect of surgical treatment is undeniable if the indication is well founded. For us it is logical and necessary to treat any femoropatellar impingement during the same operation.