Purpose of the study: The purpose of the study was to present the clinical and arthroscan results obtained in a prospective series of 32 patients who underwent Bankart arthroscopy. We wanted to identify concrete applications.

Material and methods: These 32 patients presented unidirectional anterior shoulder instability with a history of true dislocation. Unstable painful shoulders, multidirectional dislocations, and HAGL injuries were excluded as well as rotator cuff tears. An arthroscopic treatment was used in all cases, followed by the same rehabilitation protocol. All patients were reviewed at six months. External rotation (RE1 and RE2) and Gagey hyperabduction were noted as well as the Walch-Duplay, Rowe, and ISIS scores. Plain x-rays and an arthroscan were obtained preoperatively and postoperatively. Attention was focused on passage bone lesions, healing, and changes in volume of the inferior recessus after surgery.

Results: Mean follow-up was 17.1 months (range 6.5–31.3), mean age 26.3 years (range 17–46), sex-ration predominantly male: 4.3/1. Hyperlaxity was noted for 53.1% of the shoulders. The overall subjective result was unchanged since the conclusions at the 1993 SFA while the overall objective result improved. There was a significantly favourable absence of preoperative passage bone lesions. The negation of the Gagey sign and the decrease in external rotation were signs of restoration of effective capsule tension (p< 0.05) which was ofen associated with a decline in the volume of the inferior recessus, although the difference has not yet reached the level of significance.

Discussion: The very favourable results in cases free of preoperative bone lesions are in favour of early surgery, perhaps after a first dislocation. Negation of the Gagey sign and decreased external rotation are two simple reproducible postoperative signs useful for assessing the efficacy of anterior and inferior capsule tension; complementary imaging may not be necessary. Evaluation of the volume of the inferior recessus needs to be continued using a precise reproducible protocol taking into account for the rotation of the upper limb and the quantity of contrast product injected into the joint.

Conclusion: This study demonstrated results comparable with publications in the literature allowing a direct clinical application for postoperative assessment. Inclusion of new cases should confirm the pertinence of arthroscan measurement of the volume of the inferior recessus.

Purpose of the study: The objective was to analyse shoulder motion, particularly abduction and anterior elevation, in patients with an reversed prosthesis. A radiocinematographic study enable an analysis of the movements of the prosthesis it self and movements due to scapulothoracic participation.

Material and methods: This study was based on the analysis of 33 patients with an reversed shoulder prosthesis. A videoscopic recording (25 images per second) of anterior elevation from a workstation used for abduction arteriography was used. The Constant score was noted and a standard x-ray work-up (four views) was obtained for all patients.

Results: The cohort was a homogeneous continuous series of 21 women and 12 men, mean age 72.5 years (range 39–84). Two modes of motion were observed. The first (group 12, n=17 shoulders) was «monoarticular»: shoulder motion was almost exclusively related to movement of the scapulothoracic junction. Abduction did not exceed 90°. The second mode (group 2, n=16 shoulders) was «bi-articular»: joint motion began with the prosthesis (50° on average) followed by scapulothoracic participation (50° on average). The implant then was involved in the final part of the motion (in six of the 16 shoulders in group 2) to complete the range of motion exceeding 120° abduction and anterior elevation.

Discussion: This study confirmed the presence of an initial intrinsic mobility of the prosthesis followed by scapulothoracic participation. It was noted however, that for the majority of cases, the intrinsic mobility of the prosthesis was limited. In all cases, the range of motion recorded by clinical examination was greater than the range of motion measured objectively by radiocinematography.

Discussion: This study demonstrated the in vivo mobility of the reversed prosthesis. However, a range of motion greater than 100° anterior elevation and abduction is exceptional. Clinical findings reflect imperfectly the real mobility of this type of prosthesis.

Purpose: Maisonneuve fracture is a rare variant of malleolar fractures. Standard surgical care is not well defined. We performed a retrospective analysis of operated patients to propose a system to determine adequate care as a function of the type of lesions observed.

Material and methods: This retrospective analysis involved 20 patients who underwent surgery for Mai-sonneuve fracture between 1989 and 2000. Mean age was 42 years at surgery. Male gender predominated (16 patients). Seven patients (group 1) were treated without a syndesmodesis screw (osteosynthesis of the medial malleolus in six cases and suture of the medial collateral ligament in one). Thirteen patients (group 2) were treated via a first lateral approach and a syndesmodesis screw followed by a complementary medial approach in seven cases (two cases of medial malleolus osteocynthesis and five cases of medial collateral ligament suture). The Duquennoy functional score was determined at last follow-up. Quality of the reduction and presence of degenerative disease were determined on standard x-rays and computed tomographies.

Results: Mean follow-up was four years nine months (range 1–10 years). No case of tibiotalar diastasis was observed at at least one year. Among the five patients reviewed clinically, outcome was excellent in four and fair in one. In group 2 (syndesmodesis), we found two cases of residual diastasis and two cases of tight syndesmosis at at least one year. Among the nine patients reviewed clinically, outcome was excellent in three and fair or poor in six.

Discussion: This retrospective analysis collaborates the few data in the literature on Maisonneuve fractures. Ligament injury has varied greatly (with or without tear of the medial lateral ligament, more or less full thickness rupture of the interosseous membrane). In our experience, it is always difficult to reduce the diastasis via the primary lateral approach. Conversely, the primary medial approach has, after testing, enabled eliminating the syndesmodesis screw, with its recognised deleterious effects, in seven cases.

Conclusion: Due to the diversity of the ligament injuries encountered in patients with Maisonneuve fractures, we have adopted the following surgical strategy. If there is diastasis, after confirmation of any injury to the medical compartment, medial approach to suture the medial collateral ligament or osteosynthesis of the medial malleolus: in the case of diastasis reduction, we advocate a syndesmodesis screw; if diastasis persists, a secondary lateral approach is useful to reduce the medial malleolar rotation and insert a syndesmodesis screw.

Purpose: The purpose of this study was to evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of medial and lateral meniscal injury in operated and non-operated knees.

Material and methods: This prospective longitudinal study was conducted between January 1st 1995 and December 31st 1997. Each patient had a physical examination, a standard radiography study, and an MRI and an arthroscopy. The MRI was performed with two machines running at 1.5 Tesla and 0.5 Tesla. Spin-echo T2 slices were obtained in the saggital plane, and spin-echo fat saturation slices in the frontal and axial planes. Arthroscopy was performed and/or controlled by the same operator.

Results: The protocol included 132 patients. Ten patients (ten knees) had another arthroscopy after arthroscopic meniscectomy. Mean time between the physical examination and MRI was 57 days, it was 69 days between MRI and arthroscopy. Sensitivity, specificity, positive predictive value, negative predictive value and precision were, respectively, 94.8%, 61.%, 86.7%, 81.5% and 85.6% for the medial meniscus and 73%, 93.3%, 76% 93.5% and 90.1% for the lateral meniscus.

Discussion: Arthroscopy remains the gold standard for prospective comparative studies (Reigher 1986, Jackson 1988, Kelly 1991). MRI is the examination of choice for the diagnosis of meniscal injury in non-operated knees (Polly 1988). Most false positives concern injuries located on the posterior part of the medial meniscus. For radiologists (Mink 1988), these false negatives would result from poor analysis by the arthroscopic surgeon (Quinn 1991). Arthroscopists point out that radiologists overestimate injuries of the posterior segment (Barronian 1989, Fischer 1991, Spiers 1994). These false negatives involve the lateral meniscus (Cheung 1997). Our study corroborates the results reported in the literature. For repeated arthroscopies, no conclusion can be drawn from the interval of confidence observed in a population of ten knees. Nevertheless, in these knees, the MRI provided a good means of identifying recurrent lesions of both the medial and lateral menisci.

Conclusion: The physical examination provide a strong clue to meniscal injury in non-operated knees, so it is not necessary to perform an MRI before arthroscopy In all other cases, particularly there is recurrence, MRI can identify injury to the medial or lateral menisci with good sensitivity and specificity. In most cases, if the MRI is negative, it is not necessary to perform arthroscopy to search for a meniscal injury.

Purpose: Despite the development of new imaging techniques (MRI, CT scan) longitudinal studies of total hip arthroplasty (THA) are still conducted with conventional radiographs. New techniques for conventional radiograpy such as luminous screens with memory raise the question of longitudinal study in patients with THA where the new screen-film might produce artefacts.

Material and method: This prospective study examined intermethod and interobserver agreement. Thirty-seven patients were included in the series from July 1st, 1998 and September 30, 1998. Each patient had a double radiography series: three plain films using the conventional technique (C) and three digitalized screen films (D). The C were taken with a 1/1 ratio on a Philips Diagnost 90 table and developed using the Kodak M6 method using a 36 x 43 cm cassette for the pelvic x-ray and a 24 x 30 cm cassette for the x-ray of the prosthetic hip. The D were made on the Philips Diagnost 90 table and developed with the Agfa ADC70 procedure on a memory screen with a 5 pl/mm spatial resolution for 36 x 43 cm for the pelvic x-ray and 28 x 35 for the prosthetic hip. The same operator performed the complete radiography series in the same patient (C and D). The images were read examining the cement/bone interfaces and the prosthesis/cement interfaces looking for the classical radio-lucent lines in the De Lee and Charnley sectors. The presence and the thickness of the radiolucent line were classed in three groups: no line, line less than 2 mm, line greater than 2 mm. For each patient, the films were placed in anonymous folders and two subgroups were selected at random for the readers (a radiologist and an orthopaedic surgeon) who did not read successively the same films for the same patient. The results were recorded with an Excel data sheet and the statistical analysis was done with the BMDP software.

Results: Thirty-seven patients were included (22 women and 15 men) with 40 THA. Mean age was 64 years (42–86). Mean follow-up of the THA was 25 months (2–248). Four patients had mechanical pain or deceased joint amplitude and 33 patients had no clinical sign. Only one lucent line was found measuring less than 2 mm in the 1st quadrant of the cup and the 3, 4, and 5 zones on the AP view and the 10, 11, 12 zones on the lateral view on the tail of the pros-thesis. In this study, the kappa value was less than 0.5 for the mean concordance according to the Landis and Koch classification. The Kappa was higher for the intermethod analysis irrespective of the reader, than for the interobserver analysis.

Discussion, conclusion: Independent readers of the two types of images (C and D) did not demonstrate any difference for cemented or noncemented prosthesis in a longitudinal study of THA. The reproducibility between the C and D techniques was small. However, our study only analysed a few of the numerous radiographic signs considered to favour loosening (stress shielding, lucent lines etc.…). However, the analysis of the Kappa results demonstrated mean concordance between the techniques better than mean concordance between observers.

We describe a syndrome combining abnormalities of the pelvis, knee and foot in three related patients with a familial history of small dislocated patellae. The clinical and radiological appearance of the patella and pelvis is consistent with the ‘small-patella’ syndrome, a rare autosomal dominant disorder. There were also previously unreported deformities affecting the feet.