Background

Specifically designed control interventions can account for expectation effects in clinical trials. For the interpretation of efficacy trials of physical, psychological, and self-management interventions for people living with pain, the design, conduct, and reporting of control interventions is crucial.

Purpose of the study: The objective of this study was to investigate a new test (the bear-hug test) in search of a more sensitive way of diagnosing small infrascapular tears. The bear-hug test was compared with other tests (lift-off, belly-press, Napoleon).

Material and methods: From January to March 2004, 68 patients were scheduled for arthroscopic shoulder surgery. We searched for correlations between the preoperative clinical results and the anatomic observations during the diagnostic phase of the arthroscopy.

Results: The prevalence of infrascapularis lesions was 29.4%. Forty percent of the infrascapularis lesions had not been identified by any of the clinical diagnostic tests. The bear-hug test was the most sensitive (60%) compared with the belly-press test (40%), the Napoleon test (25%), and the lift-off test (17.6%). The lift-off test was the most specific (specificity 100%) versus 97.9% for the Napoleon test, 97.9% for the belly-press test and 91.7% for the bear-hug test. The bear-hug test was more sensitive than the Napoleon test and the lift-off test with statistically significant difference, irrespective of the size of the tear (p< 0.05), but this difference was not found for the belly-press test (p> 0.06). Conversely, for small tears (50%), there was a statistically significant difference in favor of the bear-hug test (Se bear-hug 50%; Se belly-press 21.4%; p< 0.035). The bear-hug test was thus moe sensitive for diagnosing small tears of the upper third of the infrascapularis. A positive bear-hug or belly-press tes would suggest at least a 30% infra-scapularis tear, while a positive Napoleon test suggests at least a 50% tear. The lift-off test is only positive when 75% of the infraspinatus is injured.

Conclusion: The sensitivity of the bear-hug test optimizes chances of detecting a tear of the infrascapularis at the physical examination. Combining all of these tests is useful for predicting the size of the tear.

Purpose: Bilateral tears of the ACL are classically described as occurring after a first tear. Few reports have examined the underlying mechanism and the frequency and predisposing morphological factors

Material and methods: We reviewed retrospectively a series of 3722 ACL plasties performed from 1984 to 2001, including 148 patients who underwent bilateral repair. In this group, we detailed the demographic features, the time from tear to repair, the type of sports activity and focused on the radiological measurement of tibial tilt.

Results: The estimated frequency of bilateral tears was 4%. We noted that these bilateral tears were associated with: male predominance (60%), mean age 21 years (±5.5) at first tear, younger age for females, second tear at 24.5±6.5 years, predominant practice of pivot sports without contact (56%), and competition sports. The time between the two tears was 48 months on average. The rate of contralateral tears during the first postoperative year was 16%, it was 60% at three years. The mean tibial tilt was 9.91±2.87° versus 6.8±1.87° in the control population.

Discussion: Our findings were in agreement with the literature for frequency, young age at first tear, particularly for women, short time between the two tears, and type of sports activity. The high rate of contralateral tears during the first year is a significant finding. Hypotheses put forward include loss of confidence in the operated knee leading to more stress on the contralateral knee, but also poorly adapted use of the healthy knee in sports activity. Rehabilitation exercises focusing on bilateral proprioception, respecting sufficient time after the first repair before resuming sports activities, and good control of knee laxity with an ‘anatomic’ plasty appear to be important elements of prevention. The favouring role of a narrow intercondylar notch has been established in the literature. We found that tibial tilt should also be taken into consideration.

Conclusion: Careful search for predisposing factors is important because of the frequency of bilateral tears of the ACL. The rehabilitation program should be well adapted and the patient should be informed of the risk. These measures should help decrease the incidence of this relatively frequent complication.

Purpose: Cyclope syndrome is a complication which occurs after ligamentoplasty of the anterior cruciate ligament. It is characterised by permanent flexion which may or not be associated with anterior pain, cracking or hydroarthrosis, typically during exercise. The diagnosis is confirmed by MRI. Arthroscopic treatment is indicated for resection of the nodule and as needed bone plasty of the notch if permanent flexion persists. In the literature, short-term results have been disappointing. We wanted to know more about the long-term outcome.

Material and methods: From January 1992 to December 1994, 835 patients underwent bone-tension plasty. Thirty-six underwent secondary surgery for cyclope syndrome (4.3%). Mean age at revision procedure was 26.2 years (16–43). Most of the subjects were athletes. Twenty-three patients (63.9%) were seen at follow-up consultation and 16.7% responded to a telephone interview. Mean time to review was nine years (8–10 years). We used the IKDC 1999 chart for subjective assessment and clinical evaluation and measured laxity with KT1000. We also studied changes in symptoms related to cyclope syndrome.

Results: We had two cases of recurrent tears (6.9%). The mean final subjective IKDC score was 81.6 points. Half of the patients had good outcome (> 82 points) and half had disappointing results (scored 50–80 points). The final objective IKDC scoring was: A=17.4%, B=65.2%, C=8.7%, D=8.7%. Thirteen patients had persistent signs of cyclope syndrome (44.8%). Fourteen still had limited joint motion (48.3%). Fifteen reduced their physical activity level (51.7%).

Discussion: The origin of the cyclope syndrome remains controversial. It is difficult to assess the risk of recurrent tear due to the small size of the population and the long time to review in this series.

Conclusion: Cyclope syndrome does not appear to be a factor of risk of laxity but is a non-negligible factor of morbidity, even ten years later. It appears to be important to operate early in order to avoid the spiral of chronic suffering. The postoperative flexion, which had been advocated in the past, does not appear to be useful.