Purpose of the study: The aim of this retrospective epidemiological study was to report the complete arthroscopic results concerning meniscus or cartilage injuries for procedures performed to repair the anterior cruciate ligament (ACL). The goal was to search for risk factors and improve patient care.

Material and methods: Between 2000 and 2004, the same operator performed 129 consecutive ligamentoplasties to repair ACL tears. The following preoperative factors were analyzed: body weight, height, type and level of sports activity, laxity, positive pivot test, morphotype, time from accident to surgery. Meniscal lesions were identified and classified according to Trillat. The Beguin and Locker classification was used for cartilage lesions. The Panthéon-Sorbonne statistics laboratory performed the statistical analysis.

Results: Meniscal lesions were found in 53.5% of knees and cartilage lesions in 24.2%. The medial meniscus was involved in 75.4% and the lateral meniscus in 20.3%, both in 4.3%. The injury could be repaired by suture or a conservative procedure for 45%. The medial compartment presented cartilage injury in 51.6% of knees, the patella in 29%, the trochlea in 19.35% and the same percentage for the lateral condyle. The degree of preoperative laxity, the time from accident to surgery and body mass index were statistically correlated with presence of a meniscal injury. Age, the degree of pre-operative laxity and body mass index were statistically correlated with presence of a cartilage injury.

Discussion: Meniscal injuries are frequent in knees with ACL tears. The posterior segment of the medial ligament, which blocks anterior translation of the tibia if the ACL is absent, is predominantly involved. The amount of tibial movement below the femur and stress applied to the knee (particularly related to body mass) favor such lesions. Many lesions will heal spontaneously after surgery. Inversely others are more frequent after a longstanding tear. Cartilage injury is also frequent and occurs often on aging cartilage. The extent of tibial movements and their repetition as well as important stress are factors predictive of such injuries.

Conclusion: Indications for reconstruction of the ACL in the young subject are well identified, less so in the older subject. This study confirms the usefulness of reconstructing the ACL to protect the menisci and joint cartilage. Excessive weight appears to be another important point to take into consideration for the surgical management of these patients.

Purpose: External fixators are widely used for limb lengthening procedures. More recently the femoral nail has been introduced combining the advantages of progressive lengthening obtained with external fixation and of the percutaneous approach of internal fixation. This retrospective analysis of 14 patients treated with the progressive femur lengthening nail (ECMP) Albizzia®, was conducted to analyse results in terms of limb length correction, bone healing and complications.

Material and methods: The fourteen patients, nine men and five women, mean age 27.3 years had leg length discrepancies = 20 cm. All were treated with the ECMAP nail (Albizzia®)in January or February 2000. There were nine right legs and five left legs. The patients had discrepancy subsequent to trauma (64.3%), hip dysplasia (21.4%) or neurological (7.15%) or infantile (7.15%) conditions. Mean leg length discrepancy was 41.5mm (20–150 mm); 57.1% of the patients wore a raised heal and 14.2% used crutches. The nail was inserted with reaming and locked on both ends. The corticotomy was made with an endomedullary saw in a closed procedure for 78.5% of the patients and with an open procedure for 21.5%. Angular correction was associated in 32.7% of the cases. Outcome was analysed on the basis of operative time, blood loss, rhythm and amount of limb lengthening, delay to healing and complications.

Results: Mean follow-up was 25 months. Mean operative time was 2 hr 28 min. The lengthening procedure began 4.1 days after nailing with, on the average, 20 ratchet clicks per day. Mean duration of the lengthening procedure was 32.5 days. Mean lengthening was 32.15 mm, i.e. 0.99 mm/day. Ten patients had a general anaesthesia at least twice to manipulate the nail ratchet. There were five cases with mechanical complications and one case of regressive nerve injury. There were no infections, no cases of joint stiffness and no axis defects. Bone healing was achieved a mean 2.7 days. There was one nonunion. Mean haemoglobin loss was four points, three patients required transfusion. Limb length was equivalent in six patients, with < 5 mm discrepancy in three, 6–10 mm discrepancy in one, 11 mm discrepancy in two and 64 mm discrepancy in one. One lengthening procedure had to be interrupted before term.

Discussion: ECMAP is unable to avoid the complications inherent in lengthening procedures but does offer undeniable advantages over external fixation. The risk of infection is very low and skin scars are minimal. Patient comfort is greatly improved (elimination of the cumbersome external fixator). Delay to bone healing is satisfactory and axial rotation defects can easily be corrected. This technique appears to be an excellent means for lengthening the femur in trauma patients.