Cedric J. Ortiguera

Total Hip Arthroplasty for Osteonecrosis Matched-Pair Analysis of 188 Hips With Long-Term Follow-Up

A matched comparison was made between total hip arthroplasties done for osteonecrosis and those done for osteoarthritis. Patients were matched for age, sex, surgical approach, prosthesis, and surgeon. All received cemented Charnley replacements and had minimal follow-up of 10 years. There were 118 women and 70 men with a mean age of 58 years. Thirty-five patients were younger than 50. The mean follow-up was 17.8 years (range, 10 to 25.4 years). Revision rates for osteonecrosis and osteoarthritis were 18% and 19% (not significant). The mechanical failure rate (revision for loosening plus radiographic loosening) was greater, but not significantly so, in the osteonecrosis group. In patients younger than 50 years, the revision rate in osteonecrosis (50%) was significantly higher than that in any other group. Similarly, the mechanical failure rate in osteonecrosis was significantly greater in the patients younger than 50. Radiographic femoral loosening was greater in osteonecrosis at all follow-up intervals, and dislocations occurred more frequently in the osteonecrosis group than in the osteoarthritis group. Results of arthroplasty in both groups were comparable in patients over 50 years of age, although patients with osteonecrosis had an increased rate of dislocation. Patients with osteonecrosis who are younger than 50 years have a significantly higher rate of mechanical failure than those with osteoarthritis who are younger than 50 years. Cemented total hip arthroplasty should be recommended in this group with caution if at all.

Posterior cruciate ligament-sparing versus posterior cruciate ligament-sacrificing arthroplasty: Functional results using the same prosthesis

The functional outcomes of 143 total knee arthroplasties performed by 1 surgeon between 1988 and 1992 were reviewed. Ninety-three procedures were carried out with sacrifice of the posterior cruciate ligament (PCL); in 50, the PCL was preserved. All cases were performed using the Kinemax prosthesis (Howmedica, Rutherford, NJ). Demographically, there were no differences between the 2 patient groups. Patients were evaluated over a mean follow-up period of 3 years (range, 2-6 years) using the 100-point Hospital for Special Surgery knee scoring system. The data revealed no difference in clinical or early radiographic outcome between PCL-sacrificing and PCL-retaining arthroplasties and support the argument that PCL sacrifice should be considered in cases in which extensive releases and complex ligamentous balancing are required.

Injuries in youth football: a prospective observational cohort analysis among players aged 9 to 13 years

OBJECTIVE To determine the risk of injury in youth football games. SUBJECTS AND METHODS Nine hundred fifteen players aged 9 to 13 years on 42 teams participated, including 10 teams in each grade from grades 4 through 6 and 6 teams each in grades 7 and 8. The study was conducted in the fall of 1997. Injury incidence, prevalence, and severity were calculated for each grade level and player position. Additional analyses examined the number of injuries according to body weight. RESULTS A total of 55 injuries occurred in games during the entire season (overall prevalence, 5.97%). Most injuries were mild, and the most common type was contusion, which occurred in 33 players (60%). Four injuries (7%) were severe enough to prevent players from participating for the rest of the season. All 4 severe injuries were fractures involving the ankle physis. The risk of injury increased as players matured in age and grade level. Injury risk for an eighth-grade player was 4 times greater than the risk of injury to a fourth-grade player. A trend was identified for heavier players to be at increased risk, but no significant correlation was evident between body weight and injury. CONCLUSION Our prospective observational analysis showed that most youth football injuries are mild. Older and heavier players appear to be at higher risk.

Popliteus Strain Causing Tibial Nerve Palsy with a Permanent Partial Deficit: A Case Report

A 57-year-old male tennis player (National Tennis Rating Program Rating, 4.5) noticed a slight pulling sensation in the posterior aspect of his left knee while playing in a match. The exact onset of symptoms was not clear. He was able to complete the match without difficulty and denied any history of similar discomfort. The next day, he noticed increased pain along the lateral aspect of the knee radiating into the calf, numbness on the plantar aspect of his foot, and inability to flex his toes. He was able to bear weight with slight difficulty. He came to our clinic 2 days after the tennis match with the above symptoms. He denied prior trauma to the knee; however, he did have a history of ipsilateral Achilles tendon rupture 10 years before this injury. The Achilles tendon rupture had been treated with open repair using nonabsorbable sutures to the calcaneus. There was no injury to the plantaris, and the patient returned to full activity without symptoms. The remainder of his medical history was unremarkable. On examination, his gait and station were normal. His knee range of motion was 0° to 120°. There was mild, diffuse tenderness about the posterolateral aspect of the left knee. Stability testing showed negative results on Lachman test, pivot-shift test, and posterior drawer test; no varus/valgus laxity at 0° or 30°; and no increased external rotation at 30° or 90°. Sensation was diminished to pin prick on the plantar aspect of his foot, and he had 3 of 5 strength of flexor hallucis longus and flexor digitorum muscles. The remainder of his neurovascular examination was normal. Radiographs showed mild degenerative changes of the knee with no fracture or other osseous abnormality. Magnetic resonance imaging of the knee and proximal calf depicted enlargement of the proximal popliteus muscle with marked increased signal within the substance of the popliteus muscle on fluid-sensitive sequences. The MRI findings were compatible with partial tearing of the popliteus muscle with intrasubstance hemorrhage and edema within the musculature. The proximal popliteus tendon was intact. Associated tibial nerve compression related to mass effect from the enlarged popliteus muscle was apparent on MRI (Figure 1). Magnetic resonance imaging of the lumbar spine showed mild degenerative changes with no evidence of nerve root compression. He was treated nonoperatively with activity modification and relative rest. At 4 weeks, his knee pain had markedly decreased, but he continued to have numbness of the plantar foot and weakness of the toe flexors. Treatment options were discussed with the patient, including surgical decompression. Based on the patient’s improvement in symptoms and satisfactory outcome of a similar case reported in the literature, nonoperative management was continued. At 8 weeks, the patient denied any pain but continued to complain of mild weakness of his toe flexors as well as persistent numbness and tingling into the plantar aspect of his foot. He felt much improved and was able to return to unlimited tennis at this time. Repeat MRI at this time showed diminished size of the popliteus musculature with decreased interstitial hemorrhage and edema. The reduced size of the musculature resulted in diminished mass effect Popliteus Strain Causing Tibial Nerve Palsy With a Permanent Partial Deficit

Pectoralis Major Avulsion in a Skeletally Immature Wrestler: A Case Report

Injuries of the pectoralis major tendon, once thought rare, are increasing in frequency. Originally reported by Patissier in 1822, approximately 200 cases have been described in the literature, with more than 75% of these identified in the past 30 years. The increase in incidence is likely due to the greater emphasis on weight lifting and physical activity over the past several decades. Weight lifting— particularly, the bench press—is the most common mechanism of injury, followed by trauma incurred from football, water-skiing, wrestling, and ice hockey. Despite multiple reports of pectoralis major tendon injury in men, to our knowledge there is only 1 case report of this injury in adolescent patients under the age of 18 years. Because of the perceived rarity of this condition, many cases in the pediatric population may be misdiagnosed at the initial evaluation. Our purpose is to illustrate a case of pectoralis major tendon injury in an adolescent athlete and to review the pertinent literature.

Arthroscopic Treatment of the Unstable Mesoacromion

Unstable symptomatic os acromiale is an unusual cause of impingement syndrome and rotator cuff pathology. Failure of nonoperative measures may require surgical intervention. Arthroscopic excision of the unstable bone fragment and treatment of any associated minor rotator cuff pathology have produced acceptable results.

Popliteus muscle hemorrhage as a rare cause of a proximal tibial neuropathy.

Proximal tibial neuropathy is an uncommon focal mononeuropathy that is most often caused by trauma, ischemia, or neoplastic infiltration or compression of the tibial nerve. We report a patient who presented with a tibial neuropathy following a leg injury, which initially mimicked a lumbosacral radiculopathy but which was the result of a proximal tibial neuropathy. Electrophysiologic studies confirmed a proximal tibial neuropathy and MRI revealed a popliteus muscle hemorrhage with mass effect on the tibial nerve. Following conservative management the patient had little recovery of function after 15 months.