Ganglion of the Hip: Report of Five Cases--Richard Mährlein, MD

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Ganglia are benign cystic tumors originating from synovial tissue. They mainly occur at the wrist, hand, foot, and knee, those of the knee being known as Baker’s cyst. The typical clinical appearance usually leaves no doubt about the correct diagnosis. Only Baker’s cyst deserves additional diagnostic measures to assess the presence and extent of any underlying disease of the knee joint.

Cementless S-ROM Femoral Component: Effect of Stem Length on Stability After Extended Proximal Femoral Osteotomy--Umesh T. Bhagia, MD, R. Scott Corpe, MD, David E. Steflik, EdD, Timothy R. Young, DO, John Schnars, MD

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The extended proximal femoral osteotomy is becoming increasingly popular in revision total hip replacement. Our study was done to determine the femoral stem length required for stable fixation of a cementless femoral component after an extended proximal femoral osteotomy. Three lengths of the S-ROM femoral stem were implanted in paired cadaver femora and tested under torsional and axial loads. The results indicate that the standard (160 mm) and long (215 mm) stems do not provide adequate torsional stability after a 160 mm extended proximal femoral osteotomy. The extra-long (255 to 315 mm) stems provided significantly greater stability, suggesting that the extended proximal femoral osteotomy may need to be bypassed by more than 2 cortical diameters, especially when a flexible stem such as the S-ROM is used.

Elbow Arthroscopy for Neglected Osteochondritis Dissecans of the Capitellum--J. W. Thomas Byrd, MD

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We reviewed results of elbow arthroscopy for neglected osteochondritis dissecans (OCD)of the capitellum. Of more than 140 patients having elbow arthroscopy at our institution, 10 patients (11 elbows) had OCD of the capitellum and fulfilled inclusion criteria. Criteria included symptoms of at least 2 years’ duration, loss of motion for at least 6 months, or radiographic evidence of secondary degenerative changes. One patient was lost to followup. The remaining 9 (10 elbows) were male patients with a median age of 20 years (range, 15 to 58 years). Follow-up averaged 4.6 years (range, 2 to 8 years). Using a 100-point system, postoperative elbow scores averaged 92 (range, 55 to 100). All patients returned to preoperative activities, though only 8 of 10 believed that surgery resulted in improvement. Elbow arthroscopy for neglected OCD can result in functional improvement. However, results are not as good as those reported with earlier intervention.

Primary Patellar Tendon Repair and Early Mobilization: Results in an Active-Duty Population--Jerome G. Enad, MD, Larry L. Loomis, PT, OCS

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We retrospectively reviewed 13 patellar tendon repairs done over 32 months at a tertiary care, military medical center. Early mobilization was initiated within 2 weeks postoperatively. Clinical and functional results were statistically examined with relation to age, timing of surgery, length of follow-up, quadriceps atrophy, extensor lag, patella position, and time to full duty. At an average of 24 months’ follow-up, six patients (46%) had thigh girth atrophy, and one patient (8%) had an extensor lag >5°. Mean Lysholm score was 84 (range, 57 to 100). Maximum postoperative Tegner activity scores averaged 7.1 (range, 5 to 10). Clinical results classified five cases as excellent, three good, three fair, and two poor. Functional results classified three cases as excellent, four good, two fair, and four poor. Time to return to duty averaged 13 months. Our results suggest that adequate extensor function can be restored after primary repair and immediate motion therapy.

Anatomy of the Knee Extensor Mechanism: Correlation With Patellofemoral Arthrosis--Michael A. Mont, MD, Amar D. Rajadhyaksha, MD, Kyle Low, MD, Dawn M. LaPorte, MD, David S. Hungerford, MD

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The patellofemoral articulation is a common and significant source of disability and discomfort in the aging population. This study examined the anatomy of the knee extensor mechanism in patients having primary total knee arthroplasties, characterized the anatomic variations of the extensor mechanism, and correlated these findings with the location and extent of osteoarthritic change of the patellar undersurface. Sixty-two knees (57 patients) were evaluated prospectively. Specific characteristics that were analyzed included the mean Outerbridge grade for rating patellar cartilage degeneration and anatomic patterns of the extensor mechanism. Knees with a quadriceps tendon width at 2 and 5 cm above the patella that differed by less than 1 cm had more statistically significant patellar degeneration in all patellar locations than knees with tendon width differences greater than 1 cm. Anatomic variations, such as tendons with minimal increments in width in the proximal-distal direction, may be associated with an increasing amount of patellar arthrosis at the lateral facet, central ridge, and, most significantly, medial facet.

Knee Flexion Contractures: Soft Tissue Correction With Monolateral External Fixation--James F. Mooney III, MD, L. Andrew Koman, MD

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We assessed the efficacy of progressive soft tissue distraction using monolateral external fixation in the management of severe knee flexion contractures. We prospectively evaluated 10 knee deformities in seven pediatric patients. After gradual distraction using the modified Orthofix Limb Reconstruction System (LRS), most recent functional status and knee range of motion were determined. This treatment was applied to 10 extremities in seven patients, ranging in age from 2 to 16 years. Diagnoses included arthrogryposis (4), sickle cell disease (1), previous sepsis (1), and congenital pterygium (1). Average preoperative flexion contracture was 80.5°. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures. Management of knee flexion contractures using a monolateral fixator appears to be a viable alternative to extensive release or femoral osteotomy. Long-term follow-up will be essential to assess the overall risk of recurrence and complications.

Osteogenesis in a Rat Model: Use of Bone Marrow Cells and Biodegradable Gelatin Matrix Carrier--Stephen Troum, MD, Martin L. Dalton, Jr., MD

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We investigated the use of a biodegradable porcine gelatin matrix (Gelfoam) as a carrier for marrow cells that induce osteogenesis at ectopic sites in rats. Bone marrow cells obtained from the long bones of 6-week-old Sprague-Dawley rats were dissociated enzymatically and the cells reconstituted in rat serum. Twenty million cells in 0.1 mL of serum were then adsorbed into 1-cm3 pieces of gelatin matrix substrate and implanted into ectopic sites in live Sprague-Dawley rats. The implants were retrieved and analyzed histologically for bone and cartilage formation 3, 4, 6, and 8 weeks after implantation. Woven bone was seen as early as 3 weeks and persisted through 8 weeks. No cartilage was observed. Osteoclasts first appeared at 3 weeks, peaking in number at 4 weeks. By 6 and 8 weeks, only small islets of substrate remained, surrounded by dense, woven bone. Control implants, consisting only of serum adsorbed into the carrier, showed no bone formation. We conclude that biodegradable gelatin matrix can serve as a carrier for the osteogenic cells of bone marrow in rats in ectopic sites. Such a system may be further developed to augment bone healing.

“Always Do Right . . .”*--Boone Brackett, MD

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Doctor Elmer Nix, the 82nd President of The Clinical Orthopaedic Society, in his address at the 1996 meeting stated, “I believe the banner of medical ethics is sagging and has perhaps fallen to the ground.” He challenged the society to become “the conscience of medicine.” Webster defines conscience as a “sense of right and wrong with an urge to do right.” We, as bearers of the staff of Aesculapius, must conduct ourselves so that we, like Caesar’s wife, are above suspicion. We must resist pressures that erode our authority to make medical decisions based on patients’ needs rather than on economic forces.

Osteoid Osteoma of the Coracoid Process--Isidro A. Gracia, MD

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Osteoid osteoma is a small, benign, and painful tumor most commonly affecting the extra-articular portions of the long bones, especially the femur or tibia. Osteoid osteoma of the coracoid process is so rare that we have found only three previously reported cases in the international literature. We describe our experience in managing a case of osteoid osteoma in this unusual location.

Heterotopic Ossification After Lateral Epicondylectomy--Mike Cushing, MD, Gary M. Lourie, MD, Drew V. Miller, MD, Jeffrey A. Hohn, BME

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Lateral epicondylitis is a common affliction that can be treated nonsurgically. However, surgical treatment is rarely indicated, and results are usually effective in more than 90% of patients. Although complications have been described, ours is the first report of heterotopic ossification after an uncomplicated lateral epicondylectomy.

Septic Sacroiliitis: The Overlooked Diagnosis--David E. Attarian, MD

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Infection of the sacroiliac joint is extraordinarily rare. However, the initial symptoms and signs associated with this condition are mundane, thus leading to delay in diagnosis, or even misdiagnosis. I report an extremely unusual pyogenic sacroiliitis caused by Salmonella and discuss key clinical components and protocol for the successful evaluation, diagnosis, and treatment of this uncommon illness.

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