Template Versus Freehand Bone–Patellar Tendon–Bone Harvest for Anterior Cruciate Ligament Reconstruction: Its Effect on Patellofemoral Morbidity--Eugene E. Berg, MD
To test the hypothesis that a template system for harvesting bone–patellar tendon–bone (BTB) would cause fewer postoperative patellofemoral problems than freehand graft harvests, two groups of 20 patients who had arthroscopically assisted anterior cruciate ligament (ACL) reconstructions were compared at 1 and 3 years. Three years after surgery, no significant differences were found in the quality of the ligament reconstruction. One intraoperative patellar fracture occurred in the freehand group (group 1). All other complications were similar between groups. Squatting profiles were slightly better in the template group (group 2). Averaged and outlier scores from three published patellofemoral scoring systems showed no significant differences between the two groups. It was concluded that current methods for measuring patellofemoral function detected little morbidity and no significant outcome differences between ACL reconstructions done with BTB grafts harvested by freehand versus templated techniques.
Management of Leg Length Inequality--James J. McCarthy, MD
Leg length inequality is common. Treatment objectives include obtaining leg length equality, producing a level pelvis, and improving function. Clinical assessment should include determination of a level pelvis with the patient standing using a set of blocks of various heights to estimate the amount of leg length inequality. Radiographic measures include the teleroentgenogram, orthoradiograph, and computed tomography (CT). A prediction of the ultimate leg length inequality at skeletal maturity will be needed to determine treatment. Our guidelines for treatment of leg length inequality are as follows:
Replantation of Digits and Hands*--L. Andrew Koman, MD
Since the first major limb replantation of an arm by Malt1 in Boston in 1962 and the historic report of replantation of the thumb by Komatsu and Tamai2 in 1968, revascularization and replantation of human digits has become a common occurrence. Over the past 40 years, the indications have been better delineated, with consequent improvement in outcome. Simultaneously, improved safety procedures in the workplace have diminished the incidence of work-related traumatic amputation. However, amputations continue to occur from a variety of mechanisms.
Acute Carpal Tunnel Syndrome Caused by Idiopathic Tumoral Calcinosis--Alfredo Sánchez-Martín, MD
We present a case of acute carpal tunnel syndrome due to compression of the median nerve within the carpal tunnel caused by tumoral calcinosis. Wrist immobilization and oral corticosteroids produced excellent clinical resolution. Radiologically, the calcific mass disappeared.