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We report herein a very rare case of semitendinosus tear that formed a tumor in the popliteal region after not having recovered as a result of only being instructed to rest. The soft tissue tumor was discovered on ultrasonography 4 months after pain and sensation of discomfort appeared in the popliteal region. We considered this symptom as dependent on the presence of the tumor and selected surgical treatment. Intraoperatively, this soft tissue tumor was connected with the pes anserinus by tendinous tissue. On pathological examination, the soft tissue tumor was diagnosed as skeletal muscle showing necrosis. From imaging, operative findings, and pathological diagnosis, this was considered to represent a rare case in which myorrhexis developed into a soft tissue tumor in the popliteal region after a semitendinosus tear remained unhealed and was neglected over the long term. Although we had trouble confirming a diagnosis and treatment procedure, we were able to acquire good results with surgical treatment. This is, to the best of our knowledge, the first report of damaged semitendinosus becoming a soft tissue tumor in the popliteal region after long-term neglect without healing.

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PURPOSE: The purpose of this retrospective study was to analyze the effects of age at surgery on the clinical results, arthritic progression, and changes in lower limb alignment during long-term follow-up of total resection for discoid lateral meniscus. METHODS: A total of 37 knees in 32 patients were reviewed as a whole group and also after division into the following 3 groups according to the age at surgery: group A, 11 knees in patients aged less than 20 years; group B, 13 knees in patients aged 20 to 39 years; and group C, 13 knees in patients aged greater than 39 years. The mean age at surgery was 31.2 years (range, 9 to 52 years), and the mean length of follow-up was 14.5 years (range, 10 to 22.4 years). RESULTS: According to the scale of Ikeuchi, clinically excellent or good results at the final follow-up were found in 84% of the knees in the whole group, 91% of those in group A, 85% of those in group B, and 77% of those in group C. Moderate or severe narrowing of the lateral joint space was seen in 11% of the knees in the whole group, 0% of those in group A, 8% of those in group B, and 23% of those in group C. In an analysis of lower limb alignment, statistically significant postoperative lateral shifts of Mikulicz's mechanical axis were observed in groups B and C. CONCLUSIONS: The clinical results were satisfactory and the postoperative arthritic changes were mild in patients aged under 40 years. However, it is necessary to carefully monitor arthritic progression in patients who are aged over 19 years and have valgus deformities, because most of the knees in patients above this age became more valgus postoperatively. LEVEL OF EVIDENCE: Level IV, prognostic case series.

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It is widely accepted that high tibial osteotomy (HTO) is an effective surgical treatment for medial gonarthrosis. However, long-term follow-up studies have revealed that the clinical results deteriorate over time and varus deformity often recurs. We performed barrel-vault osteotomy in HTO with a correction angle that did not cause arthritic progression in the medial compartment of the knee or recurrence of varus deformity. Thirty patients (44 knees) were followed clinically and radiographically for a minimum of 10 years (average, 11.4 years). We aimed for an average postoperative femorotibial angle (FTA) of 165.3 degrees (range, 162-169 degrees ) according to our method using a correction angle chosen on the basis of the so-called Mikulicz's mechanical axis. The clinical results were good in 30 (68.2%) knees, fair in 7 (15.9%) and poor in 7 (15.9%). Arthritic progression in the medial compartment was only found in 1 (2.3%) knee, while in the lateral compartment it was found in 17 (38.6%) knees. Of the knees with arthritic progression in the lateral compartment, six (35.3%) were classified as poor. The average postoperative FTAs were 164.3 degrees at 1 year, 164.0 degrees at 5 years and 163.5 degrees at 10 years after the operation, indicating that the knees tended to become slightly valgus over time. The clinical results were not poor after slightly overcorrected osteotomy was performed. Since overcorrection tended to occur, when the preoperative lateral tibial thrust was severe, HTO is not a good indication for such cases.

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The purpose of our study is to evaluate whether the hamstring tendons can regrow after harvesting for anterior cruciate ligament (ACL) reconstruction and whether the regenerate tissue can be histologically characterized as tendinous. Eleven of the patients (eight female and three male; mean age, 23 years; range 17-37 years) consented to participate in this study. One year after the ACL reconstruction, surgical biopsy was done. Regeneration of the tendon was detected macroscopically in 9 of the 11 patients. Histologically and immunohistochemically, the regenerated tendons closely resembled normal ones. The results of this study show the hamstring tendons can regenerate after harvesting for the ACL reconstruction.

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Seventeen years ago we treated a nonunited avulsion fracture of the anterior tibial spine with open reduction and pull-out wires. When the patient was 9 years old, she fell and bruised her left knee. The knee was immobilized for a month in a long cast. When she was 24 years old, she felt severe knee pain and giving way after playing tennis 1 month before her first visit to our hospital. She complained of knee pain, giving way, locking, and 15 degrees loss of knee extension. Radiographs showed a large nonunited fragment at the intercondylar eminence of the tibia. She underwent a reattachment surgery. When she was re-evaluated 17 years after surgery, she had no pain, no giving way, no locking, and no loss of knee extension. On physical examination, there was no instability. Plain anteroposterior and lateral radiographs showed a well-united fragment of the anterior tibial spine. In conclusion, the open reduction for knee pain, giving way, locking, and loss of knee extension caused by nonunion of avulsion of the anterior tibial spine yielded satisfactory results. We believe that in cases of nonunited anterior tibial spine fractures it is necessary to attempt to secure the anterior cruciate ligament in an anatomic position.

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This study aimed to show the results of osteochondritis dissecans fragment excision. We reviewed 85 patients (98 knees) with osteochondritis dissecans in a retrospective study of the results of merely excising the osteochondral lesion. Thirty-one knees were treated by only the removal of the fragment. Of these, it was possible to contact and examine 14 patients (14 knees); the average follow-up periods were 8.3 years (range 4.5-32 years). Knee function was evaluated according to the criteria of the International Knee Documentation Committee (IKDC), 12 knees in the 14 patients had no further symptoms and the 2 others had mild pain when going up- and downstairs. Roentgenograms at follow-up showed slight osteoarthritic changes. The preoperative femoro-tibial angle measured at surgery showed no marked change compared with that at follow-up. The study suggests that clinical and radiological results are good following removal of the osteochondral loose fragments are excised.

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INTRODUCTION: We attempted to reinforce the transplanted ligament by wrapping it with the iliotibial tract (ITT) flap to get more volume and to protect the graft from impingement in the intercondylar space postoperatively in reconstruction of the anterior cruciate ligament (ACL) using bone-patellar tendon-bone (BTB), and investigated the results in comparison with those of BTB alone. MATERIALS AND METHODS: The study included 88 cases (88 knees). Group A comprised 43 knees with the reinforcement and group B 45 knees with BTB alone. Both groups were evaluated by second-look arthroscopy, magnetic resonance imaging (MRI), manual testing, International Knee Documentation Committee (IKDC) score, and histopathological evaluation more than 2 years after the reconstruction. RESULTS: In the second-look arthroscopic findings, 84% of the reconstructed ACL in group A had good appearance, and no fibrous split was observed. The ratio of fibrous disorder was significantly less in group A in comparison with group B (p=0.0037). Distinct reduction of the tension of the reconstructed ligament was observed in 9% of group A and 36% of group B (p=0.0088). Regarding the results of the Lachman test, the ratio of the negative group was higher in group A (p=0.0067). In the MRI findings fulfilled pictures to the inside of the reconstructed ligament were observed in 77% of the patients photographed in group A. In contrast, the fibrous split was observed in 55% in group B. CONCLUSIONS: Reinforcement by wrapping with the ITT flap for the BTB autograft was effective in ACL reconstruction. The ratio of fibrous disorder and reduction of tension in the reconstructed ligament decreased.

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INTRODUCTION: Synovial hemangioma is a rare intra-articular benign tumor that is difficult to diagnose because of its nonspecific symptoms. Patients are generally children or young adults with a nontraumatic recurrent swollen painful knee. CASE PRESENTATION: A 24-year-old woman presented with a 20-year history of recurrent pain and swelling in the right knee. Physical examination revealed a small painful point adjacent to the medial side of the patella. Magnetic resonance imaging revealed an intra-articular tumor. After arthroscopic examination, surgical excision was performed. The histology was characteristic of synovial hemangioma. RESULTS: Open complete synovectomy of the circumscribed capillary hemangioma was successful, and the patient remains asymptomatic 2 years after surgery.

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BACKGROUND: We report a rare case of glomus tumor that occurred in the lateral joint of the knee. A 54-year-old man was referred to us with a 3-year history of lateral pain in the left knee and the diagnosis of lateral meniscus injury. Physical examination revealed a small trigger point localized just on the lateral joint space. Magnetic resonance imaging (MRI) showed a very small round mass in the subcutaneous tissue at the level of the lateral joint space. TREATMENT: Excisional biopsy was performed, and the histology was characteristic of a glomus tumor. The patient was asymptomatic immediately after the operation. At the 3-year follow-up after the operation, no recurrence was seen.

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