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The origin of chronic pain after external ankle sprain is better known with arthroscopy's contribution. Chronic hypertrophic synovitis of the anterolateral ankle region is seemingly the cause, resulting in "anterolateral ankle impingement." But is partial synovectomy with fibrosis resection under arthroscopy always possible without any distraction? Are results affected? This retrospective study concerned only patients with soft tissue ankle impingement. All cases with bone and joint diseases were excluded. The final sample of 24 patients had a mean age of 35 years (21-54 years) and presented anterolateral mechanical pain associated with oedema following external ankle sprain. Medical and rehabilitative treatment was undertaken for more than 6 months before arthroscopy. Average time between trauma and arthroscopy was 21 months (5-60 months). Clinical examination revealed no ankle instability or laxity. Debridement with joint lavage was systematically performed under arthroscopy without any distraction. Average patient follow-up was 22 months (12-92 months). All patients had a good Kitaoka score, with 22 patients registering excellent results. There were no septic complications or algodystrophy. Two transient hypoesthesias were observed in the dorsal surface and lateral border of the foot with full postoperative recovery at 6 months. Distraction was never used and simple dorsiflexion was sufficient to perform arthroscopic debridement. In this study, anterolateral ankle impingement diagnosis was primarily clinical. Arthroscopic treatment yielded significant benefits on pain, oedema and resumption of sport activities. Arthroscopic treatment of anterolateral ankle impingements is thus possible with simple dorsiflexion and no distraction, resulting in a possible decrease in complication rates. Level of evidence Retrospective cohort study, Level IV.

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Conservative treatment of Achilles tendon ruptures may lead to re-rupture. Open surgical repair entails a risk of skin necrosis or infection. Several percutaneous techniques have been used, such as Tenolig or Achillon, but these techniques are costly and may be marred by wound healing problems. Ma and Griffith described a technique for percutaneous repair which left the suture and the knot under the skin, thus reducing the risk for infection. From January 2001 to September 2006, we used this percutaneous treatment for 60 acute ruptures of tendo Achillis. The repair was made under local anaesthesia, using a single or double absorbable suture. Postoperative care was 3 weeks immobilistion in a non-weight bearing cast in equinus position, followed by another 3 weeks in a cast with the ankle at 90 degrees and progressive weight bearing. Mean followup was 19 months. Complications were 2 re-ruptures at 2 and 5 months respectively, 1 infection in a patient who presented with re-rupture after a previous surgical treatment, and 1 Achilles tendonitis. There was no sural nerve lesion. Mean time to return to working activities was 85 days; mean time to return to sports activities was 5 months. Clinical results were good with no loss in range of motion. This low-cost technique appeared as an interesting alternative to surgical or conservative treatment, providing strong repair with a low complication rate.

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This study assessed joint line changes after knee replacement surgery. Sixty consecutive cruciate-retaining total knee replacements were followed up. The height of the femorotibial joint line in extension and in 90 degrees flexion were analysed. A new coordinate system was used. It is based on two perpendicular axes applied to a lateral X-ray: one axis is drawn along the anterior cortex of the distal femur and the other axis overlies the intersection of the inter-condylar roof and the posterior femoral condyles. In patients with non-posterior stabilised implants, the landmarks chosen appear to be reliable and useful. In this study, the femorotibial joint line was displaced distally, and the surgical instrumentation was changed accordingly.

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Traumatic bone defects in the diaphyso-metaphyseal distal part of the femur are difficult to treat. Only two publications have described traumatic extrusion of a femoral shaft fragment and its successful replacement after autoclave sterilisation. We report the case of a 17-year-old patient who had traumatic extrusion of an 11- cm segment of his distal femur. The bone segment was retrieved on the road, and was reimplanted in its anatomical position after cleansing and autoclaving. At ten years follow-up, there is complete incorporation with full functional recovery. The preserved periosteum seems to have played a major part in this successful outcome.

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The authors performed a biometric analysis of the femoral patellar groove in fetus and compared their findings with those observed in adults. Forty-four formalin-preserved fetuses were studied (13-38 weeks). Digitalized images were used to obtain measurements (alpha angle of the groove, trochlear slopes thetaL and thetaM). A comparison of means of independent samples between our series and adults was performed. For each angle of the distal epiphysis (alpha, thetaL, thetaM) there was no significant difference between this fetal series and adults. This is the first biometry of the fetal patellar groove. The morphology of the lower femur appears to be the same in fetus and adults. The results of this study suggest that the anatomic characteristics of the patellar groove could have been integrated into the genome during the course of evolution. This would be in favor of a genetic origin of patellar groove dysplasia.

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Two angles effectively describe the upper femur geometry: The neck shaft angle (NSA) and anteversion (AV). AV and NSA decrease from birth until they reach their adult values, but little work has focused on in-utero life. Our aim was to determine if and how AV and NSA change through the fetal life. Eighty-seven femurs from 44 formalin preserved fetuses were sampled to achieve a biometry. Correlation tests and linear regression showed that AV was highly correlated with age: AV increases during the second half of gestation. No conclusion can be given concerning NSA. It is speculated that these changes may be caused by mechanical stresses.

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Forty-two children with nontuberculous spondylodiscitis treated between 1966 and 1997 were reviewed, and the clinical, paraclinical, and therapeutic results are presented. The study shows the difficulties of diagnosis and understanding the pathophysiology of the disease. Additional information is provided by new imaging techniques, disc aspiration, and biopsy. The mean age at treatment was 4 years 6 months. The initial clinical presentation was often misleading and the diagnosis was often delayed (42 days average). Standard radiographs and technetium bone scans were important for diagnosis and patient follow-up. Magnetic resonance imaging and needle aspiration of the disc gave an additional reliable aid in differential diagnosis and helped to guide treatment. Bacteria were isolated in 22 of the 35 samples taken (55% Staphylococcus aureus, 27% Kingella kingae; Coxiella burnetii in one sample). The functional outcome is good if treatment is properly carried out. Disc fibrosis and occasional vertebral fusion develop inevitably in the long term. According to these results, nontuberculous spondylodiscitis is truly osteomyelitis of the spine.

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