Tibial bone tunnels were examined with bone scans 2 years after patella ligament ACL reconstruction in 68 patients. At 2 years, scan uptake at the tibial tunnel was increased in 29% of patients. ...Marked increase of scintigraphic uptake was associated with tibial tunnel enlargement of more than 35% and a graft length in the tibial tunnel over 14 mm. Scan uptake was correlated to tunnel enlargement (r=0,64, P<0.01) and tunnel enlargement was correlated to graft length inside the tibial tunnel (r=0,59P<0,001). No correlation was found between scan uptake or tunnel enlargement and anterior laxity, sagittal tunnel position and subjective outcome. Scintigraphy indicates the enlarged tibial tunnels are filled with remodelling bone. Tibial fixation location influences ligament healing inside the tunnel: Return of osseous homeostasis at the tibial tunnel can take more than 2 years when fixation is more than 14 mm below the joint.
Background
Whether anterior cruciate ligament reconstruction retards the progression of osteoarthrosis is not established. Bone scintigraphy can be useful for monitoring the course of osteoarthrosis. ...Bone scan findings are abnormal in the majority of patients with anterior cruciate ligament deficiency. Three uptake patterns can be distinguished.
Hypothesis
Reconstruction corrects the three abnormal bone scan patterns seen in patients with anterior cruciate ligament deficiency.
Study Design
Prospective cohort study.
Methods
We performed bone scintigraphy in 80 patients, before and 2 years after anterior cruciate ligament reconstruction.
Results
Reconstruction consistently corrected type 2 bone scan pattern (meniscus scan) but not type 1 and 3 patterns (osteoarthrosis and cartilage ulcer scan). Correction of all three patterns decreased among patients who had longer duration of anterior cruciate ligament deficiency and was more reliable for the combined uptake of all three patterns among patients who had less than 6 months of deficiency.
Conclusion
These findings indicate anterior cruciate ligament reconstruction protects the menisci. Reconstruction may be best performed within 6 months after injury.
Objectives. Chronic scrotal pain is a frequent complaint. In many patients with scrotal pain, scrotal ultrasound is performed when the physical examination reveals no abnormalities. We evaluated the ...yield of scrotal ultrasound in patients with chronic scrotal pain and a normal physical examination.
Methods. The study involved the findings in 111 patients with scrotal pain lasting longer than 2 weeks, in whom physical examinations and urinalyses were normal and who underwent ultrasound evaluation. Follow-up data were available.
Results. The median age at first presentation was 37 years. The median duration of pain at presentation was 5 months. The pain in the scrotum was localized to the right side in 37% of patients, to the left in 41%, and bilaterally in 22%. Eighty-three percent had intermittent complaints, and 17% experienced continuous pain. In searching for a cause of the scrotal pain, 65% of patients were found to have a relevant medical history, such as regional surgery, infection, trauma, and low back pain, and 57% described provocative factors. Scrotal ultrasound revealed 12 epididymal cysts less than 0.5 cm and three subclinical varicoceles, but no clinically significant abnormalities. After a median follow-up of 12 months, the pain continued in 70%, although without the development of serious scrotal pathologic features.
Conclusions. Scrotal ultrasound has no diagnostic value in patients with chronic scrotal pain in whom the physical examinations and urinalyses are normal. A patient’s history may suggest an extrascrotal cause of his pain.
Primary synovial chondromatosis is a relatively uncommon condition. Synovial chondrosarcoma is considered to be very rare and it is not always clear whether the sarcoma develops by malignant ...transformation of synovial chondromatosis or whether it arises de novo. Differentiation of the two conditions on clinical and radiographic features is not possible and on histological criteria can be difficult. We report the case of a 59-year-old man who, 4 years after a synovectomy for synovial chondromatosis, developed a synovial chondrosarcoma of the hip. The literature is reviewed.
Desmoplastic fibroma is a rare benign primary bone tumor, histologically identical to the extra-abdominal desmoid tumor of soft tissues. The incidence in major series of bone tumors is 0.1%-0.3%. In ...the present study 18 cases from the files of the Netherlands Committee on Bone Tumors are reported, with an emphasis on the radiographic features. Eight female and ten male subjects were affected, with a fairly even age distribution from the second to the seventh decade of life. The most frequent sites of involvement were the femur and the pelvis. Radiographically the lesions nearly always demonstrated benign features with respect to pattern of destruction, margins, and reactive bone formation; however, soft tissue extension was sometimes present. Although desmoplastic fibroma usually presents with pain or swelling, in 5 of the 18 cases the existence of the lesion was an accidental finding, and in 2 cases the patient had long-standing, vague complaints of pain. Though overall benign radiographic features may support the final diagnosis, the main and often troublesome histological differential diagnosis is of a low-grade fibrosoma. En bloc resection is the treatment of choice in view of the high incidence of recurrence after curettage.
This is a case report of a patient with two giant cell tumors, the first in thoracic spine and the second, two years later, in the sacrum.
To report the first patient in whom multifocal primary giant ...cell tumors have been found in the spine.
There have been no similar previous reports.
The diagnoses were made by biopsy.
Curative removal of both tumors was achieved.
More than one primary giant cell tumor in the spine can develop.
The radiological appearance of giant cell tumors (GCT) in the developing skeleton was retrospectively assessed in 49 (10.6%) of the 462 patients with GCTs seen in consultation by the Netherlands ...Committee on Bone Tumors. There were 31 female and 18 male patients, all below 19 years of age. Thirty-four tumors were located in short and long tubular bones, two in the tarsus, while the others were in the pelvis, vertebral spine, and a rib. Involvement of the epiphysis in tubular bones was closely related to the age of the patient: the average age of the 3 patients with a lesion in the metaphysis was 11 years, that in the 6 patients with metadiaphyseal lesions 13 years, average age in the 10 patients with epimetaphyseal lesions 17 years, and it was also 17 years in the 17 patients with epimetadiaphyseal lesions. In tubular bones with the epiphyseal growth plates still open, the epiphysis was never involved, with the exception of two epimetadiaphyseal lesions in which closure of the growth plate was difficult to establish. Assessing GCT characteristics in this study population demonstrated that epiphyseal involvement increased with age and showed; to some extent, a predominance of female patients.
Thoracic empyema and vertebral osteomyelitis is a rare combination. We report a case of vertebral osteomyelitis possibly caused by a progressive thoracic empyema. The causative pathogen was ...Escherichia coli. Computed tomographic (CT) scan and magnetic resonance imaging (MRI) suggested the diagnosis of vertebral osteomyelitis, confirmed by transthoracic needle aspiration and operative findings. Aetiology and treatment are discussed.
Treatment of avascular necrosis (AVN) of the femoral head with a vascularized iliac bone graft was studied in nine patients (12 hips). The condition of the femoral head was classified ...radiographically before and after surgery. Magnetic resonance (MR) imaging was performed to demonstrate the extent and signal intensity characteristics of the area of AVN and to assess the viability of the graft. The radiologic results were correlated with the clinical findings. Although radiography showed progression of disease in six patients, seven of the nine patients demonstrated clinical improvement. The MR imaging results correlated better with the clinical findings: MR imaging demonstrated progression of AVN in only two patients (two hips) and no progression or reduced necrosis in six patients (nine hips). Nine of the 11 grafts (eight patients) evaluated with MR imaging appeared viable after a mean follow-up of 50 months. MR imaging appears useful in assessing marrow changes and graft viability after treatment of AVN of the femoral head with a vascularized iliac bone graft.
Many patients with anterior cruciate ligament (ACL) deficiency have an abnormal bone scan. This finding has not yet been explained. Suggested explanations include intra-articular (structural) or ...kinematic (functional) abnormalities. We examined the relationship between bone scintigraphy and cartilage degeneration or meniscal lesions in the ACL-deficient knee in 95 consecutive patients who had bone scintigraphy 1-3 days prior to arthroscopic ACL reconstruction. Intra-articular abnormalities of the knee did not explain all scintigraphic patterns of this study. We did not find clinically useful positive predictive values for scintigraphic patterns considered to indicate cartilage degeneration or a lateral meniscus lesion. A clinically useful positive predictive value was found only for medial meniscus lesions when time since ACL rupture was more than 18 months, and for local cartilage degeneration when markedly increased uptake was seen when time since ACL rupture was more than 4 months. Considering these findings, alternative explanations are discussed, based on specific aspects of abnormal kinematics and adaptive bone metabolism of the ACL-deficient knee.