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Purpose: While the coronal plane alignment of the knee (CPAK) classification serves as a useful guide in personalising total knee arthroplasty (TKA), the extent of its correlation with segmental coronal extra-articular knee deformities remains uncertain. This study aims to investigate the potential correlation between CPAK matrix groups and segmental coronal extra-articular deformities in prearthritic knees, shedding light on the relationship between these two factors that seems to be both essential to perform personalised TKA., Materials and Methods: A radiological assessment of 1240 nonarthritic knees was performed by evaluating lower limb measurements following the protocol established by Paley et al. Subsequently, all knees were classified into their respective CPAK matrix groups. In our quest to discern any correlation between the CPAK matrix groups and the presence of segmental coronal extra-articular knee deformities, nine potential coronal extra-articular deformity phenotype (CEDP) groupswere identified based on medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). Neutral values for MPTA and mLDFA were set at 90.0° ± 3.0° and then at 87.0° ± 2.0°. Each CPAK matrix group underwent detailed coronal morphology analysis and then, segmental coronal extra-articular deformities were assessed by comparing them with the CEDP groups., Results: The study revealed a mean hip-knee-ankle angle (HKA) of 178.6° ± 4.4°, mLDFA of 86.9° ± 2.5°, MPTA of 85.4° ± 2.4°, arithmetic HKA of -1.4° ± 3.2° and joint line obliquity of 172.5° ± 3.7°. The varus CPAK groups (I/IV/VII) included 435 patients, the neutral groups (II/V/VIII) comprised 630 patients and the valgus groups (III/VI/IX) had 175 patients. Notably, CPAK matrix groups were not distinctly associated with specific coronal extra-articular deformity phenotype (CEDP) groups. Particularly among the most common CPAK matrix groups (I/II/III/IV/V), there was a significant variation in segmental coronal extra-articular deformity patterns. Moreover, when neutral MPTA/mLDFA values were set at 87.0° ± 2.0°, the CPAK matrix groups exhibited even greater variability in coronal extra-articular deformities., Conclusion: The CPAK matrix groups do not exhibit a direct correlation with a specific extra-articular deformity pattern (CEDP), thus rendering them unsuitable for determining segmental coronal extra-articular knee deformities., Level of Evidence: Level III, retrospective diagnostic study., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: This study aimed to elucidate the characteristics of varus knee deformities in the Japanese population, prevalence of various around knee osteotomy procedures and influence of femoral and tibial bowing., Methods: Varus knee deformity was defined as a weight-bearing line ratio of <50%. A total of 1010 varus knees were selected from 1814 varus knees with weight-bearing full-length radiographs, obtained at two facilities, based on exclusion criteria. Various parameters were measured, and around knee osteotomy simulations based on the deformity centre were conducted using digital planning tools. Bowing of the femoral and tibial shafts was measured, with bowing defined as follows: ≤ -0.6° indicating lateral bowing and ≥ 0.6° indicating medial bowing. Statistical analysis was performed to investigate age-related correlations and their impact on surgical techniques., Results: The study revealed that the proximal tibia was the centre of deformity in Japanese varus knees (42.8%), and high tibial osteotomy was frequently indicated (81.6%). Age demonstrated a mild correlation with femoral shaft bowing (r = -0.29), leading to an increase in the mechanical lateral distal femoral angle and to a decrease in the hip-knee-ankle angle and weight-bearing line ratio (r = -0.29, 0.221, 0.219). The tibial shaft bowing was unaffected by age (r = -0.022)., Conclusion: A significant proportion of Japanese individuals with varus knees exhibit a deformity centre located in the proximal tibia, making them suitable candidates for high tibial osteotomy. No age-related alterations were discerned in tibial morphology, indicating that the occurrence of constitutional varus knees is attributable to tibial deformities in the Japanese patient cohort., Level of Evidence: Level IV., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: To quantify the prevalence of complete tibial insertion of the biceps femoris tendon in patients presenting for knee MRI scans., Methods: Knee MRI scans over a 4-year period (2014-2018) were accessed at a tertiary referral centre and community-based private practice. A total of 433 scans were reviewed. 30 scans were excluded from the study due to repeat imaging or incomplete coverage of the biceps femoris tendon insertion. Appearances of the distal biceps tendon bony insertion were scrutinized on the remaining 403 scans. Each biceps femoris tendon insertion was classified into one of the four categories-complete fibular insertion, predominant fibular insertion, predominant tibial insertion and complete tibial insertion., Results: Out of the final 403 scans included in the study, five cases of complete tibial insertion of the biceps femoris tendon were identified (just over 1% of the total population). 42 cases were identified as having predominant tibial insertion (10% of the total population). 113 cases had predominantly fibular insertion and 243 cases had complete fibular insertion., Conclusion: Complete anomalous insertion of the biceps femoris tendon on the anterolateral tibia is an uncommon entity. Such an attachment is found in approximately 1% of patients presenting for MRI evaluation of the knee.

Purpose: The aim of this study was to assess whether preoperative valgus or varus deformity affected survivorship after total knee arthroplasty (TKA) and to quantify the risk factors for implant failure in a registry-based population., Methods: The Emilia-Romagna Registry of Prosthetic Orthopedic Implants was examined regarding TKAs performed on patients with a preoperative diagnosis of valgus or varus deformity. Demographics, implant characteristic and survivorships were investigated and compared. A total of 2327 TKA procedures performed from 2000 to 2016 were included in the study. Six hundred and forty primary TKAs with a diagnosis of valgus deformity were evaluated with a median follow-up of 3.3 years; 1687 primary TKAs with a diagnosis of varus deformity were evaluated with a median follow-up of 2.5 years., Results: Bi-compartmental, cemented posterior stabilised fixed-bearing implants were preferred. For both diagnoses, the implant survivorship rate was greater than 98% in the first year. However, the survival curve of the TKAs implanted for valgus deformity showed a greater slope in the first 3 years as compared to the survival curve of those implanted for varus deformity. Valgus deformity had a 2.1-fold higher risk for revision as compared with varus deformity. Infection was a major cause of implant failure in TKAs for varus deformity, 9/24 (37.5%), while its incidence was lower for valgus deformity, 1/21 (4.8%)., Conclusions: Preoperative valgus alignment showed a twofold risk of failure as compared to varus alignment after TKA. This should be considered in daily practice, and surgeons are called on to pay more attention when performing TKAs on such patients. Prospective randomised controlled trials are, therefore, necessary to better understand the role of preoperative coronal knee deformity in implant failure., Level of Evidence: Prognostic study, level III.

Purpose: The aim of this systematic review is to compare the clinical outcomes of patients treated with different trochleoplasty procedures, the rate of complications and recurrence of patellar dislocation., Methods: A systematic review of the literature was performed, in accord with the PRISMA guidelines. PubMed, MEDLINE, CINAHL, Cochrane, EMBASE and Google Scholar databases were comprehensively searched using the keyword combinations, "Dejour trochleoplasty", "Bereiter Trochleoplasty", "Albee Trochleoplasty", "Recession Trochleoplasty", "Trochlear Dysplasia", "Instability", "Adult", "Clinical Outcome" and "Surgery"., Results: Three-hundred and ninety-two knees in 371 patients were included. Bereiter U-shaped deepening trochleoplasty was the most commonly used technique for the treatment of trochlear dysplasia in the included studies with the lowest rate of recurrence and post-operative ROM deficiency. On the other hand, Dejour V-shaped deepening trochleoplasty showed the highest mean post-operative value of Kujala score with 79.3 (SD 8.4) points. Statistical differences were found in terms of redislocation rate between Goutallier procedure and Bereiter trochleoplasty (p < 0.05) and in terms of post-operative osteoarthritis between Bereiter and Dejour procedures (p < 0.05)., Conclusion: Bereiter trochleoplasty seems to be the most efficiency procedure in terms of post-operative patellar redislocation, post-operative osteoarthritis and ROM, but the highest mean post-operative Kujala score is obtained by Dejour procedure. Therefore, none of the surgical techniques analysed highlighted a real superiority. Randomised clinical trials are needed to establish whether of available surgical technique is the best to treat patient with trochlear dysplasia. The clinical relevance of this paper is that the three most popular trochleoplasty techniques are associated with significantly improved stability and function, showing a relatively low rate of osteoarthritis and pain, and a moderate rate of complications., Level of Evidence: Systematic review, Level IV.

Purpose: Regarding TT-TG in knee realignment surgery, two aspects have to be considered: first, there might be flaws in using absolute values for TT-TG, ignoring the knee size of the individual. Second, in high-grade trochlear dysplasia with a dome-shaped trochlea, measurement of TT-TG has proven to lack precision and reliability. The purpose of this examination was to establish a knee rotation angle, independent of the size of the individual knee and unaffected by a dysplastic trochlea., Methods: A total of 114 consecutive MRI scans of knee joints were analysed by two observers, retrospectively. Of these, 59 were obtained from patients with trochlear dysplasia, and another 55 were obtained from patients presenting with a different pathology of the knee joint. Trochlear dysplasia was classified into low grade and high grade. TT-TG was measured according to the method described by Schoettle et al. In addition, a modified knee rotation angle was assessed. Interobserver reliability of the knee rotation angle and its correlation with TT-TG was calculated., Results: The knee rotation angle showed good correlation with TT-TG in the readings of observer 1 and observer 2. Interobserver correlation of the parameter showed excellent values for the scans with normal trochlea, low-grade and high-grade trochlear dysplasia, respectively. All calculations were statistically significant (p < 0.05)., Conclusion: The knee rotation angle might meet the requirements for precise diagnostics in knee realignment surgery. Unlike TT-TG, this parameter seems not to be affected by a dysplastic trochlea. In addition, the dimensionless parameter is independent of the knee size of the individual., Level of Evidence: II.

Purpose: The purpose of this study was to compare the insertion sites of the posterior horn between discoid and non-discoid lateral meniscus using magnetic resonance imaging (MRI)., Methods: Two hundred and twenty-seven patients who had MRI scans before surgery and underwent arthroscopy were enroled in this study. A coronal view showing the narrowest width of the midbody of the lateral meniscus was chosen to measure the widths of the entire tibial plateau and the midbody of the lateral meniscus. Considering the ratio of the meniscal width to the tibial plateau width, the patients were divided into non-discoid, incomplete discoid, and complete discoid groups. On a coronal view accurately showing the insertion of the posterior horn of the lateral meniscus, a distance between the peak of the lateral tibial eminence and the centre of the insertion of the posterior horn, and a width of the lateral tibial plateau between the lateral edge of the tibial plateau and the peak of the lateral tibial eminence were measured., Results: The insertion centre of the posterior horn was located more medially in the incomplete and complete discoid groups than in the non-discoid group (p = 0.003, 0.010, respectively). When individual differences in the knee size were corrected, the insertion centre of the posterior horn in the incomplete discoid and complete discoid groups was located more medially than in the non-discoid group (p = 0.009, 0.003, respectively)., Conclusion: The insertion centre of the posterior horn of the lateral meniscus is located more medially to the apex of the lateral tibial eminence in the discoid group than in the non-discoid group. This finding needs to be considered for an accurate position of the posterior horn of lateral meniscus during the lateral meniscal allograft transplantation., Level of Evidence: IV.

Purpose: Increased tibial tubercle trochlear groove distance (TT-TG) is frequently associated with trochlear dysplasia (TD). Since the trochlear groove appears more distally in patients with TD compared to controls, it is unknown whether TT-TG might be comparable and meaningful., Methods: Fifty patients with TD were retrospectively analysed and compared to 52 age- and gender-matched patients (CG). TT-TG was measured on transverse MR images, as the distance between the trochlear groove of minimal 2 mm depth proximally and the centre of the patellar tendon at its distal insertion. The height of the femoral reference point above joint line was recorded for both groups. TT-TG measurement was repeated in CG using the first (P25), second (P50) and third quartile (P75) above joint line of TD., Results: Patients with TD had a significantly smaller vertical distance between the most proximal trochlear deepening and the femorotibial joint line (20.6 mm, range 10.3-30.9) compared to CG (33.8 mm, range 25.4-41.1; p < 0.001). TT-TG values measured at 20 mm (P50) and 15 mm (P25) proximal to the femorotibial joint line were significantly smaller compared when measured with the most proximal reference point [1.8 mm (95 % CI 1.3-2.3, p < 0.001) and 2.4 mm (95 % CI 1.9-3.0, p < 0.001)] in CG. The inter-rater reliability was excellent (ICC 0.99)., Conclusion: TT-TG distance depends significantly on the femoral reference point. Since the trochlear groove is seen more distally in patients with TD compared to controls, TT-TG of the patients with highest risk of recurrent patellar instability might be underestimated., Level of Evidence: Diagnostic study, Level I.

Purpose: Hypoplasia of the lateral femoral condyle has been reported in discoid lateral meniscus patients, but associated imaging findings in the axial plane have not been characterized. In this study, we aimed to identify differences in the lateral femoral condyle between patients with discoid lateral meniscus and those with normal menisci using axial MRI images., Methods: Twenty-three patients (24 knees) with complete discoid lateral meniscus, 43 (45 knees) with incomplete discoid lateral meniscus, and 50 with normal menisci (50 knees) were enrolled and distributed into three groups. Two new angles, posterior lateral condylar angle (PLCA) and posterior medial condylar angle (PMCA), were measured on axial MRI images; the posterior condylar angle (PCA) was also measured. Differences between the three groups in the PLCA, PMCA, PCA, and PLCA/PMCA were analysed. The predictive value of PLCA and PLCA/PMCA for complete discoid lateral meniscus was assessed., Results: In the complete discoid lateral meniscus group, PLCA and PLCA/PMCA were significantly smaller compared with the normal meniscus group and the incomplete discoid lateral meniscus group (P < 0.001). A significantly larger PCA was identified in the complete discoid lateral meniscus group compared with the incomplete discoid lateral meniscus group (P < 0.05) and normal meniscus group (P < 0.05). Both PLCA and PLCA/PMCA showed excellent predictive value for complete discoid lateral meniscus., Conclusions: Hypoplasia of the posterior lateral femoral condyle is typically seen in patients with complete discoid lateral meniscus. PLCA and PLCA/PMCA can be measured from axial MRI images and used as excellent predictive parameters for complete discoid lateral meniscus., Level of Evidence: Diagnostic study, Level III.

Objective: To assess anatomical risk factors in patients after lateral patellar dislocation (LPD) and controls using MRI., Methods: MR images of 186 knees after LPD and of 186 age- and gender-matched controls were analysed. The presence of trochlear dysplasia was assessed by evaluation of trochlear inclination, facet asymmetry, and trochlear depth; patella alta was evaluated by the Insall-Salvati index and Caton-Deschamps index; the lateralised force vector was measured by the tibial tuberosity-trochlear groove (TT-TG) distance., Results: Compared with controls, dislocators had significantly lower values for all three parameters of trochlear dysplasia (-32 %, -32 %, -44 %) and significantly higher values for patella alta (+14 %,+13 %) and TT-TG (+49 %) (all P < 0.001). Trochlear dysplasia was observed in 112 dislocators (66 %), of whom 61 (36 %) additionally had patella alta and 15 (9 %) an abnormal TT-TG. As isolated risk factors, patella alta (15 %) and abnormal TT-TG (1 %) were rare. Only 25 dislocators (15 %) had no anatomical risk factors. Trochlear dysplasia in conjunction with abnormal TT-TG or patella alta is associated with a 37- and 41-fold higher risk., Conclusion: Most dislocators have anatomical risk factors, varying in severity and constellation.

The objective of this article is to report an anterior cruciate ligament variation that has not been previously described, in which the posterolateral bundle of anterior cruciate ligament is congenitally not developed. The clinical picture and the magnetic resonance images are presented, and the arthroscopic appearance is described.

Purpose: The treatment of fixed knee flexion deformity through anterior distal femoral stapling has been investigated in only two studies so far, with promising results. The aim of the present study was to determine whether this technique might improve fixed knee flexion deformity in a series of growing children and adolescents with different conditions. Follow-up examinations were continued after staple removal in terms of a possible impairment of this deformity., Methods: We reviewed the medical records of all patients with fixed knee flexion deformity who had been treated by anterior distal femoral stapling at our institution. Twenty patients (37 knees) with a mean age of 12.7 years met the inclusion criteria (>12 months of follow-up; no additional procedures to correct fixed knee flexion deformity such as hamstring lengthening or posterior capsulotomy) and were evaluated in this study., Results: The mean fixed knee flexion deformity significantly improved from 21.4° (SD = 11.6) preoperatively to 7.0° (SD = 9.8) after a mean follow-up of 35.3 months. Young patients (<12 years) revealed superior improvement of this deformity, and especially children with distinct fixed knee flexion deformity of 30° or greater had benefit from early treatment. Impairment of flexion deformity was only seen in one patient (2 knees) after staple removal., Conclusions: Our results demonstrate that anterior distal femoral stapling is an effective method for the treatment of fixed knee flexion deformity in growing children and adolescents. Rare complications, immediate mobilization, and a low recurrence rate after staple removal provide obvious advantages of this minimally invasive procedure., Level of Evidence: Retrospective therapeutic study, Level IV.

Purpose: Severe varus deformity may lead to premature failure of total knee arthroplasties (TKAs) because of technical difficulties associated with satisfactory alignment and good ligament balance. The aim of the study was to assess whether preoperative varus severity would affect the longevity, clinical outcomes, and complication rates of TKAs., Methods: From a prospectively collected database, we assessed outcomes in 168 knees that underwent primary TKAs using a single posterior stabilized design. These included 86 knees with mild preoperative deformity (varus mechanical tibiofemoral angle≤5°) and 82 knees with severe preoperative deformity (varus angle≥15°). Survivorship was analyzed by a life-table method. Clinical outcomes were also compared, including Knee Society knee and functional scores and complication rates., Results: The postoperative tibiofemoral angle of the mild varus group was 7.1°±2.5°, whereas that of the severe varus group was 6.4°±2.5° (n.s.). There were no significant differences in terms of perioperative complications. Both groups showed the same cumulative survival rate, with absence of mechanical failure, of 98% at 7 years without difference (n.s.). There were no significant between-group differences of clinical parameters throughout the each follow-up period., Conclusion: The knees with preoperative severe varus deformity were achieved the results comparable to those in knees with mild varus deformity, as determined by survival rate and clinical results. These data suggest that preoperative severe varus deformities can be successfully managed and do not have any detrimental effect on the longevity and clinical outcomes after a modern posterior stabilized TKA.

The purposes of this study were to report clinical features of the developmental anomaly of ossification type bipartite or tripartite patella using a large series and to propose a new classification for the developmental anomaly of ossification type bipartite or tripartite patella. The first author prospectively examined 111 patients with symptomatic or asymptomatic bipartite (131 knees) or tripartite (8 knees) patellae. Eighty-six (77%) were male and 25 (23%) were female. Forty-three patients (39%) showed right knee involvement and 40 (36%) showed left, while 28 (25%) showed involvement in both knees. Forty-six bipartite and 4 tripartite patellae (36%) were symptomatic and 85 bipartite and 4 tripartite patellae (64%) were asymptomatic at initial examination. The median age at onset of pain of symptomatic patients (50 knees) was 15.6 ± 8.1 years (range, 10-51 years). The most common symptom was pain at the separated fragments during or after strenuous activity in all 50 knees. Physical examination revealed localized tenderness over the separated fragments in all 50 knees. Bipartite or tripartite patellae were classified by evaluating location and number of fragments. One hundred fifteen knees (83%) were classified as supero-lateral bipartite type, 16 (12%) were lateral bipartite type, 6 (4%) were supero-lateral and lateral tripartite type, and 2 (1%) were supero-lateral tripartite type. For the developmental anomaly of ossification type bipartite or tripartite patella, a classification based on both location and number of fragments is simple and easy to understand and applicable to all types of bipartite or tripartite patella.

Objective: Juxta-articular venous malformations (VMs) are uncommon, but may cause early arthropathy of the knee in children and adolescents. We sought to describe the prevalence, extent and initial magnetic resonance imaging (MRI) features of knee arthropathy in children with VM adjacent to the knee joint., Methods: Thirty-five patients with VM adjacent to the knee who had MRI performed between 2000 and 2009 were identified through a keyword search of the radiology information system., Results: VM extended to the joint in 17 of the 35 patients (5.4-21.5 years, mean 11.8 years). Most of these 17 patients had joint changes (15/17, 88%), most commonly haemosiderin deposition (14/17, 82%). Other findings included the presence of subchondral bone lesions (eight, 47%), cartilage loss (six, 35%), synovial thickening (six, 35%), marrow oedema (six, 35%), joint effusion (five, 29%), subchondral cysts (five, 29%) and one loose body (6%). VM location and size did not correlate with the degree of articular involvement. Joint changes were present in focal as well as non-discrete VM., Conclusion: We found that the frequency of arthropathy increased with extension of VM into the joint itself. This finding stresses the importance of early MRI evaluation of all juxta-articular VM.

This study examined the changes in knee alignment after an open wedge high tibial osteotomy before and after weight-bearing. From 2004 to 2006, 36 high tibial osteotomies were performed to treat unicompartmental arthritis with a varus deformity. Thirteen patients without instability and with an accurate radiographic evaluation were included. The changes in the deviation of the mechanical axis and femorotibial angle were evaluated retrospectively using whole extremity radiographs immediately after surgery (supine position) and 4 months after surgery (weight-bearing position). In the nonweight-bearing radiograph obtained immediately after surgery, the mean deviation of the mechanical axis was 22% laterally and the mean femorotibial angle was valgus 8.9 degrees . The weight-bearing radiograph at 4 months after surgery showed that the former shifted laterally 34% and the latter shifted valgus 10.6 degrees . The changes in the mechanical axis and femorotibial angle were significant (P < 0.001). During open wedge high tibial osteotomy, the surgeon should consider the increase in deviation of the mechanical axis and femorotibial angle after weight-bearing.

Congenital anomalies of the muscles of the lower extremity are rare. A case of complete absence of the semimembranosus muscle incidentally found with magnetic resonance imaging is reported. The patient was a 55-year-old female presenting with knee pain and no previous history of trauma. Clinical and imaging findings were consistent with meniscal tears. Two cases of uncommon distal insertion of the semimembranosus tendon are also described to illustrate the anatomical variations in this area. The anatomical and biomechanical relations between the semimembranosus muscle and the posteromedial corner of the knee are examined in this case report.

Popliteus muscle sesamoid bone, also known as cyamella, is an accessory ossicle that is located in the vicinity of the proximal musculo tendinous junction. While commonly seen in small mammals such as cats and dogs, its presence in humans is very rare. In this report, we present the radiological findings of the popliteus muscle sesamoid bone, incidentally detected in a 47-year-old male. CT and MRI features of this ossicle are described.

Drop foot is not uncommon after high tibial osteotomy for genu varum. The authors report their results of a prospective study of 16 patients operated on between May 1990 and May 1991. All patients had medial femoro-tibial osteoarthritis with a constitutional genu varum. They all had a subtraction valgus high tibial osteotomy fixed by a blade plate. The experimental protocol included clinical review, antero-lateral compartment pressure measurements, intra- and post-operative electromyography, assessment of the post-operative drainage, serum estimation of muscle enzymes and post-operative arteriography. From their own results and a literature review, the authors consider successively the different aetiological factors for post-operative drop foot. Certain deficits occur due to direct trauma on the nerve during high osteotomy of the fibula, by local high pressure due to poor haemostasis or ineffective drainage. In addition, there are several related phenomena. The pneumatic tourniquet sensitises the nerve to trauma, and stretching of the nerve during correction of the deformation depends on the local anatomical factors and their marked variation. In order to diminish the frequency of these post-operative complications, the authors suggest limiting the surgical approach, and limiting as far as possible the traumatic manoeuvres on the nerve by using a tibial resection jig, which allows correction without forced manoeuvres. Finally, the authors discuss the benefits of using a pneumatic tourniquet.

Mesenchymal tissue that forms compartments in the knee joint begins to be resorbed in the 8th week of embryologic life. Unless these mesenchymal tissues are totally resorbed, they remain as septal remnants, and are termed mediopatellar, infrapatellar, suprapatellar, and lateral plicae. We report a case of united anterior plica; the inferior part of the anterior mesenchymal septum at the back of the patellar tendon was unseparated and unresorbed, and one-half of the superior part of the septum beginning from the inferior pole of the patella formed the V-shaped medial and lateral plicae such that their opening looked upwards.

A 20-year-old man presented with failure to thrive and bilateral genu valgum. On the basis of growth failure, skeletal deformity, hyperchloremic metabolic acidosis with alkaline urine and hypokalemia, nephrocalcinosis, and hearing loss, a diagnosis of distal renal tubular acidosis (DRTA) with sensorineural deafness was made. The genu valgum was treated by corrective osteotomy. Skeletal deformity was corrected and impaired growth improved after sustained therapy of metabolic acidosis with alkali supplementation. During an 8-year follow-up period the patient's glomerular filtration rate remained stable, the nephrocalcinosis did not progress, and his height increased 10 cm. Although nephrolithiasis led to atrophy of the right kidney, at last follow-up, when the patient was 44 years old, his creatinine clearance was 50 ml/min per 1.73 m2 body surface.

Popliteal artery entrapment (PAE) syndrome is an uncommon congenital anomaly seen in young adults causing ischemic symptoms in the lower extremities. It is the result of various types of anomalous relationships between the popliteal artery and the neighboring muscular structures. The purpose of this study was to define the role of MR imaging combined with MR angiography in the diagnosis of PAE cases. Four cases with segmental occlusion and medial displacement of popliteal artery in digital subtraction angiography (DSA) examinations were diagnosed as PAE syndrome by MR imaging and MR angiography. The DSA and MRA images are compared. All of the cases showed various degrees of abnormal intercondylar insertion of the medial head of the gastrocnemius muscle. The MR images showed detailed anatomy of the region revealing the cause of the arterial entrapment. Subclassification of the cases were done and fat tissue filling the normal localization of the muscle was evaluated. The DSA and MRA images demonstrated the length and localization of the occluded segment and collateral vascular developments equally. It is concluded that angiographic evaluation alone in PAE syndrome might result in overlooking the underlying cause of the arterial occlusion, which in turn leads to unsuccessful therapy procedures such as balloon angioplasty. Magnetic resonance imaging combined with MR angiography demonstrates both the vascular anatomy and the variations in the muscular structures in the popliteal fossa successfully, and this combination seems to be the most effective way of evaluating young adults with ischemic symptoms suggesting PAE syndrome.

In order to study the incidence and variations of the suprapatellar septum, 100 knee joints of 50 neonatal cadavers were examined anatomically. In 26% of the neonatal knee joints, a complete septum was found. Perforated septa with different shapes and residual septa were seen in 64% knees. A complete involution of the former septum was found in 10 of our cases. A suprapatellar septum combined with a mediopatellar plica was found in 18 knees.