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Diffuse pigmented villonodular synovitis (PVNS) of the knee is a rare, locally aggressive disease. Since 1995 the senior author has been treating patients with diffuse intra- and extra-articular PVNS of the knee with a bimodality treatment protocol, consisting of anterior and posterior open synovectomies in conjunction with external-beam radiation. The purpose of this study was to describe the surgical technique, evaluate our protocol's efficacy in limiting local recurrences, and assess its functional implications and associated morbidities. The medical records of nine consecutive patients were analyzed. Functional results were measured using the Knee Society score. The mean follow-up was 67 months (range 37-103 months). Eight patients were disease free and one patient had local recurrence, which was extra-articular, localized and non-progressive. The mean knee rating and functional rating had significantly improved from 65.2 and 70 preoperatively to 93.7 and 96.6 postoperatively respectively. Maximal knee flexion ranged from 90 degrees to 130 degrees, and only 3 patients developed flexion contractures of 5 degrees. In conclusion our bimodality protocol of anterior and posterior open synovectomies, in conjunction with external-beam radiation, limited the recurrence of diffuse intra- and extra-articular PVNS of the knee. All patients showed good-to-excellent functional outcomes and were able to return to their previous level of activity.

Managing tumors of the proximal fibula may require en bloc resection of the fibular head with the attachment site for the lateral collateral ligament. These resections of the proximal fibula cause unavoidable knee instability. We describe a reconstructive technique intended to minimize that instability. We retrospectively reviewed 24 patients who had proximal fibular resections from 1987 to 2004 and analyzes their knee stability and functional outcome. Resections were less (Type I) or more (Type II) radical depending upon the tumor type. Reconstruction included stapling the lateral collateral ligament to the lateral tibial metaphysis, cast immobilization, and protected weightbearing for 3 weeks. MSTS function scores were available for 19 of the 24 patients. At their most recent followup, 20 patients had a stable knee, three had 1 to 5 mm lateral joint space opening, and one had 6 to 10 mm lateral joint space opening. Patients with Type I resection had a better stability and function than those with a Type II resection. Stapling the lateral collateral ligament was a reliable technique for reconstructing the lateral collateral ligament after resecting the proximal fibula.

Background: The diagnosis of posterolateral instability of the knee is often based on a typical indirect mechanism of injury, a history of "giving way" and a positive dial test. Our search of the English literature revealed no mention of including the valgus stress test in the diagnostic protocol for posterolateral instability., Hypothesis: Based on our experience, we hypothesised that a medial collateral ligament (MCL) tear will also produce a positive dial test and that a valgus stress test would provide differential diagnostic information., Methods: The MCL's of 14 fresh cadaveric knees (7 cadavers) were cut to simulate a grade 3 tear, taking care not to damage the medial retinaculum or the posteromedial stabilisers of the knee. The amount of tibial external rotation (the dial test) was measured for each knee before and after transection of the MCL., Results: The results of the dial test after transection of the MCL were similar to those stemming from a solitary injury to the posterolateral corner. There was a significant increase in external rotation of the knee in 30 degrees and 90 degrees of flexion. More over, external rotation in 30 degrees was significantly greater than external rotation in 90 degrees of knee flexion., Conclusions: Whenever suspecting a posterolateral complex injury, one has to carefully perform a valgus stress test in 0 degrees and 30 degrees. Although the support of a clinical study is needed in order to make a definite conclusion, the dial test is probably not reliable in the presence of medial instability, and alternative diagnostic measures should be used.