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We report the case of a tenosynovial giant-cell tumor causing limitation of extension of the knee. The tumor was treated successfully by arthroscopic removal.

Arthroscopic debridement and drainage was done in 10 patients with septic arthritis of the hip. Staphylococcus aureus was the most commonly identified organism. All patients were placed in the supine position on a fracture table and three arthroscopic portals were used during the procedure. No major complication related to the arthroscopy of the hip resulted. The average followup was 4 years 11 months. All patients had excellent results.

Cystic lesions around the knee are usually either meniscal cysts or popliteal cysts. Intra-articular ganglia of the knee are uncommon 1. Ganglia arising from cruciate ligaments have rarely been reported 2. In the cases that have been reported, ganglion cysts produced vague knee discomfort but sometimes they also produced mechanical symptoms suggestive of a meniscal tear or a positive finding with the McMurray test 3,4. The present report describes a patient who had a large ganglion cyst that was adjacent to the anterior cruciate ligament and enclosed in a common sheath and that had eroded the medial aspect of the lateral femoral condyle. An eighteen-year-old girl presented with a three-year history of progressively increasing pain in the right knee. She stated that there had been no prior trauma to the knee. She reported a deep ache in the knee that was aggravated by activity, especially squatting. There was no catching, swelling, or sense of giving-way. Physical examination revealed a full range of motion and negative findings on the Lachman and pivot-shift tests. There was no swelling or tenderness along the joint line. The findings on radiographs of …

A new technique of semitendinosus tenodesis has been developed to treat medial instability of the knee. The semitendinosus tendon was sectioned at the musculotendinous junction. The accessory insertion of the tendon was dissected to be overlapping and parallel to the anterior band of the medial collateral ligament. An isometric point on the femur was located around the medial epicondyle. A bony trough was created just above the isometric point and a screw with washer was placed. The semitendinosus tendon was looped around the screw and the screw was tightened to hold the tendon in place. The free end of the tendon was pulled obliquely backward and passed through the insertion of the direct head of the semimembranosus tendon to reconstruct the posterior oblique ligament. The semitendinosus tendon reinforced both the medial collateral ligament and the posterior oblique ligament.

This study investigated 11 patients with localized pigmented villonodular synovitis of the knee that was diagnosed and treated by arthroscopic technique. There were six male and five female patients between the ages of 15 and 59 years (mean, 34.6 years). Seven patients reported extension limitation without joint line tenderness. Four of the 11 patients had a history of trauma before the onset of knee symptoms. All patients were treated by arthroscopic resection with partial synovectomy. The most common involved site was the anteromedial synovium near the anterior horn of the medial meniscus (five patients). The remaining cases were located in the anterior fat pad (two patients), suprapatellar pouch, posteromedial compartment, medial gutter, and the anterior horn of the lateral meniscus. Nine patients had one mass, and the remaining patients each had two or three masses. There was no evidence of recurrence at followup for an average of 29.9 months (range, 24-48 months). Arthroscopy is effective in the diagnosis of localized pigmented villonodular synovitis with minimal morbidity, and complete arthroscopic excision can be considered the definitive treatment for localized pigmented villonodular synovitis.

Dear Editor, We thank Dr. DiFelice et al. for their interest in our article [1] and their sincere comments. We apologize that we did not quote their article published in Skeletal Radiology [2]. We would like to congratulate them on their clinical success in the short term. There are some differences between our technique of meniscal repair and theirs. We used a posteromedial portal higher than the usual posteromedial portal to achieve the correct angle for insertion of a suture anchor. We felt that the use of a suture hook (Linvatec, Largo, FL) was easier than other instruments for passing a suture relay, and we inserted the suture hook through the anteromedial portal [they did not mention which portal was used when inserting the Viper (Arthrex, Naples, FL)]. We are very cautious in selecting patient for this procedure. We agree, as in their series, that meniscal root tears combined with multiple ligamentous injuries can be an indication for this type of repair. However, considering many medial meniscus root tears occur within the context of early osteoarthritis, indications should be considered carefully. Other contraindications would be severe displacement or degeneration of the torn edge of the meniscus from its insertion. Therefore, in patients with varus alignment and extrusion of the medial meniscus, high tibial osteotomy may be preferable to meniscal repair. Repair of the medial meniscus root tear is a valuable technique to protect from hoop tension in the meniscus. We look forward to long-term clinical outcome results after repair of medial meniscus root tears with this technique.

The Tikhoff-Linberg procedure is a limb-sparing surgical option to be considered for bony and soft tissue tumors in and around the proximal humerus and shoulder girdle. The authors reported 6 cases of the Tikhoff-Linberg procedure for tumors around the shoulder joint at the Department of Orthopedic Surgery of Severance Hospital from March 1988 to May 1989. The results of the study are as follows: The 6 cases were composed of: osteogenic sarcoma 2 cases, chondrosarcoma 2 cases, chondroblastoma 1 case, and giant cell tumor 1 case. The tumors were completely removed by the Tikhoff-Linberg procedure without amputation or disarticulation of the upper extremity. The distal clavicle, upper humerus and part of all of the scapula were resected. The Tikhoff-Linberg procedure was performed for patients whose tumors did not involve the neurovascular bundle in the axilla. The function of the hand and forearm after the Tikhoff-Linberg procedure was nearly normal in all cases. The Tikhoff-Linberg procedure would be recommended as a limb-sparing operation for tumors around the shoulder joint that require wide resection without disarticulation or forequarter amputation of the upper extremities.

Purpose: The purpose of this prospective study was to define the relation between the integrity of cross-pin femoral fixation and stability after anterior cruciate ligament (ACL) reconstructions. Methods: Thirty-one consecutive ACL reconstructions were performed with hamstring tendons fixed with bioabsorbable cross-pin femoral fixation. All patients underwent magnetic resonance imaging at 6 months postoperatively to assess the status of the cross-pin fixation. Clinical evaluations were performed via the Lachman and pivot-shift tests. The side-to-side differences were measured by KT-1000 testing (MEDmetric, San Diego, CA) at 2 years postoperatively. The patients were divided into 2 groups according to the status of the cross-pin. Group I consisted of those in whom the cross-pins were intact, and group II had broken cross-pins. Results: There were 19 patients in group I and 12 (38.7%) in group II. Among the 24 cross-pins used in the 12 patients in group II, 18 were broken. Among the patients in group I, the tip of the cross-pin was inside the posterior cortex of the distal femur in 7 (36.8%) and outside in 12 (63.2%). In group II the tip of the cross-pin was outside the posterior cortex of the distal femur in all patients. This number was significantly higher than that in group I ( P = .017). Group I had significantly lower KT-1000 measurements than group II ( P = .003). The mean KT-1000 side-to-side difference was 0.47 mm in group I and 3.0 mm in group II. The Lachman and pivot-shift test data revealed no significant differences between the 2 groups ( P = .467 and P = .796, respectively). Conclusions: This study showed that breakage of bioabsorbable cross-pins is a relatively common phenomenon. Broken cross-pins were a factor relating to laxity after ACL reconstructions with hamstring grafts. Posterior direction of the cross-pin may be a cause of pin breakage. Level of Evidence: Level IV, therapeutic case series.

Purpose : This article presents a retrospective study of treatment modality for children’s diaphyseal forearm fractures. Materials and Methods : A total 148 forearm fractures (October. 1997-October. 2001) were examined, of which 19 required operation, a teenager whose growth plate had closed was excluded from the study. 17 patients required intramedullary K-wire fixation, 2 patients required open reduction and plate fixation. Time to radiologic union, complications at the last follow up were evaluated. Results : In 17 intramedullary K-wire fixation patients, the average time to union was 6 weeks and complications including 1 ulnar shortening, 1 pin infection, 1 osteomyelitis, which developed due to a patient’s mistake. In 2 plating patients, average union time was 6 weeks with no complications. Conclusion : We think that the treatment method of pediatric forearm fracture should be decided upon based on the fracture site and type of fracture. Intramedullary K-wiring for diaphyseal forearm fracture is an effective method and we recommend that the wire is inserted across the physis in cases of diaphyseal fractures of the forearm bone close to the metaphysis. If the diaphyseal forearm fracture is refracture or a bony gap is shown at the fracture site, open reduction and plate fixation is needed. If reduction and fixation of the bone alone in a diaphyseal fracture of both forearm bones restores the stability of other fracture, fixation of the other bone can be avoided.