A series of 60 matched and paired patients with complete rupture of the anterior cruciate ligament (ACL) was studied; 30 were treated conservatively, even though operation was recommended, and 30 were operated on within 35 months (range 18 to 48 months) after the ACL rupture. The average age was 34 years in each group. They were assessed 39 months after arthroscopy or reconstruction. At follow up, no patient had flexion of less than 100 degrees, 13 of the reconstructed knees had an extension deficit, but in only one was this more than 10 degrees. Thirty-six percent of the reconstructed and 14% of the conservatively treated patients graded their sports activity as unlimited, while 13% of the ACL reconstructions and 21% of those treated conservatively were severely limited. The Lysholm, Cincinnati and OAK scores were significantly better in the reconstructions. The anterior drawer sign was positive in 24% of the ACL reconstructions and in 81% of the conservatively treated patients; 19% had a positive pivot shift after reconstruction compared to 75% of those treated conservatively. Even though there was a considerable number of patients with a decreased range of motion after ACL reconstruction because of the slow regime of postoperative mobilisation used, the results of operation are significantly better than after conservative treatment even when ACL reconstruction was carried out late after injury.

Fifty patients with impingement syndrome refractory to long-term conservative treatment were randomized to three treatment groups. All patients received an injection of 10 ml 0.5% bupivacaine, in group 1 without corticosteroid, in group 2 with crystalline corticosteroid and in group 3 with lipoid corticosteroid. Treatment in group 1 had to be stopped because of inefficacy. In groups 2 and 3 favorable results were achieved in 19 out of 40 patients.Résumé 50 patients avec conflit sous-aeromial, qui ne montraient pas d'amélioration après un long trâitement conservatif récevaient une injection dans la bourse subacromiale. Le premier groupe récevait une injection contenant un anaesthétique local pur, groupe 2 une mixture d'anaesthétique avec des corticostéroides cristalins et groupe 3 avec des corticostéroides lipoides. Le trâite-ment du groupe 1 devait être arrété cause d'inificacité. 19 de 40 patients du groupe 2 et 3 montraient une amé-lioration après 6 mois.

Fifty-four consecutive patients were studied prospectively with magnetic resonance imaging before microdiscectomy, and the findings correlated with clinical symptoms before and after operation. A sequestrated fragment was found in 59% of cases, a subligamentous disc sequestration in 25% and a disc protrusion in 16%. The levels operated on were L4/5-36%, L5/S1-62.5%, and one at L3/4; 71% were laterally placed, 10% lay intraforaminal and 10% medial. The diameter of the protrusion was 4 mm to 13 mm for the craniocaudal extension, and 5 mm to 18 mm for the anteroposterior extension. No correlation could be found between a neurological deficit and the size of the prolapse. A positive correlation was present between the increasing degree of canal obstruction and the degree of disc degeneration determined by imaging for extrusions, subligamentous disc sequestrations and free sequestrations. Nerve root inflammation and enlargement was seen in 36% of the images, corresponding to an operative finding of 32%. Magnetic resonance imaging is a helpful pre-operative diagnostic investigation which shows structural changes in the disc and the correct localisation and size of the disc sequestration, but there was no correlation between the imaging findings and the clinical symptoms.

Regarding strict criteria of evaluation almost 70% of our patients not responding to conservative treatment achieved good and excellent results after surgery. Smaller lesions and tears solely involving the supraspinatus-tendon were associated with a better prognosis. Ultrasonography allows a reliable examination of the rotator-cuff-anatomy postoperatively performed, too.