One year after treatment, characterized chondrocyte implantation was associated with a tissue regenerate that was superior to that after microfracture. Short-term clinical outcome was similar for both treatments. The superior structural outcome may result in improved long-term clinical benefit with characterized chondrocyte implantation. Long-term follow-up is needed to confirm these findings.

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One hundred forty-nine medial prostheses were implanted in 140 patients between 1988 and 1996. After a mean of 67 months 28 patients had died, without the need for revision. Seventeen prostheses were lost to follow-up. Revision surgery using a total knee prosthesis was performed in 16 cases. In four others, a lateral prosthesis was implanted subsequently to a medial one. One of these four was revised to a total knee prosthesis 6 years later. In another four cases, late complications of the meniscal bearing were treated with replacement of this bearing. The surviving prostheses were seen back after a mean of 126 months. The cumulative survival rate at 10 years was 82% for the whole population and 84% when knees with a previous high tibial osteotomy were excluded. Since these results compare poorly to the survival of total knee arthroplasty, this prosthesis is not the first-choice implant. Because it preserves a maximum of bone stock and is revised to a total prosthesis almost without difficulty, it is the first-choice implant for medial unicompartmental osteoarthritis in patients younger than 65. Further research is mandatory to confirm that this prosthesis very rarely needs revision in patients older than 75. It should not be used in osteotomized knees.

Interpretation of computed tomographic and magnetic resonance arthrograms of the shoulder is complicated by normal variants of the labrum and glenohumeral ligaments. A superior sublabral recess is located at the 12 o'clock position and represents a normal recess between the superior labrum and the cartilage of the glenoid cavity. A sublabral foramen is located at the 2 o'clock position and represents localized detachment of the labrum from the glenoid rim. Buford complex is characterized by absence of the anterosuperior labrum and cordlike thickening of the middle glenohumeral ligament. Imaging features of damage to the anterior labrum include absence or detachment of the labrum and an irregular frayed appearance. Superior labrum anterior-to-posterior (SLAP) lesions are classified as type I (tear confined to the superior labrum), type II (labrum and biceps tendon detached from the superior glenoid), type III (bucket handle tear of the superior labrum), or type IV (bucket handle tear of the superior labrum with lateral extension into the biceps tendon). Increased distance between the labrum and the glenoid, an irregular appearance of the labral margin, or lateral extension of the separation may suggest a SLAP lesion rather than a normal anatomic variant. However, differentiation between normal variants and pathologic conditions and between various types of SLAP lesions remains difficult.

During decennia the treatment of radial head fractures has been controversial. For Mason type II fractures, more recent studies agree that open reduction and internal fixation is the treatment of choice. It restores biomechanical properties, allows an early mobilisation of motion and results in better functional outcome compared with other treatments. In this study, we present the mid-to-long-term results of an arthroscopic technique for reduction and percutaneous fixation. Fourteen patients were available for follow-up with a final assessment performed at an average of 5 years 6 months (range 1 year to 11 years 3 months). Patients were evaluated for pain, motion and radiological findings. The average elbow score (Broberg and Morrey in J Bone Joint Surg Am 68:669-674, 1986) was 97.6 points (range 86-100), corresponding with 3 good and 11 excellent results. Two of the patients with only good results had associated cartilage lesions of the capitellum. Our results show that arthroscopically assisted reduction and internal fixation of type II radial head fractures is a valid technique with consistently good outcome. Although the technique is technically demanding, it allows more precise articular fracture reduction control, as well as better evaluation of associated lesions.

We have reviewed the history of 154 primary, traumatic dislocations of the shoulder in order to determine the risk of recurrence. We found a recurrence rate of 68% in patients under the age of 20, after a follow-up period of 1-9 years (average 4.5 years). There was a highly significant difference (p < 0.0001) in the recurrence rate of patients under, and above, 30 years of age. Twenty per cent of the patients had a concurrent minor fracture at the shoulder with 2 out of 39 of the recurrent cases (5%) and 29 of the 115 non-recurrent cases (25%); this is also a significant difference (p < 0.01). Neither the need for general anaesthesia at primary injury nor the occupation of the patient was a relevant factor in the final outcome of the dislocation. Four nerve injuries were encountered (3%), with no severe sequelae at follow-up. The young patient with no concurrent fracture at the time of the primary shoulder dislocation has a high risk of recurrence.

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The operative treatment of lesions of the anterior cruciate ligament (ACL) in athletes has been widely advocated and performed. We have investigated the outcome of non-operative management in a lowerdemand, general population. We reviewed a consecutive group of 228 patients, which excluded professional and high-level athletes, for two to 12 years after an ACL lesion had been diagnosed by arthroscopy.There was a low incidence of secondary ACL and meniscal surgery, 5.4% and 3.5% respectively, and all these procedures were performed during the first three years after the ACL injury.We studied a subgroup of 109 patients with follow-up of at least five years (mean 8.5 years) and evaluated them using the IKDC score. The general outcome was reasonably satisfactory, with 23% in grade A, 50% in grade B, 21% in grade C and only 6.4% in grade D. We found no statistically significant prognostic effect within this group as regards age, activity levels, or the incidence of associated lesions.J Bone Joint Surg [Br] ] 1996;78-B:446-51. Received 25 August 1995; Accepted after revision 29 November 1995Lesions of the anterior cruciate ligament (ACL) in athletes have been studied extensively in orthopaedic sports medicine, and operative treatment using grafts is widely advocated for this particular group of patients (Fetto and Marshall 1980;Noyes et al 1983a;Kannus and Järvinen 1987;Andersson et al 1989;Barrack et al 1990;Daniel and Fithian 1994). Many ACL lesions, however, are seen in nonathletes as a result of accidents or low-grade recreational activities (Jain, Swanson and Murdoch 1983;Casteleyn, Handelberg and Opdecam 1988). We aimed to investigate the outcome of the conservative treatment of ACL lesions in a lower-demand population. PATIENTS AND METHODSOver a period of 12 years, we managed a total of 274 patients with acute traumatic knee haemarthrosis. All had examination under anaesthesia and arthroscopy.Of these, we treated 46 by ACL reconstruction. They included patients with gross or multidirectional joint laxity (grade-3 or grade-4 pivot shift, combined lesions of the ACL and lateral collateral ligament (LCL) or posterior cruciate ligament (PCL)) and in addition all high-level or professional athletes. These 46 cases (16.8%) were excluded from the study group.This left a consecutive group of 228 patients (83%) who were managed conservatively. There was an almost fourfold male to female ratio and the mean age at the time of injury was 33.2 years (16 to 66). The main causes of injury were daily living activities (28.1%), traffic accidents (11.8%), and recreational activities (60.1%) ( Table I). Initial management. In 83% of the cases, arthroscopic evaluation was within three weeks of the index injury. The proportions of isolated ACL ruptures and those associated with meniscal and ligamentous lesions were comparable with those reported in previous studies (Casteleyn et al 1988) (Tables I and II); only 21 of the ACL tears (9%) were partial. Intrasynovial ACL lesions (14; 6.1%) were left as much as possible within the synov...