Idiopathic chondrolysis of the hip: case report with a review of the literature

The first case of idiopathic chondrolysis of the hip from South-East Asia is reported, with a review of the literature. The problems of differential diagnosis are discussed. As the condition is rare, it is likely to be misdiagnosed and may well be over-treated. The rarity of the condition and its natural history terminating in spontaneous fusion make it mandatory that a correct preoperative diagnosis be established in order to avoid needless radical surgery. Some of the significant clinicopathological findings are highlighted.

[Arthroscopy of the knee joint]

The clinical usefulness of arthroscopies of the knee joint has been evaluated on the basis of 282 examinations. The procedures were performed under general anesthesia with sterility precautions as for arthrotomy. In nearly all cases, direct observation of articular surfaces, synovial membranes and the menisci of the ventral two thirds of the joint was possible. The dorsal recessus, the posterior third of medial meniscus, the posterior cruciate and Baker's cyst could not be inspected. The diagnostic accuracy of arthroscopy was compared with that of double contrast arthrography. The results are as follows: incipient degenerative lesions of articular cartilage, especially chondromalacia of patella, and dislocated bucket handle tears of menisci are more accurately diagnosed by arthroscopy. For other meniscal lesions double contrast arthrography provides better results. - Arthroscopy allows the taking of synovial biopsies in cases of chronic synovitis. However, the results of histological examination are rarely of decisive value, though undetected lesions of articular cartilage have been frequently brought to light.

Interchondral subluxation or "clicking rib syndrome"

A case history of the interchondral subluxation syndrome is presented, the anatomy as related to the symptoms discussed and the literature of this so-called "clicking-rib syndrome" reviewed. Unfortunately, this syndrome is not widely recognized but it is hoped that this article will bring it to the attention of those most likely to encounter it-the primary-care physician-and so save numerous unnecessary investigations and consultations. Once one is aware of its existence, the condition is easily diagnosed by careful history and examination alone.

Chondromalacia Patellae. A prospective study

In a prospective study of 105 arthrotomies for chondromalacia patellae, patella alta or an increased Q angle was found in most of the knees and was considered to be the usual cause of chondromalacia. The chondromalacia on the patella was usually centrally located with extension equally onto the medial and lateral facets. Femoral changes were uncommon. Patellar realignment together with excision of chondromalacic cartilage gave a satisfactory result in 79 per cent of the eighty-seven knees that could be followed.

Common errors made by pathologists in the diagnosis of bone tumors

The pathologist must obtain X-rays before attempting to make a diagnosis in a bone tumor. Errors are made with both benign and malignant lesions associated with calluses. Infection may stimulate a malignant bone tumor radiographically and pathologically. Secondary aneurysmal bone cyst may dominate the radiographic and pathologic findings and obscure the primary diagnosis. Osteoblastomas are becoming increasingly difficult to diagnose. The question of whether such an entity can become malignant has not been resolved. Cartilagenous tumors are often difficult to diagnose and the pathologist must not only rely on histologic findings, but in particular pay attention to the radiographic pattern which is often diagnostic. Accuracy of diagnosis in Ewing's sarcoma is essential because the treatment now can result in a cure rate of almost 40%. Certain lesions such as lymphoma or osteosarcoma can mimic this tumor. To re-emphasize the problem, the pathologist must have all the clinical information before attempting a diagnosis of a bone tumor and without the pertinent X-ray, errors are almost inevitable.

Clinical features of the degenerate meniscus with the results of meniscectomy

A series of 172 patients with an unambiguous diagnosis of horizontal cleavage lesion is reviewed, the average duration of which was 4 1/2 years. Although all the patients complained of pain, night pain and mechanical instability were not invariable. Joint line tenderness was the commonest physical sign. Whereas all but 7 per cent were either 'cured' or 'improved', nearly half the patients had persistent complaints, usually pain. The objective physical findings at review frequently failed to correspond with patients' opinions of their knees. Recovery after meniscectomy may be slow.