One hundred patients were operated on by the Maquet procedure for chondromalacia patellae. All of them were first re-examined after a mean follow-up of 4 years, and 65 of them re-examined after a mean follow-up of 11 years (range, 8-15 years). The pain score improved significantly after the operation and remained unchanged with longer follow-up. The success rate was only 62% at both follow-ups. Outerbridge grade IV chondral lesions at the time of surgery were associated with a significant improvement of the pain score at the 4-year follow-up and a success rate of 69%. The Maquet procedure should only be proposed for chronic retropatellar pain with grade IV chondral lesions, after conservative treatment has proven unsuccessful, as the expected failure rate is about 30%.

Few prostheses allow preservation of the anterior cruciate ligament (ACL) during total knee replacement. We report a short-term, prospective, open study of 32 ACL-retaining and 93 ACL-replacing total knee replacements and compare the respective outcomes of both prosthesis types with a follow-up time of 2-3 years. Mean operative time, complication or revision rates did not differ, nor did the early and late clinical and radiological evaluations. This study does not support the suggestion that technical difficulties increase for ACL preservation. The clinical and functional results were neither improved nor worsened for ACL-retaining prostheses. There is thus no advantage, but also no inconvenience, in retaining the ACL according to short- to mid-term results of a gliding posterior cruciate ligament (PCL)-retaining prosthesis with ACL-replacement design. The possibility of an improved long-term outcome of an ACL-retaining prosthesis should be investigated further.

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R~sum~. Les auteurs d6crivent la m6thode d'Ilizarov dans le traitement des pseudarthroses infectdes du tibia etdans la reconstruction des pertes de substance osseuse. Cette technique a dtd utilis~e chez 37 patients dans 29 cas de pseudarthroses infectdes du tibia sans perte de substance osseuse et dans 8 cas avec des d6fects osseux consdquents, allant jusqu'gz 15 cm. Les r6sultats ont dtd variables et moins satisfaisants que ceux publi6s par Ilizaroy Iui-mOme ou d'autres auteurs trop enthousiastes. Les rdsultats tardifs sont meilleurs dans les pseudarthroses infect(es sans ddfect osseux (79 % de consolidations et 68 % de tarissements de l'infection) que dans les cas avec perte de substance osseuse (44 % de consolidations et 55 % d'ass~chements). La mdthode d'Ilizarov est considdrer comme difficile d'application et comme astreignante pour le patient comme pour le chirurgien. Ndanmoins, c'est la seule technique permettant [z la fois et dans le m~me temps de traiter l'infection et la consolidation. Abstract. The authors describe Ilizaroy's method for the treatment of infected tibial pseudarthrosis and for reconstruction of diaphyseal bone defects. This technique was used on 37 patients: 29 cases consisted of infected tibial non-unions without bone defect and 8 cases with consequent bone defect between 2 and 15 cm. Results are variable and less satisfactory than those published by Ilizarov himself or other authors. The late results are better in cases of infected pseudarthrosis without bone defect (79 % bone consolidation, 68 % cure of infection) than in cases with extensive bone defect (44 % bone consolidation, 55 % cure of infection). Ilizarov's method must be considered as very demanding for the patient and also for the surgeon. It is however the only technique for treating simultaneously infection and consolidation. The treatment of infected non-union of long bones, particularly in tibial pseudarthrosis, has four requirements : 1) bone stabilisation by external fixation [18] 2) local treatment of infection with irrigation drainage [6], antibiotic cement [11, 12], plaster beads [17], antibiotic fibrin clots [3], collagen fleece [1] or tauroline gel [13] 3) achievement of bone consolidation by traditional surgical operations such as open cancellous bone grafting [16] or free vascular bone grafting [8]. 4) skin covering by various muscle flap techniques [14].Recently Ilizarov [9, 10] has described a new and original method of treatment for infected non unions with or without bone defect. MethodThe Ilizarov technique allows the simultaneous achievement of eradication of infection and bone consolidation without debridement and without bone grafting. In animal studies, Ilizarov showed the importance of a stable but elastic bone stabilization and the role of conservation of the vessels, of the periosteum, the endosteum and the bone marrow.The Ilizarov ring fixator with transfixing Kirschner wires allows absolute rigidity of a long bone pseudarthrosis in flexion and rotation, but preserves some axial elasticity. So, earl...

We studied 561 cases of osteoarticular and soft-tissue infections treated with gentamicin-PMMA-beads. Healing of the infection occurred in 85% of cases. Recurrence was observed in 10% of cases after I year and 20% after 10 years. No allergic or toxic complications were seen due to the gentamicin. The PMMA-beads loaded with gentamicin may be used in the treatment of osteoarticular and soft-tissue infection in addition to surgical debridement, which is the main therapeutic step. They give high tissue antibiotic concentration without risk of general toxicity, and in this way avoid or diminish the associated systemic antibiotherapy, while the disadvantages related to their use seem minor.