BackgroundIntra-articular injection of hyaluronic acid is a well-established therapy for the treatment of knee osteoarthritis. The aim of the study was to assess the effectiveness and safety of the use of Arthrum HCS® (40 mg hyaluronic acid and 40 mg chondroitin sulfate in 2 mL).Materials and methodsThis was an open, multicenter, prospective study. Men or women over 40 years of age with documented knee osteoarthritis and WOMAC subscore A (severity of pain) ≥25 were enrolled. They received three weekly intra-articular injections of sodium hyaluronate 2 % and chondroitin sulfate 2 % in combination. WOMAC subscore A was assessed at 1, 3 and 6 months after the last injection.ResultsOne hundred and twelve patients were included (women, 66 %). The mean (SD) WOMAC subscore A decreased from 52.1 (15.2) at inclusion to 20.5 (19.7) at month 6 (P < 0.0001). The mean subscore was already significantly decreased 1 month after the last injection at 25.7 (P < 0.0001). Pain relief and consumption of analgesic drugs, both assessed with visual analogic scale (VAS), consistently decreased. The investigators were satisfied/very satisfied as regards the therapeutic effectiveness of sodium hyaluronate-chondroitin sulfate in reducing pain (77 %), improving mobility (78 %) and reducing the consumption of analgesics (74 %). Only one adverse effect was reported by one patient (knee tumefaction).ConclusionThese results suggest that intra-articular injections of Arthrum HCS® (sodium hyaluronate plus chondroitin sulfate) in patients with knee osteoarthritis are efficient and safe. These results should be confirmed in a randomized controlled study.Level of evidenceIV.

We used end-to-side nerve coaptation combined with standard end-to-end neurotisations to treat 11 patients who presented with complete (six cases) or incomplete (five cases) traumatic brachial plexus injuries. All patients were available for functional evaluation at a minimum of 2 years postoperatively. In three patients with shoulder abduction recovery, electromyographical studies (EMG) showed a contribution from the end-to-side neurotisation. In the remaining cases end-to-side neurotisations were unsuccessful. Our study did not demonstrate a reliable role for end-to-side nerve suture in brachial plexus surgery. We believe that at present end-to-side suture must not be a substitute for standard reconstructive techniques in brachial plexus surgery. Occasionally termino-lateral nerve sutures may represent a support to standard reconstructive procedures especially in case of severe injuries when few undamaged donor nerves are available.

Restoration of ACJ anatomy is the key to a successful therapy. The surgical technique should be personalized. The miny-open surgery and also the arthroscopic surgery are adequate with good clinical results. However, according to the SPORTS score, the patients treated with mini-open surgery returned to their sport with less pain and better performance than those belonging to the other group.

In a recent article, Leigh (J Bone Joint Surg [Br] 88-B: [16][17][18] 2006) notes that patients do not lay down memory when being counselled as to the risks involved in prospective surgery. In our article we focused on the patients' recall of risk factors involved in elective spinal surgery. We assessed the influence of written information provided to the patients during the consenting process on their recall of operative risks. The study was a prospective randomised study. All patients having elective spinal surgery were included in our study from February 2006 to November 2006 as a consecutive series. Patients were randomised into two groups, one of which received routine consent with verbal explanations (group 1), the other received the same information supplemented by a written sheet explaining the risks of the surgery (group 2). Two weeks later we assessed patients' recall of the risk involved in the surgery with a questionnaire and compared both groups with a Student t-test. Fifty-three patients (twenty in group 1 and twenty three in group 2) were involved. We noted a significant difference between the two groups in terms of mean number of risks recalled and number of patients recalling each risk (p<0.001 and p<0.005, respectively). The addition of a written sheet given to patients during the consenting process makes a significant difference in terms of their recall of the surgical risks in elective lumbar spine surgery. We advocate the routine use of written booklets during the consenting process.Résumé Rappel: dans un article récent, Leigh montre que les patients ne se souviennent pas très bien des indicationsqui leur ont été données en ce qui concerne l'information sur les risques avant une intervention chirurgicale. Nous avons souhaité, dans notre étude mettre l'accent sur les risques pouvant survenir dans la chirurgie rachidienne. Nous avons essayé d'évaluer l'importance de l'information écrite lors de la mise en place du consentement éclairé de ces patients. Méthode : cette étude est une étude prospective randomisée. Tous les patients devant bénéficier d'une chirurgie rachidienne ont été inclus dans notre étude sur une période s'étalant de février 2006 à novembre 2006. Tous les patients consécutifs ont été randomisés en deux groupes. Le premier groupe n'ayant que des explications par voie orale, (groupe 1) et le deuxième groupe avec un complément d'informations écrites, (groupe 2). Deux semaines après, ces patients ont été évalués avec un questionnaire et les deux groupes ont été comparés. Résultats : 53 patients dans le groupe 1 et 23 dans le groupe 2 ont été pris en compte dans cette étude. Nous avons noté une différence significative entre les deux groupes soit sur le nombre d'informations retenues par le patient ou le nombre de patients ayant pris en compte ces informations. En conclusion : outre l'information orale, une information écrite remise au patient durant le processus de consentement éclairé en chirurgie du rachis lombaire, est nécessaire avec une différence signif-

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