The condition referred to as patella infera is characterized by a permanent shortening of the patellar ligament and is associated with a severely limited range of motion of the knee joint. Patella infera is a common complication of injury or surgery to the knee joint, and it is generally considered a condition that presents after a variable, albeit considerable time after injury. A review of the knee roentgenograms of patients with arthrofibrosis and patella infera showed this condition to be an immediate complication of knee fractures. Therefore, in order to better define the development of patella infera, the patellar height was studied during treatment of 146 knee joint fractures (46 supracondylar fractures, 50 patellar fractures and 50 tibial plateau fractures). Using the Caton-Deschamps method patella infera was detected in eight cases (17.39%) immediately after supracondylar fractures, in six cases (12%) after patellar fractures, and only in two cases (4%) after tibial plateau fractures. The patellar ratio remained unchanged or worsened further after treatment, and its incidence was unaffected by the type of treatment. These observations rule out etiologies such as inflammatory or algodystrophic phenomena and quadriceps inhibition, because the reduction of patellar height was evident immediately and persisted at follow-up examinations.

In this study, we surveyed a consecutive series of 500 patients who had undergone an open procedure for chronic anteromedial and/or anterolateral instabilities. Those patients who had an open arthrotomy were separated for analysis. All of the patients were examined before and during surgery. A knee sheet, based on the kind used at the Hughston Orthopaedic Clinic in Columbus, Georgia, was used to record all clinical findings. Chondromalacia of the articular surface of the femur was detected at surgery in 161 patients (32%). A statistical analysis showed that the variables directly influencing degenerative changes of the cartilage are: a previous surgery that did not sufficiently restore joint kinematics (chi square = 20.238, P less than 0.001) and a time lapse of more than 30 months between first trauma and surgery (chi square = 21.736; P = 0.001). A higher score on dynamic (jerk or pivot shift) and static (internal and external anterior drawer) tests, indicating instability, or a meniscal tear alone do not statistically correlate with chondromalacia, but together they influence degenerative changes of the cartilage.

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We evaluated patients at very long term with rupture of the long head biceps tendon (LHBT) in whom the tendon stump had been sutured to the coracoid tip (Gilcreest technique). Our aim was to determine the natural history of shoulders deprived of the LHBT and to assess the validity of the surgical technique. Between 1969 and 1981, 30 patients with rupture of the LHBT and no evidence of cuff tear underwent the Gilcreest operation. The mean age of the patients was 32 years (range, 20-49). Six of them were professional gymnasts. The 28 patients that could be traced were evaluated a mean of 31 years after operation. The mean Constant score (CS) was 74 in the entire group, and 86 in 22. The latter patients complained occasionally of mild shoulder pain. The remaining six patients had a mean CS of 56 (range, 40-81). Of the six, four (aged 66-71 years) had clinical and MR evidence of rotator cuff tear. The other two had undergone arthroscopic cuff repair (CS,(75)(76)(77)(78)(79)(80)(81). After operation, all professional gymnasts had returned to sport activity and all the other patients had resumed their jobs. After 30 years, the majority of the patients who had undergone the Gilcreest operation had good functional and cosmetic outcomes. Only a few patients had a cuff tear. The role of the LHBT as depressor of the humeral head is probably less important than generally believed.

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