Arthroscopic treatment of cysts of the lateral meniscus

We have treated 69 patients with 72 cystic lateral menisci by arthroscopic surgery. Meniscal tears were observed in all cases, and 69 of these had a horizontal cleavage component. Three types of tear were identified and may be progressive. Treatment was by arthroscopic resection of the meniscal tear, and decompression of the cyst through the substance of the meniscus. After a mean follow-up of 34 months the results were good or excellent in 64 knees (89%) and there were few complications. We recommend this technique as the treatment of choice for cysts of the lateral meniscus.     

MR imaging of the anterior cruciate ligament: frequency of discordant findings on sagittal-oblique images and correlation with arthroscopic findings

OBJECTIVE: The purposes of this study were to determine the frequency of discordant MR findings of the anterior cruciate ligament (ACL) using sagittal-oblique images and the arthroscopic integrity of the ACL in knees with a discordant MR appearance. MATERIALS AND METHODS: The frequency of discordant MR features was determined by independently reviewing the sagittal-oblique images of 53 consecutive patients undergoing subsequent arthroscopic surgery. The first 25 consecutive knees were examined using a conventional, dual-echo, T2-weighted spin-echo (SE) sequence; the subsequent 28 consecutive knees were examined using both a T1-weighted SE(T1) and a fat-suppressed, fast spin-echo (FSE) T2-weighted sequence. Two examiners who were unaware of patient identification and arthroscopic results evaluated only the sagittal images that included the ACL. Each reviewer graded the ACL as torn or intact. The MR appearance was considered discordant when one MR sequence showed disrupted or poorly seen ACL fibers and the other sequence showed intact ACL fibers. The arthroscopic integrity of the ACL was determined for the 20 knees with a discordant MR appearance. RESULTS: A discordant MR appearance of the ACL was seen in 20 of the 53 knees (38%), including 10 knees evaluated using conventional T2-weighted sequences (40%) and 10 knees using T1/FSE T2 (36%) sequences. Arthroscopic examination of these knees showed intact ACL fibers in all 20 knees; the ACL was normal in 18 knees and a partial tear was questioned in two knees. CONCLUSION: A discordant appearance of the ACL was frequently encountered (38%) using either conventional T2-weighted sequences or T1 and FSE MR sequences in the sagittal-oblique plane. Intact ACL fibers were found during arthroscopy in all 20 knees with a discordant MR appearance.     

Anterior cruciate ligament injury: fast spin-echo MR imaging with arthroscopic correlation in 217 examinations

OBJECTIVE: Our objective was to evaluate the accuracy of MR imaging strategy that uses primarily fast spin-echo sequences for the diagnosis of anterior cruciate ligament tears. MATERIALS AND METHODS: The original clinical interpretations of MR images of 217 examinations of the knee joint were correlated with subsequent arthroscopic results. Each MR examination included a double-echo fast spin-echo sequence as the only imaging sequence in the sagittal plane. Subsequent discordant MR and arthroscopic examinations were then subjected to reanalysis by two observers who were unaware of arthroscopic results to determine if misinterpretations were observer or image dependent. Two hundred sixteen patients who underwent MR imaging for suspected internal derangement of the knee subsequently underwent arthroscopic surgery. Two patients had both knees evaluated. One patient was excluded because he was referred for evaluation for osteomyelitis, not internal derangement. This yielded a total number of 217 MR examinations for suspected internal derangement of the knee. RESULTS: For 56 arthroscopically proven tears, the sensitivity of MR imaging was 96%. The specificity was 98%, yielding an overall accuracy rate of 98%. The positive and negative predictive values were 95% and 99%, respectively. These values are within the ranges of previously reported MR imaging strategies using conventional spin-echo sequences. CONCLUSION: Fast spin-echo MR imaging of the knee can be an alternative to conventional spin-echo imaging for the detection of anterior cruciate ligament tears.     

Condylar chondroma: report of a case

Sixty-two consecutive patients with recurrent traumatic anterior instability of the shoulder were prospectively observed. Thirty patients were observed after arthroscopic stabilization, and 32 were observed after open Bankart repair during a mean follow-up of 36 and 40 months, respectively (range, 24 to 60 months for both groups). To reattach the labrum, the arthroscopic technique used transglenoid sutures and the open technique used bone anchors. Redislocation occurred in two patients (6%) in the open repair group and in five patients (17%) in the arthroscopic repair group. Three of the five patients with redislocations in the arthroscopic repair group underwent reoperation. According to the criteria of Rowe et al., 29 patients (90.6%) who had open repair and 24 patients (80%) who had arthroscopic repair had good-to-excellent results. The patients averaged 90.6 points in the open repair group and 83.1 points in the arthroscopic repair group postoperatively. Little or no limitations in their postoperative sport activities were reported by 30 patients (94%) who underwent open repair and by 25 patients (83%) who had arthroscopic repair. Despite similar patient populations and using arthroscopic examination to select the type of repair in both groups, the results of arthroscopic shoulder stabilization are inferior to those of the classic open Bankart procedure.     

Arthroscopic partial resection of the discoid meniscus in children

Thirteen children with 14 lateral discoid menisci were reviewed at an average follow-up of 2.7 years. Their average age at the time of the operation was 12.8 years. Most of the children had vague and intermittent painful symptoms, and the classical "clunk" was demonstrable in nine of the 13 patients in clinical examinations. Thirteen children underwent arthroscopic partial meniscectomy for symptomatic discoid lateral meniscus, by performing partial resection. This procedure, modifying the discoid lateral meniscus to the normal semilunar shape, was indicated only when the capsular attachment was intact. The results were excellent both clinically and radiologically. Furthermore, rehabilitation time was considerably shorter than the time required after open procedures. Arthroscopic discoid meniscus surgery performed by experienced and skilled hands gives better results. According to the literature and our experiences, it is better to perform open techniques in patients with stiff knees. Additionally, it is technically feasible to use small joint instruments in the pediatric age group.     

Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations

PURPOSE: To determine the ability of MRI to detect the presence of crystals of calcium pyrophosphate in the articular cartilage of the knee. DESIGN AND PATIENTS: The MR studies of 12 knees (11 cases) were reviewed retrospectively and correlated with radiographs (12 cases) and the findings at arthroscopy (2 cases) and surgery (1 case). A total of 72 articular surfaces were evaluated. Radiographic, surgical or arthroscopic demonstration of chondrocalcinosis was used as the gold standard. Additionally, two fragments of the knee of a patient who underwent total knee replacement and demonstrated extensive chondrocalcinosis were studied with radiography and MRI using spin-echo T1-, T2- and proton-density-weighted images as well as two- and three-dimensional fat saturation (2D and 3D Fat Sat) gradient recalled echo (GRE) and STIR sequences. RESULTS: MRI revealed multiple hypointense foci within the articular cartilage in 34 articular surfaces, better shown on 2D and 3D GRE sequences. Radiographs showed 12 articular surfaces with chondrocalcinosis. In three cases with arthroscopic or surgical correlation, MRI demonstrated more diffuse involvement of the articular cartilage than did the radiographs. The 3D Fat Sat GRE sequences were the best for demonstrating articular calcification in vitro. In no case was meniscal calcification identified with MRI. Hyperintense halos around some of the calcifications were seen on the MR images. CONCLUSION: MRI can depict articular cartilage calcification as hypointense foci using GRE techniques. Differential diagnosis includes loose bodies, post-surgical changes, marginal osteophytes and hemosiderin deposition.     

In vitro activities of antimicrobial agents against Candida species

A single surgeon's consecutive series of 50 arthroscopically repaired meniscal tears in 48 patients was retrospectively reviewed. None of these patients had concomitant ligament damage to the knee. The average follow-up period was 10 years, 9 months. Criteria for clinical success included 1) history of pain of grade 1 or less and absence of locking, catching, or giving way; 2) a physical examination demonstrating no significant effusion and a painless and negative jump sign; and 3) no subsequent surgical procedures on the repaired meniscus. Patient satisfaction was quite high, although clinical confirmation was possible in only 38 knees, indicating a clinical success rate of 76%. Bilateral standing radiographs were obtained on these 38 operated knees and were evaluated using Fairbank's classification. Evaluation of the radiographs revealed that 8% of the operated knees had minimal joint changes, as compared with 3% in the contralateral, nonoperated knee. This study demonstrates that arthroscopic meniscal repair in knees with isolated meniscal tears has the potential for a long-term successful clinical and radiographic outcome.     

Cytologic diagnosis of anal intraepithelial neoplasia using smears and cytyc thin-preps

Because of inconsistencies in the literature regarding popliteus and its relation to the lateral meniscus, it was decided to investigate the influence on the behavior of the lateral meniscus of contraction of the popliteus muscle via arthroscopy. A series of 50 knees from 44 patients who underwent elective arthroscopic surgery were examined. During arthroscopy, popliteus was stimulated to contract using surface electrodes. Any resultant meniscal retraction was observed and recorded. Thirty-one knees showed such retraction, and no retraction was observed in the remaining 19 knees. The clinical implications of this study are limited, but the results may support a number of proposed theories. It may be concluded that in a population exhibiting normal, intact lateral menisci, popliteus variably acts as a retractor of the lateral meniscus.     

Arthroscopic debridement for osteoarthritis of the knee: a seven years follow-up study

We reviewed 32 knees with osteoarthritis of the knee treated by either arthroscopic debridement in association with drilling the subchondral bone or arthroscopic debridement alone and followed for 2.5 to 11 years. Eighteen knees had arthroscopic debridement and drilling the subchondral bone, and 14 knees had arthroscopic debridement alone. In the group treated with arthroscopic debridement and drilling the subchondral bone, 55.6% had good to excellent results, 22.2% had fair results, and 22.2% had poor results. In the group that had arthroscopic debridement alone, 57.2% had good to excellent results, 35.7% had fair results, and 7.1% had poor results. There was better relief of pain in the group with arthroscopic debridement alone.     

A 2.5-Mb transcript map of a tumor-suppressing subchromosomal transferable fragment from 11p15.5, and isolation and sequence analysis of three novel genes

The purpose of this prospective study was to determine whether or not abrasion arthroplasty promotes cartilage regeneration in osteoarthritic (OA) knees with eburnation. Patients with OA knees were divided into a group of 51 knees treated by osteotomy with abrasion arthroplasty (Group A) and another group of 37 knees treated by osteotomy alone (Group B). Regeneration of cartilage was compared between the groups both arthroscopically and histologically. The Outerbridge classification was used for arthroscopic grading with Grade 0 being normal and Grade IV representing eburnation. On arthroscopic examination, around 12 months after surgery, Group A showed a significantly higher incidence of Grade II repair (a smooth articular surface and small fissures) and a lower incidence of Grade IV repair than Group B on both the femoral (P < .001) and tibial (P < .01) joint surfaces. Age was the only factor influencing the grade of tibial cartilage in Group A. Histological examination showed that 64% of the regenerated tissue studied consisted of fibro-cartilage at around 12 months after surgery. There was no difference in the clinical outcome at 2 to 9 years postoperatively between Groups A and B.     

The prevalence and related symptomatology of Helicobacter pylori in children with recurrent abdominal pain

The plicae are synovial septa remaining in adult life that existed in early fetal life. The suprapatellar plica separates the suprapatellar pouch from the knee joint. The plica syndrome has clinical significance, which has been occasionally overlooked, but the pathophysiology of symptomatic plicae may be hard to explain. To evaluate the clinical significance of the suprapatellar plicae, the authors reviewed 34 cases in 23 patients with vague pain around the knee and a total septum of the suprapatellar plica at arthroscopic examination from September 1991 to December 1993. The follow-up period was from 6 months to 2 years and 9 months. The most common presenting symptom was chronic mild knee pain, aggravated by prolonged squatting or standing, with other patients reporting recurrent swelling, instability, giving-way, or a feeling of snapping. The objective findings include palpable band on the superomedial side, audible snapping, and local tenderness, but there were no significant abnormal findings in the laboratory. The radiographic findings were few, with sclerosis of the articular surface of the patella in 2(6%), malalignment in 1(3%), and mild degenerative change in 4 cases(12%). Five of 11 patients evaluated by bone scan had increased uptake around the patellofemoral joint, and 7 of 13 knees had a relatively small suprapatellar bursa on conventional arthrogram or pneumoarthrogram. At arthroscopy, a suprapatellar plicae with complete septum was identified in 30 of 34 cases (88%) and associated lesions presented as meniscal tears, loose body, and discoid meniscus without tear. The complete plicae were surgically excised under arthroscopic control in 30 patients and the results were excellent in 22 patients (73%), good in 5 (17%), and poor in 3 (10%)at 17 months follow-up; there were no failures. In our opinion, the complete suprapatellar plica is clinically significant in patients who have equivocal diagnosis of knee problems and further studies of the pathophysiology of complete suprapatellar plica are needed.     

Ultrasound and hepatic metastases

Recent advances in ultrasonic technology have permitted differentiation of tissue within an organ. Fifty-nine patients in whom satisfactory follow-up could be obtained underwent grey-scale ultrasonic examination of their livers. Fifty-three patients were scanned successfully and of these a correct diagnosis as to whether metastases were present or not was given in 46. Ultrasound is a safe non-invasive way of detecting hepatic metastases.     

Prospective preoperative evaluation of anterior cruciate ligament instability of the knee joint and results of reconstruction with patellar ligament

Of 54 patients with chronic (n = 49) or acute (n = 5) anterior cruciate ligament instability, 52 were evaluated after mean 16 months' follow-up interval after open (n = 18) or arthroscopic assisted (n = 36) bone-tendon-bone patellar ligament reconstruction. Preoperative Knee Signature System side-to-side difference in anterior displacement decreased from 7.9 mm to 3.5 min at follow-up evaluation (p < 0.0001). An objectively satisfactory limit of 5 mm in side-to-side difference was achieved in 73% of the patients. At follow-up evaluation, there was a positive pivot shift sign in eight knees (one definite and seven trace). Average Lysholm knee scores improved from 69 to 83. The only significant difference between the arthroscopic assisted and open groups was smaller side-to-side anterior displacement difference in the arthroscopic group (2.2 mm versus 4.8 mm, p = 0.002). Results suggest that more accurate and isometric placement of the graft is possible with the arthroscopic-assisted technique.     

A clinicopathologic study of the resected cases of adenosquamous carcinoma of the lung

Low-grade malignant tumors (LGMT) of the lung were surgically treated in our institute between 1981 and 1997. Both the characteristics and prognosis were examined. We studied 10 cases with LGMT of the lung, male to female ratio 1:1, age range 15 to 71 years, mean 55 years, 6 central and 4 peripheral. Five patients had lobectomy, 3 had sleeve lobectomy and 2 had bilobectomy. Pathologically, 5 samples were typical carcinoid, 3 were mucoepidermoid carcinoma and 2 were adenoid cystic carcinoma. None of the patients had lymph node metastasis. Nine patients were stage I and one stage IIIA. Seven patients underwent absolutely curative resection; 2, relatively non-curative resection; 1, non-curative resection. In preoperative examination, only 4 patients was diagnosed correctly and the others were misdiagnosed. Mean survival time was 167.5 months. One patient died from causes other than the primary cancer and the others are surviving (range 2-173 months). The LGMT group was significantly younger and had a significantly better prognosis compared with the control group (p=0.02). Mediastinal lymph node dissection is suggested to be omitted. However, further accumulation of cases is necessary regarding to the omission of lymph node dissection.     

Results of knee replacement with the Walldius and geometric prostheses. A comparative study

Sixty-two knees that were replaced with Walldius prostheses and twenty-five knees with geometric replacements were studied prospectively. The follow-up ranged from twenty-four to 162 months (average, seventy-four months) for the knees with the Walldius prostheses and from twenty-four to seventy-five months (average, forty-seven months) for those with the geometric prostheses. Using a 100-point clinical rating scale, the knees of patients who underwent Walldius replacement improved from their preoperative status by an average of 33 points (from 44 to 77 points) and those with geometric prostheses, an average of 24 points (from 54 to 78 points). Twelve patients with twenty Walldius prostheses were followed for more than 100 months (average, 127 months). The greater average improvement (36 points) in this group was due primarily to the absence of any major complications. Six patients underwent replacement of one knee with a Walldius prosthesis and one knee with a geometric implant. Although the ratings for the two knees were similar in each patient, four patients preferred the Walldius implant; one, the geometric replacement; and one had no preference. Significant technical errors or complications (defined as those affecting the end result) occurred in 8 per cent of the knees with Walldius implants and in 12 per cent of the knees in the geometric group. There were two late infections in each group. One Walldius prosthesis was removed and the knee was fused. The other three prostheses (one Walldius and two geometric) associated with infection were salvaged.     

Aspiration of the knee joint before revision arthroplasty

Sixty-four operative procedures were performed on 55 patients with knee arthroplasties for pain, loosening, instability, or suspicion of infection. Forty-three knees had a preoperative aspiration. In 19 knees, the aspiration showed growth on solid media, and in 18 of these knees the diagnosis of infection was confirmed by the intraoperative cultures. In 1 knee with an infected total knee replacement, the patient was receiving an intravenous antibiotic at the time of arthroscopic irrigation and debridement and the cultures showed no growth. In 23 of 24 knees with a negative preoperative aspiration, the intraoperative cultures showed no growth on solid media. In 1 knee with a preoperative aspiration that had negative results, a single intraoperative culture grew Staphylococcus epidermidis. However, the presenting symptoms, examination, preoperative radiographs, and intraoperative evaluation were consistent with aseptic loosening of a cemented total knee arthroplasty. Thus, the preoperative aspiration of the prosthetic knee joint had a sensitivity of 100%, specificity of 100%, and accuracy of 100%. The Westergren erythrocyte sedimentation rate, peripheral leukocyte count, and presenting symptoms correlated poorly with infection. Radiographs were also not helpful in the diagnosis of infection, with loosening of components, periostitis, focal osteolysis, and radiolucent lines frequently seen in infected and noninfected knees. Preoperative aspiration of the knee is the most helpful study for the diagnosis or exclusion of infection in a prosthetic knee joint.     

Symptomatic intraarticular ganglia of the cruciate ligaments of the knee

This case report draws attention to the clinical presentation, differential diagnosis, and recommended diagnostic modality and treatment of symptomatic ganglia of the anterior and posterior cruciate ligaments. One patient presented with a recurrent inability to fully extend the left knee. Another patient presented with pain and soreness over the lateral aspect of the knee, including the lateral joint line. The diagnosis of ganglia of the cruciate ligaments was made after clinical, radiographic, and magnetic resonance examination. Both patients were treated successfully with resection of their ganglia using arthroscopic techniques.     

Selective approach to the treatment of oesophageal cancer

Between September 1985 and December 1994, 322 patients with oesophageal cancer were treated. Of the 190 patients who underwent operation, 173 had an oesophageal resection; in 124 this was performed as an abdominothoracic resection and in 49 by the transhiatal approach. The assessment of radicality after histological examination revealed a curative (R0) resection in 121 patients (70 per cent) and a palliative (R1-R2) resection in 52 (30 per cent). Prognosis was correlated with the extent of mediastinal lymph node dissection. In 77 patients with stage pT1-3 pN0-1 pM0 the 5-year survival rate was 40 per cent after abdominothoracic resection with two-field lymph node dissection and zero after transhiatal resection (P = 0.01). The authors propose a differentiated surgical approach involving abdominothoracic resection with two-field lymph node dissection for patients with limited tumours (pT1-3 pN0-1 M0) if the operative risk is tolerable. Transhiatal resection appears to be effective only in patients with early tumours (Union Internacional Contra la Cancrum stage 0).     

Estimating mechanical blood trauma in a centrifugal blood pump: laser Doppler anemometer measurements of the mean velocity field

There are different opinions on the duration of post-operative shoulder immobilisation following arthroscopic repair of labrum tears. Between 1993 and 1994 at our department arthroscopic repairs of the glenoid labrum as described by Habermeyer (15, 16) have been performed in 38 patients. In 20 of these patients postoperative treatment included immobilisation of the operated shoulder in a Gilchrist-bandage for 3 weeks, while in the remaining 18 patients this postoperative immobilisation period was decreased to only 1 or 2 weeks. Physiotherapy started the day after the operation, using a device for passive-motion exercises. The mean follow-up time of our examinations was 15.4 month. The mean score by Rowe rose significantly from 20.0 preoperatively to 82.6 at the follow-up examination. Results were excellent or good in 89.4% of all cases, new shoulder dislocations did not occur in any case. Patients having their shoulders immobilised for 3 weeks reached significantly higher Rowe-scores at our follow-up than those patients, whose shoulders were immobilised for only 1 or 2 weeks. Therefore, postoperative management following arthroscopic repair of labrum tears should include immobilisation of the operate shoulder for 3 weeks and an early start of passive-motion exercises.     

Arthroscopy of the knee under general anesthesia: an aid to the determination of ligamentous instability

During a 34-month period (March 1976 through December 1978), 790 patients underwent arthroscopic examination of the knee under general anesthesia. Preoperative assessment of ligementous instability was compared with the ligamentous examination while under general anesthesia. Eight percent of the patients with no preoperative instability first demonstrated ligamentous instability under general anesthesia. Thirty-six percent of the patients with preoperative instability and 27% of the patients with previous surgery had either an increased grade or additional component of instability found when examined under general anesthesia. Information gained from arthroscopy without a comprehensive ligament examination under anesthesia may result in an incomplete diagnosis and ineffective treatment. Patients at high risk include those with acute injuries, preoperative instability, or previous surgery.