Is MRI efficient for diagnosing all the knee disorders?

MRI is now established as a primary imaging modality in the knee. It is a simple technique which enables all the bony and soft tissue structures to be visualized noninvasively. But arthroscopy still has the upper hand in diagnosing the majority of different knee affections although invasively. Two hundred and fifty-three different knee lesions in 160 patients were evaluated by MRI and arthroscopy to judge importance of each. MRI is valuable in the investigation of patient with suspected internal derangement of the knee since it accurately assesses meniscal and ligamentous integrity, but detecting the shape of meniscal tears was not as accurate as by arthroscopy. MRI may be used to assess hyaline cartilage, synovium and bone in the complete spectrum of disorders of the knee, but it failed to differentiate between rheumatoid arthritis and pigmented villo-nodular synovitis which is a very easy and accurate by arthroscopy. Also, detection of various types of chondromalacia patillae and visualization of synovial plica could not be revealed. On the other hand, various kinds of extrasynovial lesions could not be accurately diagnosed by arthroscopy which is an easy job of MRI

osteocutaneous free fibular graft for extensive defects in long bones

Free composite osteocutaneous flaps were used to reconstruct five extensive bone and skin defects. Four cases had tibial and skin losses, while the fifth patient suffered from ulnar and skin defect over it. Fibular bone graft with its overlying skin and the peroneal artery with its venae comitants were anastomosed by the aid of microvascular technique and the bone was fixed in place after preparation of the recipient site. The skin color of the flap was checked every few hours. Thrombectomy was performed in one case, while Thiersch skin graft was done to cover the raw area of sloughed skin in another case. The third reported complication was a draining sinus which closed conservatively after one month. The fourth complication happened in the first case after three months was fracture of the fibular graft and bony union occurred after another two months fixation by above-knee cast. It is concluded that osteocutaneous fibular graft can solve many problems of extensive bone and skin losses