Estudio del nivel de concordancia entre los diagnósticos prequirúrgico y artroscópico de lesiones meniscales asociadas a lesiones del ligamento cruzado anterior / Concordance between preoperatory diagnosis and arthroscopy findings of meniscal lesions associated to anterior cruciate ligament injury

Introducción: Las lesiones ligamentarias de la rodilla son comunes durante la segunda y tercera décadas de vida, su diagnóstico clínico es difícil ya que puede diferir con el diagnóstico definitivo. El objetivo es determinar la concordancia entre el diagnóstico preoperatorio-diagnóstico postoperatorio y entre la lesión meniscal sospechada-lesión meniscal encontrada, en pacientes con lesión del ligamento cruzado anterior. Material y métodos: Estudio transversal. En 29 pacientes con lesión del ligamento cruzado anterior a los cuales se realizó artroscopía. Las variables fueron edad, género, lado afectado, diagnóstico preoperatorio, diagnóstico postoperatorio, lesión meniscal sospechada, lesión meniscal encontrada. La estadística utilizada fue descriptiva, para la concordancia se usó índice de Kappa de Cohen. Resultados: Fueron 29 pacientes, 23 (79.3%) hombres y 6 (20.7%) mujeres, la edad promedio: 39.04 (15-50) ± 13.19 años, lado afectado derecho 69% e izquierdo 31%; el diagnóstico preoperatorio en 22 (75%) pacientes fue LLCA aislada, LLCA + menisco medial 6 (20.7%), LLCA + menisco lateral 1 (3.4%) y el diagnóstico artroscópico fue en 20 (68.96%) sin lesión meniscal, 7 (24.1%) lesión en menisco medial, 2 (6.9%) en menisco lateral, con una concordancia baja (Kappa 0.2), la concordancia diagnóstica preoperatoria intraobservador fue perfecta (Kappa 1.0); y la concordancia entre el diagnóstico de la lesión meniscal preoperatoria y de la lesión meniscal artroscópica fue baja (Kappa 0.2). Conclusiones: La concordancia entre el diagnóstico clínico-radiológico y el diagnóstico artroscópico en lesiones del LCA con asociación de lesión meniscal es baja, lo cual se tiene que tener en cuenta en la realización del diagnóstico inicial y en el tratamiento artroscópico de los pacientes.

Introduction: Ligament injuries of the knee joint are common during the second and third decades of life, clinical and radiological diagnosis presents difficulties since the surgical findings may differ significantly. The objective is to determine correlation between clinical-radiologic and arthroscopic diagnosis in patients with injury of the anterior cruciate ligament (ACL) and meniscal lesions. Material and methods: Cross-sectional study held in 29 patients with ACL injury associated to meniscal lesions treated arthroscopically. Variables were age, gender, affected side, preoperative and postoperative diagnosis, type and location of meniscal injury; descriptive statistics and Cohen Kappa for concordance were used. Results: There were 29 patients, 23 (79.3%) men and 6 (20.7%) women, mean age 39.04 (15-50) ± 13.19 years; right side was affected in 69% and left in 31%; 19% had not meniscal lesion, 17.2% had injury in anterior horn, 10.3% in posterior horn and 6.9% in the body. The concordance between preoperative and artroscopic diagnosis was: Kappa 0.2; intraboservador was Kappa 1.0; between suspected meniscal injury and arthroscopic findings was: Kappa 0.2. Conclusions: The concordance between the clinical-radiological and arthroscopic diagnosis in patients with ACL injuries and meniscal injury associated is low, which has to be considered in the initial review and the arthroscopic treatment of patients.

A importância da ressonância magnética pré-operatória nas fraturas do planalto tibial / The importance of pre-operative magnetic resonance image in tibial plateau fractures

OBJETIVO: Caracterizar a importância da Ressonância Nuclear Magnética (RNM) como método de investigação pré-operatória nas fraturas do planalto tibial, tratando de correlacionar o padrão de lesão óssea, classificado de acordo com os critérios de Schatzker, com a ocorrência de lesões ligamentares e meniscais. MÉTODOS: Foram avaliados as imagens de 25 pacientes com fraturas do planalto tibial, estudando a correlação entre lesões ósseas e de partes moles. Estabeleceu-se uma correlação entre a classificação de Schatzker e os achados de RNM. RESULTADOS: As lesões meniscais foram diagnosticadas em 96 por cento dos casos e as lesões ligamentares foram encontradas em 44 por cento dos pacientes. Houve correlação entre o tipo de fratura, segundo a classificação de Schatzker, e as lesões meniscais e/ ou ligamentares encontradas na RNM. As fraturas do tipo I e do tipo II de Schatzker apresentaram lesão do menisco lateral em 71,4 por cento e 83,3 por cento dos casos, respectivamente. Nas fraturas clas- sificadas como Schatzker tipo IV encontramos lesões de um ou mais ligamentos na RNM pré-operatória em 75 por cento dos pacientes. CONCLUSÃO: A RNM é um exame que agrega informações importantes para o entendimento da magnitude do dano em fraturas do planalto tibial, auxiliando no planejamento e tomada de decisões no tratamento destas lesões. Os autores recomendam, portanto, a incorporação da RNM no protocolo de avaliação pré-operatória das fraturas do planalto tibial.

OBJECTIVE: The aim of this study was to emphasize the role of Magnetic Resonance Image (MRI) as an adjuvant diagnostic tool for tibial plateau fractures, concerning the establishment of a relationship between bone fracture patterns and ligament and/ or menisci injuries. METHODS: Evaluation of image database of 25 patients victims of tibial plateau fractures. A correlation between bone and soft tissues has been established, based on Schatzker classification for tibial plateal fractures. RESULTS: 96 percent of these patients presented with associated menisci in- juries and 44 percent of them were diagnosed with associated liga- ment injuries. A correlation was established between fracture pattern, according to Schatzker classification, and soft tissue lesions detected by MRI. Fractures types I and II of Schatzker had association with lateral meniscus injury in 71,4 percent and 83,3 percent, respectively. Fractures of medial tibial plateau (Schatzker IV) were associated with ligament injuries in 75 percent of the cases. CONCLUSIONS: The authors conclude that MRI is a valuable and recommendable diagnostic method, enhancing the understanding of the injury and supporting preoperative planning and decision-making.

Sinovite vilonodular pigmentada localizada do joelho diagnóstico diferencial de lesão de menisco / Localized pigmented villonodular synovitis differential diagnosis of the knee meniscus injury / Sinovitis villonodular pigmentada localizada de la rodilla diagnóstico diferencial de lesión del menisco

Introdução: Este trabalho discute uma rara patologia que acomete principalmente o joelho e pode apresentar-se com sintomas clínicos de uma lesão de menisco. Trata-se da Sinovite Vilonodular Pigmentada Localizada, uma rara patologia caracterizada pela proliferação sinovial com deposição de pigmentos e presença de células gigantes, em articulações, bursas ou bainha de tendões. Com uma incidência de 1,8 casos por milhão de pessoas ao ano, a doença ocorre nas formas difusa e localizada, sendo esta última responsável por apenas 25por cento do total de casos. O joelho é a articulação mais afetada pela SVNP localizada. Seu diagnóstico é difícil e muitas vezes é confundida com uma lesão meniscal. Objetivos Apresentar um caso de SVNP localizada no joelho, bem como uma revisão da literatura. Conclusão Sendo a forma localizada da SVNP uma patologia rara e de difícil diagnóstico clínico, comumente seu diagnóstico passa desapercebido e seus sintomas são muitas vezes atribuídos a lesões meniscais, principalmente quando o paciente cursa com dor nas interlinhas e sintomas mecânicos. A anamnese, o exame físico e o uso de exames complementares, como a ressonância, podem ajudar a esclarecer estes casos. A Artroscopia é indicada como método eficiente tanto no auxílio ao diagnóstico como também no tratamento, permitindo a resolução do problema com uma rápida recuperação e a segurança de baixa taxa de recidivas.

Introduction This paper discusses a rare disease that primarily affects the knee and may present with clinical symptoms of a meniscus injury. This is the Localized Pigmented Villonodular Synovitis, a rare disease characterized by synovial proliferation with deposition of pigment and presence of giant cels in joints, bursae or tendon sheath. With an incidence of 1.8cases per million people per year, the disease occurs in localized and diffuse forms, the latter being responsible for only 25 per cent of cases. The knee is the joint most affected by localized PVNS. Its diagnosis is difficult and is often confused with a meniscal injury. Objectives To present a case of localized PVNS in the knee, as well as a literature review. Conclusion Since the localized form of PVNS is a rare condition and difficult to diagnose clinically, the diagnosis often goes undetected and the symptoms are often attributed to meniscal injuries, particularly when the patient presents with interline pain and mechanical symptoms. Medical history, physical examination and the use of supplementary tests such as MRI, may help clarify these cases. Arthroscopy is indicated as an effective method both to aid the diagnosis but also as treatment, permitting the resolution of the problem with a rapid recovery and safety of low recurrence rate.

Introducción: Este trabajo discute una rara patología que acomete principalmente la rodilla y puede presentarse con síntomas clínicos de una lesión del menisco. Se tratae de la Sinovitis Villonodular Pigmentada Localizada, una rara patología caracterizada por la proliferación sinovial con deposición de pigmentos y presencia de células gigantes, en articulaciones, bursulas o bainas de tendones. Con una incidencia de 1,8 casos por millón de personas al año, la enfermedad ocurre en las formas difusa y localizada, siendo esta última responsable por apenas 25 por ciento del total de casos. La rodilla es la articulación más afectada por la SVNP localizada. Su diagnóstico es difícil y muchas veces es confundido con una lesión meniscal. Objetivos Presentar un caso de SVNP localizado en la rodilla, bien como, una revisión de la literatura. Conclusión Siendo la forma localizada de la SVNP una patología rara y de difícil diagnóstico clínico, comunmente su diagnóstico pasa desapercibido y sus síntomas muchas veces son atribuidos a lesiones meniscales, principalmente cuando el paciente cursa con dolor en las interlineas y síntomas mecánicos. La anamnese, el exámen físico y el uso de exámenes complementarios, como la resonancia, pueden ayudar a esclarecer estos casos. La Artroscopía es indicada como método eficiente, tanto en el auxílio al diagnóstico como también en el tratamiento, permitiendo la resolución del problema con una rápida recuperación y la seguridad de baja tasa de recidivas.

A Study on the Development of Degenerative Osteoarthritis after Arthroscopic Total Menisectomy / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological incidence of osteoarthritis after a total meniscectomy. MATERIALS AND METHODS: Seventy eight patients, who underwent a total meniscectomy, were evaluated after a minimum follow up of five years. The operations were a medial meniscectomy (group I) in 16 cases, a lateral meniscectomy (group II) in 17 cases, a discoid meniscus (group III) in 29 cases and medial meniscectomy with an anterior cruciate ligament reconstruction (group IV) in 16 cases. The development of degenerative osteoarthritis was analyzed using the Kaplan-Meyer survivorship. RESULTS: At postoperative 5 years and 7 years, degenerative osteoarthritis developed in 17% and 36% of patients, respectively. The incidence ofdegenerative osteoarthritis at postoperative 5 years and 7 years in groups I, II, III and IV was 9% and 18%, 14% and 29%, 25% and 46%, and 28% and 55%, respectively. The difference was statistically significant. CONCLUSION: The meniscus deficient knee joint which varies according to the patterns of a meniscal injury, had a higher incidence of degenerative osteoarthritis. Careful attention should be paid to the treatment of meniscal tears.

Ho∶YAG Laser Operations Under Arthroscope for Meniscal Injuries / 中国微创外科杂志

Objective To evaluate the outcomes of meniscal injures treated by Ho∶YAG laser using arthroscopy.MethodsA total of 31 patients with meniscal injury were treated with holmium∶YAG laser by arthroscopy from January 2006 to March 2008 in our hospital.Among the cases,11 had flap tear,8 had horizontal tear,6 showed bucket-handle tear,and 6 were found with longitudinal tear.The pre-and post-operative Lysholm score,and compilations in the patients were recorded.Results The operation was completed successfully in all the cases with a mean operation time of 44 min(rang,22-55 min).No injuries to the vessels and nerves occurred in the surgery.The patients got out of bed in 1 to 4 days after the surgery(mean,2.1 days).All the surgical wounds achieved primary healing.Follow-up was carried out in the patients for 9 to 28 months(mean,14.5 months).The patients showed significantly lower Lysholm score at 6 months during the follow-up than that determined before the operation(92?6 vs 57?13,t=13.61,P=0.00).Among the cases,21 showed excellent outcomes,7 were good,and 3 were improved.The rate of excellent and good results was 90.3%(28/31).Conclusion Ho∶YAG laser is a safe,simple,and effective tool in cutting menisci under a arthroscope.

Relationship between meniscal injury & articular cartilage defect in arthroscopy

PURPOSE: We studied to know the relationship between meniscal injury & defect of articular cartilage and its clinical importance. MATERIALS AND METHODS: 252 patients were selected, who undergone arthroscopic surgery for meniscal injury from May 1997 to December 2001. We excluded patients with severely progressed osteoarthritis or degenerative changes in simple X-ray. Physical examinations, simple X-rays, MRI & arthroscopic photographs were taken for all patients. And the results were analyzed according to age, duration from accident to operation and type of meniscal injury RESULTS: 40 cases (15.9%) showed defects of articular cartilage with meniscal injury. Among them, 18 cases (45%) in femur, 10 cases (25%) in tibia, and 12 cases (30%) in both. Incidence of articular cartilage defect was significantly higher in patients over the age of forty (p<0.01) and in those with a history longer than six months (p<0.05). Posterior horn tears were associated with the highest incidence of articular cartilage defect, but were also associated with a longer history and with older patients. CONCLUSION: In patients with meniscal injury, older age, long duration of symptom and tear at posterior horn have higher incidence of articular cartilage defect, especially femoral condyle. The reason for this is not entirely clear but these patients need close attention and early treatment.

Incidence of Internal Derangement of Knee in the case of Total Knee Arthroplasty

PURPOSE: To evaluate the incidence and types of internal derangement of the knee, observed during total knee arthroplasty in patients with degenerative osteoarthritis and to correlate the findings with preoperative clinical presentations. MATERIALS AND METHODS: From January 1996 to January 2002, 435 patients(622 cases) with degenerative osteoarthritis who underwent total knee arthroplasty were analyzed for the presence of meniscal or cruciate ligament injuries. The type, site and patterns of injuries of the meniscus were recorded. Then the patients were categorized into group I; without meniscal injuries and group II; with meniscal injuries. Comparative analyses were also made between the two groups according to age, height, body weight, hospital for special surgery score(HSS score), the knee society clinical rating system(TKSCRS) score, and injuries of ACL and PCL. RESULTS: The medial meniscal injury is the most frequently involved type and was found in 288 cases(46.3%). Midportion to posterior horn location and midportion radial and posterior horn complex patterns showed the most cases in respect to site and pattern of meniscal injury. ACL injury was found in 48 cases while 55 cases showed PCL injury. Preoperative range of motion(I: 128.5 +/-9.7 degree, II: 114.8 +/-15.5 degree) and knee functional tests, such as, HSS score(I: 61.9 +/-14.0, II: 56.8 +/-14.9) and TKSCRS score(I: 97.3 +/-27.3, II: 81.1 +/-31.1) were significantly low in group II(p<0.05). Average age was 64.3 years in group I and 67.8 years in group II respectively. And age ranges were higher in group II(p<0.05). Injury of ACL and PCL were more common in group II. CONCLUSION: Meniscus injuries that were frequently seen in total knee arthroplasty have clinical relations to the patient 's ages, range of motion, function.

Meniscal Injury by Different Methods of Resection / 대한정형외과학회잡지

Partial meniscectomy was a common method of treatment for a meniscal injury and currently available instruments were scalpel, punch, electrocautery, CO2, laser, Nd: YAG laser, etc. However some methods could cause injuries to adjacent meniscal tissue after meniscectomy. An experimental study was conducted in order to examine the depth of injury to adjacent meniscal tissue according to above 5 different methods of meniscectomy. 25 medial menisci were harvested from Yorkshire pig knee immediately after the death of pig. Meniscal injury, 1.5cm long and 0.5cm wide, was made by using 5 different methods and was analysed macroscopically and microscopically. Average depth of injury was 237 in Nd: YAG laser group. 258um in electrocautery group, 307um in CO2, laser group, and nil in scalpel and punch group. The depth of meniscal injury of Nd: YAG laser and electrocautery group were less than that of CO2, laser group. Scalpel and punch were the most safe methods to adjacent meniscal tissue. CO2, laser, Nd: YAG laser and electrocautery should be carefully applied because they could cause the significant depth of injury in the adjacent meniscal tissue.

Clinical Study of the Discoid Meniscus / 대한정형외과학회잡지

This paper is aimed to study the incidence, age and sex distribution, and type of lateral meniscal lesion including discoid meniscus in Korea. It is reported higher incidence of lateral meniscal lesion in Korea. 132 cases with meniscal lesions were surgically treated at the Department of Orthopedic Surgery, Seoul National University Hospital between 1973 and 1982. Of the 98 patients who had lateral meniscal lesions, forty-four (44.9%) were found to have a discoid meniscus. The mean age of the patients with discoid meniscus was 17.9 years, and 30 patients of them were younger than 20 years of age. The patients with discoid meniscus were followed after meniscectomy for an average of 6 months. The summary of this study are as follows: l. Over-all incidence of discoid meniscus were 44 cases (33.3%) out of 132 cases of the meniscal disease. All forty-four cases had a lateral discoid meniscus, and they formed 44.9% among 98 cases of lateral meniscal injury. 2. The discoid meniscus was most frequent in the age group between 11 and 20 years old (65.9%), and was more prevalent in female by a ratio of 1.4. 3. Qf the 26 patients with torn discoid meniscus, twelve (46.2%) denied the history of trauma. 4. Symptom of click sound was present in 42 cases (95.5%), and the rate of positive McMurray sign was 81.8%.