Management of discoid lateral meniscus tears

Is to report my experience in diagnosis and management of discoid lateral meniscus and to correlate the clinical and radiological evaluation with the arthroscopic finding. Retrospective study of a group of patients with a recorded data of discoid lateral meniscus. Of 52 patients mean 35.46 +/- 6.15 [11-52] years had a collected data between December 2001 to January 2008, the study include patients clinical status, its pre and post follow up radiological finding and arthroscopic picture of the type of discoid lateral meniscus including the shape of tear and associated cartilaginous changes at the lateral compartment. Pain was the most presenting symptom seen in all patients followed by snapping in 52% of patients. OA changes at the lateral compartment were seen in x-ray films in 56% of cases, with no significant changes at the postoperative follow up. MRI failed to diagnose shape of tear in 56% of reports. According to Watanabe et al classification I found 35 [67%] complete, and 13 [25%] incomplete, and 4 [8%] Wrisberg- ligament type of discoid lateral meniscus. The horizontal cleavage tear was the most common tear seen in 20 [38%] of cases. And as regard I keuchi's grading system I got 65% of patients with satisfactory results and 35% with fair results at the postoperative follow up. The most common type of tear was the complete type, which tear commonly with horizontal cleavage. No significant changes at pre and post x- ray at follow up, but there is significant correlation between the presence of pain and cartilaginous changes at the lateral joint area

effect of low energy laser as an adjunct to nerve mobilization technique for sciatica

The purpose of this study is to determine the effect of low energy laser therapy when it is combined with nerve mobilization technique in cases of patient with sciatica due to lumbar disc lesion. Sciatica is a common clinical problem causing pain and functional disability. Conservative treatment is a common line to avoid surgery. There are many studies that supporting the efficacy of either Laser alone or the use of nerve mobilization as a method of pain relief in sciatica, but up till now combination of both technique did not exist. Thirty patients [16 females and 14 males] diagnosed as LBP with sciatica due to prolapsed lumbar disc participated in our prospective study. They were randomly assigned into two groups. Patients were referred to physiotherapy department for 3 sessions a week for one month. A true Laser therapy combined with nerve mobilization were applied for group A and sham Laser and nerve mobilization in group B. Pain, self reported functional disability and physical performance test battery were recorded for each patient before and after the program of treatment. Both groups achieved improvement in pain, functional disability and physical performance test. Moreover group A achieved a significant improvement in pain and functional disability in relation to the group [B] with p- value < 0.05. Addition of laser to nerve mobilization technique as conservative methods for patient with sciatica showed a clear significant improvement in decrease of pain and disability

Radiological and histological tissue reaction to different kinds of ACL graft

A retrospective study of tissue reaction had been evaluated to three different kinds of grafts used to reconstruct ACL deficient knee. The grafts had been implanted using a modified over the top technique. An artificial ligament of Trevira band was inserted in the first group of patients, while augmented combined graft of semitendinosus and gracilis tendons+ Trevira ligament was implanted in the second group and pure autogenous graft was used in the 3rd group. As a routine for post operative evaluation a radiological changes was noticed at the tibial tunnel at one and half month, 6 months and one year after operation, histological study [intra-articular synovial biopsy and graft tunnel junction biopsy] was obtained from only cases available for second look arthroscopy due to certain reason and covered by patients consent. Early and late radiological finding at the tibial tunnel in cases of artificial ligament showed: neither opacification nor sclerosis, while in cases of augmented ligament, a late opacification and sclerosis was a common finding, in contrary opacification was regularly noticed as early radiological changes in patients with pure autageonous graft. Histological study at the ligament bone tunnel interface showed only weak fibrous tissue heeling in patients with artificial ligament, while it showed feature nearly of chondral enthesis with poorly developed fibrocartilage layer in augmented and pure autogenous graft group. The synovial study showed in most of the cases no reaction, Grade [0] in autogenous graft, but in artificial or augmented grafts Grade 1 and 2 were often seen. In conclusion, the presence of artificial ligament as a replacement for ACL alone initiate chronic synovitis and needs a permanent extra tunnel fixation device, while augmented and pure autogenous graft derived a tissue reaction in the tunnel that makes grafts more independent for their outside fixation device

Conservative treatment for an acute isolated posterior cruciate ligament injury

The goal of our study is to evaluate the outcome of the conservative treatment from the point of young active athletic patients for an acute isolated posterior cruciate ligament injury [PCL]. Our prospective study was performed on a 16 young active patients with an average age of 24 [range from 20-32] years collected from differrent centers by closed comunication. The time of presentation at our hospital was an average of 14 weeks since injury [a range of 2 - 22]. All patients were involved in differrent kind of sports activity, 7 patients in addition doing manual labour work, the pre- injury level of their activity was an avearage of 6 points 4-8] according to Tegner scale. All patients were put under a conservative regimen, consisting of quadriceps muscle strengthening exercise and range of knee motion, provided pain and swelling disappear. The patients are then allowed to return to their sports and hard work activity. A special performance test are then begun to improve their athletic activity skills[low-high speed running turning, side stepping, picking up ball, kicking, jumping, vertical stair ascending and descending.]. At one year after the injury, all patients were evaluated and self questioned, and gave an answer of doing the test as Normal, near normal, abnormal and severely abnormal. 13 patinets were rated normal and nearly normal. And no patients were rated severly abnormal. The most affected test was high speed running [all patients], kicking with the normal limb in [10 patients] and vertical stair descending in [8 patients]. Only one patient bad return to his pre-injury level, pain and fear of reinjury with sense of instability was the reason of decreased activity in other patients. Despite of improved gravity posterior sag test in lateral view radiogram and in consequences of improved quadriceps muscle, the athletic performance skills was apparentlly affected. But in my believe conservative treatment still has a rule in management of acute isolated PCL injury