Relationship between Radiographic Classification and Articular Cartilage Lesions in Medial Degenerative Arthritis of the Ankle / 대한족부족관절학회지

PURPOSE: To investigate the relationship between classification based on simple radiographic findings and arthroscopic findings of the cartilage lesions in medial degenerative arthritis of the ankle joint. MATERIALS AND METHODS: We studied 41 ankles of 36 patients with asymmetrical narrowing of the medial joint space. Degenerative arthritis following fracture and those with generalized arthritic disease were excluded, but those with a history of ankle sprain were included. Standing radiographs of all patients were graded according to the Takakura classification and the Kellgren-Lawrence (K/L) classification. Arthroscopic findings were classified according to the depth, width, and anteroposterior dimension of articular cartilage damage. RESULTS: According to the Takakura classification, 29 ankles were classified as stage II, 7 cases as stage IIIA and 2 cases as stage IIIB. According to our classification of arthroscopic findings of 29 ankles in stage II, 1 ankle was graded as Grade I, 3 ankles as grade II, 10 ankles as grade III, and 15 ankles as grade IV. Spearman correlation coefficient between Takakura classification and arthroscopic classification was 0.342 (P=0.028), and coefficient between K/L classification and arthroscopic classification was 0.480 (P=0.001) CONCLUSION: Degenerative changes of the articular cartilage are more advanced than radiographic findings in many patients with ankle degenerative arthritis with asymmetrical narrowing of medial joint space. Therefore, we conclude that more aggressive effort should be made for correct diagnosis and treatment of degenerative arthritis.

Discoid Meniscus: Arthroscopic Classification , Pattern of the Tear and Treatment / 대한정형외과학회잡지

Discoid meniscus has been defined as a morphological anomaly, and several clinical classification has been proposed. Commonly used classification is Watanabes classification; complete, incomplete and Wrisberg ligament type discoid meniscus. It is a relatively more common disease of the knee in Korea and Japan than western countries. Eighty-one discoid meniscal tears which were operated arthroscopically between the period of June, 1991 and August, 1996 were reviewed retrospectively. The purpose of this study is to analyze the pattern of the tear and the extent of arthroscopic resection according to the arthroscopic classification of the discoid meniscus. Thirty-three cases were classified as complete and forty-five cases as incomplete and three cases were Wrisberg ligament type. The major pattern of the tear in the complete type lesions was horizon- tal(in twenty-three) and complex(in seven) tear. Of the knees that had an incomplete type lesion, longitudinal(in ten including six bucket-handle tear) and degenerative tear(in eight) were observed more frequently, and horizontal tear(in ten) less frequently than that of the complete type. The extent of arthroscopic resection of the discoid meniscus was related to the pattern of tear and type of the discoid meniscus. For the majority of the horizontal tear, arthroscopic partial meniscectomy (twentyeight of thirty-four) was performed, but arthroscopic subtotal and total meniscectomy was performed more frequently for longitudinal tear, complex tear, and Wrisberg ligament type.

Arthroscopic Classification of Bankart Lesion and Modification of Arthroscopic Capsular Suture / 대한정형외과학회잡지

Forty-five modified arthroscopic transglenoid suture capsulorrhaphy were performed between January 1989 and May 1995 with minimum follow-up of one year among sixty-four recurrent anterior shoulder instability in Chungnam National University Hostital. The average age at operation were 25 year and average time interval from injury to surgery were 12 month. we classify the Bankart lesion into 4 type according to the extent of capsulolabral complex detatchment, associated glenoid rim fracture, type II SLAP lesion and absence of glenoid labrum. Type Ia have a separation of labrum and inferior glenohumeral ligament from the glenoid rim and scapular neck (classic Bankart lesion) and type IIa have a capsular separation and glenoid rim fracture. Type IIIa have above mentioned type Ia or type IIa with type II SLAP lesion and type IVa have capsular separation without identifiable labral structure. We also subdivided the each type into subgroup b according to coexistence of capsular laxity. We modify the capsular suture technique according to classification. Type Ia, and type IIa were treated with in situ Bankart repair. Type Ib and type IIb were treated with capsular advancement. Type IIIa and 1IIb were treated with Bankart repair and additional fixation of SLAP lesion. Type IVa and IVb were treated with purse string type suture (capsular shift superiorly) with multiple stitches. All patients had various shape of Bankart lesion, so author s proposed classification of the Bankart lesion can be applied to each type. Arthroscopic finding were as follows. Twelve shoulders (27%) have type Ia Bankart lesion and six patient (13%) have type lIa lesion. Type lIIa were observed in eight shoulders (18%) and four patient (9%) were type IVa. The capsular laxity (subgroup b) were found in 15 patient (33%). None of the 45 patients experienced intraoperative complications or infec tion. All patients had full, painless range of motion and had no recurrence except four patient. One is type IIIa Bankart lesion in which associated type II SLAP was not repaired and the other two patients had sport injury and one patient had severe retrauma on 2 years after operation. We conclude that Bankart lesion is the essential lesion of recurrent anterior shoulder instability and were founded in all cases of recurrent anterior shoulder instability, and modified athroscopic transglenoid suture capsulorrhaphy according to arthroscopic classification is safe and effective method with acceptable recurrence rate.