Comparative results of conservative and arthroscopic partial medial meniscectomy in patients with medial compartment osteoarthritis

Meniscus tears can occur in 91% of cases with osteoarthritis [OA] of the knee. The available literature is lacking studies to compare the results of arthroscopic partial meniscectomy [APM] versus conservative treatment for patients with meniscal tears in the same compartment with osteoarthritic changes. The study was to determine whether arthroscopic partial meniscectomy provides better symptom relief and superior functional outcome than conservative treatment in patients with a torn medial meniscus and degenerative changes in the same compartment using a validated functional outcome measure. Fifty eight patients [60 knees] with a medial meniscus tear and medial compartment osteoarthritis were included in this prospective controlled study. Thirty eight patients [40 knees] constituted the study group in which arthroscopic partial meniscectomy was done for a medial meniscus tear. Twenty patients [20 knees] constituted the control group in which conservative treatment was given for the same pathology. In the study group, there were 28 men [30 knees] and 10 women [10 knees] with a mean age of 56.3 years. Patients were followed up for a mean period of 27.5 months. In the control group, there were 12 men [12 knees] and 8 women [8 knees] with a mean age of 58.8 years. Patients were followed up for a mean period of 27.3 months. The outcome of treatment was evaluated and compared between both groups using the Lysholm Knee Scoring Scale. The mean initial Lysholm score improved significantly at final follow up for the study and control groups [P < .0001, P= .004 respectively]. Although there was no statistically significant difference between the two groups regarding the initial Lysholm score [P = .767], there was a highly significant difference in the final Lysholm score and the percentage of change in the Lysholm score [P < .0001 for both variables]. In no case [knee] within the study group there was worsening of the final score as compared to the pre-operative one. In 3 knees within the control group [15%], the final Lysholm score was lower than the initial score. Two out of these 3 cases [10%] had undergone total knee replacement. No significant differences in the outcome between different age groups, males and females, or patients with different grades of cartilage damage or different types of meniscal tears. Patients with grade 4 osteoarthritic changes had a statistically significant lower final Lysholm score when compared with patients with grade 1-3 changes. However, there was no statistically significant difference between the four groups of patients regarding the percentage of change in the Lysholm score. Arthroscopic partial meniscectomy is expected to provide better symptom relief and improved functional outcome than conservative treatment for patients with meniscal tears in the same compartment with degenerative changes. This procedure is justified in older patients with grade 4 osteoarthritic changes and/or grade IV cartilage damage

Outcome of arthroscopic treatment of anterolateral soft tissue impingement of the ankle

Anterolateral ankle impingement is due to entrapment of pathological tissues in the anterolateral aspect of the joint. Different types of intraarticular soft tissue pathologies have been reported to cause chronic ankle pain after an inversion injury. Arthroscopy is a useful method for the diagnosis of the anterolateral impingement of the ankle, and for treatment of patients who do not respond to conservative measures. The study was to evaluate the results of arthroscopic diagnosis and treatment in patients with anterolateral soft tissue impingement of the ankle. Twenty patients with anterolateral ankle impingement who had arthroscopic debridement were included in this prospective study. There were 16 males and 4 females with a mean age of 35.8 years. All the patients were complaining of persistent anterolateral ankle pain after a single or multiple inversion injuries for a mean period of 13.3 months. Surgery was considered after the failure of conservative treatment for at least 3 months. Four types of intraarticular soft tissue pathologies were found impinging the anterolateral aspect of the joint; synovial hypertrophy was found in 13 patients, impinging distal fascicle of the anterior inferior tibiofibular ligament in 2 patients, torn anterior inferior tibiofibular ligament in 3 patients and fibrofatty scar tissue in 2 patients. Associated cartilage damage of the anterolateral aspect of the talus ranging from grade I to II was seen in 7 patients. During the follow up period, 4 patients had additional inversion injuries to the affected ankle after the arthroscopic procedures. The final clinical outcome was assessed using the Meislin's criteria and the Japanese Society for Surgery of the Foot [JSSF] standard rating system, ankle-hindfoot scale. Final results were excellent in 11 patients [55%], good in 6 patients [30%], fair in 2 patients [10%], and poor in 1 patient [5%]. The mean preoperative JSSF scale of 46.8 had improved to 86.5 at final follow-up. One out of the 7 patients with associated cartilage damage had excellent results, 5 patients had good results and the remaining patient had fair result. Two out of the 3 patients with complete tear of the anterior inferior tibiofibular ligament had fair result and the other one had poor result. One out of the 4 patients with additional inversion injuries during the follow up period had good results, two had fair results and one patient had poor result. Ankle arthroscopy is useful in the diagnosis and treatment of anterolateral ankle impingement. Factors negatively affect final outcome are associated chondral lesions of the talus, associated syndesmotic lesions and new inversion injuries after the arthroscopic procedure

anatomical study of the sartorial branch of the saphenous nerve: its surgical relevance in anterior cruciate ligament reconstruction

Reports on nerve injury after arthroscopic anterior cruciate ligament [ACL] reconstruction using hamstring tendon autograft had mainly focused on injury to the infrapatellar branch of the saphenous nerve [IPBSN], with few reports on injury of the sartorial branch of the saphenous nerve [SBSN]. Was to calculate the prevalence of injury to the SBSN after arthroscopic ACL reconstruction using hamstring tendon grafts, and to define the level of anatomical termination of the saphenous nerve in relation to the level of the knee joint line and the relation of its sartorial branch to the surrounding tendons so that it could be avoided during hamstring tendon harvesting. The clinical study included 56 patients with a complete tear of the ACL who had arthroscopic ACL reconstruction using hamstring tendon autograft. Patients were followed up for a mean period of 28.3 months after surgery. Postoperative evaluation included neurologic examination for any post-surgical numbness and/or hyposthesia at the distribution of IPBSN, SBSN, or both nerves. The anatomical study included cadaveric dissection of the medial aspect of the knee joint of 25 preserved knees. The saphenous nerve was dissected proximal to the knee joint and followed distally till it was divided into its two terminal branches. At 3 months post surgery, numbness and hyposthesia were present at the distribution of the SBSN in 21.4%, at the distribution of the IPBSN in 19.6%, and at the distribution of both nerves in 30.4%. At final follow up, numbness and hyposthesia were present at the distribution of the SBSN in 18.4%, at the distribution of the IPBSN in 10.2%, at the distribution of both nerves in 32.6%. In 68% of the dissected knees, the saphenous nerve gave its two terminal branches at a mean distance of 8 +/- 4.1 [range 3.5-21.5cm] above the knee joint line. In 32%, the level of termination of the saphenous nerve was below the knee joint line by a mean distance of 3 +/- 1.2 [range 1-4cm]. In 92% the saphenous nerve or the SBSN was passing posterior to the sartorius tendon, while in 8% the nerve was anterior to the tendon at the knee joint line. In 68% the saphenous nerve or the SBSN continued distally anterior to the gracilis tendon, while in 16% the SBSN continued distally posterior to it. In 12% the saphenous nerve or the SBSN was lying directly on the gracilis tendon and in 4%, the SBSN was lying deep to the tendon at the knee joint line. In 24% the distance between the saphenous nerve or the SBSN and gracilis tendon was 5 mm or less. In all the knees the saphenous nerve or the SBSN was passing distally anterior to the semitendinosus tendon. The saphenous nerve or its terminal branch the SBSN, are liable to be injured during arthroscopic ACL reconstruction using hamstring tendon auto graft. The nerve is at a close anatomical relation with the gracilis tendon. This might predispose the nerve to be damaged during passage of the tendon stripper over the tendon. Injury of the saphenous nerve or its terminal branch [SBSN] might be an intrinsic problem associated with the technique itself