Arthroscopically-assisted internal fixation of tibial plateau fractures: adding an anti-settling screw

Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits, and the benefits of adding an antiglide screw. Fifty patients with tibial plateau fractures were treated in Assiut University hospital. Of these patients only [16 patients] were included in this study. Fourteen were men, and two were women. The age ranged between 27-60 years [mean 43 years]. Inclusion in this study was limited to cases of split split depression, or local depression unicondylar fractures using Schatzker classification. Mean follow up was 15 months [6-24 months]. The post operative clinical evaluation depended on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen. Complete anatomical reduction of the fracture fragments was achieved in 14 knees [87.5%]. Up to 2 mm displacement or step off was accepted in two knees [12.5%]. Clinical assessment according to Rasmussen classification was: 10 knees [62.5%] excellent, 4 knees [25%] good, 2 knees [12.5%] fair, and none was poor. Radilogical results were: 13 knees [81.25%] grade one, 2 knees [12.5%] grade two, and one knee [6.25%] grade three. None of the cases was grade four at the final follow up radiograph. The use of arthroscopy allowed precise anatomic reduction of the articular surface in the knee. It is particularly helpful in type two and three injuries with central articular depression which often are difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries as meniscal tears and/or ligamentous injuries and their management if possible. The antiglide screw may help in prevention of loss of reduction

Role of arthroscopy in unexplained knee pain

This study evaluates 48 patients, with chronic knee pain in whom no definite clinical diagnosis could be reached. The arthroscopic findings were: five cases with hypermobile meniscus and they were treated with partial meniscectomy, seven cases with torn meniscus had partial meniscectomy, seven cases with plica syndrome had partial resection, seven cases with chondral ulcers were treated by debridement or abrasion arthroplasty, four cases with chondromalacia patella [arthroscopic chondroplasty], two cases with loose knee bodies [arthroscopic retrieval], two cases with localized synovial hypertrophy [arthroscopic resection], one case synoviosarcoma [biopsy], five cases of chronic non specific synovitis [biopsy] and in eight cases there was normal arthroscopic findings [normal synovial biopsies]. Arthroscopy helps in the early diagnosis of obscure lesions and in their management

Arthroscopic management of medial shelf syndrome of the knee joint

The medial shelf or the medio-patellar plica is a synovial fold runs along the medial wall of the knee. From June 1991 to March 1993 at Orthopedic Department of Assiut University Hospital, 27 patients of anterior knee pain underwent arthroscopy and prooved to be pathologic plica. There was no response from the medical treatment. It was not easy to diagnosis certain cases of medial plica in such patients. Athroscopy is an excellent tool for visualizing and evaluating the pathologic plica. By arthroscopy, removing of 1 cm of the plica substance down to the base was performed. After releasing of the fibrotic plica; ensure that it no longer impinges on the medial femoral condyle. In this article; etiology; material; arthroscopic evaluation and follow up are discussed