ABSTRACT
We proposed to establish a system of assessing severity of chondropathy taking into account localization, size, and depth of cartilage lesions. The design of the study was prospective and multicenter. The subjects were 755 patients who had undergone arthroscopy of the knee. Criteria for assessment of severity of chondropathy were as follows: (a) Physician's overall assessment using a 100-mm-long Visual Analogue Scale, and (b) size, grade, and localization of cartilage lesions recorded on a diagram. We used multivariate parametric and nonparametric analyses. The analyses resulted in two systems of assessing severity of chondropathy: SFA scoring for the three compartments of the knee, which is a continuous variable, and SFA grading, which is a semiquantitative variable. These systems seem to be of clinical relevance. However, more studies are required to further validate them and their capacity to detect changes in severity of chondropathy.
Subject(s)
Arthroscopy/statistics & numerical data , Cartilage, Articular/injuries , Knee Injuries/classification , Trauma Severity Indices , Adult , Cartilage, Articular/surgery , Data Interpretation, Statistical , Female , Humans , Knee Injuries/diagnosis , Knee Injuries/surgery , Male , Middle Aged , Observer Variation , Prospective StudiesABSTRACT
Arthroscopy was carried out after subcutaneous injection of lignocaïne to produce local anaesthesia, using controlled pressure-irrigation with bupivacaïne, followed by final rinsing with an isotonic solution. This procedure, which was painless for the patient and had no systemic toxic effects, gave very good distension of the joint and clear visualization of its structure. A sharp peak in the serum bupivacaïne level (Cmax: 76.2 ng/ml) was observed only 5 min after the start of the irrigation, which was attributed to synovial resorption. This was followed by a slight increase in blood concentration 4 to 5 h after the end of the arthroscopy, probably as a result of absorption by the peripheral soft tissues. Bupivacaïne concentrations never exceeded 350 ng/ml (much lower than the toxic level). The drug persisted in blood for 36 to 48 h (terminal half-life 12.1 h).
Subject(s)
Arthroscopy , Bupivacaine/blood , Adult , Anesthesia, Local , Female , Half-Life , Humans , Lidocaine , Male , Middle AgedABSTRACT
The authors have performed 1 005 arthroscopies of the knee for diagnostic purposes. The exploratory method has made it possible to correct the initial diagnosis in 50% of the cases, to avoid arthrotomy in 10% and to suggest surgery in 9%. The most common cause of error was the radioclinical confusion between patellar and medial meniscus symptoms. The most frequent associated lesions were patellar chondropathy (73%), condylar chondropathy (33%) and middle patellar folds (34%).
