How effective is a saline arthrogram for wounds around the knee?

UNLABELLED: Traumatic arthrotomies may predispose patients to subsequent septic arthritis and therefore are regarded as serious injuries requiring emergent treatment. The saline arthrogram is a commonly used test to determine if a patient has a traumatic arthrotomy. We determined the sensitivity of the saline arthrogram to identify known intraarticular wounds in 78 patients (80 knees) undergoing elective arthroscopic procedures. There were 66 infrapatellar and 14 suprapatellar incisions. The average length of the incision was 7.5 mm. Intraarticular position was confirmed with a blunt probe. A saline arthrogram then was performed using 60 mL normal saline. The known arthrotomy (operative wound) was observed during the injection for evidence of saline leakage (positive static test). If no leakage was observed, the knee was brought through a range of motion with continued observation for leakage from the arthrotomy (positive dynamic test). Twenty-two of 80 knees had a positive test without passive range of motion of the knee (static sensitivity, 36%). Eight additional knees had a positive test with subsequent passive motion (dynamic sensitivity, 43%). Our data suggest a saline arthrogram has low sensitivity for detecting known small traumatic arthrotomy wounds of the knee. LEVEL OF EVIDENCE: Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Diagnosis and management of massive rotator cuff tears: the surgeon's dilemma.

Several studies have documented high success rates following the surgical treatment of full-thickness rotator cuff tears. Historically, however, less favorable and predictable results have been found in the treatment of massive tears (>5 cm) compared with small and medium sized tears. Determining the most appropriate treatment for a patient with a massive rotator cuff tear can be challenging because of inconsistent outcome results. Some patients function well with nonsurgical treatment of massive tears, some have initially favorable results from surgical débridement of tears without repair that then deteriorate over time, and other patients who are surgically treated continue to maintain good function despite documented retears. Nonsurgical treatment of massive rotator cuff tears may be suitable for elderly patients with chronic tears and limited functional goals below shoulder level. Surgical débridement without repair of the tear may be considered for patients with low physical demands whose predominant symptom is pain. Surgical repair is recommended for patients who require maximal postoperative function, particularly for overhead activities. Open repairs have a lower rate of rerupture than arthroscopic repairs; however, arthroscopic repair offers the benefits of decreased morbidity and decreased risk of postoperative deltoid detachment. Early studies of arthroscopic repairs have shown good functional results; however, there has been a high incidence of retears. Tendon transfers and other reconstruction techniques may offer improvements in certain salvage cases, but results of these procedures are inferior to those for primary repair. Preservation of the coracoacromial arch should be considered in all forms of treatment of massive rotator cuff tears to avoid the devastating complication of superior humeral head escape.