Prognostic factors affecting the outcome of arthroscopic saucerization in discoid lateral meniscus: a retrospective analysis of 48 cases.

PURPOSE: The purpose of this retrospective study was to evaluate the results and prognostic factors affecting the outcome of arthroscopic saucerization for discoid lateral meniscus (DLM). METHODS: Forty-eight patients who underwent arthroscopic saucerization for DLM between January 2009 and January 2012 in two hospitals were included. There were 21 (43.8%) male and 27 (56.3%) female patients with a mean age of 36.02 ± 14.5 (range 9-65) years at the time of operation. According to Watanabe classification, 33 (68.7%) patients had type II (incomplete) discoid meniscus and 15 (31.3%) had type I (complete) discoid meniscus. Of the 48 patients, 26 (54.2%) had an associated lateral meniscal tear. Seventeen patients (35.4%) had accompanying ligamentous, chondral and/or medial meniscal lesions. The symptoms were present for a mean of 8.04 ± 4.48 (range 1-24) months before the operation. All patients were followed up with a mean of 27.7 ± 10.7 (range 12-47) months using Lysholm knee score. We analyzed the relationship between the outcome variable (Lysholm knee score at the final follow-up) and the predictor variables (age, gender, type of DLM, presence of meniscal tear, duration of symptoms, follow-up and accompanying intra-articular lesions). RESULTS: The mean preoperative Lysholm knee score was 46.6 ± 10.2 points and increased to 85.08 ± 13.45 points at the final follow-up (p = 0.0001). Twenty (41.7%) excellent, seven (14.6%) good, nineteen (39.6%) fair and two (4.2%) poor results have obtained. No complications were observed in any patient. Regression analysis showed that age was the only predictor of the Lysholm score at the final follow-up (R2 = 0.545, p = 0.0001). The linear regression equation was (Lysholm score at final follow-up) = 106.1 - [0.58 × (age of patient)]. CONCLUSIONS: This study demonstrated that arthroscopic saucerization is an effective and safe treatment modality for DLM. Furthermore, age of the patient was shown to be the most important prognostic factor over the final clinical outcome. An excellent or a good result can be expected when the patient is young at the time of operation. LEVEL OF EVIDENCE: IV.

The efficacy of technetium-99m ciprofloxacin (Infecton) imaging in suspected orthopaedic infection: a comparison with sequential bone/gallium imaging.

Technetium-99m ciprofloxacin (Infecton) has recently become established as a new radiopharmaceutical for the imaging of infection. This study was performed to determine the value of Infecton imaging in demonstrating orthopaedic infection and to compare the results with bone/gallium imaging. Twenty-two patients (12 female, 10 male; mean age 51.7+/-16.8 years) with suspected orthopaedic infective conditions were included in the study. The patients underwent three scintigraphic studies in the following sequence: 740 MBq 99mTc-methylene diphosphonate (MDP) three-phase bone scintigraphy; at least 2 days later, 370 MBq Infecton scan at 1-4 h; and finally, 185 MBq gallium-67 scintigraphy. 67Ga imaging could not be performed on four patients. All images were blindly interpreted by two independent observers. The final diagnosis was made by consensus when the readings were different. Interpretation of the early and late Infecton images was made separately, with visual findings being classified according to a four-grade scale (0, +, ++, +++). Images graded 0 and +, and also those regions which showed a decrease in uptake grade on late images as compared with early images, were classified as negative for infection; grades ++ and +++ were classified as positive. Bone/gallium images were considered positive when the images were spatially incongruent or when gallium uptake was more intense than that of 99mTc-MDP. The diagnosis was confirmed by intraoperative microbiological or histological findings, or by the presence of gross purulence. The sensitivity of Infecton imaging was found to be 85%, the specificity 92% and the accuracy 88%, as compared to figures of 78%, 100% and 90%, respectively, for bone/gallium imaging. Although the two modalities showed a similar clinical yield, the easy availability of Infecton and the short investigation time make Infecton imaging the better option for the detection of orthopaedic infection.

Central acetabular fracture-dislocation following electroconvulsive therapy: report of two similar cases.

Acetabular fracture-dislocations usually occur as a result of high velocity trauma. Such fractures following electroconvulsive therapy are extremely rare. In this report, two similar cases of acetabular fractures and central fracture-dislocations following ECT are presented. This rare complication could be eliminated easily by using short-acting anaesthetic agents and muscle relaxants.