Arthroscopic evaluation and treatment of the symptomatic previously operated knee.

One hundred seventy-six knees in 172 consecutive patients with persistent or recurrent symptoms following a previous operative procedure were reevaluated and treated arthroscopically. Most knees had multiple findings, which are described. On the basis of these findings, four categories were defined: (a) the degenerative group; (b) the new meniscal tear group; (c) the fibroarthrosis group; (d) the minor problems group. Preoperative radiographic and clinical findings were correlated with the arthroscopically defined category. Follow-up evaluation by either comprehensive examination or detailed questionnaire was possible in 110 patients, with a mean follow-up interval of 31.4 months. A subjective rating scale relating to symptom level, functional level, and perceived surgical benefit was used. Overall, 68% of the patients were rated as satisfactory. By category, the frequencies of satisfactory results were: the degenerative group, 81%; the new meniscal tear group, 100%; the fibroarthrosis group, 75%; and the minor problems group, 47%. Workers' compensation claims correlated with a lower percentage of satisfactory results. Preoperative characteristics of those in the minor problems group were described. The poor results in this group suggest that common findings such as mild surface damage, minor adhesions, and minor meniscal lesions are often not symptomatic. Conservative management rather than arthroscopy may be more appropriate for patients in this group whereas arthroscopy is more reliable in treating symptomatic knees in the other three groups.

Motion-limiting arthrofibrosis of the knee: the role of arthroscopic management.

With the advent of effective arthroscopic methods of intra-articular surgery, it has become possible to lyse intra-articular adhesions under direct vision using arthroscopic techniques. This article reviews the present indications for this procedure, the techniques, the methods of after-care, and the reported results. Previous studies and an additional series of patients are reviewed.

The medial patellar plica syndrome.

A retrospective review of all patients diagnosed at arthroscopy as having a medial patellar plica with no other intraarticular pathology was conducted. Characteristic clinical findings, including pseudolocking, were identified. The clinical response of 68 patients (78 knees) to shelf resection was noted at 3 and 6 months. The 6-month review demonstrated 60% to be totally relieved of their preoperative pain and 31% with occasional discomfort, but capable of full activities. Three patients were graded with poor results (4%) due to limitations in their work and sports, and four patients were lost to followup. The overall good and excellent results totalled 91%. No surgical complications, infections, or wound dehiscences were noted.

Arthroscopic treatment of postoperative knee fibroarthrosis.

Twenty-four patients with severely limited knee motion following open knee surgery were treated by percutaneous release of adhesions under arthroscopic control. The mean interval between the last open surgical procedure and our treatment was 2.75 years (range, 3 months-27 years). The mean follow-up interval was eight months (range, 1 month-4 1/2 years). The mean passive flexion was increased from 70 degrees preoperation to 115 degrees at final evaluation after all arthroscopic procedures, a 45 degrees mean increase in flexion. Morbidity was low, complications were infrequent and mild, and the duration of hospitalization was brief.

The bucket handle meniscal tear. A technique using two incisions.

The bucket handle tear is a common meniscal tear in both the medial and lateral menisci, occurring in a relatively young age group, and with a high incidence of associated intra-articular pathology. Treatment of the tear consists of removal of the mobile fragment leaving a remaining meniscal rim that is both stable and smoothly contoured. This can be accomplished percutaneously under arthroscopic visualization. Numerous different methods for arthroscopic removal of the bucket handle fragment have been described and often in any particular situation, one method works slightly better than another. It is therefore important for a surgeon who routinely performs arthroscopic meniscal surgery to be comfortable with a wide variety of techniques and approaches. THe seven step technique that has been described is presently the easiest, most accurate, and most reliable technique in my experience. Progress, both in the development of new methods and in the development of better instrumentation, is extremely rapid in this field and therefore this technique must be considered in this context of rapid change.

Arthroscopic debridement for degenerative knee joint disease.

A series of 77 knees in 72 patients, ages ranging from 24 to 78 years (mean, 56 years), with moderate or severe degenerative arthritis, were treated by percutaneous debridement of the joint under arthroscopic visualization. Three per cent had a previous meniscectomy, and 81 percent had a tear of at least one meniscus. Additional pathologic problems included loose bodies in 21 percent, absent anterior cruciate ligaments in 13 percent, adhesions in 9 percent and chondrocalcinosis in 9 percent. Sixty-two patients with 68 knees were followed for at least six months, with a mean follow-up of 13.6 months. Subjectively, 84 percent of the patients were found to have a good or fair result. Complications were few and mild in nature, and there was little morbidity. Arthroscopic debridement of the knee joint is recommended as a useful therapeutic modality in many patients with degenerative arthritis of the knee.