Accuracy of imaging the menisci on an in-office, dedicated, magnetic resonance imaging extremity system.

Magnetic resonance imaging effectively defines and characterizes musculoskeletal pathologic lesions, particularly meniscal tears. Most studies comparing the efficacy of magnetic resonance imaging and arthroscopic evaluation have been performed on high-field (1.5-T) systems. The effectiveness of a low-field (0.2-T), dedicated, extremity magnetic resonance imaging device in diagnosing meniscal tears was studied prospectively on 35 patients with knee symptoms who subsequently had arthroscopic evaluation. Magnetic resonance imaging examinations were performed before surgery and were read by an experienced radiologist who was blinded to the results of the arthroscopic evaluations. Specificity was 100% for both the medial and lateral menisci. Sensitivity was 86% for the medial menisci, 89% for the lateral menisci, and 87% for both. Accuracy was 91% for the medial menisci, 97% for the lateral menisci, and 94% overall. The positive predictive values were 100% for the medial menisci, 100% for the lateral menisci, and 100% for both. The negative predictive values were 81% for the medial menisci, 96% for the lateral menisci, and 91% for both. The low-field magnetic resonance imaging system provided specificity and sensitivity that were equal to or better than previous reports with high-field systems. In particular, this low-field system eliminated the problem of false-positive results that has been found in some studies using high-field systems.

Semimembranosus tendinitis: an overlooked cause of medial knee pain.

A significant number of patients presenting with nontraumatic chronic medial knee pain have been found, after careful examination, to have chronic semimembranosus tendinitis. Of 115 patients diagnosed and treated for semimembranosus tendinitis over a 5 year period, 10 patients were refractory to conservative treatment. The purpose of this paper is to discuss the symptomatology and diagnosis of semi-membranous tendinitis, and to relate the treatment that these 10 patients underwent, i.e., surgical exploration, drilling of the insertion site, and semitendinosus tendon transfer. Most cases of semitendinosus tendinitis respond to conservative therapy; however, if surgical treatment is considered, arthroscopy should probably be performed at the time of surgery. In this way, it is possible to determine the presence of significant intraarticular abnormalities that may have a causal relationship with the onset of semimembranosus tendinitis.

Arthroscopic assisted internal fixation of certain fractures about the knee.

A technique is presented by which single-fragment, major intra-articular fractures about the knee can be reduced anatomically under arthroscopic control and internally fixed with percutaneously placed cancellous screws. A displaced intra-articular fracture of the femoral condyle and a tibial plateau fracture were treated utilizing this technique. Both patients obtained excellent results with rapid return of function of the injured limb.

Trigger wrist: a case report.

Previously published reports on trigger wrist have described triggering of the fingers at the wrist. We observed a case of true triggering of the wrist that was due to a nodule in the extensor carpi radialis longus tendon as it entered the second dorsal compartment. Reduction tenoplasty of the traumatic nodule and release of the second dorsal compartment relieved all symptoms. This is the first reported case that is accurately identified as trigger wrist.

A complication of Silastic hemiarthroplasty in bunion surgery.

Seven cases of painful reactive synovitis following great toe Silastic hemiarthroplasty have been observed. All cases were treated successfully with synovectomy and removal of the implant. Microscopic examination of the synovium uniformly demonstrated a chronic foreign-body giant-cell reaction with intracellular and extracellular silicone elastomer particles. Gross examination of the implants showed varying degrees of erosion of the articulating surface. Abrasion of a Silastic implant creates free-floating silicone elastomer particles that can precipitate a reactive synovitis. The authors believe an irregular, degenerated first metatarsal head is a contraindication to an interpositional Silastic hemiarthroplasty.