Meniscectomy in children and adolescents. A long-term follow-up study.

Thirty-nine patients treated with total meniscectomy younger than 16 years of age were studied. The average follow-up period was 21 years; 71% of the patients reported pain; 68%, stiffness; 54%, swelling; and 41%, giving way. Approximately half the patients described progression of symptoms, but only 27% were asymptomatic. Only 10% noted limitations at work, but 62% had limitations in sports. Twelve percent have had further knee surgery. Forty-nine percent received unsatisfactory subjective/functional ratings. On physical examination, 25% of patients had range of motion loss of greater than 5 degrees, 22% had thigh atrophy of greater than 1 cm, and 20% developed substantial instability. Overall, 27% received unsatisfactory objective ratings. Ninety percent of patients had abnormal roentgenograms. Changes occurred predominantly in the meniscectomized compartment. Forty-four percent of patients had unsatisfactory roentgenographic ratings. Overall ratings indicated that 63% of patients' results rated unsatisfactory. More unsatisfactory results occurred in patients with a follow-up period of longer than 26 years, in those with substantial instability, and in males. Few differences existed between medial and lateral meniscectomies or with increasing durations of symptoms preoperatively.

Residual bone-mineral density and muscle strength after fractures of the tibia or femur in children.

This study compared the bone-mineral density in the proximal part of the femur and the flexion and extension strength of the knee in the fractured and the non-fractured limbs after an uncomplicated fracture of the tibia or femur in children. Thirty-eight children, whose ages ranged from two to fifteen years at the time of the injury, were evaluated at an average of 2.3 years after the injury. The mean difference in bone-mineral density between the fractured and non-fractured limbs was 3.3 per cent (p = 0.004). There was no significant difference between the bone-mineral density of the limbs that had been immobilized for less than four weeks and that of the contralateral, non-fractured limbs. However, the mean difference between the bone-mineral density of the limbs that had been immobilized for more than eight weeks and that of the contralateral limbs was 4.3 per cent (p = 0.006). There was little or no relationship between the time since the injury and the difference in bone-mineral density between the two limbs of the patient at the intervals of follow-up that were studied. No residual weakness in flexion and extension of the knee was detected, and no relationship was established between the limb-to-limb differences in strength and the limb-to-limb differences in bone-mineral density. The residual bone-mineral deficit was found to be minimum after an uncomplicated fracture. This difference, while statistically significant, is unlikely to be clinically important in the long term. However, the fact that there was a deficit raises a potential concern for children who have more severe or repeated injuries.

Postarthroscopy analgesia with bupivacaine. A prospective, randomized, blinded evaluation.

The analgesic effect of intraarticular bupivacaine injected at the conclusion of knee arthroscopy done under general anesthesia was investigated in a prospective, randomized, and blinded fashion. Pain scores, the use of analgesic medications, crutch use, weight-bearing, activity level, and difficulty sleeping the night after surgery were all unaffected by the use of bupivacaine. The apparent lack of effect is most likely due to rapid clearance from the knee, leaving only a transient, 1 to 2 hours of potential benefit. In this study, the patients were already quite comfortable during this time period due to the routine use of intraoperative narcotics. The preoperative level of knee discomfort was found to be a major determinant of postoperative discomfort. Other much less important factors were synovial and chondral shaving, sex of the patient, and experience of the surgeon.

Repair of peripheral nerves with the argon laser. A functional and histological evaluation.

A technique for repair of peripheral nerves with the argon laser was evaluated with regard to functional and histological recovery. The results were compared with those of reconstruction by a microsurgical epineurial-suture technique. The terminal branch of the peroneal nerve to the extensor digitorum longus in thirty-three New Zealand White rabbits served as the experimental model. Histology and neuromuscular function were evaluated at one, two, and six months after repair. When the diameters of the axons and the morphology distal to the site of repair were evaluated, the nerves that had been repaired with the laser more closely resembled those of the control rabbits. Examination of the site of repair also revealed less foreign-body reaction and axonal outgrowth in the laser-repaired nerves than in those that had been reconstructed with epineurial suture. Neuromuscular function was evaluated by measurement of the force of contraction of the extensor digitorum longus after electrical stimulation of the nerve proximal to the site of repair. Functional recovery paralleled the histological findings. At one month, there was no difference in the neuromuscular function that had been achieved with either technique. At two months, the laser-repaired nerves began to show increased muscular strength at higher frequencies of stimulation (sixteen and thirty-two hertz). Six months postoperatively, the nerves that had been repaired with the laser had consistently better neuromuscular function than those that had been repaired by epineurial suture. The improvement was most marked at higher voltages of stimulation (threshold multiplied by ten) and at frequencies of stimulation of more than sixteen hertz.