The effect of technique on histology of arthroscopic partial meniscectomy with electrosurgery.

Fifty-one patients had arthroscopic partial meniscectomies with electrosurgery between 1982 and 1985. Two patients who had undergone prior meniscectomies with electrosurgery had biopsies of the old excision site at repeat arthroscopy, necessitated by new injuries. Three different combinations of electrocautery tips and either a standard electrocautery generator or a new electrocautery generator specifically designed for arthroscopic electrosurgery were used in different combinations. Depth of damage as defined by the Trichrome stain was measured by a micrometer. A rating summary of the quality of resection technique was also performed. Overall, the newly developed electrocautery generator and the newly developed electrocautery tips were not beneficial in reducing the depth of damage. The average depth of damage was .29 mm. Forty-seven percent of patients showed no histologic evidence of damage from the electrosurgical resection. The two individuals with repeat biopsies showed normal histology. Arthroscopic partial meniscectomy with electrosurgery causes a very thin layer of tissue damage. This appears to resolve with time. Recently developed instruments specifically designed for arthroscopic electrosurgery do not appear to decrease the depth of damage.

The treatment of idiopathic osteonecrosis of the medial femoral condyle with arthroscopic debridement.

Five patients with idiopathic osteonecrosis underwent arthroscopic debridement with instruments designed for arthroscopic abrasion arthroplasty. Each lesion was large enough to require total knee or tibial osteotomy using criteria previously published by other authors. Using the Hospital for Special Surgery Rating System, four of five patients were rated good postoperatively (average rating: preop 52 points and postop 82 points). Biopsies of two patients at repeat arthroscopy showed that fibrocartilage fills in the defects created by the debridement. Average follow-up was 31 months.

Treatment of displaced segmental radial-head fractures. Long-term follow-up.

We did a retrospective study of forty segmental fractures of the radial head in thirty-nine patients. Good results were achieved in twenty of thirty-four fractures with non-operative treatment. In six patients the radial head was excised totally and in only one was a good result achieved. The average follow-up was 10.0 years. Only rarely was there deterioration of the short-term results. The prognosis was not affected by the extent of the depression, the size of the fragment, or the degree of comminution. We concluded that the only indication for operation in this type of fracture is a loose fragment in the joint.

Fractures of the tibial plateau. Treatment by closed reduction and spica cast.

A retrospective study of sixty-one displaced fractures of the tibial plateau treated by closed manipulative reduction and immobilization for six weeks in a molded single hip-spica cast revealed that there was bone union in all cases. Weight-bearing was carefully avoided for twelve to sixteen weeks while motion of the knee was regained. Fifty-three patients were followed for six months to twenty-two years, an average of 3.8 years. Objectively, 85 per cent of the patients' results were rated good or excellent while subjectively 94 per cent of the patients were satisfied with their results.