How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons.

AIM: In general, arthroscopy is considered the "gold standard" for the evaluation of cartilage lesions. In this multicenter survey, we ascertained the general opinion of surgeons regarding arthroscopic cartilage diagnoses. METHOD: A total of 301 highly experienced arthroscopists (instructors of the AGA, the German-speaking society of arthroscopy) were contacted in writing with a request to complete the survey. RESULTS: The data from 105 respondents (34.8% of those contacted) were used for the investigation. In the grading of the cartilage lesions, the Outerbridge classification was most frequently used (n = 87), followed by the ICRS protocol (n = 8) and the Insall score (n = 3). The majority (61%) of the arthroscopic surgeons felt that differentiation between healthy cartilage and low-grade cartilage lesions was simple. For differentiation between grade I and grade II lesions, and for differentiation between grade II and grade III lesions, 41.9 and 51.4%, respectively, thought that there was a "need for improvement". In the case of grade IV lesions, 70.5% of the surgeons thought that the diagnosis was valid. The respondents also judged the utility of incorporating objective measurements (e.g., intraoperative biomechanical tests): 13.3% (n = 14) responded that such measurements would be "very useful" and 61.9% (n = 65) responded that they would be "somewhat useful". CONCLUSIONS: Among surgeons, arthroscopy was not perceived to be as reliable as a "gold standard" for the diagnosis of cartilage lesions. The majority of experienced arthroscopists felt unsure of the results in general, or at least in some cases. A universal and definitive grading system for lesions appears to be needed. For questionable cases, measurement devices are needed for objective cartilage grading.

Arthroscopic electrothermal shrinkage of chronic posterolateral elbow instability: good or moderate outcome in 21 patients followed for an average of 2.5 years.

BACKGROUND: The lateral collateral ligament complex is the key structure involved in recurrent elbow instability. Treatment is surgical, by repair or reconstruction of the lateral collateral ligament complex. We evaluated the effect of arthroscopic electrothermal shrinkage for treatment of chronic posterolateral rotator elbow instability. METHODS: 21 patients, median age 32 (24-50) years, suffering from chronic lateral elbow instability underwent arthroscopic electrothermal ligament shrinkage with a bipolar shrinkage probe. All patients were available for follow-up after median 30 (8-48) months. RESULTS: No complications were seen. The Morrey score increased from 40 to 77 points. The result was moderate (50-80 points) in 10 patients, and in the other patients a good result was achieved (80-95 points). The manual stress radiography showed a mean lateral joint opening of 13 (8-18) mm preoperatively. During follow-up, it decreased to 2 (1-4) mm. INTERPRETATION: Our findings suggest that arthroscopic bipolar ligament shrinkage is sufficient for the treatment of chronic posterolateral rotator elbow instability.