Fifteen-year follow-up of arthroscopic partial meniscectomy.

From an original pool of 283 patients, 146 patients who had undergone arthroscopic partial meniscectomy an average of 14.7 years before were followed-up. Lysholm score, Tegner activity level, satisfaction index on a scale of 1 to 10, and standing anteroposterior and flexion weight-bearing radiographs of both knees, were obtained. A physical examination was performed on each knee emphasizing motion, swelling, and ligament evaluation. Radiographs were graded for degenerative changes for each knee. Each knee joint space was also measured in millimeters and compared, operative knee with unoperated knee. The unoperated knee had no injuries or surgeries and was used as a control. Patients were 83% male and 17% female; 78% had undergone medial meniscectomies, 19% lateral, and 3% both. There were 88% good and excellent results in anterior cruciate ligament-stable knees. The radiographic grade side-to-side difference showed the operative knee to be only a 0.23 grade worse than the nonoperative knee. Age at the time of meniscectomy was not found to be a factor. Male patients had better radiographic results than female patients, but not better functional scores. Medial meniscus and lateral meniscus results were not significantly different. Knees with a femoral-tibial anatomic alignment of > 0 degree valgus compared with < or = 0 degree and that had undergone medial meniscectomy had significantly better radiographic results. Patients with anterior cruciate ligament tears and meniscectomy did significantly poorer than stable knees with meniscectomy in regards to radiographic grade change, Lysholm, satisfaction index, Tegner level, and medial joint space narrowing.

Arthroscopic meniscectomy.

Arthroscopic partial meniscectomy is indicated for unstable, irreparable tears. Meniscal repair and partial meniscectomy are not mutually exclusive concepts. These are complementary procedures, with each having specific indications. Larger, more peripheral tears are repaired, whereas smaller, more central irregular or irreparable tears are treated by arthroscopic partial meniscectomy. The emphasis is on leaving a well-contoured stable meniscus while excising only the unstable or damaged portion. The remaining meniscus may still provide some protection for the hyaline cartilage of that compartment.

Arthroscopic knee surgery.

Endoscopic knee surgery, like other endoscopic procedures in other specialties, takes considerable time and patience to learn. But once the technique is learned, the noninvasive, nondestructive nature of endoscopy lends itself well to many types of knee operations, and we are beginning to see results at 4 and 5 years that are at least equal to those achieved by the same operation done with an arthrotomy, and with a marked reduction in complications and morbidity. Patient acceptance of these endoscopic knee procedures is very high because of the small scars, minimal postoperative discomfort, rapid rehabilitation and return to work, and avoidance of a lengthy and costly hospitalization. The challenge to arthroscopic surgeons is to perform these operations without damaging normal structures within the knee joint. The use of television has greatly enhanced the ability to teach residents and carry on postgraduate instruction. The coming years should bring an ever-increasing utilization of arthroscopy in managing most knee problems, as well as some limited use in other joints.

An arthroscopic method for lateral release of subluxating or dislocating patella.

Arthroscopically controlled lateral release for subluxating and dislocating patellae was reviewed in 93 knees (79 patients) at an average of 48.7 months follow-up. Of the patients, 92 % reported significant subjective improvement. Eighty-nine per cent of males and 69% of females were rated good or excellent by objective criteria. Failure to maintain good quadriceps muscle strength was the major reason for fair and poor results. Of 14 knees with dislocations, none had a recurrence after surgery. Patellar shaving was not done in any of the knees. The results of lateral release did not correlate with the severity of chondromalacia patellae. Complications and morbidity were significantly reduced by this outpatient procedure. Experience in endoscopic techniques is an important prerequisite. In the properly selected and motivated patient, this procedure offers an effective alternative to major patellar realignment procedures.

Chondral fractures of the knee. Arthrographic, arthroscopic, and clinical manifestations.

Chondral fractures are a distinct clinical entity and should be distinguished from the more frequently recognized osteochondral fracture. They occur most often in the medial femoral condyle of young adults following a rotational injury or direct blow to the knee. Clinically, the chondral fracture mimics a torn meniscus and may or may not be associated with a meniscal tear. Unlike osteochondral fractures, chondral fractures exhibit no specific abnormalities on routine radiography, necessitating arthroscopy or arthrography for diagnosis. The abnormality is seen as as a scooped-out defect or linear fracture in the articular cartilage on arthrography; on arthroscopy the findings are similar, though the fracture may appear stellate in cases of a direct blow to the knee.

Implementation of attractive dialogues in nutritive analysis and clinical dietetics information systems.

The implementation and evaluation of a system providing both extensive nutritive-analysis calculations and interactive capabilities are described. The extensive calculating ability of the system arose from the historic need for nutrient intake estimates in clinical investigation and nutritional research. The availability of computer-aided instruction (CAI) system software lead to adoption of the interactive style originating at Ohio State University. Capabilities evolved into an extended interactive processor utilizing an extensive data-base. The interactive processor functions either directly, for immediate response, or as a preprocessor for the more extensive processing system. Use of this capability by a dietetics consortium in the Pacific North-west has lead to definitions of effective and desirable styles of interaction by dietitians with a food and nutrient data-base. Hosting the PILOT CAI language with a high-level language, SAIL, allowed convenient and flexible dialogue creation as well as computational power. The central data-base was restructured on two occasions to accommodate the required characteristics for foods and their nutrients. The lack of interfaces between medical-information packages, and between languages, presently limits the growth of this system into a fully integrated component of the health-care information domain.