Bilateral discoid medial menisci. Case report.
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Adult↗
Biomedical subjects
W Del Pizzo
Publications and source records attributed to W Del Pizzo.
MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material.
OBJECTIVE: After surgical resection or repair of a torn meniscus, the healed area may have areas of abnormal signal intensity on MR images. Consequently, routine MR imaging is not reliable for detecting recurrent meniscal tears. As a result, we studied the efficacy of MR imaging with intraarticular contrast material (MR arthrography) for detecting recurrent tears of the meniscus. SUBJECTS AND METHODS: Thirty-seven patients who previously had a meniscal tear treated by either meniscal resection or repair had conventional MR imaging and MR arthrography with 40-50 ml of a 1:100 solution of gadopentetate dimeglumine in saline. All patients had arthroscopy shortly after the MR studies. Follow-up arthroscopic surgery was performed within an average of 6.6 weeks after the MR arthrograms. The routine MR images and MR arthrograms were reviewed separately and randomly, and these results were compared with the arthroscopic findings. Meniscal morphology, signal intensity, and the presence of joint fluid tracking into recurrent tears were evaluated. RESULTS: The overall accuracy in diagnosing recurrent meniscal tears in the post-operative meniscus was 66% when conventional MR imaging was used and 88% when MR arthrography was used. In patients who had only minimal meniscal resection, both methods had an accuracy of 89%. In patients who had more extensive meniscal resection, accuracy was 65% with conventional MR imaging and 87% with MR arthrography. In four patients who had only a small meniscal remnant, the accuracy was 50% with routine MR imaging and 100% with MR arthrography. On conventional MR images, the presence of an effusion tracking into a meniscal tear had a sensitivity and positive predictive value of 90% for detection of recurrent meniscal tears; however, the sensitivity was only 41%. CONCLUSION: Our results show that the sensitivity of MR imaging in detecting meniscal tears after surgery varies with the extent of the resection. Sensitivity was considerably improved when intraarticular contrast material was used. MR arthrography should be considered as an alternative to arthroscopy in patients who have had resection or repair of the meniscus.
Adolescent↗
A historical review of shoulder arthroscopy.
The last decade has seen a huge increase in the application of arthroscopic techniques to the shoulder. From early efforts around 1980, arthroscopic shoulder surgeries have become well established and accepted. With the creative development and application of new techniques, the scope of shoulder pathology amenable to arthroscopic treatment continues to expand.
Arthroscopy↗
Arthroscopic-assisted anterior cruciate ligament reconstruction with the semitendinosus tendon: comparison of results with and without braided polypropylene augmentation.
Fifteen chronic anterior cruciate ligament-deficient knees were arthroscopically reconstructed with a semitendinosus tendon polypropylene (STP) augmented composite graft. A comparison group of 28 reconstructions with the semitendinosus tendon (ST) but without augmentation was simultaneously reviewed. The mean follow-up in the STP group was 31 months (range of 24-42 months) and in the ST group it was 34 months (range 26-54 months). Both patient groups had similar age, sex, preinjury functional sports level, injury-to-surgery interval, and associated meniscal pathology. Good-to-excellent subjective results were reported in 86% of STP patients and 78% of ST patients, whereas 86% of the STP patients and 88% of the ST patients returned to sports activity. Objective examination revealed 73% of the STP group and 82% of the ST group to have a negative or 1+ Lachman test result. A negative pivot shift was noted at follow-up in 80% of the STP group and in 82% of the ST group. KT-1000 testing revealed 60% of the STP patients and 61% of the ST patients to have less than or equal to 3 mm of side-to-side difference. In the STP group there was no evidence of graft breakage, deep infections, or sterile effusions. Overall subjective and functional results were uniformly better than objective results in both patient groups. Analysis of subjective, objective, and functional results reveal no difference in outcome between the STP and the ST patient groups.
Adult↗
Partial thickness rotator cuff tears: results of arthroscopic treatment.
Thirty-one patients with arthroscopically documented partial thickness rotator cuff tears treated by arthroscopic debridement of the lesion were retrospectively reviewed. The patients had had symptoms for an average of 20.5 months prior to surgery. Twenty-two of these 31 shoulders also had bursoscopy, with 18 having arthroscopic subacromial decompression. The results were graded by both the UCLA Shoulder Rating Scale and Neer's criteria. Twenty-six (84%) of the patients had satisfactory results with the remaining 5 (16%) patients having unsatisfactory results. A classification system for the size and location of partial thickness rotator cuff tears is presented. The lesion size did not affect the result. Repeat arthroscopy in three patients demonstrated no further deterioration of their rotator cuff. The results with and without subacromial decompression were similar. The need for subacromial decompression is best determined by the arthroscopic finding of a bursal side tear.
Adult↗
Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients.
Magnetic resonance images of the knee were made for 1014 patients, and the diagnosis was subsequently confirmed arthroscopically. The accuracy of the diagnoses from the imaging was 89 per cent for the medial meniscus, 88 per cent for the lateral meniscus, 93 per cent for the anterior cruciate ligament, and 99 per cent for the posterior cruciate ligament. The magnetic resonance examinations were done at several centers, and the results varied substantially among centers. The accuracy ranged from 64 to 95 per cent for the medial meniscus, from 83 to 94 per cent for the lateral meniscus, and from 78 to 97 per cent for the anterior cruciate ligament. The results from different magnetic-resonance units were also compared, and the findings suggested increased accuracy for the units that had a stronger magnetic field. Of the menisci for which the magnetic resonance signal was reported to be Grade II (a linear intrameniscal signal not extending to the superior or inferior meniscal surface), 17 per cent were found to be torn at arthroscopy.
Adolescent↗
SLAP lesions of the shoulder.
A specific pattern of injury to the superior labrum of the shoulder was identified arthroscopically in twenty-seven patients included in a retrospective review of more than 700 shoulder arthroscopies performed at our institution. The injury of the superior labrum begins posteriorly and extends anteriorly, stopping before or at the mid-glenoid notch and including the "anchor" of the biceps tendon to the labrum. We have labeled this injury a "SLAP lesion" (Superior Labrum Anterior and Posterior). There were 23 males and four females with an average age of 37.5 years. Time from injury to surgery averaged 29.3 months. The most common mechanism of injury was a compression force to the shoulder, usually as the result of a fall onto an outstretched arm, with the shoulder positioned in abduction and slight forward flexion at the time of the impact. The most common clinical complaints were pain, greater with overhead activity, and a painful "catching" or "popping" in the shoulder. No imaging test accurately defined the superior labral pathology preoperatively. We divided the superior labrum pathology into four distinct types. Treatment was performed arthroscopically based on the type of SLAP lesion noted at the time of surgery. The SLAP lesion, which has not been previously described, can be diagnosed only arthroscopically and may be treated successfully by arthroscopic techniques alone in many patients.
Accidental Falls↗
MR arthrography of the shoulder: comparison with conventional MR imaging.
Twenty-three patients underwent both conventional MR imaging of the shoulder and MR shoulder arthrography for clinically suspected labral or rotator cuff abnormalities. Images obtained before and after contrast administration were studied independently, and without knowledge of clinical findings, by two radiologists for the presence of abnormalities of the glenoid labrum or rotator cuff. Results were correlated with surgical findings in all patients. Nine patients had surgically proved labral tears. MR arthrography detected all nine labral abnormalities, while six of the nine were missed on conventional MR imaging. Fourteen patients had surgically proved rotator cuff tears. MR arthrography detected 11 of the 14 tears and missed three partial tears on the bursal surface. Conventional MR imaging detected nine cuff tears and missed five tears; two of these were complete rotator cuff tears and three were partial tears of the undersurface of the rotator cuff. Our results suggest that MR arthrography enhances the accuracy of MR in the evaluation of the glenoid labrum and rotator cuff tendon.
Adolescent↗
Results of arthroscopic meniscectomy.
It would appear that arthroscopic partial menisectomy offers as good, if not better, results compared with open meniscectomy. Authors who have compared patients undergoing open meniscectomy with those undergoing arthroscopic meniscectomy have also shown that the other variables and parameters so important to the patient in the early postoperative period weight very heavily in favor of arthroscopic meniscectomy.
Arthroscopy↗
Acute anterior cruciate ligament reconstruction. Analysis of complications.
One hundred fifty-six patients treated with intraarticular anterior cruciate ligament (ACL) reconstruction were analyzed to determine the incidence of complications. The study group of 31 patients (Group I) was treated with repair or reconstruction of an acute ACL injury. A comparison group of 125 patients had reconstruction for chronic ACL instability (Group II). The patients were evaluated clinically and by roentgenograms. The average follow-up time for the study group was 52.2 months. In Group I, 35% developed fibroarthrosis postoperatively that required arthroscopic lysis of adhesions and manipulation to restore motion. In Group II, only 12% developed this complication. However, developing this complication did not affect a patient's long-term clinical result when properly recognized and promptly treated.
Adolescent↗
Intraarticular versus intraarticular and extraarticular reconstruction for chronic anterior cruciate ligament instability.
One hundred twenty-seven patients were evaluated for the results of surgical stabilization in chronic anterior cruciate ligament instability. Eighty-four patients had been treated with intraarticular reconstruction alone, while 43 patients had been treated with a combination of intraarticular and extraarticular stabilization. Patients were evaluated by questionnaire to assess subjective and functional status by clinical examination of objective findings, and by roentgenograms and instrumented ligamentous stability testing. The follow-up interval averaged 45.2 months for the entire group (range, 24-90 months). Using a 200-point scale, the rating for the group treated with intraarticular reconstruction alone was 169.1, while the average rating for the group treated with combined intraarticular and extraarticular stabilization was 166.2. Overall, an excellent or good result was obtained in 67% of patients in the intraarticular only group and in 70% of the patients in the combined reconstruction group. There were no significant differences between the two groups in terms of changes seen on roentgenograms or in terms of residual laxity measured by instrumented testing. Thus, there is no demonstrable benefit derived from combined intraarticular and extraarticular stabilization procedures for chronic anterior cruciate ligament instability, provided that a well-placed intraarticular substitute of sufficient strength is functional.
Adolescent↗
Reconstruction of the anterior cruciate ligament using a torn meniscus.
In eighty of 100 patients, reconstruction of the anterior cruciate ligament using a torn meniscus was successful in restoring stability. The length of follow-up ranged from two to six years and the mean interval from injury to operation was two years. Preoperatively, all but one patient had a positive (2+ or 3+) Lachman test and a positive pivot-shift test. Only ten patients had evidence of major instability, as seen on either test. The result was the same regardless of whether the patient had had a concomitant extra-articular (Ellison) procedure. The results of arthroscopic biopsy in eleven patients did not support the hypothesis that the meniscus underwent metaplasia to ligamentous tissue. Although this procedure yielded results similar to those of other procedures in which autogenous tissues are used to reconstruct the ligament, the meniscus should rarely, if ever, be used for reconstruction of the anterior cruciate ligament. The procedure is indicated only for patients who, in addition to needing reconstruction of the anterior cruciate ligament, also have a torn meniscus that would otherwise have to be totally excised.
Adolescent↗
Failed arthroscopic meniscectomy: prognostic factors for repeat arthroscopic examination.
The authors have reviewed 44 patients retrospectively who failed arthroscopic partial meniscectomy. The study attempts to define the chances for success and to identify prognostic factors as these patients return for reoperation. Each patient had a repeat arthroscopic examination from 2 to 60 months after partial meniscectomy (average 19 months). They were reviewed an average of 31 months after reoperation (6 to 60 months), and each completed a subjective questionnaire evaluating the efficacy of their repeat arthroscopic surgery. Seventy-one percent of the patients had improvement with reoperation and were classified as good or excellent. Twelve patients (29%) did not improve and were rated poor. Ten parameters, as recorded before repeat arthroscopic examination, were investigated in an attempt to correlate each with success and to find those that are significant prognostic factors. Age of the patient, number of surgeries on the involved knee, time between arthroscopic examinations, nature of history (acute or chronic), workers' compensation or private insurance status, range of motion on physical examination prior to repeat arthroscopy, and degree of chondromalacia as seen at the first surgery were not found to correlate with the ultimate success of the patient. The presence of mechanical complaints before reoperation was a statistically significant parameter that led to a good or excellent result in 86% of the patients at follow-up. Lateral meniscal pathology seen at first partial meniscectomy gave more favorable results than medial meniscal pathology even if the patient had nonmechanical complaints. A history of reinjury between arthroscopic surgeries is helpful only if positive. In the absence of such a history, no conclusion can be drawn.
Adolescent↗
Patellar instability: treatment by arthroscopic electrosurgical lateral release.
We reviewed the results of arthroscopic lateral release using electrosurgery in 39 patients (45 knees) with a history of recurrent patellar subluxation or dislocation. The average follow-up time was 28 months (range, 24-36). At follow-up, the patients had decreased swelling, instability, and pain. There was an improvement in flexion activities, sports participation, and overall functional ability. Only 20% of the knees had completely normal physical findings: 11.1% of the knees were rated as excellent; 64.4% were improved; and 24.5% were poor. Dislocators had more frequent poor results. The complication rate was 4.4%. There were no postoperative hemathroses. One patient was considered a surgical failure. The technique yields results comparable with those of open extensor realignment procedures and avoids the complications inherent to lateral release in general. The place for this procedure in patellar instability is well-documented.
Adult↗
Treatment of the anterior cruciate ligament-absent knee with associated meniscal tears. Instrumented testing and clinical evaluation of two patient groups.
The UCLA instrumented clinical testing apparatus was used to measure postoperative stiffness and laxity for two groups of patients with documented chronic absence of the anterior cruciate ligament (ACL) and associated meniscal tears. Group 1 consisted of 76 patients (average age, 25 years) who had undergone anterior cruciate substitution using the torn meniscus, and a second group of 34 patients (average age, 31 years) who had partial meniscectomy alone without ACL substitution. Subjective and objective evaluations were significantly higher and symptoms of pain and buckling significantly lower in the substitution group. In addition, 29% of Group 1 and only 7% of Group 2 patients were able to return to their preinjury sports without limitations, while 5% of the former and 12% of the latter could not return to any sport. At 90 degrees of flexion, there were no significant differences in stiffness or laxity between the patient groups. At 20 degrees of flexion and neutral foot rotation, the meniscal substitution group had an average of 1.4 mm less side-to-side laxity difference than the partial meniscectomy patients; 51% of the substituted patients still had an injured knee laxity that was at least 2 mm greater than the uninjured knee, as contrasted to 67% of the partial meniscectomy patients who exceeded this upper limit of the normal range. At 20 degrees, anterior stiffness of the injured knees of the substitution patients was 28% greater than the injured knees of the partial meniscectomy group; 42% of the substituted patients had an injured knee stiffness within the normal range, while only 18% of the partial meniscectomy patients fell within normal limits. There were no statistical correlations of stiffness or laxity values with clinical scores or patient symptomatology in either group.
Adult↗
Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases.
In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.
Adolescent↗
Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results.
Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.
Adult↗
Autogeneic anterior cruciate ligament (ACL) anterior reconstruction of the knee. A review.
Anterior cruciate ligament (ACL) reconstruction with patellar-tendon-bone, semitendinosus/gracilis, iliotibial band, and meniscus have all given "success" rates between 75% and 85% with reasonably short (less than three years) follow-up periods. A 7.9-year average follow-up evaluation of patellar tendon ACL reconstruction would probably represent the overall success rate of the above procedures at 69% good or excellent. All of these procedures require significant dissection and lengthy rehabilitation periods of six months to a year. In attempting to compare these various reconstructions, it is obvious that it will be necessary to develop a consistent and reproducible subjective and objective knee rating system that is presently not used by these authors. Prior to the use of the various prosthetic ACL reconstructions, careful follow-up analysis of the existing body of autogenous ACL reconstructions must be constantly reviewed and assessed in light of the newer data. As Ivar Palmer stated in 1938, "However, it cannot be denied that interferences of this kind are extensive, time-consuming and rather risky, and at the best of times, they cannot result in a restitutio ad integrum."
Bone Transplantation↗