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Arthroscopic management of degenerative meniscus tears
ABSTRACTS re-examined and found to have an anterior cruciate insufficient knee with anterior lateral rotatory instability. The message that we would like to emphasize is that complete bucket handle tears of the meniscus, w h e t h e r it be medial or lateral, lend themselves nicely to repair with a high success rate. We feel that the emphasis in the treatment of bucket handle tears should be in the best long term result rather than on the quickest return to sporting activities.
Arthroscopic Management of Degenerative Meniscus Tears, James A. Rand, M.D., Mayo Clinic, Rochester, MN. Meniscal pathology frequently accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right side was involved in 44 and 47 were men. Preoperative radiographs demonstrated os-
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teoarthritis in 53. The medial meniscus was involved in 82 while the lateral meniscus was affected in nine. Four knees had involvement of both menisci. The most frequent lesion was a tear of the posterior horn of the medial meniscus being present in 72. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 ± 13 (mean _+ S.D.) days. Symptomatic improvement was present in 81% at 3 months, 82% at 6 months, 83% at I year, 78% at 2 years, 96% at 3 years, and 71% at 3.5 years. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. There was no apparent correlation between the patient's age or mild to moderate radiographic abnormalities and the clinical result. ComPlications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one. Arthroscopic meniscectomy is a valuable adjunct to the management of the older patient with early degenerative arthritis of the knee and symptomatic meniscus tears.
Arthroscopy, Vol. 1, No. 2, 1985
Arthroscopic Management of Degenerative Meniscus Tears, James A. Rand, M.D., Mayo Clinic, Rochester, MN. Meniscal pathology frequently accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right side was involved in 44 and 47 were men. Preoperative radiographs demonstrated os-
151
teoarthritis in 53. The medial meniscus was involved in 82 while the lateral meniscus was affected in nine. Four knees had involvement of both menisci. The most frequent lesion was a tear of the posterior horn of the medial meniscus being present in 72. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 ± 13 (mean _+ S.D.) days. Symptomatic improvement was present in 81% at 3 months, 82% at 6 months, 83% at I year, 78% at 2 years, 96% at 3 years, and 71% at 3.5 years. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. There was no apparent correlation between the patient's age or mild to moderate radiographic abnormalities and the clinical result. ComPlications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one. Arthroscopic meniscectomy is a valuable adjunct to the management of the older patient with early degenerative arthritis of the knee and symptomatic meniscus tears.
Arthroscopy, Vol. 1, No. 2, 1985