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High-resolution magnetic resonance imaging evaluation of meniscal tears
ABSTRACTS safely for arthroscopic repair of medial meniscal tears are not applicable to lateral meniscal tears in the posterior one-third of the meniscus secondary to the significant risk to major neurovascular structures. Identification of the peroneal nerve through a small incision is recommended to protect it during repair.
Arthroscopic Meniscectomy of the Discoid Meniscus. Yung-Cheng Chen. Tokyo, Japan. Arthroscopic meniscectomy of the discoid meniscus is one of the most difficult applications in arthroscopic surgery. The purpose of this paper is to present the indications, techniques, and results of the arthroscopic discoid meniscectomy. From April 1978 to June 1987, arthroscopic discoid meniscectomies were performed on 130 knees (55 right, 55 left, and I0 bilateral) of 120 patients (55 males and 65 females) with a mean age of 30.3 years (range, 3-80 years). All patients considered for discoid meniscectomy were the discoid meniscus disorders caused by tear in 99 (76%), abnormal thickening or softening in 26 (20%), and others in 5 (4%). All arthroscopic discoid meniscectomies were technically successful by the double puncture technique through the medial and lateral infrapatellar portals with scissors and/or a knife. The fragments were then removed with a punch. The types of meniscectomy were 13 partial meniscectomies (10%), 113 subtotal meniscectomies (87%), and four total meniscectomies (3%). Of the 85 knees in 80 patients that were available for follow-up with intervals ranging from 6 months to 9 years and 3 months (mean, 3 years 1 month) postoperatively, the results were: 72 knees (84.7%) excellent, eight knees (9.4%) good, and five knees (5.9%) fair. There were no poor results. Follow-up arthroscopy was carried out on six knees in five patients from 2 months to 3.5 years (mean, 1 year 10 months) after surgery. Five knees in the group of subtotal meniscectomy revealed good triangulation of the peripheral meniscus rim, and one knee with total meniscectomy revealed osteoarthritic change in the lateral compartment of the knee. Rupture of the residual meniscus was experienced in one patient with partial meniscectomy, which was treated subsequently by subtotal meniscectomy with good results. Arthroscopic subtotal meniscectomy is recommended as a useful technique in the treatment of the discoid meniscus disorders.
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High-Resolution Magnetic Resonance Imaging Evaluation of Meniscal Tears. Kevin Lynch, Peter Jokl, Francis Wessbecher, Shirley McCarthy, Christopher Pope, Robert Lang, and Stanley Rapoport. New Haven, Connecticut, U.S.A We evaluated the sensitivity and specificity of magnetic resonance imaging in the diagnosis of meniscal tears. One hundred fifty-four knees were evaluated for meniscal injuries using a 1.5 T imager. Patients with prior meniscal surgery were excluded from the study. High-resolution images were obtained using a dedicated extremity coil and 256 x 256 matrix. Images were obtained in the axial, sagittal, and coronal planes using proton density, T1- and T2weighted sequences. Criteria used to diagnose a meniscal tear were: (a) linear or globular increased signal intensity extending to an articular surface and present on two or more contiguous sections, and (b) disruption of meniscal contour. Correlation with the arthroscopic findings was obtained in 43 patients (96 menisci) in whom 31 tears were identified. When only the sagittal plane was evaluated, sensitivity for diagnosis of meniscal tears was 87% and specificity was 94%. When both sagittal and coronal planes were used, sensitivity was 100% and specificity 94%. Evaluation of the signal characteristics showed that only nine of the 31 tears demonstrated high signal intensity on the T2-weighted images, and specificity was not improved. We conclude that high-resolution magnetic resonance imaging is both sensitive and specific in the diagnosis of meniscal tears and that sensitivity is increased to 100% when both sagittal and coronal planes are used.
Arthroscopic Surgery of the Wrist. Edward S. Bittar, Paul C. Dell, and Purcell Smith IlI. Gainesville, Florida, U.S.A. Twenty-five patients underwent wrist arthroscopy for the evaluation and treatment of chronic wrist pain. All patients were evaluated preoperatively with plain radiographs and radiocarpal arthrography. Arthroscopy was performed with patients under general anesthesia using a 25 °, 2.3-mm telescope, saline insufflation, distraction using a wrist holder, and dorsal arthroscopic portals. Nineteen of the 25 patients had positive preoperative arthrograms suggesting tears of the triangular fibrocartilage complex. Of the 19 patients with positive Arthroscopy, Vol. 4, No. 2, 1988
Arthroscopic Meniscectomy of the Discoid Meniscus. Yung-Cheng Chen. Tokyo, Japan. Arthroscopic meniscectomy of the discoid meniscus is one of the most difficult applications in arthroscopic surgery. The purpose of this paper is to present the indications, techniques, and results of the arthroscopic discoid meniscectomy. From April 1978 to June 1987, arthroscopic discoid meniscectomies were performed on 130 knees (55 right, 55 left, and I0 bilateral) of 120 patients (55 males and 65 females) with a mean age of 30.3 years (range, 3-80 years). All patients considered for discoid meniscectomy were the discoid meniscus disorders caused by tear in 99 (76%), abnormal thickening or softening in 26 (20%), and others in 5 (4%). All arthroscopic discoid meniscectomies were technically successful by the double puncture technique through the medial and lateral infrapatellar portals with scissors and/or a knife. The fragments were then removed with a punch. The types of meniscectomy were 13 partial meniscectomies (10%), 113 subtotal meniscectomies (87%), and four total meniscectomies (3%). Of the 85 knees in 80 patients that were available for follow-up with intervals ranging from 6 months to 9 years and 3 months (mean, 3 years 1 month) postoperatively, the results were: 72 knees (84.7%) excellent, eight knees (9.4%) good, and five knees (5.9%) fair. There were no poor results. Follow-up arthroscopy was carried out on six knees in five patients from 2 months to 3.5 years (mean, 1 year 10 months) after surgery. Five knees in the group of subtotal meniscectomy revealed good triangulation of the peripheral meniscus rim, and one knee with total meniscectomy revealed osteoarthritic change in the lateral compartment of the knee. Rupture of the residual meniscus was experienced in one patient with partial meniscectomy, which was treated subsequently by subtotal meniscectomy with good results. Arthroscopic subtotal meniscectomy is recommended as a useful technique in the treatment of the discoid meniscus disorders.
131
High-Resolution Magnetic Resonance Imaging Evaluation of Meniscal Tears. Kevin Lynch, Peter Jokl, Francis Wessbecher, Shirley McCarthy, Christopher Pope, Robert Lang, and Stanley Rapoport. New Haven, Connecticut, U.S.A We evaluated the sensitivity and specificity of magnetic resonance imaging in the diagnosis of meniscal tears. One hundred fifty-four knees were evaluated for meniscal injuries using a 1.5 T imager. Patients with prior meniscal surgery were excluded from the study. High-resolution images were obtained using a dedicated extremity coil and 256 x 256 matrix. Images were obtained in the axial, sagittal, and coronal planes using proton density, T1- and T2weighted sequences. Criteria used to diagnose a meniscal tear were: (a) linear or globular increased signal intensity extending to an articular surface and present on two or more contiguous sections, and (b) disruption of meniscal contour. Correlation with the arthroscopic findings was obtained in 43 patients (96 menisci) in whom 31 tears were identified. When only the sagittal plane was evaluated, sensitivity for diagnosis of meniscal tears was 87% and specificity was 94%. When both sagittal and coronal planes were used, sensitivity was 100% and specificity 94%. Evaluation of the signal characteristics showed that only nine of the 31 tears demonstrated high signal intensity on the T2-weighted images, and specificity was not improved. We conclude that high-resolution magnetic resonance imaging is both sensitive and specific in the diagnosis of meniscal tears and that sensitivity is increased to 100% when both sagittal and coronal planes are used.
Arthroscopic Surgery of the Wrist. Edward S. Bittar, Paul C. Dell, and Purcell Smith IlI. Gainesville, Florida, U.S.A. Twenty-five patients underwent wrist arthroscopy for the evaluation and treatment of chronic wrist pain. All patients were evaluated preoperatively with plain radiographs and radiocarpal arthrography. Arthroscopy was performed with patients under general anesthesia using a 25 °, 2.3-mm telescope, saline insufflation, distraction using a wrist holder, and dorsal arthroscopic portals. Nineteen of the 25 patients had positive preoperative arthrograms suggesting tears of the triangular fibrocartilage complex. Of the 19 patients with positive Arthroscopy, Vol. 4, No. 2, 1988