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MRI Measurements Associated with Patellofemoral Instability
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ABSTRACTS
Results: Of the 72 orthopaedic residents surveyed, 70% use open-access videos as a resource monthly and 25% weekly. Over 70% or respondents perceived the video content to be accurate and informative. We reviewed 39 unique video tutorials on physical examination. Of the 39 videos, 61% rated poor ( Conclusion: Orthopaedic surgery residents frequently use open-access videos tutorials that are overwhelmingly inaccurate. MRI Measurements Associated with Patellofemoral Instability SS-65 Saturday, April 25 at 2:15 PM JACQUELINE MUNCH, M.D., PRESENTING AUTHOR JARON SULLIVAN, M.D. JOSEPH NGUYEN, M.P.H. ANDREW HILLMAN, B.S., M.A. DOUGLAS MINTZ, M.D. DANIEL GREEN, M.D., M.S. SABRINA STRICKLAND, M.D. BETH SHUBIN STEIN, M.D. Introduction: Parameters correlating in the literature with patellofemoral instability include patella alta, tibial tubercle-to-trochlear groove (TT-TG) distance, and trochlear dysplasia. Our hypotheses were: TT-TG measurements would demonstrate lower interrater reliability in the setting of trochlear dysplasia, and patellar articular overlap would correlate well with indices of patellar height. Methods: MRIs of 219 knees were reviewed by 3 attending surgeons, 2 fellows, and 1 musculoskeletal radiologist. Measurements included articular overlap (figure), % articular coverage, Caton-Deschamps Index, Blackburne-Peel Index, Modified Insall-Salvati Index, Dejour classification of trochlear dysplasia, TT-TGs measured at the most cranial and caudal portions of the trochlea, and tibial tubercle-to-PCL distance (TT-PCL). Results: Interrater reliability was high for the Dejour classification (ICC¼0.736) and TT-TG measurements (ICC¼0.807 cranial and ICC¼0.936 caudal). TT-PCL was moderately reliable (ICC¼0.625), and correlated with TT-TG (r¼0.457, p Conclusion: The caudal trochlear measurement is the most reliable method of reporting TT-TG. Patellar articular overlap and % patellar articular coverage show promise in evaluation of patellar height, and future studies are needed to evaluate the range of normal and relationship to our traditionally used measurements. Long-Term Clinical Follow-Up of Arthroscopic Treatment of Symptomatic Discoid Lateral Meniscus in Children SS-66 Saturday, April 25 at 2:30 PM DANIEL GREEN, M.D., M.S., PRESENTING AUTHOR JONATHAN HASKEL, B.S. TYLER UPPSTROM, B.A. DAVID DARE, M.D. SCOTT RODEO, M.D.
Introduction: The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children. Methods: A previous study at our institution identified twenty-seven consecutive patients that underwent arthroscopic meniscal saucerization by one of two surgeons between 1997 and 2002. These patients were included in this study if they were willing and able to complete the five outcomes questionnaires. Seven additional patients that were treated consecutively at least 10 years ago were also included in the study. Patients were also offered a knee exam performed by one of the two surgeons. Associations between outcome scores and discoid type, location of instability, and age at surgery were identified. Results: Of the 34 eligible patients (23 female, 11 male), 22 patients were contacted, and 21 agreed to participate. The average length of follow-up was 13.7 years, ranging from 10.3-16.6 years. Average age at surgery was 9.3 years. Longterm follow-up revealed average IKDC, Kujala, and Lysholm scores of 82.87, 86.63 and 83.73, respectively. Additionally, Marx and Tegner scores were 5.36 and 5.63, respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% excellent, 18.2% good, 27.3% fair, and 9.1% poor. The average IKDC Knee Examination score was A (normal). Overall, 20.6% (7 of 34) of patients underwent a subsequent surgical procedure on the affected knee. Conclusion: Numerous studies have demonstrated good to excellent short-term outcomes after arthroscopic treatment of discoid meniscus. At an average follow-up of nearly 14 years, our data suggests that clinical outcome scores decline over time. Compared to our 2-year followup study, there is an increased rate of knee pain, mechanical symptoms, and functional limitations. The overall modest results demonstrate the challenging clinical problem of discoid lateral meniscus in young patients and illustrate the need for further solutions for meniscus repair or replacement. Percutaneous Partial Medial Collateral Ligament Release (PPMCLR) Does Not Result in Residual Medial Collateral Laxity (MCL) SS-67 Saturday, April 25 at 2:35 PM MICHAEL HINTON, M.D., PRESENTING AUTHOR Introduction: The intra-articular posterior medial knee can be difficult to approach during arthroscopy. This is especially true for medial meniscal tears, medial meniscal repairs or medial meniscal transplantation. Various methods and instruments have been proposed to help with this approach. PPMCLR is one of these methods. This study found that this is a safe technique and does not result in measurable laxity of the MCL. Methods: 50 consecutive patients took part in the study. The patients were then randomized into a control or partial percutaneous release group (25 in each group). Prior to arthroscopy each patient had standardized 30 degree valgus stress radiograph performed. The MCL was
ABSTRACTS
Results: Of the 72 orthopaedic residents surveyed, 70% use open-access videos as a resource monthly and 25% weekly. Over 70% or respondents perceived the video content to be accurate and informative. We reviewed 39 unique video tutorials on physical examination. Of the 39 videos, 61% rated poor ( Conclusion: Orthopaedic surgery residents frequently use open-access videos tutorials that are overwhelmingly inaccurate. MRI Measurements Associated with Patellofemoral Instability SS-65 Saturday, April 25 at 2:15 PM JACQUELINE MUNCH, M.D., PRESENTING AUTHOR JARON SULLIVAN, M.D. JOSEPH NGUYEN, M.P.H. ANDREW HILLMAN, B.S., M.A. DOUGLAS MINTZ, M.D. DANIEL GREEN, M.D., M.S. SABRINA STRICKLAND, M.D. BETH SHUBIN STEIN, M.D. Introduction: Parameters correlating in the literature with patellofemoral instability include patella alta, tibial tubercle-to-trochlear groove (TT-TG) distance, and trochlear dysplasia. Our hypotheses were: TT-TG measurements would demonstrate lower interrater reliability in the setting of trochlear dysplasia, and patellar articular overlap would correlate well with indices of patellar height. Methods: MRIs of 219 knees were reviewed by 3 attending surgeons, 2 fellows, and 1 musculoskeletal radiologist. Measurements included articular overlap (figure), % articular coverage, Caton-Deschamps Index, Blackburne-Peel Index, Modified Insall-Salvati Index, Dejour classification of trochlear dysplasia, TT-TGs measured at the most cranial and caudal portions of the trochlea, and tibial tubercle-to-PCL distance (TT-PCL). Results: Interrater reliability was high for the Dejour classification (ICC¼0.736) and TT-TG measurements (ICC¼0.807 cranial and ICC¼0.936 caudal). TT-PCL was moderately reliable (ICC¼0.625), and correlated with TT-TG (r¼0.457, p Conclusion: The caudal trochlear measurement is the most reliable method of reporting TT-TG. Patellar articular overlap and % patellar articular coverage show promise in evaluation of patellar height, and future studies are needed to evaluate the range of normal and relationship to our traditionally used measurements. Long-Term Clinical Follow-Up of Arthroscopic Treatment of Symptomatic Discoid Lateral Meniscus in Children SS-66 Saturday, April 25 at 2:30 PM DANIEL GREEN, M.D., M.S., PRESENTING AUTHOR JONATHAN HASKEL, B.S. TYLER UPPSTROM, B.A. DAVID DARE, M.D. SCOTT RODEO, M.D.
Introduction: The purpose of this study was to examine the long-term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children. Methods: A previous study at our institution identified twenty-seven consecutive patients that underwent arthroscopic meniscal saucerization by one of two surgeons between 1997 and 2002. These patients were included in this study if they were willing and able to complete the five outcomes questionnaires. Seven additional patients that were treated consecutively at least 10 years ago were also included in the study. Patients were also offered a knee exam performed by one of the two surgeons. Associations between outcome scores and discoid type, location of instability, and age at surgery were identified. Results: Of the 34 eligible patients (23 female, 11 male), 22 patients were contacted, and 21 agreed to participate. The average length of follow-up was 13.7 years, ranging from 10.3-16.6 years. Average age at surgery was 9.3 years. Longterm follow-up revealed average IKDC, Kujala, and Lysholm scores of 82.87, 86.63 and 83.73, respectively. Additionally, Marx and Tegner scores were 5.36 and 5.63, respectively. Stratifying the Lysholm scores revealed outcomes that were 45.4% excellent, 18.2% good, 27.3% fair, and 9.1% poor. The average IKDC Knee Examination score was A (normal). Overall, 20.6% (7 of 34) of patients underwent a subsequent surgical procedure on the affected knee. Conclusion: Numerous studies have demonstrated good to excellent short-term outcomes after arthroscopic treatment of discoid meniscus. At an average follow-up of nearly 14 years, our data suggests that clinical outcome scores decline over time. Compared to our 2-year followup study, there is an increased rate of knee pain, mechanical symptoms, and functional limitations. The overall modest results demonstrate the challenging clinical problem of discoid lateral meniscus in young patients and illustrate the need for further solutions for meniscus repair or replacement. Percutaneous Partial Medial Collateral Ligament Release (PPMCLR) Does Not Result in Residual Medial Collateral Laxity (MCL) SS-67 Saturday, April 25 at 2:35 PM MICHAEL HINTON, M.D., PRESENTING AUTHOR Introduction: The intra-articular posterior medial knee can be difficult to approach during arthroscopy. This is especially true for medial meniscal tears, medial meniscal repairs or medial meniscal transplantation. Various methods and instruments have been proposed to help with this approach. PPMCLR is one of these methods. This study found that this is a safe technique and does not result in measurable laxity of the MCL. Methods: 50 consecutive patients took part in the study. The patients were then randomized into a control or partial percutaneous release group (25 in each group). Prior to arthroscopy each patient had standardized 30 degree valgus stress radiograph performed. The MCL was