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Stiffness of the knee joint: Open versus arthroscopic arthrolysis
134
ABSTRACTS
croscopy and in greater detail with low-power SEM. Standard light microscopy of thin-section specimens was used to evaluate histologic changes. Stereomicroscopic and SEM analysis demonstrated that all cutting techniques produced small amounts of surface fibrillation at the cut surface. Both electrosurgical instruments also created varying amounts of thermal necrosis, with the end-cutting instrument consistently producing greater amounts of thermal retraction and surface irregularity as compared with the wire prototype instrument. Histologically, tissue cut with the basket forceps retained continuity of collagen planes, whereas the electrosurgically instrumented menisci demonstrated disruption of the collagen orientation at the margin. These effects were exaggerated in the thicker meniscal tissues, with a maximum depth of necrosis of 1,100 txm in the wire-cut specimens and 1,600 I~m in the end-cutting-instrumented menisci. Subjectively, the electrosurgical instruments provided less proprioceptive feedback than did basket forceps. The end-cutting instrument had difficulty accessing the posterior horn of the medial meniscus, whereas the prototype electrosurgical instrument and basket forceps provided comparable accessibility. A significant complication involved scoring of the articular cartilage with the end-cutting electrosurgical instrument. In conclusion, the basket forceps and prototype wire-cutting electrosurgical instrument demonstrated comparable surface cutting characteristics in human menisci, with the end-cutting instrument demonstrating greater irregularity due to thermal necrosis. The time-dependent functional significance of the histologic and surface differences will require additional investigation.
Correlation of Pathology Observed in Double Contrast Arthrotomography and Arthroscopy of the Shoulder. Jeffrey S. Kniesel, Howard J. Sweeney, and Milton L. Paige. Evanston, Illinois, U.S.A. Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic'surgery diagnostic results was made in 40 patients with persistent shoulder pain or instability. Between March 1984 and June 1986, 40 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 26 patients and instability in 14 patients. DCAT was performed following the method of E1-Khoury and Albright, Arthroscopy, Vol. 3, No. 2, 1987
and all arthroscopies were performed in similar fashion by one of us (H.J.S.). Both tests were reviewed separately in a double-blind fashion, and results were correlated. For labral pathology, the sensitivity/specificity for the instability group was 0.75/0.83, respectively; sensitivity/specificity for the pain group was 0.14/0.90. For complete rotator cuff tears and loose bodies, sensitivity/specificity was 1.0; for partial rotator cuff tears in both groups, sensitivity was 0.125. False positives and false negatives for labral tears was 27% in instability patients. Sensitivity in the pain only group was poor for labral tears. These two facts cast doubt on DCAT as a useful screening test. DCAT must be considered inconclusive. It is certainly not perfect, and it does not approach the diagnostic capabilities of diagnostic shoulder arthroscopy.
Stiffness of the Knee Joint: Open Versus Arthroscopic Arthrolysis. Matthias Kolb and C. J. Wirth. Munich, ER.G. Stiffness of the knee joint is a severe handicap for patients. From 1946 to 1980, 75 patients underwent an open arthrolysis. From 1980 to 1984, 42 patients were treated arthroscopically. Limited extension of >20 ° or limited flexion >30 ° and an effectless vigorous rehabilitation were considered indications for operation. Reasons for joint stiffness, surgical techniques, and postoperative rehabilitation are described. Follow-up of the 66 open-treated patients was done for an average of 10 years; the mean follow-up of 34 arthroscopically treated patients was 3 years. Results of both methods were compared according to subjective, clinical, and radiological findings, and overall results showed that arthroscopial technique is most preferable. Greater range of motion, less pain, less postoperative morbidity, and a much shorter hospitalization are the advantages of this procedure. Only in severe cases was a lengthening of the quadricepstendon necessary; additional open operation is required.
Allograft Reconstruction of the Anterior Cruciate Ligament. Richard L. Levitt. Miami, Florida, U.S.A. This study reports results of the first 36 patients who underwent allograft reconstruction of the ante-
ABSTRACTS
croscopy and in greater detail with low-power SEM. Standard light microscopy of thin-section specimens was used to evaluate histologic changes. Stereomicroscopic and SEM analysis demonstrated that all cutting techniques produced small amounts of surface fibrillation at the cut surface. Both electrosurgical instruments also created varying amounts of thermal necrosis, with the end-cutting instrument consistently producing greater amounts of thermal retraction and surface irregularity as compared with the wire prototype instrument. Histologically, tissue cut with the basket forceps retained continuity of collagen planes, whereas the electrosurgically instrumented menisci demonstrated disruption of the collagen orientation at the margin. These effects were exaggerated in the thicker meniscal tissues, with a maximum depth of necrosis of 1,100 txm in the wire-cut specimens and 1,600 I~m in the end-cutting-instrumented menisci. Subjectively, the electrosurgical instruments provided less proprioceptive feedback than did basket forceps. The end-cutting instrument had difficulty accessing the posterior horn of the medial meniscus, whereas the prototype electrosurgical instrument and basket forceps provided comparable accessibility. A significant complication involved scoring of the articular cartilage with the end-cutting electrosurgical instrument. In conclusion, the basket forceps and prototype wire-cutting electrosurgical instrument demonstrated comparable surface cutting characteristics in human menisci, with the end-cutting instrument demonstrating greater irregularity due to thermal necrosis. The time-dependent functional significance of the histologic and surface differences will require additional investigation.
Correlation of Pathology Observed in Double Contrast Arthrotomography and Arthroscopy of the Shoulder. Jeffrey S. Kniesel, Howard J. Sweeney, and Milton L. Paige. Evanston, Illinois, U.S.A. Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic'surgery diagnostic results was made in 40 patients with persistent shoulder pain or instability. Between March 1984 and June 1986, 40 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 26 patients and instability in 14 patients. DCAT was performed following the method of E1-Khoury and Albright, Arthroscopy, Vol. 3, No. 2, 1987
and all arthroscopies were performed in similar fashion by one of us (H.J.S.). Both tests were reviewed separately in a double-blind fashion, and results were correlated. For labral pathology, the sensitivity/specificity for the instability group was 0.75/0.83, respectively; sensitivity/specificity for the pain group was 0.14/0.90. For complete rotator cuff tears and loose bodies, sensitivity/specificity was 1.0; for partial rotator cuff tears in both groups, sensitivity was 0.125. False positives and false negatives for labral tears was 27% in instability patients. Sensitivity in the pain only group was poor for labral tears. These two facts cast doubt on DCAT as a useful screening test. DCAT must be considered inconclusive. It is certainly not perfect, and it does not approach the diagnostic capabilities of diagnostic shoulder arthroscopy.
Stiffness of the Knee Joint: Open Versus Arthroscopic Arthrolysis. Matthias Kolb and C. J. Wirth. Munich, ER.G. Stiffness of the knee joint is a severe handicap for patients. From 1946 to 1980, 75 patients underwent an open arthrolysis. From 1980 to 1984, 42 patients were treated arthroscopically. Limited extension of >20 ° or limited flexion >30 ° and an effectless vigorous rehabilitation were considered indications for operation. Reasons for joint stiffness, surgical techniques, and postoperative rehabilitation are described. Follow-up of the 66 open-treated patients was done for an average of 10 years; the mean follow-up of 34 arthroscopically treated patients was 3 years. Results of both methods were compared according to subjective, clinical, and radiological findings, and overall results showed that arthroscopial technique is most preferable. Greater range of motion, less pain, less postoperative morbidity, and a much shorter hospitalization are the advantages of this procedure. Only in severe cases was a lengthening of the quadricepstendon necessary; additional open operation is required.
Allograft Reconstruction of the Anterior Cruciate Ligament. Richard L. Levitt. Miami, Florida, U.S.A. This study reports results of the first 36 patients who underwent allograft reconstruction of the ante-