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Technique and results of arthroscopic treatment of calcific tendonitis of the rotator cuff using fluoroscopic localization
322
ABSTRACTS
In all cases, SEPs were recorded at the cerebral cortex on electric stimulation of the ACL. The greatest potentials were recorded on stimulation of the midsubstance of the ligament and the least at the femoral end. These findings provide direct evidence for, and strongly support the presence of, active proprioceptive receptors within the intact ACL of the human knee. Correlation of Patello-Femoral Crepitus with Arthroscopic Findings. Stephen R. Soffer, Martin Yahiro, Bruce Wolock, Leslie Matthews, and O’Donnell. Baltimore, Maryland, U.S.A.
John
Crepitation of the patellofemoral joint is thought to be a characteristic physical finding of chondromalacia patellae (CMP). There is controversy as to whether patellofemoral crepitus (PFC) is specific for patellofemoral joint pathology. The purpose of this study is to examine the relationship of the physical finding of crepitus to the arthroscopic findings in the patellofemoral joint. This is a prospective blind study of 100 knees in 99 patients undergoing arthroscopic surgery. There are 67 men and 32 women, ages 11-85 years (mean age = 34.6 years). Preoperatively, crepitus was graded by severity (grades O-3) in three ranges of knee flexion, under loaded and unloaded conditions. Routine arthroscopies with care to examine and probe the articular surface of the patella were performed. Knee diagrams were then completed documenting size, location, and grade of CMP. In all three arcs of knee flexion, under loaded and unloaded conditions, low grades of PFC predicted low grades of CMP and high grades of PFC predicted high grades of CMP (p < 0.01). There was no correlation between the grade of PFC and the location of size of the CMP. There was no relationship between PFC and the presence of other intraarticular pathology. PFC is an accurate predictor of patellofemoral joint pathology and is a useful diagnostic aid in delineating anterior knee pain. Measurement of PFC in three arcs of knee flexion under loaded and unloaded conditions is not clinically useful. Technique and Results of Arthroscopic Treatment of Calcific Tendonitis of the Rotator Cuff Using Fluoroscopic Localization. Stephen C. Weber. Sacramento, California, U.S.A. Arthroscopy.
Vol. 7, No. 3, 1991
Arthroscopic removal of calcific deposits has been the subject of several small studies. Early studies have shown the technique to be efficacious but difticult, because the calcitic deposits are buried within the substance of the rotator cuff, and previously described techniques have required blind probing of the rotator cuff to localize the calcitic deposits. This causes iatrogenic damage to the rotator cuff, and significantly extends the time required to perform this surgery. Intraoperative fluoroscopic localization of calcium has not been previously described. In this study, 20 patients with a mean age of 43.7 years who failed at least 6 months of conservative management with calcific tendonitis were treated. Sixteen were female and four were male. Diagnostic arthroscopy of the joint was performed, and then bursoscopy. A Phillips BV25 image intensifier was then brought over the lateral aspect of the shoulder and was used to create an anteroposterior image of the shoulder. This was used to place a 4.5-mm synovial resector tip directly over the deposit; the deposit was then removed. Calcium fragments were arthroscopically visualized in all patients using this technique; fluoroscopic time averaged 2.2 min. Arthroscopic acromioplasty was performed in all cases. Mean follow-up averaged 17 months (SD = 5.92). Sixteen patients had complete relief of pain, two had some relief, and two were not improved. No complications were encountered. The addition of fluoroscopic control to the arthroscopic removal of calcium appears to significantly improve the predictability of this procedure for the rare patient who fails conservative management for this condition. Osteochondritis Dissecans of the Lateral Femoral CondyI+Natural History and Treatment. John C. Garrett. Atlanta, Georgia, U.S.A. In osteochondritis dissecans, lesions of the lateral femoral condyles are less common than those of the medial condyle and have unique characteristics that affect their natural history and treatment. Formerly, they have been relatively neglected in treatises on osteochondral dissecans. To gain a greater appreciation of their attributes, 28 consecutive cases of osteochondritis dissecans of the lateral femoral condyle treated from 1984 through 1990 were studied and compared with a similar number of lesions of the medial femoral condyle. Patients were studied prospectively as to clinical presentation including Lysholm scores, roentgenographic
ABSTRACTS
In all cases, SEPs were recorded at the cerebral cortex on electric stimulation of the ACL. The greatest potentials were recorded on stimulation of the midsubstance of the ligament and the least at the femoral end. These findings provide direct evidence for, and strongly support the presence of, active proprioceptive receptors within the intact ACL of the human knee. Correlation of Patello-Femoral Crepitus with Arthroscopic Findings. Stephen R. Soffer, Martin Yahiro, Bruce Wolock, Leslie Matthews, and O’Donnell. Baltimore, Maryland, U.S.A.
John
Crepitation of the patellofemoral joint is thought to be a characteristic physical finding of chondromalacia patellae (CMP). There is controversy as to whether patellofemoral crepitus (PFC) is specific for patellofemoral joint pathology. The purpose of this study is to examine the relationship of the physical finding of crepitus to the arthroscopic findings in the patellofemoral joint. This is a prospective blind study of 100 knees in 99 patients undergoing arthroscopic surgery. There are 67 men and 32 women, ages 11-85 years (mean age = 34.6 years). Preoperatively, crepitus was graded by severity (grades O-3) in three ranges of knee flexion, under loaded and unloaded conditions. Routine arthroscopies with care to examine and probe the articular surface of the patella were performed. Knee diagrams were then completed documenting size, location, and grade of CMP. In all three arcs of knee flexion, under loaded and unloaded conditions, low grades of PFC predicted low grades of CMP and high grades of PFC predicted high grades of CMP (p < 0.01). There was no correlation between the grade of PFC and the location of size of the CMP. There was no relationship between PFC and the presence of other intraarticular pathology. PFC is an accurate predictor of patellofemoral joint pathology and is a useful diagnostic aid in delineating anterior knee pain. Measurement of PFC in three arcs of knee flexion under loaded and unloaded conditions is not clinically useful. Technique and Results of Arthroscopic Treatment of Calcific Tendonitis of the Rotator Cuff Using Fluoroscopic Localization. Stephen C. Weber. Sacramento, California, U.S.A. Arthroscopy.
Vol. 7, No. 3, 1991
Arthroscopic removal of calcific deposits has been the subject of several small studies. Early studies have shown the technique to be efficacious but difticult, because the calcitic deposits are buried within the substance of the rotator cuff, and previously described techniques have required blind probing of the rotator cuff to localize the calcitic deposits. This causes iatrogenic damage to the rotator cuff, and significantly extends the time required to perform this surgery. Intraoperative fluoroscopic localization of calcium has not been previously described. In this study, 20 patients with a mean age of 43.7 years who failed at least 6 months of conservative management with calcific tendonitis were treated. Sixteen were female and four were male. Diagnostic arthroscopy of the joint was performed, and then bursoscopy. A Phillips BV25 image intensifier was then brought over the lateral aspect of the shoulder and was used to create an anteroposterior image of the shoulder. This was used to place a 4.5-mm synovial resector tip directly over the deposit; the deposit was then removed. Calcium fragments were arthroscopically visualized in all patients using this technique; fluoroscopic time averaged 2.2 min. Arthroscopic acromioplasty was performed in all cases. Mean follow-up averaged 17 months (SD = 5.92). Sixteen patients had complete relief of pain, two had some relief, and two were not improved. No complications were encountered. The addition of fluoroscopic control to the arthroscopic removal of calcium appears to significantly improve the predictability of this procedure for the rare patient who fails conservative management for this condition. Osteochondritis Dissecans of the Lateral Femoral CondyI+Natural History and Treatment. John C. Garrett. Atlanta, Georgia, U.S.A. In osteochondritis dissecans, lesions of the lateral femoral condyles are less common than those of the medial condyle and have unique characteristics that affect their natural history and treatment. Formerly, they have been relatively neglected in treatises on osteochondral dissecans. To gain a greater appreciation of their attributes, 28 consecutive cases of osteochondritis dissecans of the lateral femoral condyle treated from 1984 through 1990 were studied and compared with a similar number of lesions of the medial femoral condyle. Patients were studied prospectively as to clinical presentation including Lysholm scores, roentgenographic