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Technique for arthroscopic meniscus suture in the posterior segment
ABSTRACTS
Meniscal lesions were seen in 27 knees (77%) in Group I, 14 knees (70%) in Group II, 10 knees (83%) in Group III, and 16 knees (100%) in Group IV. Chondral lesions were found in 8 knees (23%) in Group I, 9 knees (45%) in Group II, 8 knees (67%) in Group III, and 12 knees (75%) in Group IV. The frequency of meniscal and chondral lesions increased with time after the initial injury, and both the extent and grade of the chondral lesions progressed. Activity after injury, the presence of meniscal lesions or meniscectomy in the same compartment, and frequent reinjury made the frequency of chondral lesions higher and their severity greater. Notch Plasty in Arthroscopic Anterior Cruciate Ligament Reconstruction. Konsei Shine, et al. Osaka, Japan. We studied how frequently grafts of the anterior cruciate ligament (ACL) impinged against the intercondylar notch during arthroscopic ACL reconstruction in 30 knees of Japanese patients. Graft impingement was observed in 16 cases (53%), and notch plasty was required. Roentgenographic measurements in tunnel views were not useful to predict which patients would require the procedure. We concluded that direct intraoperative assessment of the graft-notch relationship throughout the entire range of motion is mandatory if graft impingement is to be eliminated. Arthroscopy of Reconstructed Anterior Cruciate Ligaments with Artificial Ligaments. Hiroshi Yamaga, Kiyoshi Yokoe, Lewis Kei Hayashi, Osamu Ztoh, Hitoshi Zdota, Kouji Hasegawa, Kunio Ida, Takayuki Miura, and Ryotaro Mori. Nagoya, Japan.
Between April 1985 and February 1988, we reconstructed the anterior cruciate ligament (ACL) of 56 knees using the Leeds-Keio artificial ligament (42 knees) or a Dacron artificial ligament (14 knees). Twenty-three of the reconstructions were done arthroscopically. Postoperative arthroscopic evaluation was done in 37 reconstructions (28 Leeds-Keio and 9 Dacron) after 6-17 months (means of 11 and 13 months). Partial laceration was identified in 8 ligaments (1 Leeds-Keio and 7 Dacron), all at the edge of the femoral drill hole. Fibrous adhesion and granulation tissue were more accentuated in patients who had an open reconstruction, and they were more evident at the intercondylar notch area when recon-
403
struction was with the Leeds-Keio ligament. The tissue formed around the Dacron ligament was frayed and could be easily dissected with blunt instruments, but the tissue penetrating the LeedsKeio ligament was firmly attached to the fibers of that ligament. We concluded that although reconstruction of the ACL of these patients had been considered satisfactory, arthroscopy could not show the real status of most cases because of the presence of fibrous adhesions. The high incidence of partial lacerations (mainly with the Dacron ligament) will probably result in failure; more investigation and long-term follow-up are needed. Results of Arthroscopic Men&al Repair. Sakae Yumaguchi, Shiro Tabata, Hiroshi Kida, Mitsuaki Takahara, Hitomitsu Takada, Hironori Hyodo, and Fuji0 Matsumoto.
Since 1984, we have used arthroscopic meniscal repair for meniscus lesions in 26 knees for 25 patients (12 men and 13 women). The mean age of the patients was 21.5 years (range, 1149 years). Seventeen of the tears were of the medial menisci and the others were of the lateral menisci (23 longitudinal peripheral tears, and three hypermobile meniscus). At a mean follow-up 21 months (range, 3-48 months), 21 patients (85%) had clinically good results. One patient with a large bucket-handle tear had a rerupture at the sutured area. Two of the three hypermobile menisci were not improved. Technique for Arthroscopic Meniscus Suture in the Posterior Segment. Nuoki Katayama, Yoshimitsu Ohosawa, Yasuhiro Sakakibara, Tatsuo Matsuda, and Haruo Ohoguchi. Tokyo (NK, YO, YS, TM)
and Nagoya (HO), Japan. We report a technique for treatment of peripheral meniscus tears, but it was impossible to suture the posterior segment complete by arthroscopy. Usually, a semiarthroscopic method is used. The posterior segment can be sutured by a new technique. Four kinds of instruments are necessary: a 19G disposable lumbar puncture needle, an 18G disposable needle, 3-O monofilament nylon thread, 2-O absorbable monofilament thread (polydioxanone suture) for suturing, and a stopper (disposable cock). The key of the technique is that the lumbar Arthroscopy.
Vol. 7. No. 4, 1991
ABSTRACTS
puncture needle is inserted from a posterolateral site anterior to the lateral collateral ligament for lateral meniscus or from a posteromedial site anterior to the pes anserinus and posterior to the medial collateral ligament for medial menisci. The tear is sutured obliquely. Thus, the thread runs through the length of the flap, and the tear is closed stably. Nerves and vessels are not injured by this procedure .
Arthroscopic Management of Tibia1 Plateau Fractures. Kazuya Kuroki, Yukio Abe. Because of the variety of tibia1 plateau fractures, and the accompanying ligamentous damage or meniscal lesions, such fractures are generally treated with more difficulty than some other kinds of intraarticular fractures. Accurate diagnosis of the intraarticular pathology, reduction of the displaced fragments, adequate stabilization, early motion, and delayed weightbearing are necessary for good results. We performed the arthroscopic management of 11 cases of a total of 22 tibia1 plateau fractures. Arthroscopy has the advantages of allowing accurate reduction and rigid fixation without extensive operative exposure. In addition, it allows through lavage, removal of loose fragments, and accurate diagnosis of the intraarticular pathology. Because extensive exposure is avoided, rapid recovery with reduced pain and early full range of motion is achieved in patients managed arthroscopically.
Hemophilic Knee Arthropathy with Factor IX Inhibitor-A case report. Hirokatsu Kinoshita, Toshiro Zzawa, and Renzo Okamoto. Yokohama, Japan. We treated a lZyear-old boy with hemophilia B with factor IX inhibitor. He had many intraarticular bleeding episodes, and in the preceeding years intraarticular bleeding in the left knee occurred two or three times monthly. Orthotic treatment and replacement therapy did not control the bleeding. We performed arthroscopic examination hoping to stop bleeding caused by intraarticular washing. Before arthroscopy, concentrated factor IX (Ploplex) was injected to the vein, and the factor IX of serum was maintained 76% normal level in order to prevent bleeding dur-
Arthroscopy,
Vol. 7, No. 4. 1991
ing arthroscopy. Arthroscopic findings were of hyper-trophy and pigmentation of the synovial membrane. Ulcers and defect were seen on the surface of the articular cartilage. The arthroscopy showed more advanced articular cartilage degeneration than the preoperative radiographic findings. After the arthroscopic examination, the stimulating substances (coagulation, detached cartilage, cathespin D) were washed out by physiological saline, and then the frequency of bleeding decreased, and the bleeding was controlled. Posttraumatic Cartilage Impression of the Femoral Condyle+A report of two cases. Tadayuki Hoshi, Mitsuru Komatsu, Shinji Nishikawa, and Shinji Kawashima. Hirosaki (TH, MK, SN) and Aomori
(SK), Japan. We treated two patients with cartilage impression of the femoral condyle after trauma. Case 1 was of an l&year-old boy. He struck his knee against a rock. Symptoms were of pain of the right knee joint. Arthroscopic examination showed a cartilage impression of the articular crest of the medial femoral condyle. He was treated by an extension-block knee brace. Case 2 was of a 17-yearold girl. She was injured while playing basketball. The symptoms were of pain and a slight effusion of the left knee joint. Arthroscopic examination showed a cartilage impression of the articular crest of the medial femoral condyle and a hypermobile medial meniscus. She was treated by meniscoresis of the medial meniscus. In the course of treatment a meniscal tear occurred. A Case of Soft Tissue Mass of the Knee Joint Diagnosed with Difficulty. Kouichi Kai, Hiroshi Mizuta, Katsumasa Takagi, and Takashi Oshima. Kumamoto, Japan. Soft tissue masses of the knee are relatively rare. We present a case for which a definite diagnosis of the soft tissue mass of the knee could not be made on histological examination. The patient was a 20year-old woman who noted pain in the lateral aspect of the left knee in May 1986. She experienced locking of the left knee several times. On physical examination, there was a palpable mass at the lateral region of the patellofemoral joint. Arthroscopic examination showed a white mass with a pedicle arising from the synovia of the lateral pouch. The mass
Meniscal lesions were seen in 27 knees (77%) in Group I, 14 knees (70%) in Group II, 10 knees (83%) in Group III, and 16 knees (100%) in Group IV. Chondral lesions were found in 8 knees (23%) in Group I, 9 knees (45%) in Group II, 8 knees (67%) in Group III, and 12 knees (75%) in Group IV. The frequency of meniscal and chondral lesions increased with time after the initial injury, and both the extent and grade of the chondral lesions progressed. Activity after injury, the presence of meniscal lesions or meniscectomy in the same compartment, and frequent reinjury made the frequency of chondral lesions higher and their severity greater. Notch Plasty in Arthroscopic Anterior Cruciate Ligament Reconstruction. Konsei Shine, et al. Osaka, Japan. We studied how frequently grafts of the anterior cruciate ligament (ACL) impinged against the intercondylar notch during arthroscopic ACL reconstruction in 30 knees of Japanese patients. Graft impingement was observed in 16 cases (53%), and notch plasty was required. Roentgenographic measurements in tunnel views were not useful to predict which patients would require the procedure. We concluded that direct intraoperative assessment of the graft-notch relationship throughout the entire range of motion is mandatory if graft impingement is to be eliminated. Arthroscopy of Reconstructed Anterior Cruciate Ligaments with Artificial Ligaments. Hiroshi Yamaga, Kiyoshi Yokoe, Lewis Kei Hayashi, Osamu Ztoh, Hitoshi Zdota, Kouji Hasegawa, Kunio Ida, Takayuki Miura, and Ryotaro Mori. Nagoya, Japan.
Between April 1985 and February 1988, we reconstructed the anterior cruciate ligament (ACL) of 56 knees using the Leeds-Keio artificial ligament (42 knees) or a Dacron artificial ligament (14 knees). Twenty-three of the reconstructions were done arthroscopically. Postoperative arthroscopic evaluation was done in 37 reconstructions (28 Leeds-Keio and 9 Dacron) after 6-17 months (means of 11 and 13 months). Partial laceration was identified in 8 ligaments (1 Leeds-Keio and 7 Dacron), all at the edge of the femoral drill hole. Fibrous adhesion and granulation tissue were more accentuated in patients who had an open reconstruction, and they were more evident at the intercondylar notch area when recon-
403
struction was with the Leeds-Keio ligament. The tissue formed around the Dacron ligament was frayed and could be easily dissected with blunt instruments, but the tissue penetrating the LeedsKeio ligament was firmly attached to the fibers of that ligament. We concluded that although reconstruction of the ACL of these patients had been considered satisfactory, arthroscopy could not show the real status of most cases because of the presence of fibrous adhesions. The high incidence of partial lacerations (mainly with the Dacron ligament) will probably result in failure; more investigation and long-term follow-up are needed. Results of Arthroscopic Men&al Repair. Sakae Yumaguchi, Shiro Tabata, Hiroshi Kida, Mitsuaki Takahara, Hitomitsu Takada, Hironori Hyodo, and Fuji0 Matsumoto.
Since 1984, we have used arthroscopic meniscal repair for meniscus lesions in 26 knees for 25 patients (12 men and 13 women). The mean age of the patients was 21.5 years (range, 1149 years). Seventeen of the tears were of the medial menisci and the others were of the lateral menisci (23 longitudinal peripheral tears, and three hypermobile meniscus). At a mean follow-up 21 months (range, 3-48 months), 21 patients (85%) had clinically good results. One patient with a large bucket-handle tear had a rerupture at the sutured area. Two of the three hypermobile menisci were not improved. Technique for Arthroscopic Meniscus Suture in the Posterior Segment. Nuoki Katayama, Yoshimitsu Ohosawa, Yasuhiro Sakakibara, Tatsuo Matsuda, and Haruo Ohoguchi. Tokyo (NK, YO, YS, TM)
and Nagoya (HO), Japan. We report a technique for treatment of peripheral meniscus tears, but it was impossible to suture the posterior segment complete by arthroscopy. Usually, a semiarthroscopic method is used. The posterior segment can be sutured by a new technique. Four kinds of instruments are necessary: a 19G disposable lumbar puncture needle, an 18G disposable needle, 3-O monofilament nylon thread, 2-O absorbable monofilament thread (polydioxanone suture) for suturing, and a stopper (disposable cock). The key of the technique is that the lumbar Arthroscopy.
Vol. 7. No. 4, 1991
ABSTRACTS
puncture needle is inserted from a posterolateral site anterior to the lateral collateral ligament for lateral meniscus or from a posteromedial site anterior to the pes anserinus and posterior to the medial collateral ligament for medial menisci. The tear is sutured obliquely. Thus, the thread runs through the length of the flap, and the tear is closed stably. Nerves and vessels are not injured by this procedure .
Arthroscopic Management of Tibia1 Plateau Fractures. Kazuya Kuroki, Yukio Abe. Because of the variety of tibia1 plateau fractures, and the accompanying ligamentous damage or meniscal lesions, such fractures are generally treated with more difficulty than some other kinds of intraarticular fractures. Accurate diagnosis of the intraarticular pathology, reduction of the displaced fragments, adequate stabilization, early motion, and delayed weightbearing are necessary for good results. We performed the arthroscopic management of 11 cases of a total of 22 tibia1 plateau fractures. Arthroscopy has the advantages of allowing accurate reduction and rigid fixation without extensive operative exposure. In addition, it allows through lavage, removal of loose fragments, and accurate diagnosis of the intraarticular pathology. Because extensive exposure is avoided, rapid recovery with reduced pain and early full range of motion is achieved in patients managed arthroscopically.
Hemophilic Knee Arthropathy with Factor IX Inhibitor-A case report. Hirokatsu Kinoshita, Toshiro Zzawa, and Renzo Okamoto. Yokohama, Japan. We treated a lZyear-old boy with hemophilia B with factor IX inhibitor. He had many intraarticular bleeding episodes, and in the preceeding years intraarticular bleeding in the left knee occurred two or three times monthly. Orthotic treatment and replacement therapy did not control the bleeding. We performed arthroscopic examination hoping to stop bleeding caused by intraarticular washing. Before arthroscopy, concentrated factor IX (Ploplex) was injected to the vein, and the factor IX of serum was maintained 76% normal level in order to prevent bleeding dur-
Arthroscopy,
Vol. 7, No. 4. 1991
ing arthroscopy. Arthroscopic findings were of hyper-trophy and pigmentation of the synovial membrane. Ulcers and defect were seen on the surface of the articular cartilage. The arthroscopy showed more advanced articular cartilage degeneration than the preoperative radiographic findings. After the arthroscopic examination, the stimulating substances (coagulation, detached cartilage, cathespin D) were washed out by physiological saline, and then the frequency of bleeding decreased, and the bleeding was controlled. Posttraumatic Cartilage Impression of the Femoral Condyle+A report of two cases. Tadayuki Hoshi, Mitsuru Komatsu, Shinji Nishikawa, and Shinji Kawashima. Hirosaki (TH, MK, SN) and Aomori
(SK), Japan. We treated two patients with cartilage impression of the femoral condyle after trauma. Case 1 was of an l&year-old boy. He struck his knee against a rock. Symptoms were of pain of the right knee joint. Arthroscopic examination showed a cartilage impression of the articular crest of the medial femoral condyle. He was treated by an extension-block knee brace. Case 2 was of a 17-yearold girl. She was injured while playing basketball. The symptoms were of pain and a slight effusion of the left knee joint. Arthroscopic examination showed a cartilage impression of the articular crest of the medial femoral condyle and a hypermobile medial meniscus. She was treated by meniscoresis of the medial meniscus. In the course of treatment a meniscal tear occurred. A Case of Soft Tissue Mass of the Knee Joint Diagnosed with Difficulty. Kouichi Kai, Hiroshi Mizuta, Katsumasa Takagi, and Takashi Oshima. Kumamoto, Japan. Soft tissue masses of the knee are relatively rare. We present a case for which a definite diagnosis of the soft tissue mass of the knee could not be made on histological examination. The patient was a 20year-old woman who noted pain in the lateral aspect of the left knee in May 1986. She experienced locking of the left knee several times. On physical examination, there was a palpable mass at the lateral region of the patellofemoral joint. Arthroscopic examination showed a white mass with a pedicle arising from the synovia of the lateral pouch. The mass