Arthroscopical removal of a projectile from the intra-articular cavity of the knee joint.

We report the case of a 29-year-old patient with an uncommon handgun accident. A gun was resting in his pocket when an accidental shot was fired. The projectile penetrated the skin of the thigh, travelled through the quadriceps muscle and entered the articular cavity at the upper pole of the suprapatellar recess. It passed the femoropatellar joint space and stopped within the infra-articular fad pad. The bullet was localized by conventional X-rays and removed by arthroscopy. The patient developed no infection, and in a clinical follow-up examination 6 months postoperatively, we observed no pathological findings.

Arthroscopic all-inside meniscus repair using a new refixation device: a prospective study.

PURPOSE: To evaluate complications and clinical results after meniscus refixation using a new all-inside technique. TYPE OF STUDY: Prospective clinical study. METHODS: This study reports clinical results of 37 patients after refixation of an unstable bucket-handle meniscus tear using a new all-inside technique (Mitek Meniscal Repair System; Mitek, Ethicon, Norderstedt, Germany). Twenty tears were located in the peripheral third (red zone) and 17 in the middle third (red/white zone). The average operating time of meniscus refixation was 29.4 minutes. In 17 patients, a reconstruction of the anterior cruciate ligament (ACL) was performed 6 to 8 weeks after the refixation. All patients (aged 15 to 48 years) were re-examined after a minimum follow-up of 12 months. RESULTS: In the ACL group (n = 17) we examined the menisci arthroscopically at surgery. All menisci were still in the reduced position and they were stable to probing. In 12 cases, the anchors were not visible at arthroscopy; in 7 cases, the vertical bar was lying just beyond the femoral meniscus surface. In 1 case, we observed superficial damage of the femoral cartilage in the corresponding area. One patient developed superficial posteromedial knee pain after 4 weeks due migration of a staple into the subcutaneous fat tissue. There were 5 reruptures during the first postoperative year. Two patients reported an adequate trauma, but all had tears in the middle one third of the meniscus (red/white zone). At the 1-year follow-up, none of the remaining 32 patients had clinical symptoms indicating a rerupture such as blocking, medial joint pain, or positive meniscus signs. No patient had an effusion or local swelling. The average pretraumatic Lysholm score decreased from 95 to 91 points. The Tegner activity score decreased from 4.9 (pretrauma) to 3.6 (postoperatively). CONCLUSIONS: Short-term clinical results using an all-inside meniscus repair system seem to be promising. However, a longer follow-up is needed.