Partial meniscectomy and osteoarthritis. Implications for treatment of athletes.

The biphasic ultrastructure of the meniscus and of articular cartilage provides their function in the complex biomechanics of the knee joint including load distribution, shock absorption, viscoelasticity, a smooth low friction gliding surface and resilience to compression. Meniscectomy may lead to destruction of cartilage and to osteoarthritis of the knee joint. Osteoarthritic changes after meniscectomy have been reported in up to 89% of patients. Retrospective analysis after open or arthroscopically assisted meniscectomy revealed restriction in sports to be between 2 and 50% and cessation of sports to be between 2 and 25%. Generally, patients with degenerative changes at the time of surgery are reported to have lower knee joint function and to resume sports activities later. Pharmalogical measures to treat osteoarthritis following previous meniscectomy include pain medication and intra-articular drug administration. Additionally, range of motion and strengthening exercises and moderate athletic activities are recommended. When surgery is considered, correctional osteomies and unicompartmental or total knee arthroplasty depending on the degree of osteoarthritis are preferred.

[Ligament instability after arthroscopic partial medial meniscus resection]. / Bandinstabilität nach arthroskopischer medialer Meniskusteilresektion.

Two hundred consecutive patients were treated for medial meniscus lesions by partial arthroscopic medial meniscectomy. Only patients with intact cruciate and collateral ligaments prior to surgery and at arthroscopy were accepted for the study. Although all patients denied a new trauma, 12 patients (6%) were found to have increased anterior instability and 43 patients (22%) to have increased medial instability at follow-up 53.5 months after surgery. KT-1000 measurements in knees with increased anterior tibial translation revealed an average side-to-side difference of 4.7 mm.

[Measuring intraosseous pressure of the patella: theoretical principles--animal experiment studies. Part I]. / Die intraossäre Druckmessung an der Patella: theoretische Grundlagen--tierexperimentelle Untersuchungen. Teil I.

There are few reports in the literature about measurement of intraosseous venous pressure in bone. Necrosis of the femoral head was found to be related to higher intraosseous venous pressure. Values varied widely. Pain is thought to result when an individual critical intraosseous venous pressure is exceeded. From June 1986 to May 1987, 16 full-grown male rabbits were tested at the histological laboratory at the University of Innsbruck. The purpose of the study was to assess the intraosseous venous pressure of the patella and the revascularization and regeneration of cartilage following patella drilling. When animals were killed 3 months later, their patellas were filled with ink/gelatin. Histologically, there were numerous capillaries and new vessels in the drill-holes. The defect was filled with collagenous tissue. At the surface it differentiated into cartilage, similar to hyaline cartilage. Measurements of intraosseous venous pressure and phlebographies were also performed in four patellas in sheep at the research laboratory for experimental surgery in Davos, Switzerland. Intraosseous veins were filled with Biodur for further histological investigation.

[Measuring intraosseous pressure and osseous venography of the patella in anterior knee pain. Part II]. / Die intraossäre Druckmessung und ossäre Venographie der Patella beim vorderen Knieschmerz. Teil II.

"Anterior knee pain" is a rather meaningless term used for various forms of knee joint discomfort. Failure of venous drainage increasing intraosseous venous pressure is a cause that has hardly been considered hitherto. When exploratory surgery is performed to explain unknown anterior knee pain intraosseous venous pressure of the patella can be measured very easily during arthroscopy. Intraosseous venous pressure of the patella in patients with anterior knee pain was consistently documented higher than reported in the literature. There was a significant relationship between intraosseous venous pressure and number of veins. Intraarticular damage of cartilage did not correlate with intraosseous pressure. Drill holes in the patella reduced intraosseous pressure, as documented in an animal model. From June 1988 to October 1989 measurements and phlebographies of the patella were taken in 46 patients. Intraosseous venous pressure of 25 mmHg was considered normal. Among 46 patients treated with drill holes in the patella, six patients improved and had no symptoms following surgery. None of the patients was worse after surgery.

Arthroscopic Bankart procedure by suture technique: indications, technique, and results.

The arthroscopic Bankart procedure by suture technique was performed in 31 patients (1984-1987). In 22 of the cases, the minimum follow-up was 2 years. Fourteen patients had sustained a primary traumatic complete dislocation resulting in unidirectional instability, and eight patients experienced recurrent subluxation. Clinical examination demonstrated positive labrum pathology in all cases, which was proven in five patients by contrast computed tomography scan. None of the 22 patients experienced intraoperative complications or infection. A slight loss of abduction was found in two patients, and a minimal loss of external rotation was found in five patients, but there was no recurrence of complete dislocation of subluxation.

[Arthroscopy of traumatic hemarthrosis following sports injuries. A 5 year analysis]. / Arthroskopie des traumatischen Hämarthros nach Sportverletzungen. Eine 5-Jahres-Analyse.

This retrospective study was made to evaluate the significance of different sports activities that cause variable haemarthrosis with intraarticular lesions of the knee joint. Throughout 1984 to 1988 arthroscopy was performed in 337 patients with acute haemarthrosis. The average time between trauma and arthroscopy was 8 days. ACL rupture was diagnosed in most of these cases. Regarding the different types of sport activities ACL lesions were found in skiers (74%), other winter sports (47%), soccer (53%), tennis and squash (58%), athletics (41%) and indoor (61%). Peripheral meniscus tears associated with haemarthrosis were found in 36% and patellar dislocations in 8%. Isolated MCL ruptures were diagnosed clinically and arthroscopy was not performed in these cases. Throughout 1987 isolated ACL ruptures were fixed by reattachment. This technique was not continued any longer and ACL replacement by patellar tendon as bone-ligament-bone was performed routinely since 1988 in those patients, who required surgery. 56 patients required ACL reconstruction following conservative treatment because of ACL deficiency, when they went back to sports activities. Longitudinal peripheral meniscus tears were fixed by the scape in inside-out technique.

[Pathology, diagnosis and therapy of patellar dislocation]. / Pathologie, Diagnose und Therapie von Patellaluxationen.

Patella dislocation in sports trauma is a common injury and is influenced by minor alterations or derangements of dynamic or static factors. The sulcus angle should not exceed 138 degrees and the Q angle should not be more than 15 degrees. Patella alta has some influence on the dislocation tendency, and so has weakness and atrophy of the musculus vastus medialis obliquus, causing muscular imbalance. Diagnosis is made via x-ray in tangential as well as a.p. and lateral view. Clinical examination of the patella reveals in lateral dislocation or redislocation can be provoked after positioning. Tenderness is present along the medial retinaculum associated with haemarthrosis in most of the cases. Conservative treatment includes evaluation of haemarthrosis and physiotherapy especially with regard to strengthening the vastus medialis obliquus. Surgery includes lateral release and medial capsular plication or transposition of the patellar tendon for correction of the Q-angle.

[Knee joint hemarthrosis--differential diagnostic considerations for planning an operation]. / Der Kniegelenkhämarthros--differentialdiagnostische Uberlegungen zur Planung einer Operation.

From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Technical errors and early complications of osteosynthesis of pertrochanteric femoral fractures using the dynamic hip screw]. / Verfahrensfehler und Frühkomplikationen bei der Osteosynthese pertrochanterer Oberschenkelfrakturen mit der dynamischen Hüftschraube.

Within a period of 3 years, 198 patients with pertrochanteric fractures were operatively treated with implantation of the dynamic hip screw: 141 were female and 57 male (ratio of 2.5:1). The youngest patient was 27 and the oldest 100 years of age (average 74.4 years). Most preoperative failures in management were caused by insufficient reduction when no valgus of the femoral head and neck was achieved. Some patients had ulcers in the genital region because of forced reduction on the traction table, and in one of these cases plastic surgery was necessary. Intraoperative failures may occur because of too early removal of the guide pin, which should remain in the center of the femoral head until the screw is placed in the right position. Postoperative complications are caused by full weight bearing, which leads to varus and recurvation malposition. In 2 cases, deep wound infection occurred. The plate broke out in 3 cases, 2 of those required reoperation. Six patients between 61 to 84 years of age died in the early postoperative period during their stay in hospital.

[The value of arthroscopy following traumatic patellar dislocation]. / Die Wertigkeit der Arthroskopie nach traumatischer Patellaluxation.

Traumatic dislocations of the patella and associated osteochondral fractures can be easily diagnosed by arthroscopy. During 1984-1986 acute arthroscopy was performed in 280 patients with traumatic haemarthrosis of the knee joint. In 26 cases the intraarticular bleeding was caused by patellar dislocation. Most of these injuries occurred during sports activities. Arthroscopic surgery gave excellent results in most of the cases. Arthrotomy had to be performed in 3 patients only.

[Partial meniscus arthroscopic resection]. / Die arthroskopische Meniskusteilresektion.

Arthroscopic meniscectomy was performed in 393 patients in the "three portal technique" in the years 1981 through 1983. The medial meniscus showed a bucket handle tear in 40.3% and a flap tear in 37.3% whereas the lateral meniscus showed a bucket handle tear in 12.2% and a flap tear in 46.1%. More than one third of the meniscus lesions were associated by chondromalacia of patella or femoral condyle. Arthroscopic meniscectomy was combined with shaving of the cartilage or shaving and arthroscopic subchondral drilling in 71 cases. Second-look arthroscopy was performed in 10 patients because of rupture of the remnant rim after the first partial meniscectomy.

[Significance of acute arthroscopy for the verification of fresh isolated cruciate ligament rupture]. / Die Bedeutung der Akutarthroskopie für die Verifizierung der frischen isolierten Kreuzbandruptur.

Arthroscopy for diagnosis in isolated rupture of the cruciate ligaments of the knee. Arthroscopy of the knee was performed in the years 1981 through 1983 in 1107 patients, arthroscopic meniscectomy in 340 patients. In acute traumatic haemarthrosis of the knee 74 "isolated" ruptures of the cruciate ligaments were found. The exact disclosure of these 74 cases gave a real isolated rupture of the anterior cruciate in 28.4%, an isolated rupture combined with meniscus tears and connected with flake fracture each in 20.3%. In 17.5% the exact diagnosis was a disruption of the anterior cruciate together with meniscus tears and flake fracture. Acute arthroscopy allows a more accurate diagnosis of injury to joint structures. If there was an intraligamentary rupture of the anterior cruciate and meniscus tear or flake fracture we did arthroscopic meniscectomy and removed the small flake. The substitution of the anterior cruciate was performed, if there were instability complains, later on at agreeable time for the patient.