Total meniscectomy in adolescence. A thirty-year follow-up.

We have carried out a prospective, longitudinal 30-year review of 95 adolescents who underwent total meniscectomy in one knee, and have compared the results with those observed 13 years earlier. All the medical records were scrutinised. Of the 63 patients reviewed clinically, 47 reported decreased sporting activity, although subjective satisfaction rose by 3% to 71%. The scores on the WOMAC osteoarthritis index differed significantly between patients grouped by subjective global assessment. Satisfactory function scores increased from 48% to 60%. In the 53 patients consenting to bilateral radiography of the knee, the incidence of narrowing of the articular cartilage in the operated knee increased significantly between the reviews (19% to 36%). Progression of degenerative change paralleled reduction in activity. Outcome measures were best after medial, intermediate after lateral and worst after double meniscectomy.

Meniscal regeneration in the long-term after total meniscectomy?

A cohort of 39 patients (28 male, 11 female) that had undergone total meniscectomy as adolescents (mean age 16 years) underwent FISP 3D Magnetic Resonance Imaging at a mean follow up of 30 years. The presence of meniscal tissue was assessed by two independent observers blinded to the operation details. The volume of any meniscal tissue present was calculated. A posterior horn remnant was seen in 57% of medial and 45% of lateral meniscectomy cases. The mean volume of an operated medial meniscal remnant was 0.29 mL compared with a mean volume of 1.15 mL for an intact medial meniscus. The mean volume of an operated lateral meniscal remnant was 0.30 mL compared with 1.07 mL for an intact lateral meniscus. We have shown that the incidence of incomplete excision of the posterior horn is more common after total medial meniscectomy, and that at a mean follow up of 30 years there is no convincing in vivo MRI evidence of long-term meniscal regeneration.

A long-term follow-up study of total meniscectomy in children.

The long-term effects of single meniscectomy in 89 children have been analyzed at an average of 16.8 years after surgery. Seventy-four percent were pleased with the outcome, but only 52% or 58% had objectively satisfactory results according to the two scoring systems used. Significantly poorer results were achieved with lateral meniscectomies. The range of movement was significantly decreased after lateral meniscectomy. Minor instabilities were recorded in 45% of the patients and major instabilities in 15%. Anteroposterior and rotatory instabilities were objectively measured, and a significant increase was noted in knees that had lateral meniscectomy. Grade I gonarthrosis was recorded in 39% of the surgically treated knees and Grades II and III gonarthroses in 9%. The joint space was significantly reduced in all knees irrespective of the injured compartment.

Statistical evaluation of the diagnostic criteria for meniscal tears.

The accuracy of diagnosis was tested in a prospective study of 145 patients who were arthroscoped because a meniscal tear was suspected clinically. Multiple variate analysis was used to evaluate 68 different clinical parameters. The clinical accuracy was 61% as a tear was demonstrated in 88 knees; 73 of these tears were associated with other intraarticular abnormalities. Thirteen knees were entirely normal at arthroscopy. It was possible to predict a meniscal tear in 8 out of 10 patients.

Incidence of meniscal lesions in children. Increase associated with diagnostic arthroscopy.

In the population of Malmö the average annual incidence of symptomatic meniscal lesions in children increased from 0.7 to 2.5 per 10,000 from 1960-1965 inclusive to 1980-1985 inclusive. Soccer was the predominant cause of the lesions, and the increased incidence of the diagnosis was associated with the introduction of arthroscopy.

Lateral meniscal lesions in patients with clinically suspected medial lesions.

Double-contrast arthrography and arthroscopy were performed in a prospective study on 46 consecutive patients clinically suspected of having a medial meniscal tear only. At arthrography, 38 torn medial menisci were found; four of them were, however, false-positive and another false-negative as compared with arthroscopic examination. Moreover, seven unsuspected lateral meniscal tears were diagnosed at both arthrography and arthroscopy. The diagnostic accuracy of the double-contrast arthrography was well above the clinical accuracy, and we conclude that arthrography is a reliable method for diagnosing both medial and lateral tears.

Subcapital fractures of the fifth metacarpal bone.

The incidence of upper extremity fractures was 8.8 per 1,000 inhabitants per year. Five per cent of these fractures occurred in the subcapital region of the fifth metacarpal bone. In a patient series the volar angulation after subcapital fracture of the fifth metacarpal bone was determined with a novel technique and related to functional and cosmetic outcome. In spite of volar angulation, the patients' discomfort was minor. An absolute volar angulation exceeding 30 degrees requires reduction, however.