Concealed knee cartilage lesions: is arthroscopic probing therapeutic?

We report on 34 knee arthroscopic procedures (of 976 knee procedures performed during a 2-year period) performed on patients with chronic knee symptoms or symptoms mimicking a torn meniscus. All patients had deep articular cartilage lesions over which the superficial cartilage appeared normal. These lesions were not diagnosed on radiographs, magnetic resonance imaging, or bone scintigraphy. Only careful arthroscopic probing disclosed the deep cartilage separation. The treatment consisted of cartilage puncturing with a probe, which in 14 cases led to the evacuation of blood. This simple technique produced resolution of symptoms in 30 (88.2%) patients. This condition affects athletes and soldiers undergoing military training and, in many cases, is an expression of an overuse syndrome. The incidence of these lesions was 3.5% in a series of relatively young patients. The lesion should be suspected in cases of unexplained knee pain in the athlete and soldier and in patients with previous negative arthroscopic examinations or meniscal lesions that were treated but remained unresolved. To our knowledge, bleeding from "closed" cartilage lesions has not been previously described. We raise the question of whether arthroscopic probing and cartilage puncturing is the method of treatment.

Femoral notchplasty in the treatment of malunited intercondylar eminence fractures of the tibia.

A block of full extension may occur after malunion of an intercondylar tibial eminence fracture. Five patients with this complication were treated by arthroscopic femoral notchplasty. At follow-up, between 6 months and 5 years, four patients had regained full extension and the fifth was improved. This is an effective method of regaining extension in selected patients.

Arthroscopic treatment of sports-related synovitis of the ankle.

We describe nine cases of sports-related synovitis of the ankle joint with a followup of 24 to 44 months (average, 30.9). It affects young athletes and occurs after episodes of acute or recurrent inversion ankle sprains or undisplaced ankle fractures. The patients complain of morning pain and stiffness along with increased pain and swelling with attempted athletic participation. All ankles were stable and all failed to respond to at least 6 months of conservative treatment. The technetium bone scans were positive in eight of the cases. During arthroscopy, a hypertrophic anterior-chamber synovitis was found and treated by arthroscopic partial synovectomy. The results were excellent in eight of the patients in whom symptoms resolved, allowing full return to their previous sports, and fair in one case. The only complication was one superficial wound infection.

Percutaneous automated biopsy in the diagnosis of primary infectious spondylitis.

Three cases of primary infectious spondylitis, two caused by Staphylococcus aureus and one by tuberculosis, were diagnosed using the method previously described for automated percutaneous discectomy. All three patients, in whom biopsy using fine needle techniques previously was unsuccessful, had positive cultures from specimens obtained using the automated method. The method combines the advantages of local anesthesia and minimal morbidity with the obtaining of adequate material for culture and pathological examination.

Arthrolysis of the elbow. 13 cases of posttraumatic stiffness.

On an average 5 years after arthrolysis for posttraumatic stiffness of 13 elbows, motion was good in eight, fair in three, and poor in two. The poor cases were reoperated on with unsatisfactory results.

The proximal tibio fibular joint. An anatomical study with clinical and pathological considerations.

The proximal tibiofibular joint (TFJ) was studied in 489 dry bones and 50 specimens of dissected knees. A marked variability in morphological characteristics was found with frequent osteoarthritic changes. The most common types of joint found were the trochoid and the double trochoid, followed by the plane type. No articular facet could be recognised in 10 dry fibulae and 12 dry tibiae. The inclination of the joint ranged between 5 degrees and 80 degrees. Osteoarthritis of some degree was present in the TFJ joint in 83 fibulae (27%) and 80 tibiae (38%). It was associated with osteoarthritis of the knee joint, especially affecting the medial compartment, in 30% of cases. Osteoarthritis of the TFJ was also found in a case of multiple exostoses and in a specimen with Bejel disease. No correlation could be established between the presence of the 'squating facets' in the distal end of the tibia and the morphological characteristics or pathology of the TFJ. A clinical case of osteoarthritis of the TFJ in a women of 57 is presented, and the differential diagnosis of pain over the lateral aspect of the knee is discussed.

Synovectomy of the elbow in rheumatoid arthritis.

Twenty-five synovectomies of the elbow were performed in twenty-one patients with rheumatoid arthritis, and the patients were followed for two to eleven years. All patients had an advanced stage of the disease, with disintegration of cartilage and severe erosions of bone. The operations were performed by the same surgeon using the same technique. Follow-up studies revealed various degrees of improvement in all patients. The improvement in motion was most evident in rotation of the forearm. Pain was diminished in all but three patients. In five elbows a few degrees of flexion and extension was lost. The favorable response to synovectomy was retained throughout the follow-up period in twenty-four elbows. In only one elbow was there recurrence of the synovial swelling, about eight years after the operation.