The meniscal flounce: a valuable arthroscopic sign.

PURPOSE: The purpose of this study was to characterise the incidence and significance of the meniscal flounce. TYPE OF STUDY: Prospective Cohort Study. METHOD: A prospective study of 1088 consecutive knee arthroscopies. RESULTS: Intact menisci tended to have a flounce of characteristic size and position. The presence of this 'normal' flounce was closely correlated with an intact meniscus (p<0.0001). For the medial meniscus with a small flounce in zone 3 the sensitivity, specificity, and positive predictive value (PPV) for an intact medial meniscus were 68.5%; 92.9%; and 92.1% respectively. Conversely the presence of meniscal pathology correlated closely with either an absent or abnormal flounce (p<0.0001). The absence of a medial flounce had sensitivity, specificity, and PPV for a meniscal tear of 82.8%; 84.9%; and 81.9% respectively. CONCLUSIONS: The findings of this study are useful for arthroscopists especially when there is difficulty visualising all of the posterior half of the meniscus. In this situation the presence of a normal flounce is likely to signify an intact meniscus. However the presence of an abnormal or absent flounce may be the sign of an occult meniscal tear requiring better exposure.

Common pitfalls and the treatment of fractures.

In summary, the management of fractures is not easy. The clinician must be familiar with fractures and their management and their potential complications. If the problem appears to be outside the scope of a doctors training, it is best referred earlier rather than later.

Medium term results of per-operative knee arthroscopy in confirming suitability for unicompartmental arthroplasty.

INTRODUCTION: The status of the lateral compartment of the knee is a determining factor in the long-term outcome of medial unicompartmental arthroplasty (UKA). Various methods of assessing the lateral compartment have been used including stress radiography, radioisotope bone scanning, magnetic resonance imaging and visualisation at the time of surgery. Arthroscopy is another means of directly assessing the integrity of the articular cartilage and the meniscus in the lateral compartment. PURPOSE: This study aims to show that per-operative arthroscopy is a safe and effective means of deciding whether to proceed with UKA or convert to total knee arthroplasty (TKA). METHOD: We have used arthroscopy of the lateral compartment to assess suitability for UKA in 151 knees over 8 years. RESULTS: At time of arthroscopy 34 knees underwent a change of surgical plan from UKA to TKA (22.5%). There has been one revision to TKA and 2 bearing exchanges for dislocation. CONCLUSION: Immediate per-operative arthroscopy is a reliable method for assessing the suitability of a knee for UKA, in particular the lateral compartment.