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Background: To assess the efficacy of surgical treatment of intra-articular knee venous malformations (VM)., Methods: Between 1998 and 2010, 8 children (mean age: 12.3 y) underwent surgical resection of their vascular malformation (7 venous and 1 capillary venous) involving the knee joint. The lesion was diffuse in 6 cases and well-demarcated in 2 cases. All children were suffering from knee pain and had recurrent hemarthroses. Color-Doppler ultrasonography, magnetic resonance imaging, computed tomography scan, and blood test were performed preoperatively. Preoperative and postoperative physical examination, clinical symptoms, and orthopaedic evaluation were retrospectively reviewed. Surgery consisted in arthrotomy with total excision of the vascular malformation for the 2 well-demarcated lesions and synovectomy with squeezing of the surrounding vascular malformation for 5 diffuse lesions. One patient with an extensive venous malformation associated with severe localized intravascular coagulopathy and mild hemophilia A had undergone synovectomy by knee arthroscopy., Results: Immediate postoperative follow-up was uneventful in 6 patients, whereas 2 patients with diffuse vascular malformation and coagulopathy suffered from postoperative hemarthroses, delaying their rehabilitation. After a mean follow-up of 5.1 years, persistence of the VM within the joint was observed in the 6 initially diffuse lesions. The 2 well-demarcated lesions showed no evidence of disease at latest follow-up. Four patients with preoperative chondropathy and functional impairment were not substantially improved regarding their range of knee motion at latest follow-up, whereas the 4 others were free of symptoms. Only 1 patient presented a recurrent hemarthroses after a 5-year-symptom-free period and had to be reoperated. Patients without preoperative chondropathy recovered normal knee function mobility., Conclusions: This retrospective study highlights the importance of early surgery in patients with intra-articular venous malformation, even if asymptomatic, to prevent joint impairment. For well-demarcated lesions, total resection by arthrotomy can provide definitive healing without resuming of symptoms. Although diffuse lesions treated by synovectomy still persist in the joint, treatment avoids recurrence of hemarthroses and, therefore, protects the cartilage from further erosion., Level of Evidence: Level IV-cases series.

Purpose: To assess the effectiveness of dual-detector row spiral computed tomographic (CT) arthrography of the knee in the evaluation of the postoperative meniscus for recurrent or residual meniscal tear., Materials and Methods: Spiral CT arthrography was performed in 20 patients who presented with pain after partial meniscectomy. Findings at the initial reading of the images and at two retrospective independent readings were compared with those at second-look arthroscopy performed in all patients. At initial interpretation, conventional criteria for meniscal tear were used, including partial- or full-thickness tear of any size and meniscal separation. At retrospective interpretation, criteria for meniscal tear included large partial- and full-thickness tear and meniscal separation but not small partial-thickness tear. Sensitivity and specificity for the detection of tear of the postoperative menisci were calculated for initial and retrospective readings., Results: At initial interpretation, the sensitivity and specificity for the detection of tear of the postoperative menisci were 100% and 78%, respectively. At retrospective interpretation, the sensitivity and specificity for the detection of tear of the postoperative menisci were 79% and 89% at reading 1 and 93% and 89% at reading 2, respectively., Conclusion: Spiral CT arthrography is valuable for the assessment of postoperative menisci, but the application of conventional definitions of meniscal tear to arthrographic findings in postoperative menisci can lead to overestimation of the clinical importance of meniscal lesions.

Computed tomography imaging has achieved excellent multiplanar capability and submillimeter spatial resolution due to the development of the spiral acquisition mode and multidetector row technology. Multidetector spiral CT arthrography (CTA) yields valuable information for the assessment of internal derangement of the joints. This article focuses on the value of spiral CTA of the knee in the assessment of the meniscus, anterior cruciate ligament, and hyaline cartilage lesions. Advantages and disadvantages of spiral CTA with respect to MR imaging are presented.

Computed tomography (CT) has gained multiplanar capability and submillimeter spatial resolution due to the development of spiral acquisition mode and multidetector row technology. Multidetector spiral CT arthrography of the knee is a valuable imaging modality for the assessment of lesions of the meniscus, anterior cruciate ligament (ACL), and articular cartilage. This article presents the value of spiral CT arthrography in the assessment of the postoperative knee with emphasis on the postoperative meniscus, articular cartilage, and ACL graft. This technique may be proposed as an alternative to magnetic resonance arthrography.

Purpose: To assess dual-detector spiral CT arthrography in the evaluation of the entire knee cartilage obtained from cadavers., Materials and Methods: Two independent observers characterized articular cartilage in 12 cadaver knees in which MR imaging and dual-detector spiral CT arthrography were performed and compared their findings to those found during macroscopic assessment. The sensitivity and specificity of MR imaging and spiral CT arthrography for detecting grade 2A or higher and grade 2B or higher cartilage lesions, the Spearman correlation coefficient between arthrographic and macroscopic grading, and kappa statistics for assessing interobserver reproducibility were determined., Results: At spiral CT arthrography, sensitivities and specificities ranged between 80% and 88% for the detection of grade 2A or higher cartilage lesions and ranged between 85% and 94% for the detection of grade 2B or higher cartilage lesions. At MR imaging, sensitivities and specificities ranged between 78% and 86% and between 76% and 91% for the detection of grade 2A or higher and grade 2B or higher cartilage lesions, respectively. Spearman correlation coefficients between spiral CT arthrography or MR imaging and macroscopic grading of articular surfaces were 0.797 and 0.702, respectively., Conclusion: Dual-detector spiral CT arthrography of the knee is a valuable method for the assessment of open cartilage lesions of the entire knee.

Knowledge of precise anatomic landmarks and relationships of the distal femur can be helpful in knee surgery, especially primary and revision total knee arthroplasty. We analyzed 104 consecutive routine knee magnetic resonance imaging studies to define useful landmarks and relationships. The epicondyles are described, and the relationship of the epicondyles to the joint line is defined in multiple planes. Some significant gender differences were noted. The distance from the epicondyles to the joint line correlates with the transepicondylar width of the distal femur. This information can be helpful in determining appropriate joint line position intraoperatively. The posterior condylar angle averaged 3.11 degrees for all patients, and a tendency for the posterior condylar angle to increase with age was noted, but further study of this tendency is needed.