Search

In 228 knees submitted to arthrotomy following arthroscopy, there were eleven diagnostic errors in those knees examined under general anesthesia and five diagnostic errors in those knees examined under local anesthesia with a diagnostic accuracy of 91.1 and 95.2 per cent, respectively. Therefore, we concluded that accuracy is not diminished by performing arthroscopic examinations under local anesthesia on ambulatory out-patients. In 297 knees examined under local anesthesia, no complications were encountered. In 282 knees examined under general or spinal anesthesia, there was one pulmonary embolus and two significant hemarthroses. Except when there are specific overriding considerations, local anesthesia is preferable in the performance of diagnostic arthroscopy.

Damage to the articular cartilage does occur, on occasion, during the course of diagnostic arthroscopy and arthroscopic surgery. Because of this, we decided to do an arthroscopic gross and histologic study of the alterations in the articular cartilage and the underlying bone that we produced in the joints of dogs. Depending upon the instruments used and the depth of the lesion created, various types of lesions were produced in the cartilage, including track-like fissures, patch-like defects, and even superficial damage to the subchondral bone. Superficial lesions reaching only to the transitional zone were repaired by a smoothing of the edges of the defects. In the deeper lesions, repair consisted of a flat fibrous covering with sclerosis of the subchondral bone. These defects were followed for a period of 6 months, and in no case did a complete filling in occur. We realize that this animal experimental study is not a model for human osteoarthritis, but it casts some light on the importance of iatrogenic lesions of the joint. This study was carried out for the purpose of drawing attention to damage of the articular cartilage that can occur during arthroscopic surgery, especially in narrow joint spaces. These findings underline the need for responsible and effective education in the field of diagnostic and therapeutic arthroscopy.

One hundred twenty knees were examined prospectively with both axial computed tomography (CT) and magnetic resonance (MR) imaging to compare the value of these techniques in patients with clinical evidence of meniscal tears. Sixty-four of these knees were subsequently evaluated with diagnostic arthroscopy. In this group, CT was superior to MR imaging for meniscus evaluation in 29.7% of the knees, equal to MR in 54.7%, and inferior to MR in 15.6%. Although surface-coil MR imaging shows great promise and has numerous advantages over more conventional techniques, this preliminary experience suggests that, at least with certain imaging equipment and techniques, CT may be slightly more efficacious than 0.5-T MR imaging in meniscus evaluation. However, further comparative studies at higher field strengths are needed before the relative roles of CT and MR imaging can be established.

We present our technique of diagnostic and surgical arthroscopy of the shoulder and describe the normal and normal variational arthroscopic anatomy of the structures within the shoulder joint. To ensure accu racy, strict attention is given to consistent patient po sition and technical detail. Posterior and anterior portals are consistently located with the aid of bony anatomic landmarks. Using a large diameter angled arthroscope, structures within the shoulder joint are identified and examined in sequential order. Diagnostic arthroscopy of the shoulder can be systematic and reproducible when the surgeon is knowledgeable of the normal and normal variational anatomy of the shoulder and when attention is given to accurate placement of the arthro scopic portals and to consistent surgical technique.

The authors present a modified technique of ankle arthroscopy and describe the intra-articular anatomy of the ankle joint as it relates to the establishment of arthroscopic portals. Cadaveric dissection was used to demonstrate the relationship of the tendons and neurovascular structures to the placement of the arthroscope. Diagnostic arthroscopy of the ankle can be systematic and reproducible when the surgeon is knowledgeable of the intra-articular and extra-articular anatomy of the ankle and when attention is given to accurate placement of the arthroscopic portals and to consistent surgical technique.

The authors performed 396 knee arthroscopies on athletic patients under general or spinal anesthesia. One hundred-fifty patients underwent arthroscopy after a careful history and physical examination. The clinical diagnosis was correct in 97 patients, correct but incomplete in 25 patients, and incorrect in 28 patients. Our total clinical accuracy rate was 71%. Arthros copy increased accuracy from 71 to 97%. The remaining 153 patients had knee arthrography before undergoing diagnostic arthroscopy. The arthrographic accu racy rate for the medial compartment was 63% and for the lateral compartment was 36%. Arthroscopic accuracy rate for these patients was 95% for the medial and 97% for the lateral compartments. Two hundred of the 250 arthroscopies were followed by immediate arthrotomy. There were no deep or superficial infec tions. Arthroscopy, when compared to our clinical impression and arthrography, was the most accurate diagnostic aid. Using it we made the correct diagnosis in 392 out of 396 patients.

We report a case in which arthroscopic surgery was successfully performed for synovial chondromatosis of the hip, and report an experience with diagnostic arthroscopy of this joint

In the population of Malmo 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.

We have reviewed 167 conventional total meniscectomies with the aim of analyzing the long-term results. One hundred and twenty-five patients came to the hospital for personal view, and the Lysholm test was applied in each case. There was a 14.4% diagnostic error that caused us to remove the meniscus without demonstrable pathology. A systematic introduction of diagnostic arthroscopy has clearly modified this situation. A decision to remove a meniscus should not be based solely on clinical findings; arthroscopic confirmation is necessary. The overall acceptable results (64.5%) revealed that conventional total meniscectomy is not an operation that belongs in the past. We believe it is an alternative to be considered every time diagnostic arthroscopy shows that it is impossible to leave a stable and uniform meniscal rim.

A study of 75 patients was performed to assess the accuracy of arthroscopy carried out for clinical diagnosis of meniscal tear. In these patients, arthroscopy did not detect any intraarticular pathology that could explain the preoperative symptoms. Of the 75 patients, seven were subsequently reoperated on, but in 68 the typical symptoms of meniscal tear improved after the diagnostic arthroscopy.

There is a definite role for arthroscopy in the diagnosis and treatment of problem knees in children and adolescents. In this series, the largest reported to date, significant intraarticular pathology frequently existed in both préadolescent and adolescent groups. Three hundred ten knee arthroscopies in 285 children were reviewed. Preoperative clinical diagnoses were correlated with arthroscopic findings. In préadolescents (12 years old and younger), only 55% of preoperative clinical diagnoses were confirmed at surgery. Thirty-five percent of this group were found to have additional pathology not anticipated preoperative^. In adolescents (13 to 18 years old), 70% of clinical diagnoses were confirmed arthroscopically. Additional pathology was also found on arthroscopic examination in 25% of this group.

It has been known for years that diagnostic arthroscopy is capable of clarifying even clinically concealed meniscus lesions. After learning the diagnostic technique many workers have sought to exchange the inserted small hook for the scissors or basket forceps and to undertake arthroscopic operations. In many cases the operation has proved difficult and time-consuming. In operational management this makes the exact planning of a large operating program impossible. If diagnostic arthroscopy is being performed under local anesthesia, any operative procedure need not and should not take longer than 1 h. For these reasons, Gachter has advised miniarthrotomy under arthroscopic monitoring, which constitutes a compromise for the beginner. The diagnosis is established arthro-scopically.

Diagnostic arthroscopy of the human temporomandibular joint was investigated on both fresh human cadavers and presurgical arthrotomy patients. It was possible to visualize all of the major anatomic structures in the superior joint space. Inferior joint space techniques were explored on cadavers but not perfected for clinical use. Closed arthroscopic surgical techniques were performed on the cadaver specimens using a variety of instruments such as probes, miniature biopsy forceps, and motorized soft tissue resection and bone abraiding devices.

Diagnostic arthroscopy can be applied to the bovine stifle to directly visualize the menisci, cranial and caudal cruciate ligaments, the articular surfaces, and the synovium. Basic arthroscopic technique for the bovine stifle hock is described using line drawings and endophotography. Examples of joint lesions as seen through the arthroscope and at postmortem dissection are presented.

This study refers to a survey concerning 39 French operators who effected 25 433 arthroscopies. 44% were for diagnostic arthroscopy and 56% for operative arthroscopy. Arthroscopy was done with either local, loco-regional or general anesthesia (22629 cases).

Lateral release is a reliable component of any surgical treatment of patellofemoral dysfunction or “chondromalacia patella,” good to excellent results in approximately 80% of cases having been reported by numerous investigators. This study confirms the efficacy of the procedure and highlights the features of the open technique as compared with the arthroscopic method. We advocate diagnostic arthroscopy for complete evaluation of the joint. Particular attention is drawn to the anatomic structures that must be divided and the care taken to secure hemostasis to optimize results. Since no correlation was found between the severity of chondromalacia and the final results, this study casts doubt on the value of shaving the rough articular surface.

Seventy-six children under 16 years of age (mean age 14.5) underwent diagnostic arthroscopy of the knee. Seventeen were examined under local anaesthesia as outpatients. The referring doctors suspected a meniscal lesion in 25 cases, but in only 6 of these was the diagnosis confirmed. The surgeon's diagnosis was verified in 9 out of 31 cases; unsuspected lesions of both menisci in one knee make a total of 10 patients with meniscal lesions (10 knees, 11 menisci). The most frequent lesion found was rupture of the anterior cruciate ligament (12). Because of the arthroscopy, three minor meniscal lesions could be observed without treatment, and no menisci were totally removed. In two cases an arthrotomy would have been done on the wrong side of the knee if the operation had not been preceded by arthroscopy. Fifteen arthroscopic operations were done but only three for meniscal lesions.

We describe the results of arthroscopic partial resection of isolated flap tears of the menisci in 37 patients who were randomly selected for review from the hospital records. The results were compared with those in a control group of 39 patients that underwent diagnostic arthroscopy during the same period. The follow-up of the patients after 1 to 2 years was based on a questionnaire. The patients with resected flap tears did better than the controls, who usually suffered from minor degenerative changes of the knee joint. However, the flap-tear patients with otherwise usually normal arthroscopic findings often continued to have discomfort and failed to gain a normal Lysholm score.

The knee positioning device presented above fulfills all requirements to be met for positioning the leg for all procedures on the knee. Possible adjustments during the surgical procedure can be carried out by the operating surgeon or his assistant while maintaining the asepsis. It allows immediate arthrotomy after the diagnostic arthroscopy has been carried out without demanding a new sterile covering.

A case of a rare, large discoid medial meniscus with a bucket-handle tear is described. The radiogram was normal and the clinical impression was torn medial meniscus. A diagnostic arthroscopy revealed an unusually large medial discoid meniscus with a bucket-handle tear. Open partial excision was performed following the arthroscopy.

Arthroscopic Surgery of the Knee is a concise and precise description of the use of the arthroscope as a diagnostic and operative tool in the treatment of knee disorders.Dandy first presents an excellent review of the development of endoscopic techniques from the first report of endoscopy by Bozzini in 1806 until the present. Next, he clearly outlines his techniques for diagnostic arthroscopy, giving detailed descriptions of equipment needed, organization of the operating room staff, and useful portals of entry and a guide to successful viewing of each compartment of the knee. The remainder of the text is devoted to explaining the techniques of operative arthroscopy, including synovial biopsy, loose body removal, plica resection, lateral release, chondral shaving and drilling, and partial meniscectomy.The author rightly cautions the reader that arthroscopy and arthroscopic surgery require practice and patience. "Although the results of arthroscopic surgery are remarkably successful, the procedures are

This study explores the impact of a careful analysis of 1000 consecutive cases of diagnostic arthroscopy conducted by the author. The cases are evaluated to determine whether there is a tendency to clinically misdiagnose certain lesions. The findings furthered knowledge in regards to other possible diagnoses for specific symptom complexes. Diagnostic arthroscopy has allowed surgeons to " fine tune" their preoperative diagnostic ability and can be a very useful enhancement to the armamentarium of clinical evaluations, laboratory tests, plain radiographs, and double contrast arthrograms as diagnostic tools for knee problems. An "audit" procedure is outlined that could benefit any surgeon who is concerned about increasing their diagnostic ability.