Arthroscopy and arthrography.
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The author analyzes 132 arthrograms of patients operated on for involvement of the rotating cuff of the arm. The reliability of this technique for the detection of a complete rupture of the cuff of the arm and its inability to assess the size of the rupture and degree of retraction of the cuff of the arm are shown. Arthrographic patterns of the condition are presented.
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The atlantoaxial joints of nine cadavers were examined with Amipaque. A lateral percutaneous approach was elaborated. Interarticular communications and pertinent anatomical features were analyzed.
In four groups of patients with normal patellar cartilage, synovitis, patellar chondropathy , and degenerative changes of the patellar surface of the femur, the anatomical relationships within the medial compartment of the patello-femoral joint were examined. Clear differences were observed between these groups in the incidence of visualization of the medial alar plica and the mediopatellar synovial plica. As a consequence, an explanation has been sought for the occurrence of patellar chondropathy and degenerative changes of the patellar surface of the femur. It seems probable that a long-standing traumatic synovitis with effusion, attenuation of the synovial membrane, and the composition of the synovial fluid can lead to patellar chondropathy . The degenerative changes of the patellar surface of the femur are usually secondary to those of the load-bearing patellar facet. Insufficient covering of the cartilage by soft tissue may play a role in chondropathy of the nonload -bearing portion of the patella and the femoral condyle.
The presence or absence of a meniscal tear was established in 340 out of 475 consecutive patients who had double contrast knee arthrograms. The accuracy in these 340 cases was 95% for both the medial and lateral menisci although the specificity for lateral tears was only 0.64. Analysis of the pattern of arthrographic abnormalities revealed that both medial and lateral tears usually involved the posterior horn of the meniscus. Posterior horn abnormalities rarely caused a false positive diagnosis of a meniscal tear. In contrast, isolated blunting of the anterior horn of either the lateral or medial meniscus was an unreliable sign of a tear and accounted for many of the false positive diagnoses. It is concluded that careful attention to the posterior horn of each meniscus is essential for accurate arthrographic diagnosis of a meniscal tear.
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