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At least 19 recordsLinked to original sources
PubMed1993

Detection of intraarticular abnormalities in osteoarthritis of the knee. A pilot study comparing needle arthroscopy with standard arthroscopy.

OBJECTIVE: To determine whether intraarticular abnormalities in osteoarthritis (OA) of the knee can be detected as well by needle arthroscopy as by standard arthroscopy. METHODS: Needle arthroscopy followed by standard arthroscopy was performed on 10 patients with knee OA (diagnosed according to American College of Rheumatology criteria) whose symptoms were not entirely attributable to the OA and were therefore an indication for further evaluation. Each knee was assessed for abnormalities of the menisci, articular cartilage (6 sites), and synovium (6 sites). RESULTS: Evaluation of the 18 menisci visualized with both techniques yielded the same results: 6 abnormal and 12 normal. Among the 54 articular cartilage sites evaluable with both procedures, 16 were judged normal by both needle arthroscopy and standard arthroscopy. Of the 38 cartilage sites judged abnormal by standard arthroscopy, 34 (89%) were abnormal by needle arthroscopy. Both techniques indicated cartilage changes were the same at 42 (78%) of the 54 sites; changes at the other 12 sites were 1 grade higher by standard arthroscopy than by needle arthroscopy. Both needle arthroscopy and standard arthroscopy revealed 51 evaluable sites in the synovium. Of 34 areas judged abnormal by standard arthroscopy, 24 (71%) were also judged abnormal by needle arthroscopy; 17 areas were judged normal by both techniques. The 2 techniques assigned the same macroscopic score in 27 (53%) of 51 areas of the synovium, with a higher grade by standard arthroscopy in all but 1 of the other 16 areas. CONCLUSION: These pilot data suggest that in knee OA, needle arthroscopy can 1) accurately detect meniscal abnormalities, 2) detect cartilage abnormalities, but may underestimate the severity, and 3) detect most synovial abnormalities, but often underestimates the severity. Needle arthroscopy is a potentially valuable rheumatologic tool for the assessment of OA of the knee.

Adult↗
PubMedDate not supplied

Knee arthroscopy with the use of local anesthesia--an increased risk for repeat arthroscopy? A prospective, randomized study with a six-month follow-up.

Although there have been many reports of good results when local anesthesia is used with knee arthroscopy, it is not used as a standard anesthetic. Concerns about local anesthesia include the fear of prolonged surgery, which could result in inadequate anesthesia, thus causing the patient unnecessary discomfort. The purpose of this study was to evaluate the risk of repeat arthroscopy and the patient satisfaction rate up to 6 months after knee arthroscopy under local anesthesia. In this prospective, randomized study, 400 patients scheduled for elective knee arthroscopy were allocated to one of three groups: local anesthesia (200 patients), spinal anesthesia (100 patients), or general anesthesia (100 patients). All enrolled patients were asked to complete a questionnaire 6 months after surgery and all of their medical records were reviewed. No repeat arthroscopies occurred in the spinal and general anesthesia groups and only three occurred in the local anesthesia group, a nonsignificant difference. In only one of these three cases was the clinical course altered by the repeat arthroscopy. There was no difference in the satisfaction rate between the three anesthesia groups. We conclude that the choice of anesthesia does not influence the frequency of repeat arthroscopy, satisfaction with the procedure, or recovery at 6 months after knee arthroscopy.

Adult↗
PubMed1993

[Therapeutic possibilities of arthroscopy in chronic painful wrists. Apropos of 27 cases with 55 arthroscopies].

55 arthroscopies of radio- and midcarpal joints of the wrist were performed for chronic wrist pain with a difficult diagnosis and/or treatment. None of the patients suffered a deterioration and no complications were observed. The results were analysed according to Jackson's and Abe's criteria. In the overall series, arthroscopy was considered to be beneficial for the diagnosis in 80% of cases and for treatment in 49% of cases. Wrist arthroscopy was beneficial in 100% of cases for exact evaluation of the lesions of osteoarthritic wrists or wrists with intracarpal disorganisation and guided the subsequent therapeutic indications. Only 41% of cases obtained a therapeutic benefit from arthroscopy, which nevertheless constituted a useful alternative to surgical operations with a long postoperative course, allowing rapid return to work. Arthroscopy was beneficial for the diagnosis in 66% of chronic painful wrists in which the standard radiological and dynamic assessment was normal, by identifying the anatomical lesions. Arthroscopy was not beneficial in 34% of cases, corresponding to patients with no precise clinical symptoms. Arthroscopy was beneficial for treatment in 54% of cases, with complete cure in the majority of cases.

Adolescent↗
PubMed1986

Complications in arthroscopy: the knee and other joints. Committee on Complications of the Arthroscopy Association of North America.

A questionnaire was sent to members of the Arthroscopy Association of North America surveying complications in arthroscopic surgery of the knee and other joints. There were 395,566 arthroscopies reported including 375,069 knee arthroscopies, 14,329 shoulder arthroscopies, 4,478 ankle arthroscopies, 1,569 elbow arthroscopies, and 121 wrist arthroscopies. There were 2,215 complications reported. The overall complication rate was 0.56%. Specific procedures were surveyed for the first time. The complication rate reported for meniscal repair was 2.4%. The complication rate in anterior cruciate ligament (ACL) procedures (repairs and reconstructions) was 1.8%. The procedure with the highest complication rate was the anterior staple capsulorrhaphy of the shoulder (5.3%). Surgery in the subacromial space resulted in a complication rate of 0.76%. None of these complication rates included failures. As newer procedures are instituted into clinical practice that involve various joints, and are more technically demanding, the complication rate is increasing.

Anesthesia↗
PubMed2007

Second-look arthroscopy after arthroscopy-assisted treatment of tibial plateau fractures.

The only way to show the healing potential in hyaline cartilage after the treatment of tibial plateau fractures in humans is the second-look arthroscopy. Our aim is to examine the healing potential of the hyaline cartilage in tibial plateau fractures treated with arthroscopy-assisted surgery. We applied second-look arthroscopy to the 12 patients out of 52 who had tibial plateau fractures treated by arthroscopy-assisted surgery. The mean age was 41. The tibial plateau fractures were classified according to Schatzker classification. The period between the primary surgical treatment and second-look arthroscopy was on an average of 19 months. Step-off was detected in 3 out of 12 patients. Hyaline cartilage of nine patients who did not have step-off was found obviously on the fracture line. None of them had displacement. Three patients out of 12 were above 50 years old and the average follow-up period was 26 months. Grade II-III chondral defect was detected on the fracture line and femoral condyle in patients above 50 years. For patients below 50 years old, the follow-up period was 21 months and grade I-II chondral defect was detected on the fracture line and femoral condyle. Until now in literature, tibial plateau fractures have been evaluated clinically and radiologically, but in our cases we directly saw the lesion. Cartilage healing is limited in human beings. On the fracture line, cartilage defect continues, although anatomic reduction has been achieved. Moreover, if there is step-off, insufficient healing potential appears. Although we did not have enough cases, we can say that in tibial plateau fractures anatomic reduction is mandatory. Contrary to the common idea, step-off is not tolerated by hyaline cartilage.

Adult↗
PubMed1993

[Arthroscopy of smaller joints: hand, elbow and ankle arthroscopy].

These joints are accessible, though technically demanding, by arthroscope. Above all, the evaluation of the lesions is not simple. Arthroscopy always represents the last diagnostical alternative. The extraction of loose fragments, the debridement, the shaving and the treatment of infections are excellent indications. Postoperative rehabilitation is favoured and shortened with the arthroscopic approach. Elbow arthroscopy did not greatly, develop during the last years. Posttraumatic situations, corpora libera and cartilage lesions represent the main indications. The arthroscopies of the ankle and the wrist, however, are increasing. Carpal instability and discus problems of the wrist are quite interesting. Lately, endoscopic carpal-tunnel decompression has been propagated, but is still in its experimental phase. At the ankle, osteochondrosis dissecans, flake fracture and fibrosed plica [discovered through arthroscopy, mostly in athletes] are suitable for arthroscopic removal or reconstruction. Interfering osteophytes at the anterior border of the tibia can also be removed arthroscopically. Percutaneous internal fixation and fusion of the ankle joint need first to be evaluated in a long-term follow-up. Arthroscopic debridement and rinsing against infections are quite successful for all the joints. The arthroscopy of a small joint is technically quite demanding; therefore, it should be practised only by a few specialized centres.

Adult↗
PubMed1994

Magnetic resonance imaging (MRI) and arthroscopy in the detection of meniscal degenerations: correlation of arthroscopy and MRI with histology findings.

In a prospective double-blind study, the capability of magnetic resonance imaging (MRI) and arthroscopy in the detection and grading of meniscal degenerations is evaluated by correlating MRI findings and arthroscopic diagnoses with a histologic grading model. In 82.8% of our results, grading based on MRI studies corresponded with the histologic grading classification. In 12 instances a meniscal degeneration verified at light microscopy was not detected at MRI, whereas in 15 cases tomography yielded a false-positive result. The overall accuracy was calculated to be 0.93 with a specificity of 0.79 and a sensitivity of 0.96. Concerning the evaluation of meniscal degenerations, MRI provides a positive predictive value of 0.95 and a negative predictive value of 0.82. Compared with the diagnostic specificity of the anterior and posterior zones, that of the intermediate segment of the meniscus is significantly reduced (p < 0.001). At arthroscopy, meniscal degenerations were diagnosed with an overall accuracy of 38.8%, a sensitivity of 27.5%, and a specificity of 75.5%. In 80 cases of grade 3 abnormalities, five false-negative diagnoses were made initially. These results suggest that MRI offers a valuable diagnostic potential providing reliable information about the internal consistency of the meniscus complementary to diagnostic arthroscopy.

Adult↗
PubMed1996

Diagnostic and quantitative arthroscopy: quantitative arthroscopy.

Arthroscopy still remains the 'gold standard' for the assessment of articular cartilage and synovium because it provides direct and magnified evaluation of these anatomical structures. Thus, alongside the use of arthroscopy as a diagnostic or therapeutic procedure in knee disorders, a further function of knee arthroscopy, performed under local anaesthesia on an outpatient basis, has been proposed: the monitoring and follow-up of knee chondropathy and synovitis conducted for research purposes on patients suffering from knee osteoarthritis or chronic synovitis. This function is used in order (1) to evaluate the natural history of these diseases, (2) to assess 'de visu' the effect on chondral or synovial lesions of medical treatments or surgical interventions, and (3) to validate non-invasive imaging techniques such as plain radiographs or magnetic resonance imaging. The development of this arthroscopic outcome measurement of chondropathy and synovitis required the establishment and validation of systems for scoring the severity of chondral and synovial lesions. The author reviews both earlier and newer arthroscopic classifications and underlines the need for a quantitative description of cartilage and synovial abnormalities, either global and based on the investigator's overall assessment by using a visual analogue scale of severity, or, more analytically, taking into account the baseline parameters of the lesions, i.e. depth/intensity, extent and location.

Arthroscopy↗
PubMed2002

[MRI vs. arthroscopy in the diagnosis of cartilage lesions in the knee. Can MRI take place of arthroscopy?].

INTRODUCTION: The accuracy of magnet resonance imaging in diagnosing cartilage lesions is discussed controversially. The sensitivity of this examination ranges from 15 % to 96 %. Clinical evidence demonstrates that cartilage lesions, diagnosed by MRI, were not confirmed in arthroscopy. The purpose of this prospective study was to analyse the practicability of replacing arthroscopy by MRI in diagnosis of cartilage lesions. PATIENTS AND METHODS: 195 patients with acute or chronic knee pain were examined by reason of a pathological clinic result by MRI preoperatively. In group A (n = 86), a standard program was performed in the radiological department of German Army Hospital (sagittal STIR TSE und PD TSE, coronary und transversal T2 FFE [TR = 660 ms, TE = 18 ms, FA = 30 degrees, 512er-Matrix]), in 21 patients (subgroup AK) a cartilage specific sequence (fs T1 W FFE) without gadolinium was added. Patients in group B (n = 88) were examined in a private outpatient clinic (sagittal T1 SE, T2 SE and T2 FLASH [TR = 608 ms, TE = 18 ms, FA = 20 degrees, 256er-Matrix]) with the use of gadolinium. A clear clinical diagnosis had to be performed before MRI examination. RESULTS: 156 lesions of the cartilage were detected arthroscopically. The sensitivity of the examination was in group A 33 %; group B 53 %; group AK 38 %, specificity in group A 99 %; group B 98 % and group AK 98 %. The positive and negative predictive values were in group A 75 %/98 %; group B 48 %/98 % and in group AK 50 %/97 %. CONCLUSION: MRI was not able to detect reliable cartilage lesions. Until now, arthroscopy is the golden standard to detect cartilage lesions.

Arthroscopy↗
PubMed1983

Arthroscopy of the knee. An analysis of 588 consecutive knee arthroscopies.

In a consecutive study of 588 knee arthroscopies, the accuracy of the clinical and arthroscopical diagnosis is evaluated by means of the diagnostic specificity and sensitivity. The investigation includes a number of orthopaedic knee disorders, and it is shown that arthroscopy gives a substantial increase in the diagnostic accuracy. Follow-up examination of the non operated patients showed that surgery was avoided in 19 per cent of the patients, in whom surgery was indicated by clinical diagnosis. It is concluded that arthroscopy is a safe and valuable procedure in the diagnosis of knee disorders, and the best method to avoid unnecessary surgery.

Adolescent↗
PubMed1988

Diagnostic arthroscopy of the knee joint: comparison of the accuracy of physical examination, contrast arthrography and arthroscopy.

A group of 474 patients was retrospectively studied to assess the value of physical examination, arthrography and arthroscopy in the diagnosis of knee pathology. In 54% of cases, the correct clinical diagnosis was made from the patient's history, physical examination and standard radiology. The diagnosis at arthrography, especially in chondropathy and synovitis, appeared to be unreliable (only 46% corresponded to the definitive diagnosis). Contrast-arthrography of the knee joint is an invasive technique which provides relatively little extra (reliable) information, and is therefore not suitable as a standard procedure. Diagnostic arthroscopy is a superior and safe technique. Apart from the essential clinical assessment of patients with acute or chronic knee complaints (patient history, physical examination and standard radiology), there is a wide range of indications for diagnostic arthroscopy.

Adolescent↗
PubMed1994

Principles of arthroscopy and wrist arthroscopy equipment.

This article provides an overview of the history of wrist arthroscopy. Following this, the basic principles of wrist arthroscopy are presented. In the final portion of the chapter, the equipment and instrumentation used in wrist arthroscopy are discussed, including traction apparati, arthroscopes, mechanical infusion systems, hand instruments, and shavers.

Arthroscopes↗
PubMed1979

[Diagnostic arthroscopy and arthroscopic surgery: experiences with 500 knee arthroscopies].

A diagnosis by clinical examination and arthrography was not possible in 160 out of 500 arthroscopically examined patients, most of them with post-traumatic knee disorders. In 157 cases the clinical diagnosis was wrong, and in another 58 cases incomplete. Only in 89 patients (18%) arthroscopy proved the clinical diagnosis to be correct. At arthroscopy, a meniscal injury was found in 156 patients (medial meniscus 57, lateral meniscus 64, both menisci 8). With regard to the menisci a previous arthrography was found correct only in 103 out of 213 cases, i.e. in 48%. Lesions of the articular cartilage were present in 210 patients, although they were expected clinically in only one third of these cases. Normal intraarticular structures were found in 95 examinations. The arthroscopic examination was insufficient three times because of a protruding fat pad, and wrong in 2 patients in whom an arthroscopically diagnosed meniscal tear could not be found at arthrotomy. The morbidity of arthroscopy is small. Only complications: A local allergic reaction because of a wound spray in four cases, bronchial asthma following general anesthesia in two patients. No infection occurred. Several therapeutic procedures may be carried out through the arthroscope. So loose bodies were removed from the joint in 39 and partial meniscectomy performed in 13 patients, all of them being treated as out-patients.

Cartilage, Articular↗
PubMed1989

Cysts of the lateral meniscus: arthroscopy versus arthroscopy plus open cystectomy.

A retrospective analysis was performed on 32 knees in 31 patients with the diagnosis of cyst of the lateral meniscus. Average follow-up was 41 months, with a range of 16-72 months. Surgical and histological examination demonstrated pathology varying from large meniscal tears with minimal cyst formation to large cysts with no demonstrable meniscal tear. Two theories of etiology emerged: (a) The tear begins in the meniscus and spreads through the periphery. (b) The lesion begins as a compression injury to the vascular periphery and spreads centrally, producing a meniscus tear, or peripherally, producing a cyst, or both. In our series, 20 patients managed by arthroscopic partial meniscectomy and open cystectomy had 80% excellent-good results versus 50% excellent-good results in 12 patients treated with arthroscopy and partial meniscectomy without extraarticular cystectomy. We recommend the following treatment: arthroscopy with a diligent search for a lateral meniscal tear, especially peripherally. If none is found, proceed to extraarticular cystectomy. If a tear is found, remove all unstable meniscal fragments, leaving a rim, if possible, especially adjacent to the popliteus recess, and then proceed to open cystectomy.

Arthroscopy↗
PubMed1996

Clinical results of therapeutic temporomandibular joint arthroscopy: a prospective study of 34 arthroscopies with prediscal section and retrodiscal coagulation.

Thirty-four therapeutic temporomandibular arthroscopies were done during a 24-month period for patients with debilitating joint disorders (mainly disc displacements with or without reduction) who had not responded to non-invasive treatment. Lysis and lavage with prediscal section and retrodiscal coagulation were the techniques used. Analysis of the results indicated subjective improvement of pain in 71% of cases, noise in 78%, jaw opening in 88% and diet in 97% and objective evidence of disappearance of noise in 29% and improvement of jaw opening in 94% (mean 9.24 mm). In jaw opening, improvement was highly significant, compared with the preoperative results, P < 0.01. We conclude that temporomandibular arthroscopy is safe and indicated in disc displacements and joint luxation if medical treatment has failed.

Adolescent↗
PubMed1996

Complications following arthroscopy of the temporomandibular joint: analysis covering a 10-year period (451 arthroscopies).

451 arthroscopies of the temporomandibular joint (TMJ) have been performed on 373 patients during 10 years of clinical experience. The complication rate was low (1.77%). Most complications were transient, consisting mainly of temporary deficits of the 5th and 7th cranial nerves. No patient required arthrotomy because of complications, but one patient had to undergo angiography and embolization of a traumatic aneurysm of the superficial temporal artery secondary to arthroscopy.

Adolescent↗
PubMed2006

[Arthroscopy of the wrist: compared results of MRT and arthrography and outcome in the arthroscopy -- an examination 1998 to 2003].

Between 1998 and 2004, 62 arthroscopies of the wrist were performed in the Vienna Danube Hospital. We examined if preoperative arthrography or magnet resonance tomography showed the same results concerning lesions of the discus ulnocarpalis or the scapholunate ligaments as did the arthroscopy and whether these two examinations are a good preoperative diagnostic instrument.

Adolescent↗