Adam Hede

Partial versus total meniscectomy. A prospective, randomised study with long-term follow-up

Two hundred patients with a meniscal lesion were peroperatively allocated to partial or total meniscectomy in a random manner. The results were compared at one year and at 6.3 to 9.8 years (median 7.8). After one year more patients with partial meniscectomy (90%) than with total meniscectomy (80%) had no complaints. At the later review these figures were 62% and 52%, respectively (p = 0.18). However, patients with partial meniscectomy had higher functional scores. The deterioration in function between the first review and the second showed no significant difference in the two treatment groups. The incidence of mediolateral instability rose from 8% to 47% and was more frequent after total than after partial meniscectomy. Between the two reviews the radiological signs of knee degeneration increased with no difference between the two treatment groups.

Epidemiology of meniscal lesions in the knee: 1,215 open operations in copenhagen 1982-84

In a suburban area of Copenhagen with approximately 620,000 inhabitants, all the openly operated on meniscal lesions of the knee joint between 1982 and 1984 inclusive were reviewed. The mean annual incidence of meniscal lesions per 10,000 inhabitants was 9.0 in males and 4.2 in females. The highest incidences were seen in the 3rd, 4th, and 5th decades of life. A higher frequency of trauma related to onset of symptoms was found among males (77 percent) than among females (64 percent). The bucket-handle lesion was the most frequent type of meniscal lesion in males (35 percent), whereas peripheral detachment was the most frequent in females (41 percent). A variable frequency of trauma inducing the lesions in males and females did not explain differences in type of meniscal lesion. Nineteen percent of our 1,215 patients had a partial meniscectomy, whereas 0.7 percent had meniscal repair.

Articular cartilage changes following meniscal lesions: Repair and meniscectomy studied in the rabbit knee

A well-defined, longitudinal lesion in the avascular part of the medial meniscus of the right knee was made in 30 rabbits. After 3 months, the lesion was repaired surgically in 12 rabbits, was untreated in 12 rabbits, and a meniscectomy was performed in 6 rabbits. The articular cartilage was studied macroscopically and microscopically at 3-month intervals. Cartilage changes 3 months after meniscectomy were more pronounced than after meniscal repair or than in untreated lesions. However, meniscal repair did not reverse the cartilage changes.

The course of differently treated isolated ruptures of the anterior cruciate ligament as observed by prospective stress radiography.

In a prospective stress radiographic study of the course of 21 isolated anterior cruciate ligament (ACL) injuries, primary suture was performed in eight patients and reconstruction due to chronic instability was performed in six patients. Seven patients were treated by exploratory arthrotomy only. After a follow-up period of seven years the anterior drawer sign had disappeared in five of the 14 patients who had shown this sign prior to operation, but in some of these patients progressive rotatory instabilities developed, so that the total abnormal instability did not improve in any of the three therapeutic groups. Only ten patients obtained a completely symptom-free knee. A well performed Jones procedure could reduce a chronic anterior drawer instability, but in several of the patients troublesome patellofemoral pain developed later. Acute suture of isolated anterior cruciate ligament injuries afforded the best results in this series and is recommended.

Repair of three-month-old experimental meniscal lesions in rabbits

Repair of three-month-old longitudinal meniscal lesions in the central avascular portion of the knee joint was investigated in 18 rabbits. Three months after a longitudinal incision was made in the avascular portion of the meniscus, no healing was observed. At that time a full-thickness radial cut from the lesion to the joint capsule, without using synovial flaps or implants, was performed in ten of the 18 rabbits. Three months later, nine of the ten menisci had healed mainly with cartilaginous tissue, although the repaired areas were different from the normal fibrocartilage both histologically and at gross inspection. Synovitis with hyperplasia of the lining cells, which was present in all cases at the time of repair, may play an important role in the healing process.

PROSPECTIVE STRESS RADIOGRAPHY IN 38 OLD INJURIES OF THE LIGAMENTS OF THE KNEE JOINT

In a prospective clinical and stress radiographic study comprising 38 patients, the course of chronic ligament injuries in the knee joint was evaluated. All but five patients had isolated ligament injuries, 16 of which affected the anterior cruciate ligament. The operations were performed from 18 days to 20 years after the injury had occurred. In 13 patients primary suture could be carried out, 12 patients underwent exploratory arthrotomy, and the remainder had relevant ligament repair. After a follow-up period of 7 years the instability had been cured in all patients with medial laxity and in one of two patients with lateral laxity. Nineteen patients had a drawer sign preoperatively. The anterior drawer sign disappeared in practically all patients, while a posterior drawer sign was a constant sequel to injury affecting the posterior cruciate ligament. It was difficult to prevent the development of rotatory instability--which was present in six preoperatively and in 14 at follow-up--and the rotatory instabilities were predominantly marked (greater than 6 mm). Nevertheless, only a few patients had an annoying sensation of instability. By means of ligament reconstruction, it was possible to reduce the preoperative instability appreciably. Passive instability had completely subsided in 40 per cent (15/38). The subjective result was good, only 16 per cent (6/38) having troublesome loss of function.

Prospective Stress Radiographic Study of Knee Ligament Injuries in 62 Patients Treated by Acute Repair

A prospective clinical and stress radiographic study comprising 62 patients was performed to assess the value of acute repair of 35 isolated collateral ligament injuries and 27 major injuries. After a follow-up period of 6 years there was no lateral or medical instability in 42 out of 46 patients. This included 31 out of 33 patients in the group with medial collateral ligament injuries. Among the patients with major injuries 16 (60 per cent) had drawer signs, but in only 6 was there significant instability (greater than 6 mm). In the total material it proved difficult to prevent the development of rotatory instability. This was present in 10 patients preoperatively and in 19 at follow-up. However, this instability was on the whole slight and was experienced as annoying by only 4 patients. Measurement of passive instability showed that 55 per cent (34/62) had become completely stable, but this applied to only 30 per cent (8/27) of patients with major injuries. The functional end result was unsatisfactory in 8 patients (13 per cent). Although several patients could compensate muscularly for a marked passive instability, there was a significant correlation between instability and functional loss.