Franky Steenbrugge

Long-term assessment of arthroscopic meniscus repair: a 13-year follow-up study

A prospective study was set up to evaluate meniscal suturing using an inside-out technique. Of an initial group of 20 patients who underwent closed meniscus repair between 1985 and 1988 using an inside-out technique, 13 were studied. All patients were subjected to a clinical examination and a magnetic resonance imaging (MRI) investigation. The findings were compared with those of their previous follow-up examination (1994). The Hospital for Special Surgery (HSS) knee rating system (R.G. Stone et al. Athroscopy 1990; 73-78) was used. The study included seven men and six women, ranging in age from 29 years to 50 years (mean age: 35 years 6 months). The mean follow-up was 13 years 2 months (11 years 11 months-15 years 4 months). Six left and seven right knees were involved. Seven patients also had an anterior cruciate ligament (ACL) injury of which one was repaired 6 years after meniscal repair. All patients obtained an HSS score of more than 75%. In all patients, the site of the previous suture was still visible on MRI mainly by small metal artefacts in the meniscus. Patients with an unrepaired ACL lesion had an early onset of arthrosis and cartilage degeneration. Meniscal suturing gives good clinical long-term results. Magnetic resonance imaging, however, showed signs of mucoid degeneration or scar tissue in 46% of the patients.

Pyoderma gangrenosum following trauma of the knee: a case of pathergy and review of orthopaedic cases.

Pyoderma gangrenosum (PG) is a rare noninfectious neutrophilic dermatosis. Its course can be mild or malignant, chronic or relapsing with remarkable morbidity. We describe a case of PG, which presented with severe wound breakdown following a closed tibial plateau fracture of the left knee. Two weeks after the trauma, the patient developed ulcers in both lower legs. Sepsis was suspected and concomitant treatment was begun. No causal agent was found. A suspicion of PG arose and a treatment with corticosteroids was started. The patient recovered swiftly. The very rare pathology of PG is discussed and a review of the literature of this pathology is given. This diagnosis should always be considered when confronted with an enlarging painful skin lesion, which does not grow organisms when cultured and fails to respond to antibiotic therapy, especially if there are similar lesions in other sites. To our knowledge, this is the first case report of PG following trauma without any skin lesions at initial trauma.

Arthroscopic meniscus repair in the ACL-deficient knee

Between 1985 and 1995, 45 patients underwent closed meniscus repair. There were 30 men and 15 women with a mean age of 32.5 years. In 23 patients, the anterior cruciate ligament was intact (group 1) whereas it was deficient in 22 patients (group 2). All patients were managed with the same postoperative program of partial weight bearing, immediate motion and rehabilitation of the knee. Five patients had a failed meniscal repair and underwent a repeat arthroscopy and a partial meniscectomy. These patients were considered as failures and excluded from the final scoring. After a mean follow-up of more than 9 years, all patients were subjected to a clinical examination using the Hospital for Special Surgery (HSS) knee rating system. Seven patients in group 2 had episodes of frequent giving way and had their anterior cruciate ligament (ACL) reconstructed 6 and 7 years after the initial meniscus repair. None of the other patients had any clinical symptoms or signs of a meniscal tear. In group 1, 20 patients and in group 2, 14 patients, all had a satisfactory knee score. Even though the failure rate of meniscus repair may be greater in an unstable knee, it is concluded that meniscal repair is not contraindicated in a knee with a deficient ACL.RésuméEntre 1985 et 1995 45 malades ont eu une réparation méniscale à foyer fermé. Il y avait 30 hommes et 15 femmes à l’âge moyen de 32,5 ans. Chez 23 malades le ligament croisé antérieur (LCA) était intact (Groupe 1), alors qu’il était défectueux chez 22 malades (Groupe 2). Tous les malades ont eu le même programme postopératoire avec appui partiel, mobilisation immédiate et rééducation du genou. Cinq malades ont présentés un échec et ont subi une arthroscopie secondaire avec méniscectomie partielle. Ces malades ont été considérés comme échecs et ont exclu du dernier marquage de points. Après une moyenne de suivi de plus de neuf ans tous les malades ont été soumis à un examen clinique qui utilise le score HSS pour l’estimation du genou. Sept malades du groupe 2 ont eu de fréquent épisodes de dérobement et ont eu leur LCA reconstruit 6 et 7 ans après la réparation du ménisque. Aucun des autres malades n’avait de symptôme clinique ou de signe d’une déchirure méniscale. Vingt malades du groupe 1 et 14 malades du groupe 2 avaient tous un score du genou satisfaisant. Bien que le taux d’échec de réparation du ménisque puisse être plus grand dans un genou instable, notre conclusion est que la réparation du ménisque n’est pas contre-indiquée sur un genou avec un LCA défectueux.

Ochronosis, arthroscopy of a black knee: a case report and review of the literature

Ochronotic arthropathy is a rare condition found in patients with alkaptonuria. Due to the accumulation of homogentisic acid, cartilages get a dark discoloration and become brittle and more vulnerable to mechanical stress (Centinus et al. Rheumatol Int 3:127–131, 2004; Hamdi et al. Int Orthop 23:122–125, 1999; Phornphutkul, N Engl J Med 347:2111–2121, 2002; Thacker, Arthroscopy 19:14–17, 2003). This case report is about a patient first diagnosed for ochronosis by arthroscopy of the knee. Her brother was having similar complaints during follow-up. Both patients were prescribed to take glucosamine and chondroitine. Although no report is found in the literature, regarding the success of this therapy in patients with ochronosis, both patients reported a positive effect on articular pain and daily activities.

Magnetic reasonance imaging of the surgically repaired meniscus: a 13-year follow-up study of 13 knees.

Background This study was initiated to evaluate the long-term outcome of meniscal sutures and to correlate clinical findings with MRI findings. We were interested to see if a clinically healed meniscus also showed as such on MRI and if degenerative changes were present.Patients and methods We studied prospectively 13 patients (7 men) aged between 29 and 50 years, who had undergone closed meniscus repair between 1985 and 1988 using an inside-out technique, clinically and with MRI, with a mean follow-up time of 13 years.Results Meniscal suture gave good clinical long-term results: all patients got a Hospital for Special Surgery score of more than 75%. In all patients the site of the previous suture was still visible on MRI, mainly from small metal artefacts in the meniscus. 4 of 7 patients with an unrepaired ACL lesion had signs of arthrosis and cartilage degeneration. MRI showed signs of mucoid degeneration or scar tissue in 6/13 of the patients.Interpretation We believe that asymptomatic meniscal tears produce abnormal MR signals even though they have stable unions, and that MR signals at the site of repair represent edematous scar tissue, not true nonunions.

Recurrent massive subperiosteal hematoma in a patient with neurofibromatosis

Abstract The authors report the case of a 13-year-old neurofibromatosis (NF-I) patient who suffered a blunt trauma in 1993. The diagnosis of subperiosteal hematoma was made. The pathogenesis of subperiosteal hematoma is discussed.

The problem knee

The mechanism and presentations of injuries to the knee Methods of clinical examination Investigations Paediatric injuries Ligamentous injuries Meniscal lesions Patellofemoral problems Fractures around the knee Non-traumatic conditions Treatment of soft-tissue injuries Appendices Glossary.

Differential diagnosis of black cartilage in arthroscopy of the knee

Dear Editors, We would like to thank Delialioglu and colleagues for their critical review of our article and pointing out the earlier case report on the same subject matter. Indeed our case report is the fourth and not the third published mention of arthroscopic diagnosis of ochronotic arthropathy. The authors express their concern with regards to the diagnostic process in the present case report. During the first outpatient clinic a thorough history was taken that focused on both the nature of the arthritic pain but also on specific drug consumption and intake of potentially poisoning substances. As the knee pain proved refractory to conservative treatment, an MRI was performed to objectify the complaints. This confirmed the degenerative lesions of the medial and lateral meniscus as well as damage to the knee cartilage. A knee arthroscopy was performed to further evaluate the optimal treatment strategy. During this procedure the clinical aspect of the joint was judged and biopsies of the black tissue fragments and of the synovium were taken, as mentioned in the material and methods section [4]. Microscopic evaluation of the black particles revealed that they consisted of cartilage with central calcifications and inclusion of a dark brown pigment. Microscopic evaluation of the synovial biopsies gave evidence of a non-specific chronic inflammatory reaction and the presence of dark brown pigment. The confirmation of the diagnosis of alkaptonuria, can only be achieved when urine analysis reveals elevated levels of HGA, which was found to be the case in our patient. Further evidence which suggested the diagnosis of alkaptonuria was provided by the specific changes observed on plain radiographs of the lumbar spine, as well as typical skin discoloration of the ears and eyes. The finding of the black discoloration of cartilage in combination with degenerative cartilage lesions is typical for endogenous ochronosis in patients with alkaptonuria. We appreciate that other causes of black discoloration of articular surfaces are possible. We want to point out that the list of pathologies mentioned by Delialioglu et al., copied from an article by Sudesh [7], reflects the differential diagnosis of typical ochronotic discoloration of the cartilage observed on bones retrieved 6 months post-mortem. This list of differential diagnoses can, however, not be applied to patients with symptoms of arthritis in whom black cartilage and degenerative cartilage lesions are present during life. Exogenous ochronosis is another presentation of ochronosis and stands for a typical discoloration of the skin similar to that seen in endogenous ochronosis but caused by chronic dermal contact with skin lightening products containing phenol or hydroquinones. The systemic effects seen in endogenous ochronosis, however, are not reported in exogenous ochronosis [3]. Another cause of black discoloration of the cartilage is chronic ingestion or inhalation of below lethal quantities of phenol. However, this discoloration does not cause M. Raaijmaakers (&) J. Bellemans Departement of Orthopedic Surgery, UZ Pellenberg, Universitaire Ziekenhuizen Leuven, Weligerveld 1, Pellenberg, 3212 Leuven, Belgium e-mail: raaijmaakers@skynet.be