John F. Meyers

The role of arthroscopy in the management of tibial plateau fractures.

The value of arthroscopy in the management of tibial plateau fractures was evaluated in a series of 29 patients from 1979 to 1984. It was determined that arthroscopy is of value in the management of these fractures; acute fractures and associated soft tissue injuries can be precisely defined, allowing for timely management decisions; based on direct arthroscopic observation, selected fractures can be reduced and stabilized, and appropriate postoperative management determined; and healed but symptomatic fractures may benefit from arthroscopic surgery.

Arthroscopic treatment of triplane fractures of the ankle

Failure to obtain and/or maintain adequate closed reduction of triplane ankle fractures is an indication for surgical reduction and internal fixation. Operative treatment requires anteromedial and/or anterolateral incisions for adequate visualization of fracture fragments. The added surgical trauma associated with operative treatment of these fractures can be minimized without loss of efficacy using minimally invasive techniques under arthroscopic control. Arthroscopic reduction and internal fixation (ARIF) of two-part triplane fractures provides the advantages of complete evacuation of fracture hemarthrosis, accurate and certain reduction of the articular surface, and secure fixation of fracture fragments. Two patients treated with ARIF demonstrated rapid and complete fracture healing without complication. Follow-up at 6-12 months showed no leg length discrepancy, angulation, swelling, persistent symptoms, or limitation of function. ARIF of triplane ankle fractures reduces surgical trauma, provides a method for accurate delineation of fracture fragment orientation, and ensures accurate reduction and joint congruity under direct visualization.

Laser Energy in Arthroscopic Meniscectomy

Rationale and technique are discussed for performing arthroscopic meniscectomy with a carbon dioxide laser, including presentation of findings in limited rabbit and human studies.

Arthroscopic evaluation of anterior cruciate ligament reconstructions

Fourteen patients who underwent anterior cruciate ligament (ACL) reconstruction, using fascia lata or patellar tendon, were examined arthroscopically at a mean time of 16 months following surgery. The postoperative care and rehabilitation program was standardized for all patients. Eleven of these 14 patients were recalled for a functional evaluation. Nine of these 11 patients were satisfied with the outcome of their reconstruction. Two patients complained of an occasional giving way of the knee. The arthroscopic findings were disappointing. Four patients appeared to have viable ligamentous structures in the intercondylar notch. Four patients had lax ligamentous tissue in the notch. In other cases, the notch was filled with varying degrees of amorphous scar tissue. The tissue was tested by palpation with a probe and with an anterior drawer test applied. The scar tissue did develop tension and give a firm end point to the drawer test. Other arthroscopic findings included instances of Grade II, III, and IV chondromalacia of the articular cartilage, adhesions, and capsular scarring not seen at the time of original surgery. While the patient satisfaction and functional results were generally good, we were disappointed with the arthroscopic findings. Based on the generally poor quality of the reconstructed tissue and the articular cartilage lesions, we have changed our surgical technique and postoperative regime.

Arthroscopic meniscectomy. An interim report at three to four years after operation.

Review of the records at the time of final office visits of one hundred and thirty-four patients who underwent arthroscopic subtotal meniscectomy and interview of one hundred and two of these patients three to four years after surgery revealed that symptoms related to disruption of the meniscus can be totally or significantly relieved in 99.3% of cases. Meniscal symptoms did not recur in the absence of reinjury three to four years later, despite the occasional presence of associated pathologic joint conditions. Arthroscopic meniscectomy has proved safe and effective, and it is associated with low postoperative morbidity and early return to function. Preservation of a peripheral rim of meniscus in contrast to total meniscectomy offers the theoretic advantages of preservation of some degree of joint stability and load distribution to diminish the risk of premature degenerative articular changes.