Nicolas Pujol

Meniscal Healing After Meniscal Repair A CT Arthrography Assessment

Background Studies evaluating healing of repaired meniscus are rare and primarily retrospective. The aim of this study was to assess whether there were different healing rates for arthroscopic meniscal repair with respect to the different zones of the meniscus. Purpose This study was conducted to assess outcomes and to document anatomic characteristics of the repaired meniscus with postoperative arthrography combined with computed tomography (arthro-CT), particularly the dimensions and healing of the repaired meniscus. Study Design Case series; Level of evidence, 4. Methods Fifty-three arthroscopic meniscal repairs were prospectively evaluated between 2002 and 2004 in 2 orthopaedic departments. There were 36 medial and 17 lateral torn menisci. All ACL tears (n = 31, 58.5%) underwent reconstruction. Patients were preoperatively evaluated by magnetic resonance imaging. Clinical evaluation included International Knee Documentation Committee (IKDC) scores before the operation and 6 and 12 months afterward. Healing criteria were evaluated at 6 months by arthro-CT scan. Three parameters were evaluated—healing in thickness (Henning criteria), overall healing rate, and reduction in the width of the remaining meniscus. Results According to the objective IKDC score, 26 patients were graded A, 20 B, and 4 C (92% good results). The mean subjective IKDC score was 78.9 (standard deviation [SD], 16.2). According to Hennings criteria, 58% of the menisci healed completely, 24% partially, and 18% failed. The overall healing rate was 73.1% (SD, 38.5). Twenty tears located in the posterior part had a healing rate of 59.8% (SD, 46.0). Nineteen tears extending from the posterior to the middle part had a healing rate of 79.2% (SD, 28.2). Isolated tears located in the posterior part had a lower healing rate (P < .05). There was a 9% ± 1.2% reduction in the width of the remaining medial meniscus in the middle and posterior repaired portions (P < .02). There was a 15% ± 14% reduction in the width of the remaining lateral meniscus in the middle repaired portion (P < .01). Complete healing of the posterior segment was associated with reduction in the width of the meniscus (P < .04). Conclusion A modern technique using all-inside fixation or outside-in sutures provided good clinical and anatomic outcomes. No statistically significant effect on ACL reconstruction or laterality (medial vs lateral) on overall healing after meniscal repair was identified. Partial healing occurred often, with a stable tear on a narrowed and painless meniscus. The posterior segment healing rate remained low, suggesting a need for further technical improvements.

Meniscal Healing After Meniscus Repair: A CT Arthrography Assessment

Background Studies evaluating healing of repaired meniscus are rare and primarily retrospective. The aim of this study was to assess whether there were different healing rates for arthroscopic meniscal repair with respect to the different zones of the meniscus. Purpose This study was conducted to assess outcomes and to document anatomic characteristics of the repaired meniscus with postoperative arthrography combined with computed tomography (arthro-CT), particularly the dimensions and healing of the repaired meniscus. Study Design Case series; Level of evidence, 4. Methods Fifty-three arthroscopic meniscal repairs were prospectively evaluated between 2002 and 2004 in 2 orthopaedic departments. There were 36 medial and 17 lateral torn menisci. All ACL tears (n = 31, 58.5%) underwent reconstruction. Patients were preoperatively evaluated by magnetic resonance imaging. Clinical evaluation included International Knee Documentation Committee (IKDC) scores before the operation and 6 and 12 months afterward. Healing criteria were evaluated at 6 months by arthro-CT scan. Three parameters were evaluated—healing in thickness (Henning criteria), overall healing rate, and reduction in the width of the remaining meniscus. Results According to the objective IKDC score, 26 patients were graded A, 20 B, and 4 C (92% good results). The mean subjective IKDC score was 78.9 (standard deviation [SD], 16.2). According to Hennings criteria, 58% of the menisci healed completely, 24% partially, and 18% failed. The overall healing rate was 73.1% (SD, 38.5). Twenty tears located in the posterior part had a healing rate of 59.8% (SD, 46.0). Nineteen tears extending from the posterior to the middle part had a healing rate of 79.2% (SD, 28.2). Isolated tears located in the posterior part had a lower healing rate (P < .05). There was a 9% ± 1.2% reduction in the width of the remaining medial meniscus in the middle and posterior repaired portions (P < .02). There was a 15% ± 14% reduction in the width of the remaining lateral meniscus in the middle repaired portion (P < .01). Complete healing of the posterior segment was associated with reduction in the width of the meniscus (P < .04). Conclusion A modern technique using all-inside fixation or outside-in sutures provided good clinical and anatomic outcomes. No statistically significant effect on ACL reconstruction or laterality (medial vs lateral) on overall healing after meniscal repair was identified. Partial healing occurred often, with a stable tear on a narrowed and painless meniscus. The posterior segment healing rate remained low, suggesting a need for further technical improvements.

[Quality of tibial cementing in total knee arthroplasty: one or two phase cementing of the tibial and femoral implants].

PURPOSE OF THE STUDY When implanting a total knee prosthesis, the tibial component can be cemented either independently in the flexion position by maintaining an axial force on the implant, or simultaneously in extension by applying a compression force on both the tibial and femoral implants after reducing the prosthesis. The purpose of this study was to determine whether the quality of the cementing depends on the method used: independently in the flexion position, or simultaneously in the extension position. MATERIAL AND METHODS This was a prospective comparative study between two groups of 20 patients assigned alternatively to one of two study arms: Group 2 with a tibial implant cemented independently and Group 1 with a tibial implant cemented simultaneously with the femoral implant. The cancellous surfaces were prepared by irrigation and gravity flow wash-out. Aspiration of the cancellous section surface was maintained until the radio-opaque cement with standard viscosity (CMW3) was inserted. The penetration of cement into the cancellous bone was noted by zone on the postoperative radiographs (seven days and one month). Implant position, presence of early lucent lines and cement debris were noted. Radiographs were taken under fluoroscopic guidance in order to obtain the best image of the joint space and the tibial plateau. RESULTS Cement penetration into the tibial plateau was significantly more pronounced in Group 2 for zones 1, 2 (p<0.01) and 3 (p<0.05) on the above proof view. Early translucent lines were noted in 15 of 20 knees in Group 1 (p<0.01). Cement debris and microfractures were noted in five knees in Group 1 (one in Group 2). The position of the implants was not affected by the method used for cementing. CONCLUSION This study demonstrates the theoretical and radiographic interest of cementing the tibial piece independently with the knee in the flexion position for total knee replacement. It is important to apply sustained pressure to obtain good quality cement-bone interpenetration.

Meniscal Healing after Meniscal Repair

Background Studies evaluating healing of repaired meniscus are rare and primarily retrospective. The aim of this study was to assess whether there were different healing rates for arthroscopic meniscal repair with respect to the different zones of the meniscus. Purpose This study was conducted to assess outcomes and to document anatomic characteristics of the repaired meniscus with postoperative arthrography combined with computed tomography (arthro-CT), particularly the dimensions and healing of the repaired meniscus. Study Design Case series; Level of evidence, 4. Methods Fifty-three arthroscopic meniscal repairs were prospectively evaluated between 2002 and 2004 in 2 orthopaedic departments. There were 36 medial and 17 lateral torn menisci. All ACL tears (n = 31, 58.5%) underwent reconstruction. Patients were preoperatively evaluated by magnetic resonance imaging. Clinical evaluation included International Knee Documentation Committee (IKDC) scores before the operation and 6 and 12 months afterward. Healing criteria were evaluated at 6 months by arthro-CT scan. Three parameters were evaluated—healing in thickness (Henning criteria), overall healing rate, and reduction in the width of the remaining meniscus. Results According to the objective IKDC score, 26 patients were graded A, 20 B, and 4 C (92% good results). The mean subjective IKDC score was 78.9 (standard deviation [SD], 16.2). According to Hennings criteria, 58% of the menisci healed completely, 24% partially, and 18% failed. The overall healing rate was 73.1% (SD, 38.5). Twenty tears located in the posterior part had a healing rate of 59.8% (SD, 46.0). Nineteen tears extending from the posterior to the middle part had a healing rate of 79.2% (SD, 28.2). Isolated tears located in the posterior part had a lower healing rate (P < .05). There was a 9% ± 1.2% reduction in the width of the remaining medial meniscus in the middle and posterior repaired portions (P < .02). There was a 15% ± 14% reduction in the width of the remaining lateral meniscus in the middle repaired portion (P < .01). Complete healing of the posterior segment was associated with reduction in the width of the meniscus (P < .04). Conclusion A modern technique using all-inside fixation or outside-in sutures provided good clinical and anatomic outcomes. No statistically significant effect on ACL reconstruction or laterality (medial vs lateral) on overall healing after meniscal repair was identified. Partial healing occurred often, with a stable tear on a narrowed and painless meniscus. The posterior segment healing rate remained low, suggesting a need for further technical improvements.

Degenerative Meniscal Lesions: Indications

A degenerative meniscal lesion (DML) is a meniscal tear, commonly involving a horizontal cleavage in the knee of a middle-aged or older person. It is characterized by linear intrameniscal signal (including a component with horizontal pattern) typically communicating with the inferior meniscal surface.

Qualité du scellement tibial dans les arthroplasties totales du genou : scellement en un ou deux temps des pièces tibiale et fémorale

PURPOSE OF THE STUDY When implanting a total knee prosthesis, the tibial component can be cemented either independently in the flexion position by maintaining an axial force on the implant, or simultaneously in extension by applying a compression force on both the tibial and femoral implants after reducing the prosthesis. The purpose of this study was to determine whether the quality of the cementing depends on the method used: independently in the flexion position, or simultaneously in the extension position. MATERIAL AND METHODS This was a prospective comparative study between two groups of 20 patients assigned alternatively to one of two study arms: Group 2 with a tibial implant cemented independently and Group 1 with a tibial implant cemented simultaneously with the femoral implant. The cancellous surfaces were prepared by irrigation and gravity flow wash-out. Aspiration of the cancellous section surface was maintained until the radio-opaque cement with standard viscosity (CMW3) was inserted. The penetration of cement into the cancellous bone was noted by zone on the postoperative radiographs (seven days and one month). Implant position, presence of early lucent lines and cement debris were noted. Radiographs were taken under fluoroscopic guidance in order to obtain the best image of the joint space and the tibial plateau. RESULTS Cement penetration into the tibial plateau was significantly more pronounced in Group 2 for zones 1, 2 (p<0.01) and 3 (p<0.05) on the above proof view. Early translucent lines were noted in 15 of 20 knees in Group 1 (p<0.01). Cement debris and microfractures were noted in five knees in Group 1 (one in Group 2). The position of the implants was not affected by the method used for cementing. CONCLUSION This study demonstrates the theoretical and radiographic interest of cementing the tibial piece independently with the knee in the flexion position for total knee replacement. It is important to apply sustained pressure to obtain good quality cement-bone interpenetration.

Qualité du scellement tibial dans les arthroplasties totales du genou : scellement en un ou deux temps des pièces tibiale et fémorale: Étude prospective comparative

PURPOSE OF THE STUDY When implanting a total knee prosthesis, the tibial component can be cemented either independently in the flexion position by maintaining an axial force on the implant, or simultaneously in extension by applying a compression force on both the tibial and femoral implants after reducing the prosthesis. The purpose of this study was to determine whether the quality of the cementing depends on the method used: independently in the flexion position, or simultaneously in the extension position. MATERIAL AND METHODS This was a prospective comparative study between two groups of 20 patients assigned alternatively to one of two study arms: Group 2 with a tibial implant cemented independently and Group 1 with a tibial implant cemented simultaneously with the femoral implant. The cancellous surfaces were prepared by irrigation and gravity flow wash-out. Aspiration of the cancellous section surface was maintained until the radio-opaque cement with standard viscosity (CMW3) was inserted. The penetration of cement into the cancellous bone was noted by zone on the postoperative radiographs (seven days and one month). Implant position, presence of early lucent lines and cement debris were noted. Radiographs were taken under fluoroscopic guidance in order to obtain the best image of the joint space and the tibial plateau. RESULTS Cement penetration into the tibial plateau was significantly more pronounced in Group 2 for zones 1, 2 (p<0.01) and 3 (p<0.05) on the above proof view. Early translucent lines were noted in 15 of 20 knees in Group 1 (p<0.01). Cement debris and microfractures were noted in five knees in Group 1 (one in Group 2). The position of the implants was not affected by the method used for cementing. CONCLUSION This study demonstrates the theoretical and radiographic interest of cementing the tibial piece independently with the knee in the flexion position for total knee replacement. It is important to apply sustained pressure to obtain good quality cement-bone interpenetration.