Thomas Muellner

Open Meniscal Repair: Clinical and Magnetic Resonance Imaging Findings After Twelve Years

The purpose of this study was to document the long-term clinical, radiographic, and magnetic resonance imaging results after open meniscal repair. Twenty-two patients, with 23 open meniscal repairs, were evaluated after a mean follow-up of 12.9 years using patient history, physical examination, KT-1000 arthrometer testing, the “Orthopaedische Arbeitsgemeinschaft Knie” knee evaluation scheme, Tegner activity score, weightbearing radiographs, and magnetic resonance imaging. Two of the 22 patients had retears and both occurred in unstable knees. Radiographs revealed no degenerative changes in 17 of the 23 compartments. Grade III and IV signal alterations were present on magnetic resonance imaging scans in more than 50% of the repaired menisci. We concluded that the long-term survival rate of repaired menisci was 91%, and that magnetic resonance imaging is unsuitable for diagnosis of the healing process of a repaired meniscus.

Economic Considerations for the Diagnosis and Therapy of Meniscal Lesions: Can Magnetic Resonance Imaging Help Reduce the Expense?

Abstract. With magnetic resonance imaging (MRI) the surgeon has such an effective diagnostic tool in the diagnosis of a meniscal lesion that the times of diagnostic arthroscopy should be in the past. A total of 823 patients with clinically diagnosed meniscal lesions were divided into two groups: group A, 143 patients underwent MRI and 75 of those arthroscopy; group B, 680 patients, 201 (30%) of whom were operated after being only clinically examined. MRI was done on a Siemens Medical System Magnetom 1.5 Tesla with a 256 × 256 matrix. Spinal echo and gradient echo images were performed with slices of 2 to 4 mm thickness. All meniscal tears were graded according to Reicher and Crues, respectively. Grades III and IV were judged to be positive for a meniscal lesion. Arthroscopy was carried out under general anesthesia and the usual technique. The MRI revealed the following results: Medial meniscus: accuracy 95%, positive predictive value (PPV) 92%, negative predictive value (NPV) 95%, sensitivity 98%, and specificity 82%; lateral meniscus: accuracy 97%, PPV 92%, NPV 98%, sensitivity 94%, and specificity 98%. The overall values for MRI of the medial and lateral menisci combined were: accuracy 96%, PPV 93%, NPV 98%, sensitivity 96%, and specificity 90%. The clinical examination often failed to diagnose a meniscal lesion: accuracy 64%, PPV 59%, NPV 89%, sensitivity 96%, and specificity 33% for the medial meniscus. For the lateral meniscus the accuracy was 91%, PPV 61%, NPV 98%, sensitivity 89%, and specificity 91%. The overall values for the clinical investigation of the medial and lateral menisci combined were: accuracy 78%, PPV 60%, NPV 94%, sensitivity 93%, and specificity 62%. Investigation of all 201 patients operated from group B with MRI would have cost

The diagnosis of meniscal tears in athletes : A comparison of clinical and magnetic resonance imaging investigations

160,800. The cost of 30% fewer arthroscopies would have been

Shortening of the Patellar Tendon After Anterior Cruciate Ligament Reconstruction

562,800—in total

Inter- and intratester comparison of the Rolimeter knee tester: effect of tester's experience and the examination technique

723,600. The operation of all 201 patients cost

Failed Autologous Chondrocyte Implantation Complete Atraumatic Graft Delamination after Two Years

804,000. Hence about

New instrument that uses near-infrared spectroscopy for the monitoring of human muscle oxygenation.

80,000 could have been saved by scanning all 201 patients and therefore reduce the rate of diagnostic arthroscopies.

Patellar alignment evaluated by MRI

This study evaluated the predictability of clinical examination alone in comparison with magnetic resonance imaging in the diagnosis of meniscal tears in competitive athletes. Ninety-three competitive athletes were prospectively investigated between 1992 and 1995. A total of 57 athletes were operated on based on clinical examination alone, and the 36 remaining athletes had magnetic resonance imaging before surgery. The correct diagnosis of a meniscal lesion was made on clinical examination alone in 83 athletes (89%) and on magnetic resonance imaging the correct diagnosis was also made in 89% of 36 athletes. The overall values for the clinical investigation of the medial and lateral menisci combined were 94.5%, 91.5%, 99%, 96.5%, 87% for accuracy, positive predictive value, negative predictive value, sensitivity, and specificity, respectively. The overall values for magnetic resonance imaging of the medial and lateral menisci combined were 95.5%, 96.5%, 91.5%, 98%, 85.5% for accuracy, positive predictive value, negative predictive value, sensitivity, and specificity, respectively.This study evaluated the predictability of clinical exam ination alone in comparison with magnetic resonance imaging in the diagnosis of meniscal tears in compet itive athletes. Ninety-three competitive athletes were prospectively investigated between 1992 and 1995. A total of 57 athletes were operated on based on clinical examination alone, and the 36 remaining athletes had magnetic resonance imaging before surgery. The cor rect diagnosis of a meniscal lesion was made on clin ical examination alone in 83 athletes (89%) and on magnetic resonance imaging the correct diagnosis was also made in 89% of 36 athletes. The overall values for the clinical investigation of the medial and lateral me nisci combined were 94.5%, 91.5%, 99%, 96.5%, 87% for accuracy, positive predictive value, negative predic tive value, sensitivity, and specificity, respectively. The overall values for magnetic resonance imaging of the medial and lateral menisci combined were 95.5%, 96.5%, 91.5%, 98%, 85.5% for accuracy, positive pre dictive value, negative predictive value, sensitivity, and specificity, respectively.

Is the Return to High-Level Athletics Possible After Fasciotomy for a Compartment Syndrome of the Thigh? A Case Report

In this prospective study, patellar height changes were investigated after anterior cruciate ligament (ACL) reconstruction with a mean follow-up of 22.4 months. A total of 114 patients were included. Fifty-two patients (group A) were treated by multiple suture repair, 27 patients (group B) underwent acute ACL reconstruction, and 35 patients (group C) underwent ACL reconstruction > or =6 weeks after injury with a patellar tendon graft. The patellar vertical height ratios (VHR) were evaluated preoperatively (VHR 1), 6 months postoperatively (VHR 2), and at follow-up (VHR 3). For the studied questions, the following answers were obtained: (1) The change of the patella height was the same in all three groups (i.e., disregarding the different surgical procedures). (2) The time elapsed between injury and ACL reconstruction did not influence the shortening of the patellar tendon. (3) Women showed a more pronounced shortening of the patellar tendon than did men. (4) A significant shortening of the patellar tendon occurred in 30% of our patients, and the process of shortening was finished 6 months postoperatively. (5) Anterior knee pain was present in 27.2% of our patients and occurred significantly more often after patellar tendon graftings. (6) Age had no influence on the changes of the patellar height.

Effects of a Femoral Shaft Fracture on Multiply Injured Patients with a Head Injury

Abstract. Clinical knee examination is imperative for the prognosis, follow-up, and scientific comparison of anterior cruciate ligament surgery results. A new device, the Rolimeter knee tester was studied in this study with respect to inter- and intratester reliability. We found no significant difference in the intratester evaluation, and data were reliable between repeated measurements and between different testers with the same examination technique. The testers experience seems to play a role using use the Rolimeter knee tester, but even an inexperienced tester can use it and obtain data that are very close to the data obtained by an experienced tester when the same technique is used. Furthermore, it was found that the manual examination of anterior translation also provides a reliable measurement, at least in the hand of experienced testers. Further advantages are that the Rolimeter knee tester is cheap, can be sterilized, and is simple to use