膝关节游离体的关节镜诊治

目的　探讨膝关节游离体的关节镜诊断及镜下摘除技巧。方法　 2 9例中 ,根据临床及X线片诊断游离体者 13例 ,骨性关节炎 12例 ,膝关节结构紊乱 4例 ,均经关节镜确诊为游离体并行镜下摘除。结果　经关节镜手术证实 ,与X线检查符合者7例 ,不符合 2 2例 ,均通过关节镜补充诊断 ,镜下单膝关节取出游离体最多 14枚 ,最少 1枚。术后随访时间平均 15个月 ,优良率 93 10 %。结论　关节镜诊治膝关节游离体是一种直观准确、创伤小、恢复快的好方法 ,只要注意操作技巧 ,多能获得良好效果     

A new arthroscopic technique for revision of the posterior compartment in symptomatic total knee arthroplasty

Arthroscopy is effective in treating the symptomatic knee following total knee arthroplasty. A small number of patients complain about postoperative pain in the posterior compartment. Loose bodies and degenerated remnants of the menisci are the main reasons for this pain. We present a new technique for diagnostic and therapeutic arthroscopy of the posterior compartments in patients with symptomatic total knee arthroplasty. After standard anterior arthroscopy, a wide circular notchplasty is performed to allow easy access to the posterior lateral compartment of the knee joint and to apply a posterolateral working portal under direct arthroscopic control. If inspection of the posteromedial compartment is necessary, the loose tissue behind the posterior cruciate ligament is resected to gain access to the posteromedial compartment.     

关节镜下诊断与治疗膝关节滑膜软骨瘤病

目的 报道膝关节滑膜软骨瘤病１５例,均用关节镜诊断及治疗,所有病例均经病理检查证实。作者对关节镜在术本病诊断中的优点,分型及治疗方法进行探讨,方法 所有１５例病例均为膝关节病变,左膝关节６例,右膝关节７例,双侧膝关节２例。主要临床症状为关节疼痛,交锁及反复肿胀,关节镜术野好,可全面检查关节腔,具有放大作用,可提高本病的诊断率并有助于分型,关节镜下可将本病分为三型,表浅型,深在型和游离体型,治疗采用     

双切口手术入路在膝关节镜中的应用

目的 探讨应用双切口人路进行关节镜诊治膝关节疾病的疗效。方法 对36例单纯半月板损伤、膝关节内游离体或滑膜皱襞综合征患者应用双切口人路进行治疗。结果全部病例随访8．15个月。按Lysholm膝关节评分标准：优（〉90分）27例，良（80-90分）6例，可（〈80分）3例，优良率91．7％。结论 双切口人路在治疗单纯半月板损伤、膝关节内游离体或滑膜皱襞综合征的关节镜手术中同样可以达到满意的诊断和治疗目的。     

Loose body as an obstacle for posterolateral arthroscopic portal formation in the knee joint

In this report, we present a case with difficult arthroscopic posterolateral portal formation due to loose body located in posterior compartment. These loose bodies are responsible for pain, decreased range of motion and cartilage damage in the knee joint. By making the posterior trans-septal portal prior, posterolateral portal could be made without difficulty completing the planned arthroscopic procedure.     

关节镜下诊断与治疗滑膜软骨瘤病

目的：探讨关节滑膜软骨瘤病在关节镜下的表现、诊断要点、治疗及疗效分析。方法：本组24例,共26个关节,其中膝关节23个,肘关节2个,踝关节1个;男17例,女7例,男女比例2．4：1;年龄18－73岁,平均53岁。均行关节镜检查镜下软骨瘤取出及病变滑膜切除,并描述了该病在关节镜下的表现形式（滑膜表面型;滑膜层包裹型;关节囊纤维层包裹型;游离体型）和处理方法。结果：22例24个关节获得了平均24．5个月随访,未见复发,关节功能均好于术前,效果满意。仅有2例遗漏了2个游离体,无其它并发症。结论：关节镜下游离体摘除和滑膜切除术是治疗滑膜软骨瘤病的良好方法。     

Arthroscopic Retrieval of over 100 Loose Bodies in Shoulder Synovial Chondromatosis: A Case Report and Review of Literature

Synovial chondromatosis is a rare and benign condition of unknown cause. It is also known as synovial osteochondromatosis. It is characterized by involvement of the synovial tissue, which lines various joints of our body. Initial symptoms range from pain in the joint, locking of the joint at times, especially the knee, to arthritis of the joint that is a late feature of this condition. Although large joints such as the knee are commonly affected, involvement of the shoulder joint is a rare occurrence. Historically an open arthrotomy was preferred for removal of loose bodies coupled with a thorough synovectomy. However, arthroscopy for loose body retrieval has gained popularity over the past two decades. Arthroscopic surgery is an extremely skilled procedure and there is a learning curve for operating in certain anatomical areas such as the shoulder. However, not only does an arthroscopy provide the surgeon with an excellent view of the shoulder but the patient also has a faster recovery. We report a rare case of shoulder synovial chondromatosis in which more than 100 loose bodies were successfully retrieved by an arthroscopy in an individual who had an excellent outcome post‐surgery, reaffirming our faith in the procedure. A detailed literature review of arthroscopic procedures is also presented.     

Synoviale Chondromatose

Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present, and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant transformation is unusual and can be difficult to distinguish from benign disease.     

Differentiation of the Osteochondrogenic Cells of the Periosteum in Chondrotrophic Environment

The behaviour of the cells in free periosteal grafts was studied in growing rabbits in three chondrotrophic recipient milieus: costal cartilage, ear cartilage and synovial fluid of the knee joint. The periosteal grafts first formed cartilage, which was then quite rapidly transformed into bone on the costal cartilage, quite slowly and in smaller amounts in the ear cartilage, whereas no bone was found in the cartilaginous loose bodies formed in the knee joint. In bone formation vascularization plays a major role, but other factors are also involved.     

Chondromatosis within a meniscal cyst of the knee

A 32-year-old man complained of left gonalgia for 2 years and noticed a soft tumor on the lateral side of his left knee. Roentgenograms showed some small calcified shadows at the same site of the tumor. Arhtroscopy revealed a lateral meniscus to be an incomplete discoid with degenerative tears. A the operation, a multilocular soft part tumor was noticed in continuity with the lateral meniscus macroscopically. Small, loose bodies and gelatinous fluid were found in the cavity of the tumor. Histologically loose bodies were chondroma and the soft part tumor was meniscal cyst. The meniscal cyst wall contained hyaline cartilagenous tissue. Therefore it was thought that chondroma originated from the cyst wall.     

Kaoko O. Kettunen: Skin Arthroplasty in the light of Animal Experiments with special reference to Functional Metaplasia of Connective Tissue

The behaviour of the cells in free periosteal grafts was studied in growing rabbits in three chondrotrophic recipient milieus: costal cartilage, ear cartilage and synovial fluid of the knee joint. The periosteal grafts first formed cartilage, which was then quite rapidly transformed into bone on the costal cartilage, quite slowly and in smaller amounts in the ear cartilage, whereas no bone was found in the cartilaginous loose bodies formed in the knee joint. In bone formation vascularization plays a major role, but other factors are also involved.     

The fate of intraarticular loose bodies of meniscus origin in canine species

A potential risk of arthroscopic meniscectomy is the retention of debris of meniscus origin in the knee joint. This prospective study analyzes the fate of loose bodies of meniscus origin placed into the canine knee joint. At 12 weeks, 16.7% of the free fragments were completely degraded, 16.7% were absorbed by the synovium, and 66.6% were loose, located between synovial folds. At 12 weeks, 93.3% of the fragments had disappeared, and the remaining fragments had decreased 70% in length and 50% in width. A focus of calcification was present in one fragment at 12 weeks. By three weeks, all loose bodies had a pseudocapsule composed of cells with intense fibroblastic activity, occasional mitoses, and a loss of connective tissue matrix at the periphery. A mononuclear leucocytic response was present in the synovium at 12 weeks in four of the five dogs. Free fragments of meniscus origin are most commonly degraded completely by 12 weeks. Enzymatic digestion, mechanical abrasion, and synovial phagocytosis are processes that may contribute to this phenomenon.     

An unusual presentation of synovial chondromatosis of the knee in a 10-year-old girl

Synovial chondromatosis commonly occurs in the anterior compartment of the knee joint, predominantly in middle-aged men. It is relatively unusual in female children and is rarely encountered in the synovium beneath the meniscus. The present report describes a rare case of synovial chondromatosis that developed in the synovium just inferior to both menisci of the right knee in a 10-year-old girl. At this unusual age and location, there is a greater probability of missed diagnosis, due to the lack of definite informative incidence, and difficulty in finding the lesions during arthroscopic examinations. In the present case, multiple loose bodies were hidden by the meniscus, and thus, there were no structural abnormalities in the initial arthroscopic views before probing the meniscus. After careful inspection, we found numerous cartilaginous loose bodies and removed them as much as possible with arthroscopy.     

Arthroscopic findings at the time of patellar realignment surgery in adolescents

ABSTRACT: Articular cartilage injuries and loose bodies have been associated with patellar dislocations. At the time of patellar realignment surgery (PRS), direct intraarticular visualization of the structures of concern may be limited with the use of a small arthrotomy. Concomitant diagnostic arthroscopy can improve the identification of intraarticular abnormalities, both patellofemoral and nonpatellofemoral, because of the better field of view. PURPOSE: This report details the findings from knee arthroscopy performed concomitantly with PRS in adolescents. METHODS: All patients underwent knee arthroscopy and open PRS for patellar instability, performed by a single surgeon, during a 4-year period. Patient demographics, knee history, clinical examination, operative findings, and treatment details were collected on all patients. RESULTS:: Thirty-eight patients (mean age, 14.9 years; 41 knees) were included in this analysis. Patellar osteochondral lesions were present in 30 knees (73%; mean size, 112 mm). Femoral lesions were documented in 11 knees (23%; mean size, 81 mm). Loose bodies were present in 6 knees (15%). In 8 patients (20%), an additional 11 nonpatellofemoral diagnoses were made at the time of arthroscopy: lateral tibiofemoral chondroses (n = 4), medial meniscal tear (n = 2), lateral meniscal tear (n = 2), discoid lateral meniscus (n = 1), partial anterior cruciate ligament tear (n = 1), and medial tibiofemoral chondrosis (n = 1). Because of these findings, 5 additional procedures were performed in 4 patients: partial lateral meniscectomy (n = 2), medial meniscal repair (n = 1), discoid meniscus saucerization (n = 1), and staged distal femoral valgus-correcting osteotomy (n = 1). CONCLUSIONS: By performing concomitant knee arthroscopy at the time of PRS, we were able to identify significant tibiofemoral abnormality in 4 patients, which would have been missed with direct inspection by a limited arthrotomy at the patellofemoral joint. In addition, precise evaluation of the patellofemoral joint permits customization of the PRS and aids in establishing appropriate patient expectations postoperatively. We advocate diagnostic knee arthroscopy at the time of PRS in adolescents to identify all intraarticular abnormalities and to optimize discussions with the patient and the caregivers on the long-term prognosis of the knee. SIGNIFICANCE: Arthroscopic inspection of the knee at the time of PRS permits identification of abnormality that is not routinely visual by using open arthrotomy. Twenty percent of patients had additional pathological findings; of these patients, 50% underwent an additional surgical procedure.     

Isolated lateral meniscectomy. A study of twenty-six patients with isolated tears

To better define the role that the lateral meniscus plays in stabilizing the knee, a study was made of twenty-six patients who had an uncomplicated lateral meniscectomy between 1972 and 1977. Patients with any degree of ligament instability, cruciate or collateral, prior to lateral meniscectomy were eliminated from the study. Also eliminated were any patients with roentgenographic evidence of degenerative arthrits, osteochondritis dissecans, or loose bodies. Only patients whose operative reports stated that the articular cartilage of the lateral compartment was either grossly normal or showed Grade-1 chondromalacia (less than one centimeter in diameter and only softening of the cartilage) at the time of surgery were included in the review. The meniscal lesions included bucket-handle tears, horizontal cleavage tears, and multiple linear defects. No grossly cystic menisci were included in the study. Two menisci demonstrated cystic degenerative changes on histological section. In sixteen patients some degree of ligament instability developed. The longer the interval between injury to the meniscus and its excision, the less satisfactory the result. Only fifteen (54 per cent) of the patients reported satisfactory results, and twenty lost some motion of the knee. We concluded that stability of the knee joint is a multifactorial problem, in which the lateral meniscus certainly plays an important part.     

Ankle arthroscopy

Arthroscopic assessment of the ankle joint can be an important diagnostic aid for intra-articular pathologic conditions. The major portals of entry are anteromedial and anterolateral. In one patient with loose bodies of the ankle, the authors successfully localized the loose bodies and determined the status of the articular surface by arthroscopy. In a second patient with pain and a roentgenogram suggestive of an osteochondral fracture, arthroscopic evaluation determined that the articular surface was intact, and the patient was successfully treated non-surgically. Precise indications for arthroscopy of the ankle have not yet been determined, but its role will certainly be less extensive in the ankle than in the knee.     

急性滑脱性髌股关节撞击综合征的关节镜诊断与治疗

目的探讨急性滑脱性髌股关节撞击综合征的发生机制、病理改变及其关节镜下诊断和治疗方法。方法2000年1月至2003年5月,在关节镜下诊断和治疗急性滑脱性髌股关节撞击综合征25例,均为膝关节急性屈曲外翻扭伤。根据撞击后肌肉松弛状态下髌股关节的稳定性将其分为3型:无脱位型9例,半脱位型11例,脱位型5例。关节镜检查25例均存在软骨损伤、髌骨内侧支持带损伤及关节囊积血,18例有关节内游离体。根据分型及关节镜下检查结果采用不同的手术方式:无脱位型患者行关节清理术;半脱位型患者中髌骨内侧支持带Ⅰ度损伤者,行关节清理术 外侧支持带松解术;半脱位及脱位型患者中,轻者行关节清理术 髌骨内侧支持带缝合术 外侧支持带松解术,严重者或存在滑车发育异常者同时行胫骨结节移位术。结果所有患者均获随访,时间6～46个月,平均17个月。优18例,良4例,可2例,差1例,优良率88%。1例术后1年发生再脱位,2例有关节僵直。结论关节镜检查对急性滑脱性髌股关节撞击综合征的诊断具有极高的价值,可以明确诊断,并对损伤情况作出全面评估及制定合理的治疗方案,修复须紧急处理的结构。对于急性滑脱性髌股关节撞击征早期诊断、早期合理治疗,均可获得良好的效果。     

A method of arthroscopic surgery. Clinical evaluation of synovectomy with the electric resectoscope and removal of loose bodies in the knee joint.

The structure and function of the electric resectoscope have been discussed and the application to synovectomy and removal of loose bodies in the knee joint. Our clinical results have also been reported. The advantages and problems of synovectomy and arthroscopic surgery with the electric resectoscope as used in the knee joint are discussed, especially in comparison with conventional resection of the anterior two-thirds of the synovial membrane. For intra-articular use in the knee joint the electric resectoscope used for transurethral resection in urology was modified to perform synovectomy and arthroscopic surgery. Clinical folow-up observation indicated that synovectomy performed with the electric resectoscope produced results almost comparable with those of conventional synovectomy. Arthroscopic surgery with the electric resectoscope is a new method. It is performed through a small skin incision with fewer untoward effects. The operation is relatively painless and offers more rapid recovery after surgery. A few complications were noted by this method. None were serious. There were two epsiodes of infection during the early use of this technique.     

Arthroscopic debridement of the knee joint

Arthroscopic debridement is a valuable alternative procedure in the management of osteoarthritis of the knee joint. Although palliative in nature, in many instances it yields permanent relief in the low-demand knee of the elderly. It is especially valuable in young individuals who have not yet reached the ideal age for reconstruction. The procedure is a demanding one, requiring considerable arthroscopic skills. Sclerotic lesions, synovitis, loose bodies, osteophytes, chondromalacia, and degenerative tears of menisci are encountered often in various combinations and must be addressed judiciously and completely. The procedure simplifies rehabilitation, and the risk/benefit ratio is very favorable.