Rezaei Y, Rahim Nia A, Mirmohamad S M, Vaziri K, Fakhrejahani F,
Volume 65, Issue 9 (12-2007)
Abstract
Background: The knee is the most commonly injured joint. The internal components of the knee include the meniscuses, the anterior cruciate ligament (ACL) and posterior cruciate ligaments (PCL). Magnetic resonance imaging (MRI) is now used widely because of its high accuracy and noninvasiveness. Our objective was to diagnose internal knee component injuries by MRI and compare its diagnostic value with that of arthroscopic surgery.
Methods: This process research study was carried out between May 2004 and September 2006 on 90 randomly selected patients admitted to the orthopedic ward of Baghiatollah Hospital, Tehran, Iran. Each patient had arthroscopic surgery after undergoing MRI by an expert radiologist.
Results: Out of 90 patients, 81 were male and nine were female. The mean age was 31.6 years (range: 17-71). Among patients with normal ACL as shown by MRI, 42.4% were shown by arthroscopy to have a ruptured ACL. The sensitivity and specificity of MRI in ACL abnormalities were 73% and 77%, respectively. Only 1.3% of the patients with normal PCL by MRI showed PCL rupture upon arthroscopic examination. The evaluation of the lateral meniscus by MRI had a sensitivity and specificity of 40% and 94%, respectively. Likewise, in the medial meniscus, sensitivity and specificity by MRI was 70% and 98%, respectively.
Conclusion: According to our study, considerable differences exist between MRI reports and arthroscopic findings in the diagnosis of internal knee injuries. We therefore conclude that sole reliance on MRI reports is not reasonable for making treatment decisions and MRI should be used as just one of the diagnostic tools, in conjunction with other methods, such as physical examination and arthroscopy.
Emami A, Farhoud Ar, Ganjealikhan Hakemi A, Ganji M, Mortazavi Seyed Mj,
Volume 67, Issue 4 (7-2009)
Abstract
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Background: During recent three decades, parallel to the improvement of arthroscopic
techniques, intra-articular block by direct injection of anesthetics into the
joint has been used in
knee arthroscopy. In this study the efficacy of intra- articular block by
complex of bupivacaine, lidocaine and adrenaline in knee arthroscopy has been
assessed.
Methods: Forty one healthy adults (age range: 18-55
years) with knee problems selected for diagnostic arthroscopy. Anesthesia was
induced by direct injection of 10ml 2%
bupivacaine, 10ml 0.5%
lidocaine plus 1/100000 adrenaline into the
knee joint. Duration of operation and
volume of serum used for irrigation during the procedure pain and analgesics requirement,
during and after arthroscopy VAS (Visual
Analogue Scale)
score, at time of discharge from recovery and also patient's and surgeon's
satisfaction were assessed.
Results: Sixty eight percent and 29% of cases reported
mild and moderate degree of pain perception during arthroscopy, respectively,
and only one case for which general anesthesia was performed, reported severe
pain. VAS mean was 2.78.
Seventy eight percent of cases and the surgeon in 80%
of procedures had excellent or good satisfaction with intra-articular block.
Conclusions: Considering
high level of satisfaction in both patients and surgeon and mean of VAS,
complications of other modalities of anesthesisa and simplicity of the
technique, intra-articular block can be used as an easy, safe and efficient
method for knee arthroscopy.
Reza Shahryar Kamrani, Mohammad Hossein Nabian , Leila Oryadi Zanjani ,
Volume 72, Issue 10 (1-2015)
Abstract
Background: Wrist arthroscopy is an evolving diagnostic and therapeutic modality which is progressively used by Iranian surgeons. Little data is published about the procedure’s indications, outcomes, complications and prognostic factors. In following study we evaluate the outcome and complications of diagnostic and therapeutic arthroscopy in our patients.
Methods: In a prospective study from September 2009 to March 2013, 100 patients entered in the study. All the patients had chronic wrist pain without any sign of improvement despite at list three months non-operative treatment and underwent diagnostic and therapeutic wrist arthroscopy. All patients were evaluated by wrist range of motion, visual analogue scale (VAS), the quick-disabilities of the arm, shoulder and hand (Q-DASH), and Mayo wrist functional score before and after arthroscopy. Patients were visited at 3, 6, 12 weeks intervals after surgery and every six months thereafter. The most frequent diagnoses were triangular fibrocartilage complex (TFCC) injury, dorsal wrist ganglion cyst and Kienbock disease which were treated with accordant arthroscopic methods. Major and minor complications of arthroscopy and prognostic factors were evaluated.
Results: Eighty nine patients participated in long term follow-up. The follow-up duration was 19±13 months. At final fallow-up there were 28.6±9.6 degrees improvement in wrist range of motion, 5.1±3.4 reduction in VAS score (P<0.04), 37.9±30 improvement in Mayo functional wrist score (P<0.02) and 47.5±33 reduction in Q-DASH score (P=0.009). 82% of patients were satisfied with postoperative results and 16% experienced recurrence. The preoperative diagnosis was not a prognostic factor for outcome of arthroscopic treatment. The rate of postoperative complications was 31.4%, which most of them were minor and transient complications. The most frequent complication of wrist arthroscopy in our patients was transient hypoesthesia in superficial ulnar nerve territory.
Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.
