|
Bob's ACL WWWBoard
Re: Surgery Thursday
Posted By: evang
Date: Monday, 17 March 2008, at 5:07 p.m.
In Response To: Surgery Thursday (Tom R)
Tom,
if you have posterolateral corner laxity please make sure that your surgeon is familiar with the possibility of capsular laxity as described in the abstract below. Good luck with your surgery.
Evang
Chondrolysis after partial lateral meniscectomy in athletes, Knee Surgery, Sports Traumatology, Arthroscopy (online first)
Pier Paolo Mariani1, 2 , Raffaele Garofalo3 and Fabrizio Margheritini1
(1) University of Motor Science, Rome, Italy
(2) Piazza Lauro de Bosis 5, 00194 Rome, Italy
(3) Orthopaedic and Traumatology Unit, Miulli Hospital, Acquaviva delle Fonti, Bari, Italy
Received: 5 February 2008 Accepted: 8 February 2008 Published online: 12 March 2008
Abstract Rapid chondrolysis after partial arthroscopic lateral meniscectomy has been seldom reported in literature. Considering the relatively high number of partial lateral meniscectomy performed, we cannot understand why this complication is so rare. The purpose of this paper is to report a series of athletes developing a chondrolysis associated with posterolateral corner laxity after a partial lateral meniscectomy and attempt to hypothesize the pathogenesis of this devastating complication. Five male professional soccer players of Italian championship with a mean age of 26.8 years underwent a partial lateral meniscectomy because of a traumatic lateral meniscus tear. Patients showed a slight varus knee and there were clinical signs compatible with a meniscal tear. No other pathological sign were found. An MRI scan confirmed these findings. After surgery patients were unable to resume sport activities because of swelling and knee pain during training sessions. At a mean time of 8 months (range 6–12 months) from surgery patients were re-examined and a new MRI scan was performed. Clinical examination revealed a slight swelling of the knee and signs of posterolateral corner laxity. MRI scan revealed intra-articular fluid and pathological findings of knee posterolateral corner associated with a thinning of the articular cartilage. Arthroscopy showed free cartilagineous debris floating into the knee and a high grade of cartilage damage on the lateral compartment. The evaluation of lateral compartment, ruled-out a new tear of the meniscal remnant and showed a positive drive-trough sign with knee in the Fig. 4 positioning. All patients had an open re-tensioning of the posterior meniscofemoral capsule, and in one case, an augmentation of the popliteal tendon using a free semitendinous graft was also done. This surgery gave a complete resolution of symptoms and patients resumed sports activities without any restriction after a period between 4 and 5 months. Based on this experience we hypothesize that partial lateral meniscectomy may have a role in causing a subtle rotatory instability that combined with high stress of sports activity can dramatically increase the susceptibility of joint to chondrolysis, Varus knee seems to be a possible predisposing factor. Open surgery addressing the insufficiency of lateral or posterolateral corner has been found to be effective in improving knee function and resolve patients symptoms at a short-term follow-up.
I'm coming up on surgery in a few days and not sure what
> I'm in for. No, not what knee surgery is like -- this is my
> eighth (or ninth -- I've lost count) since 1988. The most
> recent MRI wasn't clear because of the screws from my acl
> replacement in 2004, but my doc (and I) suspect meniscus
> tears on both lateral and medial sides. But, as I've
> mentioned before, I have a fair amount of posterolateral
> instability; maybe it's really just the lateral meniscus
> tear that's causing the problem. There's a bit of ACL
> laxity but the OS seems not too concerned. Just not sure
> what's what.
> And that's the rub, as it were. I asked the doctor about
> best case and worst case scenarios. He said, best case was
> just clean up some minor meniscus trouble and be done with
> it. Moving down the scale, repair some meniscus. But what
> if he finds ligament damage? Not sure I want to face that
> right now.
> Question (for patients and docs): have you ever gone into
> surgery expecting one thing and come out having faced
> another? Sure, in the end you just have to deal with
> things, but I'm just not interested right now in having to
> do that.
> Any comments or advice are certainly welcome.
> Thanks,
> Tom
Messages In This Thread
Bob's ACL WWWBoard is maintained by virtual Bob with WebBBS 5.00.
|
|