Analysis Of The Clinical Effect On 104 Knees With Meniscus Injury Under Arthroscopy

Objective: To investigate the clinical therapeutic effect of the knee meniscus injury under arthroscopy.Documents and Methods: From June 2002 to August 2006, the meniscus tears in 104 knees (53 males, 45females; aged 14-65 years, averaged 32.3 years) were treated under arthroscopy. The course of disease was 3 weeks to 30 years . There are 65 cases with evident trauma history,and 39 cases without that. All of the patients had severe pains in the knee, and there were 27 snapping knees, 36 locking knees, 18 giving way knees, 17 knees with limitation of squatting, 31 knees with limited extension, 17 knees with a positive McMurray test, and 13 knees with a positive Apley test. No one′s X-ray show bone abnormalities, and only 13 cases show narrow joint gap. There were 15 injuried knees with a preoperative MRI examination; 12 of which were confirmed under arthroscopy.In the group, the lesions were right knees in 61 cases and left knees in 43 cases . There were 56 tears in the lateralmargin meniscus, 43 tears in the medial meniscus, and 5 tears in both parts ( including 16 cases with the injury of discoid meniscus ) . There were 64 tears in the lateralmargin of the meniscus, 9 tears in the anterior angle of the meniscus, and 31 tears in the posterior angle of the meniscus. According to the O'Connor's arthroscopic classification , there were longitudinal tears in 14 cases, oblique tears in 18 cases, horizontal tears in18 cases, radial tears in 15 cases, and variant tears in 39 cases ( including the flap tears in 8 cases, the complex tears in 15cases and the meniscus cataplasis in 16 cases ).Arthroscopic partial meniscectomy was performed on 58patients who suffer from meniscus injury of the knee joint, and subtotal ectomy 31 cases, total ectomy 12 cases and menisci sutura 3 cases.Results: All of the 104 knees were scored according to Ikeuchi score scale,the follow-up for anaverage of 26 months ( range,12-67 months) showed that there are 57 excellent ones, 28 good ones and 17 fair ones, with the fineness rate of 81.7%.Discussion: Meniscus of knee joint possess significant physic- ological and biomechanical functions function. As a common disease, it shoud be oprated when there are syndroms of pains, interlock, functional disturbance. Because of the lack of the specificity symptoms, meniscus injury has a low diagnose accordance rate.The clinical diagnosis of this group are based on trauma, arthrocele history, locking knee history, tenderness of the knee joint gap, positive McMurray test, and so on. Although it do more or less favor to diagnose the desease, imageology examination are prone to miss diagnosis. Comparing to that, arthroscopic therapy has advantages of safety and reliability and easier to perform .The common therapy methods are the partial meniscectomy, subtotal meniscectomy, total meniscectomy and menisci sutura. Arthroscopic partial meniscectomy was performed on 58 patients who suffer from meniscus injury of the knee joint, and subtotal ectomy 31 cases, total ectomy 12 cases and menisci sutura 3 cases. To treat menisci injury, we traditionally choice total ectomy which is proved to enhance the incidence of OA when we do a long time following-up after surgery. Only could we make a total ectomy when the menisci has no place to reserve , which tears completely from articular capsule and tibial plateau or several different tears exist at the same time. Although it tears from articular capsule completely, wo would better repair injuried menisci, save the most of normal meniscus and avoid meniscotomy as possible as we could.Arthroscopic subtotal ectomy could be performed when the outer margin of the meniscus with a complex or degenerative tear, which may lead to instability and become aging of the knee joint. Arthroscopic partial meniscectomy could make a 2-3mm stable, entire outring of the meniscus, by removing the loosen or free flaps. McGinty and some professors presume that the near curative effect of the partial meniscectomy surpass that of the total ectomy, which not only could relieve the knee pains, stable the joint, but also could decrease the incidence of the arthromeningitis and the OA. We could perform an in-out meniscus repairment, when it injured in the margn of the meniscus, with a tear less than 5cm.It is one of the perfect and significant operations to diagnose and treat meniscus under arthroscopy in the field of arthroscope surgery. Its high accurate rate and excellent effect has made the arthroscopye technique the first method to diagnose and treat meniscus tears, which avoid and prevent the functional impairment and degeneration of joint induced by the open meniscectomy blindly .Conclusion: Arthroscopic therapy which is effective and worth popularizing has been proved to have advantages of safety and reliability and easy to perform. According to the degree of the injury under the arthroscopy, wo choice the properly surgery methods combined with regularly rehabilitation after the surgery, which will effectively restore the function of the injuried knee and have a satisfactory clinical result.With the developing of the society and more and more attention that people paied to the little wound technology, arthroscope surgery would paly a more significant role in the department of orthopaedics and athletic medicine. We believe that it would be one of the routine operations in the near future.