WISSENSCHAFTLICHER BEITRAG: Die Arthroskopie des Kniegelenks im Kindes- und Jugendalter: Sichere Diagnostik – Definitive Therapie

Abstract

What are the major indications for arthroscopy after knee joint injuries in children and adolescents? How helpful is arthroscopy in diagnosing injuries or joint diseases in children and adolescents? Between 1982 and 1995, 635 knee joint arthroscopies were performed and retrospectively evaluated in patients under 17 years of age (average 14,6 y) at the Orthopedic State Hospital Munich. Clinical diagnosis was compared to the arthroscopic diagnosis. Arthroscopies were devided into three groups: Those with full confirmation of the clinical diagnoses (1), those with confirmation of the main clinical diagnosis but not the co-diagnoses (2) and those without confirmation of the clinical diagnosis (3). 51% were male. The incidents leading to arthroscopy were mainly sports accidents (58%) followed by idiopathic complaints without trauma (26%) and general trauma (16%). 37% of all patients had hemarthrosis. Arthroscopy revealed 17% ACL lesions, 12% patellar dislocations, 12% cartilage lesions, 11% medial and 7% lateral meniscus lesions. Clinical diagnosis was fully confirmed in only 57%, partially confirmed in 21% and turned out to be wrong in 22% of the cases. Clinical diagnosis was confirmed by arthroscopy for 96% of the osteochondritis dissecans cases, for 94% of patellar dislocations and 90% of ACL tears, for 77% of medial meniscus lesions and for 74% of lateral meniscus lesions. Poorest correlation was obtained in cases of clinical suspicion of a meniscus tear. Only as little as 3,6% of the arthroscopies did not display any damage. 51% of all purely diagnostic arthroscopies established a complete different diagnosis than primarily suspected. 75% of all arthroscopies immediately led to definitive therapy. (Sport)Injuries of ACL, meniscus and joint cartilage are the major indications for knee arthroscopy in children and adolescents. Arthroscopy is only able to confirm preoperative clinical diagnosis in case of ACL tears, patellar dislocation and osteochondritis dissecans whereas there is not sufficient clinical certainty in diagnosing lesions of meniscus and cartilage.