Joint Line Tenderness Research Articles

Arthroscopic Partial Meniscectomy in Adult Patient with Symptomatic Discoid Lateral Meniscus: A Case Report

Introduction: For many years, the discoid meniscus was synonymous with snapping knee syndrome. incidence of discoid lateral meniscus is estimated to be 0.4% to 17%, whereas the discoid medial meniscus is extremely rare (0.1% to 0.3%). It has been reported that about 20% of cases are bilateral. Patients with discoid lateral meniscus (DLM) often show normal plain radiography findings but may also show subtle indirect signs. Case Presentation: Female, 59 years old, complained of pain on her left knee after walking and climbing stairs for the last two months. On examination, the range of motion of knee joint was limited due to the pain for flexion more than 90°. Patient had medial joint line tenderness, and a McMurray test elicited pain on the lateral joint line. Radiographs of the left knee showed lateral joint space widening and high fibular head. Arthroscopic examination of the left knee confirmed the presence of discoid lateral menisci (DLM). Discussion: Discoid lateral meniscus (DLM), often referred to as "popping knee syndrome," is an abnormal variation of the meniscus, primarily affecting the lateral side and more common in young individuals. This condition increases the risk of knee injury, especially if the ligament attachment to the tibia is absent. In our case, radiographic findings and a positive McMurray test led to the diagnosis, confirmed by arthroscopy showing a complete DLM. While some recommend for total meniscectomy, studies suggest that partial meniscectomy can offer good initial results, though long-term outcomes may vary. Conclusion: In symptomatic DLM, surgical treatment is necessary to treat the patient. Arthroscopic partial meniscectomy is the preferred surgical procedure to treat symptomatic DLM. Keywords: Discoid lateral meniscus, arthroscopic menisectomy, WOMAC score

Functional outcome after arthroscopic mosaicplasty for localised osteochondral defects in the knee

Background: Knee injuries are commonly encountered in active sports persons as well as nonathletes, with approximately 60% of patients having cartilage damage with or without associated ligament and meniscal injuries. In this study, we report on the functional outcome of autologous osteochondral grafting in localised cartilage lesions of the knee. MethodsA longitudinal follow-up study was conducted on 50 patients aged between 18-55 years with symptomatic focal cartilage defect in the knee of size less than 2.0 cm2 after necessary inclusion/exclusion criteria. Management involved arthroscopic autologous osteochondral grafting. The donor cartilage was from the non–weight-bearing region of the ipsilateral knee. Other associated intra-articular injuries were addressed in the same sitting. The patients were followed up after 6 weeks, 3 months and 6 months and clinical status documented by the Lysholm Knee Function Scale (LKFS). ResultsMost patients were young active males. Clinical presentation involved pain in all participants, followed by joint line tenderness. There was at least one associated injury to other intra-articular structures in 52% of the patients. The commonest associated injury was anterior cruciate ligament (ACL) tear followed by meniscus tear. The mean size of the focal cartilage defect was 1.013 cm2, ranging from 0.8 cm2 to 1.6 cm2. The mean preoperative LKFS was 56.97 ± 1.38 (standard error). There was a statistically (p < 0.001) as well as clinically significant (clinically important difference >13.0 and patient acceptable symptomatic state >70.0) improvement in the mean Lysholm score, which was 70 ± 1.32, 81.3 ± 1.12 and 92.1 ± 1.11 at the end of 6 weeks, 3 months and 6 months respectively. Eighty-four percent of the patients showed excellent functional outcome at 6 months (LKFS >90), whereas 8% and 4% had good and fair outcomes, respectively, at 6 months (LKFS: 70–90). Two patients (4%) who had failed ACL reconstruction had poor outcome (LKFS <70)at 6 months. ConclusionMosaicplasty is an excellent procedure for managing cartilage defects of small to medium sizes, less than 2.0 cm2. The short-term results are satisfying and can accelerate rehabilitation of sports injuries. It is noteworthy that instability is a contra-indication for the procedure to succeed.

Concomitant osteochondral lesion of the talus in ankle instability: Utilizing clinical presentation to guide imaging decision

Low ankle sprains are a prevalent issue, often involving the anterior talofibular ligament. While there is increased attention placed on ligamentous injuries in ankle sprains, concomitant cartilaginous injuries are frequently overlooked. This article aims to [1] evaluate the significance of magnetic resonance imaging in anterior talofibular ligament injuries to detect concurrent osteochondral lesions of the talus as well as other associated ligamentous injuries; [2] determine the importance of clinical presentation and its association with the risk of concomitant osteochondral lesions in anterior talofibular ligament injuries. We conducted a retrospective analysis of 129 patients who underwent anterior talofibular ligament reconstruction, reviewing patient data to assess the incidence of osteochondral lesions of the talus and associated ligamentous injuries. Clinical presentations were then reviewed to identify signs and symptoms associated with the occurrence of osteochondral lesions of the talus. The results indicated that calcaneofibular ligament was most injured in association with anterior talofibular ligament injuries (69.52%; n=73). Furthermore. 31.78% (n=41) of patients with anterior talofibular ligament injuries had concurrent osteochondral lesion of the talus. Analysis on clinical presentation revealed statistical significance (p<.001) between patients that had ankle joint line tenderness lasting for more than 6 weeks and the occurrence of osteochondral lesions of the talus. This study concludes that magnetic resonance imaging could be beneficial in anterior talofibular ligament injuries with patients exhibiting persistent joint line tenderness to evaluate for osteochondral lesions to ensure a comprehensive pre-operative assessment.

Meniscotibial Ligament Tear and Meniscocapsular Detachment of Anterior Horn of the Lateral Meniscus

The meniscotibial ligament (MTL) tear, along with a meniscocapsular separation, is a very rarely diagnosed injury pattern often missed on magnetic resonance imaging (MRI). The meniscus becomes hypermobile and can cause anterior knee pain, instability, and frequent locking. A 29-year-old female patient presented to the outpatient department with a history of a noncontact injury 3 months ago. Her Tegner Lysholm Knee Score was 41/100. On examination, there was lateral joint line tenderness and a positive McMurray test with a clicking sensation. MRI was performed, which showed torn fascicles in the anterior horn of the lateral meniscus. Knee arthroscopy confirmed that MTL was completely torn along with meniscocapsular detachment. A Scorpion jaw (Arthrex, Naples, FL) loaded with 2-0 FiberWire was used to take three bites from the meniscus. These ends of sutures were loaded on a 2.9 mm PushLock anchor and inserted at the tibia border. An 18G needle was loaded with a monofilament nitinol loop suture and passed through the capsule into the joint. A suture retriever was used to pick suture ends and pass through the loop. The monofilament loop was then pulled to pass the FiberWire ends from the capsule. All six FiberWire ends were passed through the capsule and three knots were tied from outside to reattach the capsule. This kind of injury can lead to anterolateral instability of the knee. Diagnosis of this lesion is very challenging and crucial. Biomechanical instability has prompted us to pay specific attention to its investigation and management. The described repair technique gives good results due to rigid fixation and the postoperative rehabilitation is also fast.

Using a combination of three clinical tests for detecting meniscal tears increases the accuracy of the clinical examination.

Recent studies indicate that using combination of two or more clinical tests for detecting meniscal tear gets a higher sensitivity and specificity than any clinical test performed individually. The study involved 84 participants who were divided into two groups: the "OP group" consisting of participants diagnosed with a meniscal tear and who consequently underwent arthroscopic meniscectomy, and the "CN group" comprising of healthy participants with no history of knee injury. Two independent observers (orthopedic surgeons) recorded the results of six clinical tests: Thessaly Test, joint line tenderness, McMurray Test, Ege Test, Steinmann I Test, and atrophy of the thigh muscles. The tests were grouped into two combinations of three tests each. The first combination included Thessaly Test, joint line tenderness and McMurray Test, while the second combination comprised of remaining three tests. Cochran's Q Test was used to calculate interobserver variability for both combinations of clinical tests and for each test performed individually. First combination of three clinical tests when considering the combination positive if two tests are positive had high sensitivity of 95%, specificity of 90.9%, and an overall accuracy of 92.9%. Furthermore, when compared to clinical tests performed individually, the combination demonstrated superior results. This study shows that using a combination of three clinical tests for detection of meniscal tear (Thessaly Test, joint line tenderness, McMurray Test), when considering the combination positive if two tests are positive, has greater accuracy than six clinical tests performed individually. There were no statistically significant differences between observers.

Checkpoint inhibitor immunotherapy induced inflammatory arthritis secondary to Nivolumab and Ipilimumab: a pediatric first

BackgroundImmune checkpoint inhibitors (ICIs) have expanded the arsenal of cancer therapeutics over the last decade but are associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. While these complications are increasingly recognized in the adult population, no cases of inflammatory arthritis irAEs have been reported in the pediatric literature.Case PresentationA 14-year-old female with metastatic epithelioid mesothelioma was referred to the pediatric rheumatology clinic after developing progressive inflammatory joint pain in her bilateral shoulders, hips, and small joints of hands following the second cycle of Nivolumab and Ipilimumab. Initial examinations showed bilateral shoulder joint line tenderness, positive FABERs test bilaterally, tenderness over bilateral greater trochanters, and bilateral second PIP effusions. Her serological profile was notable for positive HLA-B27, positive anti-CCP, negative Rheumatoid Factor, and negative ANA. PET-CT scan performed for disease response following immunotherapy showed symmetric increased metabolic activity primarily involving the supraspinatus, gluteus medius and minimus, and semimembranosus tendon insertions. Her presentation was consistent with a grade 1 irAE that worsened to a grade 2 irAE despite NSAID therapy, prompting a short course of oral prednisolone. She achieved clinical remission of her mesothelioma following six cycles of Nivolumab and Ipilimumab and her inflammatory arthritis was controlled on Celebrex monotherapy.ConclusionsTo our knowledge, this is the first pediatric case of ICI-induced inflammatory arthritis and enthesitis. This case highlights the importance of increasing awareness of diagnosis and management of irAEs in children.

Correlation between Clinical Examination, Magnetic Resonance Imaging, and Arthroscopy in Meniscal Injuries of the Knee: A Prospective Cohort Study

Abstract Purpose: In comparison to magnetic resonance imaging (MRI) imaging, this study compares the diagnostic efficacy of meniscal injury with clinical examination tests such the McMurray’s test, Thessaly test, and joint line tenderness. Methodology: Two hundred and fifteen patients having a history of knee injuries with symptoms such as pain, instability, and locking were studied from June 2020 to June 2022 at our institution, for a 2-year period. Results: The sensitivity and specificity of McMurray’s test for medial meniscus were 84% and 84.21%, respectively. The sensitivity and specificity for medial joint line tenderness were 88.15% and 55.55%, respectively. Thessaly’s test for the medial meniscus was 92.10% sensitive and 88.8% specific. The sensitivity and specificity of MRI for medial meniscal injury were 94.87% and 93.75%, respectively. McMurray’s test for lateral meniscus had a sensitivity of 84.44% and a specificity of 76.92%. Lateral joint line tenderness for lateral meniscus had a sensitivity of 86.95% and a specificity of 66.66%. The sensitivity and specificity of Thessaly’s test for lateral meniscus were 93.33% and 84.61%, respectively. MRI revealed a sensitivity of 93.75% and a specificity of 90% for lateral meniscus injuries. Conclusion: Even though MRI is a precise and noninvasive method for detecting meniscal injuries, a thorough clinical examination by a skilled physician has the same diagnostic power as MRI to rule out meniscal injuries. In contrast to previous tests, the Thessaly test can be used as a useful tool to detect meniscal injuries, as we discovered in our study.

A High-Speed Ski Crash Leading to a Unique Synovial Cause for Knee Pain

The presented case involves the evaluation, diagnosis, and management of a 20-year-old male high-level skier who presented with persistent right knee pain following a ski crash. The patient reported hitting his right knee against a tree during the accident, resulting in intermittent swelling and a sensation of a mass within the knee. Despite some initial improvement in the sensation, the pain then became persistent and worsened by activity. Physical examination revealed limited symptoms during gait and functional movements, as well as restricted medial joint line tenderness and a mildly positive McMurray's test on the right knee. Magnetic resonance imaging findings prompted an orthopedic referral, leading to a right knee arthroscopy. The procedure involved resection of nodular synovitis and a diffuse synovectomy, with pathology confirming pigmented villonodular synovitis (PVNS). Despite post-operative complications, including methicillin-resistant Staphylococcus aureus bacteremia, ultimately, the patient's recovery was successful with the gradual restoration of pain-free range of motion through physical therapy. Follow-up assessments and magnetic resonance imaging scans indicated sustained improvement and no signs of pigmented villonodular synovitis recurrence.

Anterior Cruciate Ligament Ruptured Concomitant Meniscus Discoid in Young Patient: A Rare Case Report

Background: Abnormalities of the human meniscus, including discoid meniscus, double-layered meniscus, and ring-shaped meniscus, have been reported. The prevalence of discoid meniscus is extremely rare, with an incidence of 0.9%－2.4% in the Asian population. Traditionally, discoid meniscus concomitant anterior cruciate ligament (ACL) ruptures are extremely rare cases. The aim of this study is to discuss a rare case to provide diagnosis and management properly by using arthroscopy.Case Presentation: A 21-year-old male Balinese, complained of pain in his right knee after fast walking for two months and an unstable knee in the past 1 year ago. On physical examination, the range of motion was limited due to the pain for flexion of more than 90°. Special tests such as Lachman test positive, and Anterior drawer test positive. The patient had medial joint line tenderness, and a McMurray test elicited pain on the medial joint line. Meanwhile, an MRI examination of the right knee showed a discoid medial meniscus with a horizontal cleavage tear and a discoid lateral meniscus with an incomplete tear. We performed a partial meniscectomy of the incomplete discoid medial meniscus and resection of the pathologic medial patellar plica. We performed surgical reconstruction of the ACL ruptured after the meniscus was repaired.Results: We presented a 21-year-old male with discoid meniscus concomitant ACL rupture to his right knee. After the patient was performed with partial meniscectomy of the incomplete discoid medial meniscus and resection of pathologic medial patellar plica following surgical reconstruction of the ACL ruptured. The patient had no limitation of motion or pain 1 year after the operation and he had no complaints and was satisfied with the result by radiograph.Conclusion: We concluded that This rare case of medial discoid meniscus concomitant with the ACL rupture must be reconstructed. The treatment of discoid meniscus should consider its tear pattern and whether it is symptomatic. With the development of arthroscopic techniques, the treatment of discoid meniscus has gradually changed from total meniscectomy or partial meniscectomy.Keywords: anterior cruciate ligament, meniscus, discoid, knee, arthroscopy.Correspondence: I Gusti Ngurah Wien Aryana. Department of Orthopaedic &amp; Traumatology, General Central Hospital of I.G.N.G Ngoerah Central Hospital/ Faculty of Medicine, Udayana University, Bali, Indonesia. Email: wienaryanaortho@gmail.com. Mobile: +62811-385-263.Indonesian Journal of Medicine (2023), 08(03): 317-324https://doi.org/10.26911/theijmed.2023.08.03.09

AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair.

The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray's test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

Effect of Radiosynovectomy with Rhenium-188 in the Treatment of Knee Joint Inflammation in Patients with Hemophilia

Background: One of the effective methods to control chronic hemophilic synovitis is radiosynovectomy. Rhenium-188 is a new radionuclide, and its half-life is 0.7 day. This study aimed to investigate the effect of radiosynovectomy with Rhenium-188 on the knee joint of hemophilic patients.&#x0D; Methods: Thirty patients with hemophilic synovitis of the knee visited in the orthopedic clinic in 2019 and 2020, entered the study. They all had at least two bleeding per month; in the supine position with slight knee flexion, after local sterilization, 550 to 750 MBq Rhenium-188 was injected into the knee. A splint was installed for five days. The demographic characteristics, radiography, articular line tenderness, joint line tenderness, flexion and extension restrictions, and joint volume characteristics were evaluated before and six months after injection.&#x0D; Results: The amount of monthly injected factors (VIII and IX) 6 months after injection was decreased from 5260.2±1836 units to 3870.83±1106 units (p&lt;0.001). The radiographic classification has not changed within six months. The average knee pain score decreased from 7.3±1.2 to 2.3±1.1, after six months (p&lt;0.001), and knee flexion increased from 84.6±26.22 to 114±21.58 degrees (p&lt;0.001). None of the patients have experienced complications such as skin necrosis or joint infection. All patients have reported that the pain increases 24 hr after the injection were manageable.&#x0D; Conclusion: The use of Rhenium-188 radiopharmaceutical in radiosynovectomy of 30 hemophilic patients’ knees is effective in reducing pain, tenderness of the joint line, and the number of bleeding episodes, and it improved knee range of motion in the short term (6 months).

Clinical Evaluation of the Knee Arthritis Patient

The evaluation of a patient with knee osteoarthritis (OA) has 3 main components: clinical history, physical examination, and radiographic imaging. The clinician should assess for inciting and aggravating factors for the knee pain as well as for the presence of any mechanical symptoms. A history of prior knee injury or surgery can suggest the development of early osteoarthritis. A thorough physical examination of the knee should be performed. Some features of OA include limited range of motion, crepitus in the patellofemoral compartment, and joint line tenderness. Depending on the severity of OA varus or valgus alignment can develop. Special tests such as the McMurray for meniscal tears may cause increased pain as patients with OA will often have degenerative meniscal tears. Weight bearing radiographs can confirm the diagnosis of OA. Several scales exist to grade the severity of OA with the Kellgren-Lawrence being one that is often used. Radiographic features of OA include joint space narrowing, osteophytes, sclerosis of bone and bone end deformities. If after the above evaluation the diagnosis is still unclear, advanced imaging or laboratory testing can be performed to evaluate for alternative diagnoses.

Assess Clinical Improvement Regarding Joint Line Tenderness and Childress’ Test (Duck Walk Test) after Arthroscopic Partial Meniscectomy in a Tertiary Care Hospital

Background: Clinical weight bearing provocation tests, like to determine the sensitivity and specificity of the childress’ test (duck walk test) and joint line tenderness in diagnosing meniscal tears and to determine whether the location of tear and severity of injury is important. However, evidence of the diagnostic accuracy of the childress’ test (duck walk test) and joint line tenderness test are lacking and the cause of tear (traumatic versus degenerative), and ACL insufficiency were associated with differences in the sensitivity and specificity of the test. Objectives: The aim of this study was to assess the clinical improvement regarding joint line tenderness and childress’ test (duck walk test) in a tertiary care hospital. Methods: This is a prospective interventional study. The study used to be carried out in the admitted patient’s Department of Orthopedic, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR) Sher-E-Bangla Nagar, Dhaka, Bangladesh. In Bangladesh for the duration of the period from January 2013 to December 2014. Results: This study conducted on 20 patients aged 16 to 40 years, Childress test (Duck walk test) was positive in case of 80% patients and post operatively the test became negative in all patients Out of 20 patients 90% regained normal to near-normal knee function and stability after surgery. Pain and swelling were also significantly reduced. Conclusions: Meniscus injury frequently takes place in young adult population who are very active, which reduces their endeavor level and ultimately become an economic burden. So, early intervention and partial meniscectomy, which offers very accurate momentary result, is imperative to make them healthy and return to their normal activity.

Evaluation of the Short-Term Results of Arthroscopic Partial Meniscectomy in Adults

Background: Arthroscopic partial meniscectomy is one of the most common orthopedic procedures; yet enormous evidence of its efficacy is under trial in comparison to repair of the meniscal injury. Objective of this study is to confirm of the clinical findings arthroscopically in case of meniscal injury of the knee joint and find out the results of Arthroscopic partial meniscectomy among the adult people. Methods: This prospective interventional study was conducted from January 2013 to December 2014 at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka. Twenty (20) patients with meniscus injury were treated in the form of arthroscopic partial meniscectomy. Accelerated rehabilitation protocol was followed. Patients were visited routinely and final outcome evaluation done at 6 months. Lysholm knee scoring scale was used to compare preoperative and postoperative score and to evaluate final outcome. Results: This study was carried out on 20 Patients. Preoperatively all patient had significant knee pain with positive joint line tenderness, McMurrey test, Apley’s grinding test, squat test and Thessaly test. Post operatively significant improvement was found (p&lt;0.05). Mean preoperative Lysholm knee score was 52.8 with SD ± 2.97 and postoperative score was 93.8 with SD ± 4.24. According to Lysholm knee scoring scale, excellent results (95– 100 points) were obtained in 14 patients, good results (85–94 points) in 4 patients, fair in 2 (10%) patient. Conclusion: Arthroscopic partial meniscectomy shows excellent short-term result if the procedure performed early in the adult patients.

Pseudomeniscus after knee arthroplasty: A case series for arthroscopic management of this problem and systematic review of literature

IntroductionMost patients undergoing total knee arthroplasty (TKA) experience favorable outcomes. Some patients, however, experience prolonged post-operative knee pain and tenderness at the joint line. This has been attributed in some cases to soft tissue impingement due to pseudomeniscus. The purpose of this study is to evaluate patient outcomes for arthroscopic excision of pseudomeniscus for persistent knee pain after TKA and to perform a review of literature for pseudomeniscus after knee arthroplasty. MethodsA retrospective analysis of patients undergoing arthroscopy to remove soft tissue causing persistent knee pain after previous TKA was performed. Outcome scores were asked at three time points: prior to knee arthroplasty, prior to arthroscopy, and post-arthroscopy at final follow-up. Subjective satisfaction with surgery and willingness to repeat procedures were also recorded. A two-tailed distribution paired t-test was used to determine statistical significance (p < 0.05). We also performed a review of the literature for pseudomeniscus complications for comparison. ResultsNine out of eleven patients were considered eligible to be assessed for post-operative satisfaction. Seven out of nine patients reported complete satisfaction and eight participants stated they would undergo the procedures again if they have to. Among 9 included patients, five patients have successfully completed the clinical score evaluation survey. The mean age of the patients with clinical score evaluation at the time of TKA was 61 years (range, 53–72) and the time between TKA and undergoing arthroscopy was 8 months (range, 5–13). The average follow-up period for patient-determined assessment after the arthroscopic procedure was 71 months (range, 16–115). All 5 patients reported improved Oxford Knee Scores (p=0.017), Western Ontario and McMaster Universities Osteoarthritis Index (p=0.023), and pain scores (p=0.018) comparing pre-arthroscopy to post-arthroscopy at follow-up. ConclusionArthroscopic removal of pseudomeniscus after TKA provides promising results in patients who experience persistent knee joint line pain and tenderness. Considering our results and review of literature, we recommend including pseudomeniscus in the differential for post arthroplasty knee pain. Study designCase series with a review of literature.

Prognostic factors for the treatment of meniscus horizontal tear

Meniscus horizontal tears are usually degenerative. It could be asymptomatic and unrelated to knee symptoms. Therefore, there are controversies regarding treatment choices. The aim of this study was to evaluate factors that affect the results of non-surgical and surgical treatments for meniscus horizontal tears. We retrospectively studied 159 patients with meniscus horizontal tears with a minimum 2-year follow-up period. Patients were treated non-surgically or arthroscopically. The treatment results were dichotomized into success and failure. The factors considered were age, sex, joint line tenderness, mechanical symptoms, widest tear gap width on sagittal MRI, cartilage lesion grade, discoid meniscus, tear site, and joint alignment. Joint alignment and cartilage lesion grade were the factors that significantly influenced non-surgical treatment results. The widest tear gap width and cartilage lesion grade significantly affected arthroscopic surgery results. The mechanical symptoms did not show any significant relationship with either treatment result. In treating patients with meniscus horizontal tears, patients with varus alignment and advanced cartilage lesions should be informed of possible poor outcomes with non-surgical treatment. If the patient has a wide tear gap or minimal cartilage lesion, arthroscopic surgery would be a good treatment choice. The mechanical symptom was not an adequate factor for arthroscopic surgery.

An Unusual Cause Of Knee Pain Impacting An ICU Nurse’s Ability To Run For Codes

History: A 49 yo active female ICU nurse who enjoys hiking presented with right achy knee pain that hadstarted 6 months prior, but worsened 3 months ago when she twisted her knee playing with her nephewin the pool. The pain was worse with prolonged time on her feet preventing her from exercising andimpacting her ability to work, particularly running to code blues. She also noted pain in her distal thighand intermittent swelling with increase in venous distension. PHYSICAL EXAMINATION:Right Knee examAppearance: No skin abnormalities. Mild varum deformity. Small effusion. Gait: Antalgic Palpation: Lateral joint line tenderness to palpation Range of motion: Normal range of motion, pain with flexion. Meniscal testing: Positive McMurray’s, Thessaly, and bounce test. Ligament testing: Negative Lachman’s, anterior drawer, posterior drawer. Pain but no laxity with varusstress at 30 degrees. Patellar testing: Positive inhibition Strength/Function: 5-/5 quadriceps strength DIFFERENTIAL DIAGNOSIS:1. Meniscal tear 2. Venous thromboembolism 3. Malignancy 4. Osteoarthritis Tests/Results:XR 3V Right Knee:There are small spurs along the lateral and patellofemoral compartment. The joint spaces are normal.There is a small right effusion. There is a 2.4 cm focus of ill-defined sclerosis in the distal femoral shaft.This was not evident on the comparison study. MRI Right Knee without Contrast:There is a distal femoral metaphyseal lesion with chondroid matrix measuring 28 mm. There is a 2 mmextraosseous component anteriorly at the prefemoral fat pad.There is a T2 hyperintense focus in the proximal fibula which may represent a intraosseous ganglionversus an additional small cartilaginous lesion. FINAL DIAGNOSIS:Chondrosarcoma of the femur TREATMENT/OUTCOMES:The patient was referred to Orthopedic Oncology. Follow-up CT scan of the femur and chest showed nometastasis. The patient’s case was reviewed with the medical tumor board and she was scheduled fordistal femur replacement.

Clinical outcomes of all-inside meniscal repair using pre-loaded suture anchors

Purpose: This prospective study aims to evaluate clinical results of arthroscopic repair of meniscal tears using clinical scores and functional outcome measures while establishing clinical evaluation as a dependable method of evaluating the healing process of a repaired meniscus. Methods: From June 2019 to October 2020, 203 patients with a mean age of 24 (range, 18-54) years with 203 meniscal tears underwent arthroscopic all-inside meniscal repair using a pre-loaded suture anchor. All tears were located in either the red-red or red-white zone. Simultaneous anterior cruciate ligament reconstruction was performed in 170 (84%) of the patients. Postoperatively, patients were evaluated based on clinical examination using Barrett’s criteria wherein the presence of locking, joint-line tenderness, swelling or positive McMurray test were considered to indicate clinical failure. Further, we also used the International Knee Documentation Committee score, Lysholm score and Short-Form 36 score for postoperative evaluation. Results: At average of 1.2 years follow-up, the success rate of arthroscopic meniscal repairs in this series was 94% (191 clinically healed menisci out of 203) according to the criteria of Barrett et al. The IKDC, Lysholm and SF-36 scores had significantly improved postoperatively. Conclusions: Arthroscopic all-inside repair using a pre-loaded suture anchor (FastFix 360) is a safe and effective procedure for treating meniscal tears, and clinical evaluation was found to be a dependable method of evaluating the results of a healed, repaired meniscus.

Bilateral Avascular Necrosis of Hip: An Oddity in Endogenous Hypercortisolemia

A 21-year–old female presented with progressive weight gain, amenorrhea, hyperpigmentation, and proximal muscle weakness for 4 years. She complained of bilateral hip joint pain for the preceding 1 year. On examination, she had discriminatory features of Cushing syndrome with proximal myopathy, easy bruising, rounded face, increased dorsocervical fat pad, thinning of skin, and hyperpigmented striae. She had severe antalgic gait, and examination of hips revealed bilateral anterior joint line tenderness with restriction of joint movement.

Management Dilemma of a Neuropathic Knee in a Known Case of Larsen Syndrome: A Case Report.

Larsen syndrome (LS) is a rare genetic disorder affecting mainly the connective tissues. It is characterized by characteristic facial anomalies, cervical kyphosis, cardiorespiratory disorders, and multiple joint dislocations. We present a case of a 15-year-old male with unstable neuropathic knee joint instability in a known case of LS. The paucity of literature on the management of this rare condition puts an orthopedician in dilemma regarding the optimal treatment. A 15-year-old male, known case of LS, presented to our outpatient department with pain and instability in the right knee for 2 years. Clinically, the patient was having syndromic facies. The diagnosis of LS was confirmed on gene mapping. The right knee was swollen with medial joint line tenderness and restricted flexion. The patient had coronal plane valgus instability. The hypertrophied synovium eroded the articular surface. The radiograph of knee was suggestive of neuropathic arthropathy in fragmentation stage. Orthopedician should be aware of such rare entity with its bony and soft-tissue manifestations. Neuropathic knee is not an absolute contraindication to total knee replacement, especially with advanced prosthesis. Primary arthrodesis to be considered in young adults with instability.