[Knee joint hemarthrosis--differential diagnostic considerations for planning an operation].
From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)
Benedetto
K P
KP
Universitätsklinik für Unfallchirurgie, Innsbruck.
Sperner
G
G
Glötzer
W
W
D001182:Arthroscopy / Q000379:methods*; D006395:Hemarthrosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries; D010329:Patella / Q000293:injuries; D012421:Rupture; D013978:Tibial Fractures / Q000601:surgery; D000070600:Tibial Meniscus Injuries
Der Kniegelenkhämarthros--differentialdiagnostische Uberlegungen zur Planung einer Operation.