title: Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients.
abstract: OBJECTIVE
  Menisco-capsular separation (MCS) is an avulsion type of injury of the medial and/or lateral meniscus and is defined as detachment of the meniscus from its capsular attachment. The aims of this study were to show the results of arthroscopic all-inside menisco-capsular repair in a large number of consecutive patients with acute or chronic MCS, emphasise the advantages of this safe treatment option and stress the superiority of the treatment on the basis of thorough physical examination of the knee joint over magnetic resonance imaging (MRI) diagnosis in MCS.
  
  
  METHODS
  We evaluated data of patients treated between October 2011 and July 2012. Inclusion and exclusion criteria were defined and demographic variables evaluated. All patients were examined physically and with MRI. Knee arthroscopy was performed and the MCS repaired through all-inside menisco-capsular repair. Postoperative treatment was standardised. Patients were followed up for at least 24 weeks.
  
  
  RESULTS
  Thirty-seven athletes (12 women, 25 men) were evaluated. Only in six patients was MCS detected on MRI. In all patients, MCS was diagnosed via physical examination. Arthroscopic treatment led to significant (p < 0.01) improvement. There were no complications reported postoperatively.
  
  
  CONCLUSIONS
  Isolated MCS is not as rare a meniscus pathology after trauma in young athletes as could be expected after reviewing current literature. It is occult on MRI scans in most of the cases and should therefor be taken into consideration in patients with acute or chronic tenderness at the level of the joint line and negative MRI scans. Thorough physical examination has higher diagnostic value than MRI alone, as shown in this study. Treatment of MCS using all-inside nonabsorbable sutures, as described in this study using Ultra FasT Fix®, is effective if performed by an experienced surgeon.
authors.affiliation: Center for Anatomy and Cell Biology, Department for Systematic Anatomy, Medical University Vienna, Währingerstraße 13, 1090, Vienna, Austria, lena.hirtler@meduniwien.ac.at.
authors.forename: Lena
authors.initials: L
authors.lastname: Hirtler
authors.forename: Julia
authors.initials: J
authors.lastname: Unger
authors.forename: Patrick
authors.initials: P
authors.lastname: Weninger
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000293:injuries*; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D010808:Physical Examination; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome; D055815:Young Adult