Citations

Summary Nine fresh frozen cadaveric shoulders were used to examine the changes in intraarticular pressure (IAP) of the shoulder joint and the position of the humeral head under various loads to determine the relationship between these parameters. All the soft tissues superficial to the rotator cuff were removed. The position of the humerus relative to the scapula was monitored using an electromagnetic tracking system before and after venting the capsule with 0, 0.5, and 1.0 kg of load applied to the humerus inferiorly in addition to the weight of the arm. Simultaneously, the IAP was monitored using a pressure transducer before venting the capsule. Venting had a significant effect on the position of the humeral head: the positions of the head after venting were significantly lowered in all loading conditions. The average IAP was −76 cm H 2 O without load, and the value decreased in a linear fashion with increased load; the correlations were significant in four of six shoulders without dislocation. The correlations were less significant between the pressure and the position, and there were no significant correlations between the load and the position. IAP, which is determined primarily by the load applied, is important to stabilize the shoulder inferiorly. Because IAP is intimately related to the external load and the response is specific to individuals, examination of IAP response to external load may be helpful in characterizing various instabilities of the shoulder.

Abstract Synovectomy is an effective procedure in many of the synovial proliferative diseases. It is the treatment of choice in pigmented villonodular synovitis and synovial chondromatosis. In addition, it may be a useful adjunct to treatment in carefully selected patients with rheumatoid arthritis and hemophilia. Synovectomy can now be accomplished effectively with arthroscopic techniques, and this has greatly diminished the previous morbidity and cost associated with open synovectomy. However, the indications for synovectomy remain the same, regardless of the technique.

Abstract The proper treatment of synovial proliferative disorders depends on an accurate diagnosis and a knowledge of the natural history of these afflictions. A simple classification of the major synovial disorders with a brief general description of each, highlighting the prominent clinical features, is helpful. A thorough history and physical examination should enable the clinician to categorize the nature of the synovial disorder. Further evaluation and consultation can then be directed within the appropriate category. Radiologic, laboratory, and microscopic studies aid in arriving at a definitive diagnosis. Once a diagnosis has been established, therapy or further evaluation can be instituted.

Abstract Frequently, meniscal pathology accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears, usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty‐seven knees in 84 patients were studied. The mean age was 62 (29–84) years. The right knee was involved in 44 patients, and 47 were men. Preoperative radiographs demonstrated osteoarthritis in 53 patients. The medial meniscus was involved in 82, while the lateral meniscus was affected in nine knees. Four knees had involvement of both menisci. In 72 knees, the most frequent lesion was a tear of the posterior horn of the medial meniscus. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 ± 13 (mean ± SD) days. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper‐tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. Subchondral sclerosis or osteophytes on the preoperative radiographs correlated with 72% compared to 90% satisfactory results in the absence of these findings (p < 0.03). Complications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one patient. Arthroscopic meniscectomy is a valuable adjunct to the management of the older patient with early degenerative arthritis of the knee and symptomatic meniscus tears.

Abstract The use of high energy devices has been suggested for intra‐articular surgery. Experimental studies have been performed using the laser and electrocautery. However, clinical application has primarily been with the use of the electrocautery. Electrosurgery is currently being used for lateral retinacular release as well as meniscal surgery. Inadvertent damage to articular cartilage may occur, especially during meniscal resection. The objective of the current study is to assess the effect of the Concept electrocautery with the meniscal cutting electrode on fresh human articular cartilage. Twenty fresh tibial plateaus removed at the time of total knee arthroplasty were subjected to electrocautery currents ranging from 25 to 82.5 W. The articular cartilage was stained with hematoxylin and eosin. The extent of cartilage necrosis was quantitated as a percentage of the thickness of the articular cartilage. A dose response curve was developed. The extent of articular cartilage necrosis with the electrocautery setting of 20 (24.4 W) commonly used for meniscal resection resulted in only an 11.4%‐injury to the articular cartilage. At the manufacturer's recommended setting of 24 (27 W), a 16% depth of laceration of the articular cartilage may be anticipated. We conclude that the lowest current setting possible should be utilized for meniscal surgery and the risk of articular cartilage damage from inadvertent injury is not excessive.