Arthroscopic Partial Meniscectomy Evaluation Of Its Results:

Mohamed Medhat Shedeed Zamzam

IUMMAI.YThe menisci. or semilunar cartilage. are intra-articular crescentic portions offibrocartilage situated at the periphery of the the upper articular surface of the tibia.Histologically, the menisci are composed of dense. tightly woven collagen fibres with asmall amount of elastic tissue in between.The menisci contribute to the following functions :• Articular cartilage nutrition and joint lubrication.• Stability of the knee.• Movement of the knee joint.• Shock absorption.• Weight bearing and load distribution.Various types of meniscal tears are encountered, although different kinds, andsites of tear frequently coexist. Cysts and complex lesions may also present, both inpreviously normal menisci and in congenitally abnormal or degenerate menisci. Meniscaltears will produce pain, loss of movement. and instability of the joint. The relationshipof these symptoms should be recognized. A tom meniscus produces joint line tenderness,often very localized, an effusion as well as locking. Positive McMurray and Apleygrinding test is very valuable in diagnosing meniscal lesions.Advances in arthrography, arthroscopy, computed tomography and magneticresonance imaging have enabled the orthopaedic surgeon to diagnose and treat meniscallesions, most often without arthrotomy and the incidence of errors in diagnosis hasbeen reduced. However. arthroscopy is the most accurate, reliable and standard for thedetection and treatment of meniscal tears, as its diagnostic accuracy reached 90 to 96%.The realization that the meniscus has a valuable function within the knee, evenif only the peripheral portion is present, has led to a more conservative surgical policy- 121 -when dealing with a tear. On the other hand, arthroscopy allows a more differentiatedand conservative approach to meniscal lesions with less morbidity than the conventionalopen technique.The goal of arthroscopic meniscectomy is to remove all ruptured and offendingmeniscal tissues with preservation of as much of an intaet stable rinl as is possible.Nosingle method of endoscopicmeniscectomy works best in every ~. One must notthink that there is any right or wrong way to perform an arthrosco~c meniscectomy.In general, the prognosis after meniscectomy is adversely affected by thefollowing factors :• Presenceof osteoarthrosis.• Presenceof significant ligament laxity or other injuries.• Other meniscus already removed..• Extremes of age (poor results common in children and older people).• Female sex.Our results from the study of 157 cases of partial arthroscopic meniscectomyhave shown that males were more commonly affected than females. the mean age ofincidence of meniscal lesion was 29 years. the medial meniscus was more commonlyaffected than the lateral one and sport injury was the commonest causative traumaleading to meniscal injury.Clinically. pain presented in 95’10 of cases. gtvmg way in 42% and locking in28%. On examination, joint line tenderness had the highest score of 80’10 presentationamong our cases, followed by positive McMurray’s test (64%), then joint effusion (63%)then positive Apley grinding test (5291».The mean duration of joint illness among our cases at the time of the operationwas IS months. The mean operating time was 48 minutes. The mean hospital stay was2.7 days.- 122 -longitudinal tears were found to be the commonestmeniscal lesion followed byflap tears then radial tears. Complex tear came the least in oc:curance.We did notencounter any case with cystic degenerationnor post-meniscectomyrim tears.Satisfactory results were obtained in 142 (92%) of the cases (60% w:ellent and32%good).Age and duration of illness had a significant effect on the final end result.On the other hand, sex and type of meniscal lesion as well as its location had nosignificant effect on the final result.Partial arthroscopic meniscectomyas described in the pmleDt study with nointra-operative complications,only 6 (4%) minor post-operative complications(3 caseswith stitch infection and 3 cases with haemoanhrosis)and early return to normalactivity (mean, 20 days) and sports activities (mean, 8 weeks) adding to the highpercentageof its satisfactory results, make the procedureto be the treatment of choicefor a great majority of symptomaticmeniscal tears.Finally, our results suggested to perform partial arthroscopic meniscectomyasearly as possible in symptomatic meniscal· tears with careful evaluation of olderpatients.