POSTER ABSTRACTS - ISAKOS

Meniscus injury is one of the most common
indications for orthopedic surgery today.
Extensive research into the effects of
meniscectomy on the biomechanics and long
term function of the knee has led to a prevailing
attitude toward meniscal preservation. Excellent
results have been obtained with meniscal repair of
the peripheral one third, red-red zone, of the
meniscus. To date, no reliable method for repair
with consistent healing has been developed for
tears involving the white-white zone of the
meniscus. Our previous work with radiofrequency
to stimulate healing in tendinosis has led us to
consider this adjunct to repair in such tears. The
purpose of this study is to evaluate the effect of
radiofrequency stimulation, in conjunction with
suture repair, on the healing of tears in the whitewhite
zone of the meniscus.
Materials and Methods:
A meniscus tear was created in the white-white
zone in 18 NEW ZEALAND white rabbits. Six of
these were left without further treatment, six were
treated with suture repair alone, and six were
treated with suture repair in combination with
radiofrequency stimulation at the inner portion of
each side of the tear. Half of each study group
was harvested at 4 weeks and the other half at 12
weeks postoperative. Morphologic and histologic
analysis and grading were performed for each of
the specimens. The grading was as follows:
Grade A Complete healing. Trace of injury is
hardly distinguishable.
Grade B Nearly complete healing. Trace of injury
remains on surface.
Grade C Incomplete healing. Full thickness injury
remains but will not open fully upon stress
Grade D No healing. Injury site remains fully
open.
Results:
No evidence of healing was seen in the twelve
specimens that had either no treatment, or
treatment with suture repair alone. Grade D was
observed in all the specimens. Of the six
specimens treated with radiofrequency in
combination with suture repair, three showed
evidence of a healing response on both
morphologic and histologic analysis: One Grade A
and one Grade C at 4 weeks. One Grade C was
shown at 12 weeks. The remainder showed grade
D. We find this evidence of healing encouraging
and anticipate using these results as a framework
for further study into cell proliferation (3H
thymidine), matrix synthesis (35 SO4) gene
regulation, i.e. alpha(v)IGF1, bFGF, and the
cytokine involvement in this healing stimulus. We
also plan to investigate improvements on the
technique itself to provide more consistent
results.
E-poster #755
Arthroscopic Treatment of Symptomatic
Discoid Lateral Menisci in the Childish Knee. A
Report of Cutting a Posterolateral Cordlike
Structure Instead of Meniscectomy.
Jakob Fay, Kiel, GERMANY,
Ralph Wischatta, Kiel, GERMANY
Dragan Milasinovic, Kiel, Schleswig-Holstein
GERMANY
Heinz Laprell, Kiel, GERMANY, Presenter
Lubinus-Clinicum, Hospital for Orthopaedic
Surgery, Kiel, GERMANY
The symptomatic discoid lateral meniscus is a
well-documented pathology. Three different types
of this congenital anomaly are described:
complete, incomplete and Wrisberg-ligament
type. Treatment is proposed by arthroscopic
resection up to total meniscectomy. In contrast,
only little is known about pathological
meniscofemoral ligaments (MFL) or related
posterolateral ligamentous structures. At least
one MFL is reported to be present in over 90% of
population with a higher incidence and more
voluminous shape in younger people. Since the
Wrisberg-ligament type of discoid meniscus is
synonymous to posterior MFL one might
hypothesize MFL or other posterolateral
structures to be responsible for knee pathology
usually referred to discoid menisci.
We discuss the management of knee pathology in
a 5 and 8-year-old child, both suffering from pain,
limited range of motion (Ex/Flex 0/10/110 ) and
significant limp. Pre-operative MRI described
discoid lateral menisci and a hyperintense
structures corresponding to the posterior horn of
the meniscus.
Knee arthroscopy showed a complete lateral
discoid meniscus without any meniscal tears.
Furthermore no signs of cartilage degradation
were observed. The meniscus appeared uplifted in
the posterior region with an abnormal movement
during knee extension. The presence of a
pronounced posterolateral cordlike structure was
demonstrated, originating from the lateral
meniscus' posterior horn region, extending to the
CLs and inserting into the lateral femoral condyle.
Using a razor-blade and an electric cutting device
we dissected and cut the tighten cordlike