Plastic, partial meniscectomy which preserves the marginal part of meniscal cartilage was carried out in our hospital for children with symptomatic lateral discoid meniscus. The post-operative results were good in almost all patients at the follow-up evaluation. We will report on the operative techniques and the post-operative evaluation of these cases. From June 1982 to December 1989, 34 discoid lateral menisci in 27 children under the age of 15 years were operated on Itabashi Hospital of Nihon University. After recognition of discoid meniscus with arthroscopy, plastic, partial meniscectomy was carried out via a small transverse skin incision, forming the edge of a normal meniscus. About 2/3 of the central part of a discoid meniscus was resected, leaving about 1.0 cm of its marginal part. The average duration of follow-up was 5 years 4 months. The post-operative results were rated on the basis of the JOA Score for Meniscus Injuries and for the present series stood at 92.9 points. Among these 27 children, 17 had been injured during sports activities and all of them returned to their previous activities except three. Radiologically, mild osteoarthritic changes were noted in only a few cases during the follow-up period. It was concluded that plastic, partial meniscectomy was one of the variable procedures in the treatment of symptomatic discoid meniscus in children.
Knee joints affected by rheumatoid arthritis (RA) were randomized to either arthroscopic or open synovectomy, and the postoperative results were compared retrospectively. The materials consisted of 58 patients with 75 surgically treated knees. Arthroscopic synovectomy was performed on 37 knees of 30 patients, who were followed for five years and four months on average. Open synovectomy was performed on 38 knees of 28 patients, who were followed for five years and five months on average. The results were evaluated for ; recurrence of synovitis ; duration of the symptom-free period ; progressive bone changes on radiography ; range of motion (ROM) ; duration of hospital stay ; duration of surgery. Due to the less invasive surgical procedure, arthroscopic synovectomy resulted in less post operative pain, and there was no restriction of ROM after surgery, no need for postoperative rehabilitation, shorter hospital stay, lower incidence of osteoarthritic changes, and earlier return to the daily life. However, as synovial membrane removal was unavoidably insufficient, the effect of surgery lasted for only 18 months on average and recurrence of synovitis was observed in 73 % of patients. Open synovectomy meant relatively greater invasion and postoperative pain. Due to the restricted ROM in some cases, postoperative treatment was required and the hospital stay tended to be prolonged. Nevertheless, the recurrence rate was only 37 % during follow-up and the effect of surgery persisted for an average of 75 months, much better than that of arthroscopic synovectomy. In the treatment of RA knees, the indications for arthroscopic and open synovectomies should be carefully studied in the light of the merits and for demerits of each procedure.
Objectives Elbow dislocation fractures with postero-lateral instability are sometimes encountered, but successful treatment becomes often a challenge for the surgeon, due to the potentially conflicting goals of restoring elbow stability and regaining a satisfactory arc of motion. We report on twenty-four patients who suffered from postero-lateral unstable elbow dislocations with/without fractures.
