Methodenvergleich von Kernspintomografie, Arthroskopie und Nah-Infrarot-Spektroskopie (NIRS) bei der Bestimmung des Arthrosegrads des Kniegelenks

The history of radiofrequency energy and Coblation in arthroscopy: a current concepts review of its application in chondroplasty of the knee

Radiofrequency energy has had widespread use for a variety of surgical procedures. Its application in orthopedic surgery initiated with shoulder instability. Over the last couple decades it has been applied as surgical tool for cartilage treatment as well. There have been significant gains in its technology and our understanding of its potential benefits. We address its history and advancements in becoming a surgical tool for cartilage lesions along with a review of recent long-term follow up studies.

The frequency of cartilage lesions in non-injured knees with symptomatic meniscus tears: results from an arthroscopic and NIR- (near-infrared) spectroscopic investigation

INTRODUCTION

Are symptomatic tear injuries to the menisci of the knee frequently or always associated with cartilage damage to the corresponding articular surfaces and other joint surfaces, respectively?

METHODS

A total of 137 patients (medial n = 127; lateral n = 10) underwent a meniscus resection. These patients showed no signs of a clear radiographic arthrosis and no MRI-detectable cartilage lesions > grade II. Traumatic injury was ruled out with a thorough medical history. The indication for operation was made exclusively on the basis of distinct, clinically apparent meniscus signs. In addition to the ICRS classification, all articular surfaces were examined spectroscopically (NIRS, near-infrared spectroscopy).

RESULTS

In 76.6% (n = 105) of all knees examined, clear cartilage damage (ICRS-grade III/IV) was found. For 43.8%, these were in the area of the patella, while for 34.3% they were in the area of the medial femur, and for 17.5%, in the area of the medial tibial plateau. More rarely, this damage was localized to the area of the trochlea (8.8%) or the lateral joint compartment (femoral 2.2%, tibial 15.3%). There were no significant differences between patients with medial or lateral meniscus lesions with respect to the distribution pattern of the joint injuries. During spectroscopic examination, pathological values were demonstrated (objective evidence of cartilage degeneration) in at least one of the examined articular surfaces (media n = 6, range 1-6).

CONCLUSION

Through our investigations, a high, if not complete, concomitance of degenerative cartilage lesions and degenerative meniscus damage was demonstrated. From this it can be concluded that the entity of "isolated degenerative meniscus damage" clearly does not exist in practice. It is therefore highly probable that degenerative meniscus lesions, as a part of general joint degeneration, are to be interpreted in the context of the development of arthrosis. The practical consequences still are unclear. Patients after partial meniscectomy need a longer follow-up to detect potential cartilage lesions as well as an OA progression.