Double-Contrast Arthrography of Knee with Horizontal Roentgen Ray Beam

Lateral meniscal lesions in patients with clinically suspected medial lesions

Double-contrast arthrography and arthroscopy were performed in a prospective study on 46 consecutive patients clinically suspected of having a medial meniscal tear only. At arthrography, 38 torn medial menisci were found; four of them were, however, false-positive and another false-negative as compared with arthroscopic examination. Moreover, seven unsuspected lateral meniscal tears were diagnosed at both arthrography and arthroscopy. The diagnostic accuracy of the double-contrast arthrography was well above the clinical accuracy, and we conclude that arthrography is a reliable method for diagnosing both medial and lateral tears.

The value of arthrography and arthroscopy in association with a sports injuries clinic: a prospective and comparative study of 182 patients

A series of 182 patients who presented through an athletes clinic wih internal derangements of the knee have been studied prospectively with regard to clinical, arthrographic and arthroscopic findings. The diagnostic inaccuracies of arthography and arthroscopy are detailed. In this group of patients arthroscopy achieved the greatest overall accuracy, and is recommended as the inhitial investigation. Arthrography is advocated in cases where a suspected tear of the posterior horn of the medial meniscus has not been revealed by arthroscopy.

The value or arthrography in the management of internal derangements of the knee: the first 1000 are the worst

The acceptance of arthrography of the knee as an accurate diagnostic procedure by both radiologists and orthopaedic surgeons in the United Kingdom has been slow compared to many other parts of the world. The value of arthrography in the diagnosis of meniscal lesions is discussed with reference to the first 1000 documented cases in the authors' series. It is considered that the results obtained from such early experience is more relevant to those about to start as an arthrographic service. Problems in clinical, arthrographic and arthroscopic diagnosis are discussed. Arthrography constitutes an accurate method of diagnosing such lesions and should be employed whenever clinical doubt about the diagnosis of an internal derangement of the knee is encountered. In a selected group of 137 patients, in whom both arthrography and arthroscopy was performed, the two investigations showed a comparable accuracy of 89.8 and 88.3% respectively.

Arthrographic study of the rheumatoid knee. Part 2. Articular cartilage and menisci

The changes of the articular cartilage and of the menisci in 129 knee joints with classical rheumatoid arthritis have been investigated by an improved arthrographic technique. The changes of the intra-articular components on the arthrograms coincided well with direct views at arthroscopy and surgery. The changes of the articular cartilage on the arthrograms were graded as normal, deposit and pooling, thinning, filling defect, destruction, and disappearance, and those of the menisci as normal, degeneration, tear, and disappearance. The results showed that: (1) The radiographs did not always reflect the changes of those intra-articular components in the early stages; especially in stage 2 they showed various conditions from intact to destruction. (2) The changes of the menisci were less advanced than those of the articular cartilage in the early stages. (3) The changes in those components progressed almost symmetrically in both compartments. It is necessary to appreciate not only the pathological condition of the bones of the knee joints but also that of the intra-articular components to devise more careful programmes of treatment for rheumatoid knees.

Arthrographic study of the rheumatoid knee. Part 1. Synovial proliferation

The improved method of double-contrast arthrography for the knee joint, which can give extensive information on the intra-articular components, was undertaken in 131 knee joints with classical rheumatoid arthritis. Synovial proliferation was classified by its localisation into 6 types: nonproliferated (NP); localised, subdivided into suprapatellar pouch (SPP), proper articular (PA), and posterior (POST); panarticular (PAN); and burned out type (BO). These types are intimately related to the radiological stage and pathological changes of the articular cartilage and menisci. By following the dynamic changes of synovial proliferation by arthrography the clinical course of the rheumatoid knee joint may be predicted. While in the NP and SPP types destruction of the joint is minimal, it is relatively rapid and severe in the PA and PAN types. Thus the proliferation in the joint proper has a stronger influence on joint destruction than does the suprapatellar pouch. From these results synovectomy to resect proliferated synovial tissues of the joint proper completely, and to resect those of the suprapatellar pouch only superficially in the early stage, was undertaken in 21 rheumatoid arthritic joints, giving excellent results in 80.9%. The advantages of this method are discussed.

Evaluation of a modified method for arthrography of the knee

A modified method for knee arthrography based on the technique introduced by Lindblom has been applied in 1 200 patients. The arthrographic reports on 132 patients submitted to arthrotomy are compared with the findings at surgery. The modified technique is easy to perform and offers a fairly reliable all-round method for diagnosis of both meniscus and crucial ligament lesions.