Meniscal injuries associated with acute anterior cruciate ligament tears in alpine skiers

The menisci: basic science and advances in treatment

Once described as a muscle remnant, and therefore treated with disrespect, the meniscus is now known to be a vital structure within the knee. Minimal partial meniscectomy performed arthroscopically, or meniscal repair when practical, have become the standard treatments. In spite of the advancements in understanding meniscal function and its preservation, much remains to be studied. In the future, availability of better repair techniques and the option of meniscal replacement with allograft or prosthetic menisci are expected to improve outcomes.

Magnetic resonance imaging of the knee menisci

MRI remains the most useful noninvasive test for diagnosis of meniscal tears. Knowledge of normal anatomy and familiarity with patterns of meniscal tears are prerequisites when interpreting MRI studies of the knee. Radiologists should pay close attention to technical factors, normal variants, and associated abnormalities to maintain high diagnostic accuracy. Details of meniscal tears should be described as to best aid in orthopedic decision-making.

Skiing injuries

Skiing is a winter sport enjoyed by approximately 200 million people worldwide. An overall injury rate of approximately 3 per 1000 skier-days means that skiing certainly is the riskiest sport undertaken by adults on a routine basis. However, the data suggest that one can anticipate years of enjoyable recreation free from injury. Many troubling injuries, particularly to the lower leg, have shown a steady decline over the past 20 to 30 years because of advances in boot design and binding capabilities. In addition, as information has been gathered regarding the importance of proper maintenance and adjustments, equipment now available can protect a skier more effectively than at any time in the past. Nevertheless, skiing continues to present inherent risks that can be minimized through the following strategies: 1. Enroll in a conditioning program before skiing that focuses on strength and endurance components particularly of the legs and back. 2. Have equipment that is compatible with the skier both from the standpoint of size and expertise. 3. Have equipment adjusted professionally. 4. Do routine testing of binding releases each day before beginning to ski. 5. Ski under control at speeds that are consistent with ability. 6. Stop skiing before fatigue becomes the limiting factor.

Magnetic resonance imaging, scintigraphy, and arthroscopic evaluation of traumatic hemarthrosis of the knee

Forty patients with traumatic knee hemarthrosis were examined within 1 week after injury and observations made with magnetic resonance imaging, scintigraphy, arthroscopic evaluation, radiography, and physical examination were compared. Thirty-four patients (85%) had anterior cruciate ligament injuries according to the arthroscopic findings and 28 (83%) of these had associated meniscal tears. Magnetic resonance imaging confirmed the arthroscopic findings, especially if only meniscal tears that required surgery were taken into account (sensitivity, 94% for the lateral and 83% for the medial meniscus). However, the specificity of magnetic resonance imaging was only 29% and 27% for the lateral and medial menisci, respectively, and the accuracy was 28% and 50%, respectively. Marrow edemas, or bone bruises, were seen on magnetic resonance imaging in 80% of the patients and were mainly seen in the lateral compartment. Bone scans correlated well with magnetic resonance imaging findings of marrow edemas. Plain radiographs were normal in all but one case. We show that magnetic resonance imaging does not add information on the status of the anterior cruciate ligament compared with the clinical examination, and that it may be as good as arthroscopic evaluation for the diagnosis of meniscal tears that require surgery.

The impact of surgical timing on postoperative motion and stability following anterior cruciate ligament reconstruction

A prospective study was designed to determine the impact of surgical timing on postoperative motion and stability following anterior cruciate ligament (ACL) reconstructive surgery. The study population was limited to acute ACL ruptures from downhill skiing undergoing arthroscopic ACL surgery without arthrotomy or surgical intervention for other ligamentous structures; 185 patients were entered into four separate groups based on the time interval from injury to surgery. Motion and stability were tested at multiple time points from the index surgery and adverse events were recorded. We found no statistical difference in restoration of extension or flexion in any group at any time point. KT-1000 data at 12 months showed a side-to-side difference of < or = 3 mm in 94%, with 6% showing a side-to-side difference of > 3 and < or = 5 mm. We conclude that, in this population, by using modern arthroscopic surgical techniques and an aggressive postoperative physical therapy protocol, motion and stability can be restored in a high percentage of patients and that surgical success is independent of the timing of surgery.