The Clinical Study Of Meniscus Injury

BackgroundMeniscus injury is one of the most common functional disorders in knee joint.The clinical diagnosis of the menisci tear is mainly depended on symptoms and physical signs such as the patient history,pain,muscular atrophy,tenderness and McMurray test,intumesce,with some ambiguities frequently.Some differences exist on the published documents.The Magnetic Resonance Imaging (MRI) increase the holistic accuracy significantly of the final diagnosis of meniscus tears through its clinical application and popularization while some patients can not get MRI on the knee joints because of its high price or other reasons. On the other hand,because the sensitivity of MRI in meniscus injury of knee joint is higher than its specificity, there are some misdiagnosis and missed diagnosis. As the symbol of the minimally invasive technique, with its popularization, arthroscopy improves the curative effect on clinics,and become the gold standard of the diagnosis and the treatment of meniscus injury.With the changes of the age,occupational distribution and other factors of the meniscus injury in recent years,more and more patients gradually accept arthroscopy with higher expectation.Thus, how to raise the accurace of diagnosis and curative effect become the surgeon's aim today. Through the research we hope to find out the influencing factors of the therapeutic effect of arthroscopic operation,so we can improve diagnosis,expectation about operation,and the therapeutic effect.ObjectiveTo evaluate the therapeutic effect of arthroscopic operation treatment of meniscus injury of knee joint,investigate the influencing factors from the basic conditions(age,gender,Body Mass Index,intensity of laboring),clinical manifestations and medical imaging(X-ray and Magnetic Resonance Imaging),degree of injury,operation method and Lysholm scoring system of knee joint before the operation and during the follow-up .MethodsBetween July 2001 and June 2006,arthroscopic operations was performed on menisci of 522 patients with meniscus injuries.All of patients accepted X-ray and MRI examination of knee joint after the basic conditions --including age,gender,Body Mass Index(BMI),intensity of laboring -- recorded. The clinical symptoms,physical signs and the Femor-tibial Angle(FTA),osteoarthritis(OA) and MRI were noted. Accroding to the extent and degree of meniscus tears observed intraoperatively by the arthroscopy,operations (meniscus trimming,partial meniscectomy,subtotal meniscectomy and total meniscectomy ) were performed by a single operative team.After the operations,early rehabilitation training programs including straight-leg-raising and range-of-motion exercises, were carried out. Lysholm scoring system was used to assess the function of the knee joints before the operation and during the follow-up. Data were statistically analyzed.Results345 patients were followed up for 5 months to 2 years 6 months (mean,6.3 months).The mean Lysholm score was 81.53±4.88 during the follow-up,which was significantly higher than that before operation(66.54±5.96; P<0.001). The clinical symptoms improved obviously.The frequency of symptoms and physical signs'of meniscal tears in our study,were arranged in this order:pain(90.4%)>turgidity(64.1%)>squtting-raising-limitted(62.0%)>knee-weakened(59.1%)>muscle atrophy(55.1%)>(flexion contracture of knee joint(50.1%)>claudication(49.0%)>snapping(44.6%)>knee-locked(33.6%)and the space tenderness+(56.5%)>McMurray+(47.2%)of the relative specific signs of meniscal tears arranged.The improvement rate of McMurray sign is 78.45% which is higher than that of space tenderness, 77.37%. The frequency rates of those relative specific signs of meniscal tear line in order of the arrangement:knee-weakened sign( 59.1%), the space tenderness+(56.5%), McMurray+(47.2%), snapping(44.6%)and knee-locked(33.6%).And their higher improvement rates mean better curative effect through arthroscopy.The factors,including abnormal FTA,McMurray test+,space tenderness,and knee-locked indicate intensely the diagnosis of meniscal tear.If the clinical manifestations is untypical,MRI is necessary for a precise diagnosis.Every of age,climbing-on-stairs and knee-locked signs effect a contrary function to do with the therapeutic effect of arthroscopy ,while the Lysholm system has an active contribution on clinic,and surgeons could predict the curative effect on the basis of the forementioned factors.ConclusionThese factors ,including the positive results of MRI,abnormity of FTA ,joint space tenderness and McMurray(+),may play very important role on those patients with meniscus injury of knee joint.Arthroscopy can ease or abscise the symptoms and physical signs,increase the Lysholm score and improve the function of knee joint.A precise Lysholm score system and X-ray exam.of knee joint can help surgeons expect the curative effect efficaciously.