[Clinical examination of menisci in the era of arthroscopy].

PURPOSE OF THE STUDY

A profound clinical history and examination in case of a soft-tissue injury of the knee joint has a principal significance for the diagnosis and the following treatment. Our aim was to compare the development of surgery of the soft-tissue injury of the knee in our region within a 25-year interval. The most frequently affected structures in the knee joint are the menisci. We have focussed on the evaluation of the extent to which selected clinical history and symptoms are actually associated with the affection of menisci.

MATERIAL

First we compared groups of patients operated on for the soft-tissue injury of the knee joint within a 25-year interval. The scope of the care in the out-patient department was in this period almost the same. Then we examined a group of patients with a suspect tear of menisci and focussed on the clinical history and findings which are most often related to the injuries of menisci.

METHODS

In a retrospective study aimed at the acquisition of sufficient statistical data and concentrated on the development of the surgery of the soft-tissue knee we compared a group of 91 patients operated on by arthrotomy in the period of 1973-1975 with a group of 780 patients operated on in the years 1996-98 by arthroscopy. In the subsequent prospective study we examined 104 patients sent to arthroscopic examination for a suspect tear of the medial or lateral meniscus. Based on the performed arthroscopy we divided the patients into three group--with the injured medial meniscus, with the injured lateral meniscus and without affection of meniscus. We investigated the diagnostic value of clinical history and clinical symptoms.

RESULTS

In the retrospective study comparing the groups of patients in the 25-year interval the number of knee joints operated on increased 9times, the average age decreased by 8 years and the duration of hospitalisation was reduced by 9 days, the period of after-treatment in the out-patient department was reduced by 59 days. In the prospective study focussed on the lesion of meniscus the success rate of clinical history and examinations was 62% in lesions of the medial meniscus, 47% in lesions of the lateral meniscus. Significant in the clinical history of both menisci was a joint effusion and click phenomenon in the knee joint. Of clinical symptoms relating to lesion of the medial meniscus there often (above 60%) occurred pain of the medial joint line, painful bend and positive Steinmann II test, in case of the lateral meniscus painful bend and inability of full bend (nebo flexion--co má autor na mysli termínem "dotazení?) and walking in bend. Their disadvantage is a low specificity. On the contrary lower sensitivity but higher specificity is recorded by the clinical history of the locked knee and the presence of click phenomena during clinical examination. Simultaneous affection of the cartilage of the medial condyle of the femur in the lesion of the medial meniscus was in 64% of cases and of the lateral condyle of the femur in the lesion of the lateral meniscus in 47% of cases.

DISCUSSION

Opinion on the clinical history and examination of the injured knee joint has not changed substantially during 25 years as shown by the comparison of the literature, but arthroscopy thanks to its visualisation of the joint cavity and a lower invasiveness contributed to the improvement of the diagnostics of the lesions of the knee joint, a less invasive surgery resulting in a reduced period of treatment. As compared to other authors we achieved in the evaluation of clinical history and examination practically the same success rate of diagnosis in the lesion of the medial meniscus but a lower success rate in the lesion of the lateral meniscus. As concerns clinical history we did not find any significant differences in comparison with other authors, in case of clinical examination we did not achieve such good results in case of McMurray test and as the most significant manoeuvre we consider the Steinmann II test for the medial meniscus. Frequent simultaneous injury of the cartilage and menisci corresponds to the findings of other authors.

CONCLUSION

Indication for surgery for the affection of menisci therefore has to be based on a careful analysis of clinical history and examination of the patient, it is not possible to rely on any of the menisci symptoms and their significance is only supportive. As the most significant symptoms we assess the clinical history of the verified knee swelling, click phenomena and locked knee in the knee joint, in the clinical examination pain and click phenomena of the joint lines.