Gaudernak T
Unfallchirurgie. 1982 Jun;8(3):159-69. doi: 10.1007/BF02585676.
Between December 1977 and February 1981, a series of 70 patients was examined because of an unclear hemarthrosis, the source of hemorrhage was determined by arthroscopy. In our opinion a hemarthros of the knee joint is not clear if the lateral ligaments are stable, no drawer can be loosened at an angle of 90 degrees, and if the X-ray radiograph does not clearly show a fresh fracture. In most cases, the symptom of uncertain hemarthros was provoked by a banal trauma hardly to reconstruct. Due to the violent pain caused by the thick effusion, the patients consulted the doctor early and had partly been pre-examined by several doctors. In all cases, the joint was described to possess stable ligaments and X-ray examination did not show any clear fracture sign. The thorough examination under anesthesia made by the author resulted in a suspicion of a ligament in 43% of the examined joints, however, the subsequent arthroscopy showed a rupture of the anterior cruciate ligament in 70%. A cartilage/bone lesion was found in 30%, a rupture of the posterior cruciate ligament, however, only in 5,7%. In two cases (3%), the hemorrhage was caused by a fatty body lesion or the rupture of an adhesion. In 41% of the patients we found severe combined lesions of the anterior cruciate ligament and the meniscus or cartilage lesions. In 56 patients, i.e. 80%, the lesion was so severe that they had to be treated by surgery. In 11%, we thought an immobilization by plaster cast to be sufficient. Only six patients i.e. 9%, had neither to be operated nor immobilized. The hemarthros of the knee joint which occurs even after small accidents is caused by severe inner lesions of ligaments and cartilages. In more than 50% of all cases, these lesions cannot be diagnosed even by careful clinical examination under anesthesia and special X-ray examination methods. With adequate skill and experience, however, arthroscopy allows an exact diagnosis in almost 100% of all cases. It is therefore the patient's interest to clarify by arthroscopy every case of unclear hemarthrosis.
1977年12月至1981年2月期间，对70例因关节积血原因不明而接受检查的患者进行了研究，通过关节镜检查确定出血来源。我们认为，如果外侧韧带稳定、在90度角时抽屉试验无松动且X线片未明确显示新鲜骨折，则膝关节积血原因不明。在大多数情况下，不明原因关节积血的症状是由难以追溯的轻微外伤引起的。由于大量积液导致剧痛，患者较早就诊，部分患者已由多位医生进行过初步检查。所有病例中，关节韧带均描述为稳定，X线检查未显示任何明显骨折迹象。作者在麻醉下进行的全面检查发现，43%的受检关节怀疑有韧带损伤，然而，随后的关节镜检查显示70%的患者前交叉韧带断裂。发现30%的患者有软骨/骨损伤，而后交叉韧带断裂仅占5.7%。2例（3%）患者的出血是由脂肪体损伤或粘连破裂引起的。41%的患者发现前交叉韧带与半月板或软骨有严重联合损伤。56例患者（即80%）损伤严重，必须接受手术治疗。11%的患者，我们认为石膏固定就足够了。只有6例患者（即9%）既无需手术也无需固定。即使是小事故后出现的膝关节积血，也是由韧带和软骨的严重内部损伤引起的。在所有病例中，超过50%的此类损伤即使通过麻醉下仔细的临床检查和特殊的X线检查方法也无法诊断。然而，凭借足够的技术和经验，关节镜检查几乎能在所有病例中做出准确诊断。因此，通过关节镜检查明确每一例不明原因关节积血符合患者的利益。
