PurposeDiscoid menisci can be symptomatic from instability or a tear. A torn discoid meniscus is likely to require repair to preserve meniscal function and should not be missed. This is the first study to evaluate a range of pre‐operative methods to predict the likelihood of a torn discoid meniscus. MethodsA retrospective analysis of prospectively collected data was performed. Clinical, radiographic and operative data were reviewed. Patients were grouped based on the presence of a tear or not during surgery. All patients underwent MRI scans pre‐operatively which were validated with arthroscopy findings to calculate sensitivity. All patients completed Pedi‐KOOS and Pedi‐IKDC pre‐operative scores. ResultsThere were 32 discoid menisci in 27 patients. Mean age at surgery was 10.4 years (6–16). Nineteen patients were female. Seventeen menisci were identified as torn at time of arthroscopy (53%), 15 were unstable but not torn. Clinical findings did not differentiate between the torn or unstable menisci. MRI was only 75% sensitive and 50% specific at identifying a torn discoid meniscus. There was no statistical difference between KOOS‐child (n.s.) and Pedi‐IKDC (n.s.) scores between the groups. ConclusionMRI is neither sensitive nor specific at identifying tears in discoid menisci. There is no difference in pre‐operative outcome scores for patients with a torn or unstable discoid meniscus; pre‐operative PROMs are a poor predictor of a meniscal tear. This study emphasises that pre‐operative tests and clinical findings are not conclusive for identifying a meniscal tear and the operating surgeon should be vigilant in identifying and repairing tears at the time of surgery. Pre‐operative findings poorly correlate to arthroscopic findings and potential surgical interventions required. Patients and parents/carers should, therefore, be appropriately counselled prior to surgery that post‐operative measures are dependent on intra‐operative findings and not pre‐operative findings in patients. Level of evidence III.
Category: Arthroscopy Introduction/Purpose: Hindfoot arthritis is treated usually with Tibiotalocalcaneal fusion when conservative treatment has failed. Indications of TCC fusion are wide, including post - traumatic arthritis, rheumatoid arthritis, acquired flat foot deformity (Myerson stage IV), failed total ankle arthroplasty. In the vast majority of these cases, there are skin problems because of systemic diseases or wound problems following prior surgery. Several methods have already been described and it seems that the use of intramedullary nail offers a load-sharing rigid internal fixation. The purpose of this presentation is to describe an alternative less invasive surgical technique of TTC fusion using an intramedullary retrograde nail via a posterior arthroscopy of the hindfoot. We present the surgical technique, the early results and quote several cases treated by this method. Methods: Under spinal or general anaesthesia, the patient is positioned prone. Using the standard posteromedial and posterolateral portals, a standard knee arthroscope is inserted via the posterolateral portal. Via the posteromedial portal, a soft tissue shaver is introduced to prepare the posterior gutter. Most of the preparation of the articular surface of the ankle joint is achieved with the arthroscope through the posterolateral portal and the instruments through the posteromedial portal. After the preparation of the ankle joint surfaces, under fluoroscopic control, a guide wire is inserted through calcaneus and talus into the tibia. Reaming is performed. Then a retrograde intramedullary nail is inserted through the calcaneal and the talus to the tibia. An anodized titanium alloy intramedullary nail is used and locked statically with one screw in the calcaneus, one in the talus and two screws in the tibial shaft. The preparation of the subtalar articular surfaces then takes place. Results: Deformity correction and hindfoot fusion were achieved in all five cases. There were no major complications, such as infection, trauma complications, nonunion, malunion or hardware failure. Fusion was achieved in about three months time (plus minus two weeks). All the patients returned back to their daily activities in four to five months time. The post-op AOFAS score was significantly improved. The mean hospitalization was 1.2 days. After the discharged, all the patients were followed at the outpatient clinic in a regular basis. Conclusion: This alternative surgical technique combines the advantages of the TTC fusion with an intramedullary nail and the advantages of the arthroscopic minimal intervention to the soft tissue envelope. This enables immediate mobilization of the patient and a small period of hospitalization. The key point is the steep learning curve. From the literature review can be found similar techniques with equally positive results.
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