Arthroscopy in Children

Hope, Philip

doi:10.1177/014107689108400111

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…There are several reports on arthroscopy performed in children, but only a few dealing with acute trauma. The compatibility between the clinical diagnosis and the arthroscopic findings in younger children has varied from 18 to 70 percent (Momssy et al 1982, Ziv and Carroll 1982, Suman et al 1984, Juhl and Boe 1986, Eiskjaer and Larsen 1987, Harvell et al 1989, Hope 1991, improving in older children (Suman et al 1984), like in our study. Ligamentous tears were previously thought to be less common in children (Saddowi and Hoffman 1970, Noyes at al.…”

Section: Discussionsupporting

confidence: 67%

Arthroscopy of the acute traumatic knee in children: Prospective study of 138 cases

Vähäsarja

Kinnuen

Serlo

1993

Acta Orthopaedica Scandinavica

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We performed diagnostic arthroscopy for acute knee trauma in 138 children and adolescents aged 13 (1-15) years. The compatibility between the clinical examination and the arthroscopic findings was 59 percent. Ligament injuries were found in 32 cases, 14 of which had rupture of the anterior cruciate ligament. The compatibility in the case of ligament injuries was 31 percent. 48 patients had dislocation of the patella, and a displaced osteochondral fragment was seen in 19, 14 of which were radiographically silent. In 37 cases of distortion of the knee a correct diagnosis would have been missed unless arthroscopy had been performed. Arthroscopy is therefore indicated in children with severe distortion of the knee, hemarthrosis and with dislocation of the patella.

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Section: Discussionsupporting

confidence: 67%

Arthroscopy of the acute traumatic knee in children: Prospective study of 138 cases

Vähäsarja

Kinnuen

Serlo

1993

Acta Orthopaedica Scandinavica

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“…These studies have reported overall accuracy rates of 29% to 59% in series ranging from 28 to 285 patients. 1,7,11–13,15,19,26,35,37–39 Potential explanations for the relatively low accuracy of clinical examination in the diagnosis of knee disorders in children and adolescents include difficulty in obtaining an accurate history, difficulty in localizing symptoms, lack of patient cooperation and relaxation during examination, lack of recognition of significant injuries, and the more varied differential diagnoses associated with these age groups. In a recent study assessing the agreement of clinical examination with arthroscopic findings by a single experienced pediatric orthopaedic sports medicine specialist in 28 children and adolescents, 33 the overall accuracy of clinical examination (93.5%) was similar to the accuracy in this study (86.3%).…”

Section: Discussionmentioning

confidence: 99%

“…2,5,6,8,10,14,17,18,21,24, 25,28–30,42 Other studies have assessed the diagnostic performance of clinical examination of the knee by comparing clinical diagnoses with arthroscopic findings. 1,7,11–13,15,19,26,35,37–39 Finally, some studies have correlated diagnoses based on both MRI and clinical evaluation with arthroscopic findings. 7,22,31–33…”

mentioning

confidence: 99%

Diagnostic Performance of Clinical Examination and Selective Magnetic Resonance Imaging in the Evaluation of Intraarticular Knee Disorders in Children and Adolescents

et al. 2001

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To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (< or = 16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.

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“…The clinical diagnosis was confirmed by the author in 45% of cases and in 51% arthroscopy extended preliminary diagnosis with significant elements. Hence the conclusion that an indication for arthroscopy is clinically significant pathology or chronic diseases which do not react to conservative treatment (7) .…”

Section: Discussionmentioning

confidence: 99%

The assessment of usefulness of the qualification card and ultrasonographic consultation

Pilecki

Pilecki²,

Dzielicki

et al. 2012

J Ultrason

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The result of therapeutic success is always the effect of medical professionals cooperation. The creation of adequate mechanisms of cooperation of these teams demands time and appropriate examples. In the understanding of differentiated behaviors in the line patient – diagnostician – surgeon, particularly the mechanism of the cascade of errors formation, giving simple examples may help – their awareness will facilitate the formation of an adequate pattern of diagnostic-therapeutic chain. The therapeutic team formed in this way provides optimal forms of cooperation and positive result. One of the elements of the cooperation is the surgical procedure qualification card which is an example of the communication between surgeon and diagnostician. The propagation of proven examples seems to be justified by practical reasons. The introduction of the surgical procedure qualification card enabled maintaining of the preoperative and postoperative diagnoses in the range from 88.4% to 89.29%, the barrier of 90% however is still not achieved. The diagnoses discrepancy is still the most often occurring patient safety incident and our results should head towards its mineralization. In particularly complicated cases we come back to a well-known form of medical consultation, that is the form of examination and treatment establishment basing on simultaneous physical and ultrasound examination – hence the colloquial name of ultrasound consultation. The universality of medical consultation makes out of it an excellent tool, particularly in cases of significant discrepancy between physical and ultrasound examination. This is excellent form of the experience exchange and learning about mutual possibilities. We believe that the mechanisms presented will influence the improvement of patient security.

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Arthroscopy in Children

Cited by 15 publications

References 17 publications

Arthroscopy of the acute traumatic knee in children: Prospective study of 138 cases

Arthroscopy of the acute traumatic knee in children: Prospective study of 138 cases

Diagnostic Performance of Clinical Examination and Selective Magnetic Resonance Imaging in the Evaluation of Intraarticular Knee Disorders in Children and Adolescents

The assessment of usefulness of the qualification card and ultrasonographic consultation

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