The Role of Arthroscopy in the Diagnosis and Treatment of Capsular-ligamentous and Intraarticular Lesions of the Knee Joint in Children
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Abstract
The objective: to carry out arthroscopic verification of intrarticular lesions of the knee joint in children, in order to develop optimal treatment tactics.
Materials and methods. The results of preoperative examination and arthroscopic treatment of 105 patients with intra-articular lesions of the knee joint, who have been treated in pediatric orthopedic and trauma departmertments for the last three years, were retrospectively analyzed. The average age of patients was 15.5 years (10 to 17 years), boys – 69 (61,7 %), girls – 35 (34,3 %). Radiography was performed on all patients, ultrasound was performed on 81 children, MRI was performed on 67 patients, CT scan – 14 patients.
Results. After arthroscopy, it was found: injurie of the anterior cruciate ligament in 19 (18 %) patients; meniscus injurie in 26 (25 %) children; pelvic instability in 19 (18 %) patients; fat body hypertrophy and mediopatellar fold syndrome in 17 (16 %) patients; free bone-cartilage body in 15 (14 %) children; dissecting osteochondritis in 6 (6 %) patients; osteochondral cartilage injurie in 3 (3 %) patients. In case of the meniscus break, which was close to the free edge, we performed a marginal resection, but if it is a radial break or a small break in the red zone, then the suture gives a greater chance of fusion of the meniscus. In case of the complete rupture of the anterior cruciate ligament in 9 patients, we restored it completely. In 7 cases, the plastic of the anterior cruciate ligament was performed, in 2 cases the refixation of the bone fragment with the ligament to the tibia was performed. The plastic of the anterior cruciate ligament was performed with STG autografts with fixation by interference biodegradable screws. In case of instability of the patellar 3 patients with recurrent dislocations plastic with the use of STG tendons was performed. For 10 patients with primary dislocation of the patella we made a lateral release and suture on Yamamoto, 6 patients with a clinic of instability of the patella and a subluxation of it on Kohn ≤2 c. only a lateral release was performed. In other cases, arthroscopic removal of free fragments and formations was done. In the postoperative period, all the sick children had good and excellent results.
Conclusions. 1. Arthroscopic interventions can solve diagnostic and therapeutic problems in capsular-ligamentous and intraarticular lesions of the knee joint in children.
2. Indications for surgery are made on the basis of a carefully collected medical history, comprehensive clinical and convincing MRI diagnosis with a determination of the degree of damage to the elements of the knee joint.
3. Inconnection with the elasticity of the capsular-ligamentous apparatus in children, incomplete (partial) damage to ligaments and menisci is more common.
4. Hypertrophy of the Hoff body and the mediopatellar fold in children often simulates meniscus damage, which leads to the need for arthroscopic surgery.##plugins.themes.bootstrap3.article.details##
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