In a prospective study, 41 consecutive patients with a partial tear of the anterior cruciate ligament, diagnosed by arthroscopy, were reviewed after an average of 17 months, having been in plaster for six weeks after injury. Their average age was 29 years and review included clinical examination, measurement of anterior and posterior laxity with the Stryker knee laxity tester as well as evaluation of knee function and activity level. Twenty-one patients had unstable knees at follow-up; the mean total anteroposterior laxity for these patients was 12.6 +/- 3.9 mm compared with 7.1 +/- 4.3 mm for the normal knee. Most patients had few symptoms, but there was a significant reduction in the mean level of activity in the unstable group.

Twenty-nine patients underwent meniscal repair using an inside-to-out technique and instruments developed in our department. The tears were more than 1.5 cm in length, vertical, and located in the outer third of the meniscus. The torn segment was mobile, the remainder of the meniscus stable. After six months, fourteen out of sixteen patients achieved a good or excellent Lysholm knee score. We conclude that the technique is safe and reliable and allows better access than an arthrotomy. Care must be taken to avoid neurovascular injury.

SummaryIn ti double-blind, randomised ronirolled cross-over

Arthroscopy of the knee was carried out under local anaesthesia in 313 outpatients, with arthroscopic surgery in 81. The procedure had to be abandoned because of apprehension in only 0.9%. With increasing experience, the number of arthroscopic meniscectomies increased from 5% to 64% of the lesions found. The method was particularly valuable in the assessment of patello-femoral pain since dynamic evaluation of patellar alignment, and the localisation of sensitive structures by palpation, was possible. The method is a safe, reliable and inexpensive alternative to the use of spinal or general anaesthesia for arthroscopy.

This study evaluates the role of arthroscopy in the diagnosis of acute injuries to the knee. One hundred and fifty four patients with a suspected ligament injury or effusion of the knee joint underwent arthroscopy. A haemarthrosis was present in 82% and a bloodless effusion in 10%. Meniscal tears were found in 19% of the knees. Fresh ligament ruptures were present in 71% and an associated haemarthrosis in 95% of these; 65% were partial tears. The commonest isolated lesion was a complete or partial tear of the anterior cruciate, which occurred in 15% of cases. More than one ligament injury occurred in 56%, the commonest combination being tears of the anterior cruciate and medial collateral ligaments. In a high percentage of cases, arthroscopy revealed unsuspected injuries of significance in management. In 39%, an open or closed procedure followed arthroscopy. There were no complications from the diagnostic arthroscopy. We conclude that arthroscopy provides a more accurate diagnosis than clinical examination alone, and is especially valuable for assessing the patient with a haemarthrosis of the knee.