Arthroscopic Versus Open Debridement of Penetrating Knee Joint Injuries

Raskind, John R.; Anderson, Daniel; Marder, Richard A.

doi:10.1097/00005131-199004020-00084

Cited by 7 publications

(9 citation statements)

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“…Several case series report generally “good” outcomes in patients treated for penetrating ballistic injuries without defined follow-up periods or objective outcome measurements. 5 , 8 , 20 , 23 These patients were treated with arthroscopic debridement of foreign and loose bodies without further procedures. Regarding focal cartilage lesions, only “drilling” of these defects has been described outside of a single report of allograft reconstruction for extensive bone loss of the medial femoral condyle following a gunshot wound to the knee.…”

Section: Discussionmentioning

confidence: 99%

Penetrating Blast Injury to the Knee of a United States Soldier Treated with Allograft Mosaicplasty

2010

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Objective:This is the first report of successful allograft mosaicplasty treatment of a large osteochondral lesion of the knee caused by a blast fragment sustained during combat operations. The patient was able to return to active duty following rehabilitation.Methods:An active-duty infantryman sustained an osteochondral lesion of the medial femoral condyle caused by a metallic fragment of an explosively formed projectile. Initial treatment consisted of removal of the foreign body and primary closure. The patient continued to experience pain, mechanical symptoms, and repeated effusions after initial nonoperative treatment. Allograft mosaicplasty of the lesion utilizing two 18-mm-diameter fresh allograft osteochondral plugs was performed at 6 months post-injury.Results:At 2-year follow-up, the patient remains on active duty with marked improvement in symptoms. Two years postoperatively, his outcome scores are 72 of 100 on the Western Ontario and McMaster University osteoarthritis scoring index (WOMAC) and 60 of 100 on the Knee Injury and Osteoarthritis Outcome Score (KOOS). His follow-up x-rays and MRI demonstrate intact articular cartilage and subchondral bone incorporation.Conclusion:Penetrating injuries to joints are commonplace in the battlefield environment. Combat injuries to the knee are frequently associated with articular cartilage injury. While numerous cartilage restoration techniques have been used with success for the treatment of osteochondral injuries to the femoral condyles, no published reports describe the use of allograft mosaicplasty in this location for open, penetrating injuries with focal cartilage loss. This is the first documented use of allograft mosaicplasty for a traumatic osteochondral defect of the medial femoral condyle caused by a metallic projectile. The patient was able to return to active duty following rehabilitation. We demonstrate a high level of functioning is possible following allograft mosaicplasty of a large osteochondral lesion caused by penetrating ballistic trauma.

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Section: Discussionmentioning

confidence: 99%

Penetrating Blast Injury to the Knee of a United States Soldier Treated with Allograft Mosaicplasty

2010

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“…4,5 Methylene blue can be added to the saline, based on surgeon preference, to make the diagnosis more clear. 4,6 There is limited evidence in the literature about the effectiveness of the saline load test in the elbow or the fluid volume required for elbow injection. 4,5,7-10 Some authors suggest the use of 20 mL when performing a saline load test of the elbow.…”

mentioning

confidence: 99%

Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies

Feathers

Stinner

Kirk

et al. 2011

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…However, dye may be added to the saline based on surgeon preference as it does not precipitate any deleterious effects. 14 , 19 …”

Section: Discussionmentioning

confidence: 99%

Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature

Browning¹,

Ventimiglia²,

Dixit³

et al. 2016

Acta Orthopaedica et Traumatologica Turcica

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IntroductionThe aim of this systematic review was to assess the efficacy of Saline load tests (SLTs) to evaluate extension of periarticular wounds into capsule in emergent settings.MethodsWe systematically reviewed the literature to evaluate the accuracy of the SLT in diagnosing penetrating joint injuries in the elbow, wrist, shoulder, knee, or ankle.ResultsThe SLT values to determine knee arthrotomies vary from 73.8 mL to 194 mL with sensitivities ranging between 91% and 99% depending on the size of the laceration. A SLT of 30 mL in the ankle yields sensitivities ranging from 95% to 99% in assessing joint penetration. A SLT of 45 mL in the elbow yields a sensitivity of 95% in assessing joint penetration. The addition of methylene blue does not change the sensitivity of the SLT.ConclusionSeveral studies have demonstrated the utility of the SLT as a diagnostic modality for penetrating joint injuries. However, the literature analyzed in this study was inconclusive and more studies are required to make definitive recommendations. In addition, more studies will be needed on joints other than the knee, pediatric patients, and the use of methylene blue dye in conjunction with SLT.Level of evidenceLevel II, Diagnostic study.

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Arthroscopic Versus Open Debridement of Penetrating Knee Joint Injuries

Cited by 7 publications

References 0 publications

Penetrating Blast Injury to the Knee of a United States Soldier Treated with Allograft Mosaicplasty

Penetrating Blast Injury to the Knee of a United States Soldier Treated with Allograft Mosaicplasty

Effectiveness of the Saline Load Test in Diagnosis of Traumatic Elbow Arthrotomies

Does the saline load test still have a role in the orthopaedic world? A systematic review of the literature

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