116 ABSTRACTS

defect was not performed on any of the patients. Reinspection arthroscopy was carried out on 10 pa- tients to inspect the status of the OD; eight patients had healed lesions and two patients demonstrated incomplete healing. These two patients required an additional surgical procedure. Reinspection re- vealed healed areas in both. All patients were fol- lowed up by questionnaire and phone interview, as well as by reexamination and x-ray when possible. Subjective (sub) and objective (obj) results based on the Lysholm and Gillquist knee rating scale re- vealed the following: excellent: sub, seven and obj, eight; good: sub, 14; and obj, 13; fair: sub, nine and obj, eight; and poor: sub, 0 and obj, one. There were no complications. Average return to everyday activities was 2 months (range, I - 6 months).

In conclusion, arthroscopic surgery offers sev- eral advantages over arthrotomy in the treatment of OD: (a) a direct, low-risk surgical procedure effec- tive in promoting healing of OD; (b) easy access to treat additional pathology found with OD; (c) short postoperative recovery; (d) low morbidity; (e) ex- cellent reinspection instrument; and (f) effective- ness in treating OD, especially grade IV lesions.

Arthroscopic Staple Capsulorrhaphy for Anterior In- stability of the Shoulder. Leslie S. Matthews, David L. Helfet, James Spearman, and Sami Oweida. Baltimore, Maryland, U.S.A.

Over the past 3 years, we have performed arthro- scopic staple capsulorrhaphy as an alternative to open surgery for the treatment of symptomatic an- terior instability of the shoulder. This is a study of the results of arthroscopic staple capsulorrhaphy performed on 24 shoulders (22 patients) followed for an average of 17.8 months (range, 7-25 months) postoperatively. These patients ranged in age from 16 to 54 years (average, 22.5 years). Patients were independently evaluated by quest ionnaire and physical examination. An evaluation system as de- scribed by Rowe (which places specific emphasis on pain, limitation of motion, and ability to return to sports as well as postoperative stability) was uti- lized.

Analysis of results revealed 15 shoulders to be good or excellent. Two shoulders rated poor be- cause of pain or significant limitation of motion. Four additional shoulders required subsequent open surgery to treat persistent or recurrent insta- bility. Three shoulders were lost to follow-up.

We conclude from this study that the results of

arthroscopic staple capsulorrhaphy do not ap- proach those reported for open surgical proce- dures. The procedure does have the advantage of shorter hospitalization time and lower periopera- tive morbidity than open surgery. It also appears that in those patients requiring subsequent open surgery, results are not jeopardized by the prior arthroscopic procedure.

Arthroscopy of the Elbow. James R. Andrews, Rick K. St. Pierre, William G. Carson, and Chris S. Kaga. Columbus, Georgia, and Tampa, Florida, U.S.A.

Arthroscopy is an effective means of treating elbow pathology with minimal morbidity. Sixty-two elbow ar throscopies were performed be tween March 1979 and June 1984. Results in the 51 males and 11 females were evaluated with a mean follow- up of 1.6 years. Sixty-nine percent of the patients were involved in athletics. Athletic activities in- cluded professional and college baseball (22); foot- ball (eight); Little League baseball (five); weight lifting (two); racquetball (two); golf (two); cheer- leading (one); and karate (one). Pathologic entities treated were loose bodies (14); osteophytes of the posteromedial olecranon (14); synovitis (12); osteo- chondritis dissecans of the capitellum (eight); chon- dromalacia of the radial head (six); and fibrous ad- hesions (five). Three patients had negative findings. We used a preoperative and postoperative subjec- tive and objective point accumulation rating system to analyze the results. Prior to arthroscopic treat- ment, only 38% of the patients had their elbow rated as satisfactory. The postoperative rating in- creased to 85% satisfactory results. Eighty-nine percent of the patients involved in athletics re- turned to their preinjury level of preformance. Thus we conclude that elbow arthroscopy is an effective means of treating certain elbow disorders. How- ever, attention to detail is essential in the arthro- scopic treatment of these disorders.

Clinical Applications of Wrist Arthroscopy. Terry L. Whipple. Richmond, Virginia, U.S.A.

Diagnostic arthroscopy has proven beneficial in the evaluation of soft-tissue and articular disorders of the wrist. Conventional imaging techniques such as radiography and tomography are adequate for bony disorders and articular relationships but do not demonstrate symptomatic lesions of articular

Arthroscopy, Vol. 2, No. 2, 1986

ABSTRACTS 117

cartilage, the triangular fibrocartilage (TFC), inter- osseous ligaments, and synovium. Indirect imaging by arthrography may be difficult to evaluate and does not quantify or grade the extensiveness of TFC or interosseons ligament lesions.

With improved optics and minaturized instru- mentation, articular and soft-tissue lesions may be inspected directly and explored under local or gen- eral anesthesia with virtually no morbidity. Advan- tageous entry portals are established between se- lected extensor tendon compartments, and two or three pounds of distraction allows excellent visual- ization. All volar ligaments can be identified as can the entire triangular fibrocartilage and the ulnar prestyloid recess. Degenerative and traumatic ar- ticular lesions including radius and carpal fractures can be thoroughly examined. Even the articular surfaces of the midcarpal space can be evaluated.

The surgical technique is presented as a diag- nostic adjunct and may open new vistas for the treatment of certain wrist disorders by minimally invasive means.

Hip Arthroscopy: A New Approach. James M. Glick, Thomas G. Sampson, Robert B. Gordon, and Eric Schmidt. San Francisco, California, U.S.A.

The anterior arthroscopic approach to the hip does not allow us to visualize the posterior aspect of the joint. We have devised a technique that pro- vides a complete view of the hip joint.

The approach is directly lateral over the greater trochanter. The hip is placed in abduction with the patient lying on his or her opposite side. The leg is maintained in traction over a pulley system hung from the ceiling.

We have arthroscoped six hips in this manner. Two had loose bodies. The loose bodies were re- moved successfully. Three had various degrees of arthritis. Debridement with motorized and hand- cutting instruments provided immediate improve- ment in all three. One hip arthroscopy was per- formed for a diagnosis.

The lateral approach offers new vistas for com- plete visualization and arthroscopic therapy of the hip joint.

Computerized Tomography (CT) Scanning of the Pa- tellofemoral Joint With Arthroscopic Correlation. Mehrdad M. Malek and Michael S. Usher. Oxon Hill, Maryland, and Washington, DC, U.S.A.

Conventional radiographic study of the patellofe- moral (PF)joint, regardless of the technique uti- lized, is difficult to standardize and quite often is not a reliable indicator of the true position of the patella in the femoral trochlea. This is especially true when knee approaches 0 ° from 30 ° flexion. Available methods for visualizing the PF joint rela- tions do not evaluate the joint in flexion less than 20 °. The 0~30 ° range is a critical one in patients with patellar instabilities. Since 1982, we have eval- uated a total of 80 individuals with CT scanning of PF joint in 0 °, 20 °, and 45 ° of flexion. There were ten normal individuals (five male, five female) and 70 patients (39 female, 31 male) with a variety of PF symptoms and pathologies. Average age was 27. There were 43 unilateral and 27 bilateral PF joint problems. All patients were first x-rayed in stan- dard fashion (AP-lateral and axial views) then un- derwent CT scanning using a CGR 10,000 scanner with 5-ram cuts and 5-s exposure. Each patient then underwent arthroscopic evaluation of the symp- tomatic knee, and findings were then correlated with preoperative x-rays and CT scans. Results in- dicate several practical advantages performing CT scanning of PF joint: (a) the normal relationship of the patella and femur is assessed in degrees less than 20 ° up to 0 °, both with quadriceps relaxed and maximally contracted by patient; this is important in patients with chronic subluxation; (b) the entire distal femur is visualized; this gives a true relation- ship of the patella and femur including any rotation if present; (c) the cartilagenous portion of the PF joint and the contact surface can be studied; this is of importance in cases of ELPS; (d) the thickness of the cartilage can be assessed, which is of impor- tance in patients with chondromalacia, degenera- tive arthritis, or chondral defects; and (e) normal and abnormal soft-tissue structures around the pa- tella can be evaluated including plicas, lateral and medial retinaculum, and vasti.

In correlat ing CT scans with ar throscopic findings there was 98% accuracy in detecting chon- dromalacia, early degenerative arthritis, and chon- dral and osteochondral defects. However, there were three occasions where arthroscopy and x-rays failed to visualize the lesion and CT clearly demon- strated it. Also there was 100% accuracy in de- tecting plica and shelf syndromes.

In conclusion, we believe CT scanning of the PF joint is an excellent adjunct in overall evaluation of this very complex joint and has several advantages, including dynamic testing of joint relationship,

Arthroscopy, Vol. 2, No. 2, 1986