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Clinical Experience Reports and Causes of Knee Re-arthroscopic Opration

Author: RenXiaoHua
Tutor: ZhangWeiGuo
School: Dalian Medical University
Course: Surgery
Keywords: arthroscopy re-Arthroscopic operation Knee
CLC: R687.4
Type: Master's thesis
Year: 2011
Downloads: 5
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Abstract


Objective:Discuss and induct the causes of knee re-arthroscopic opration, timely and accurately diagnose knee joint diseases, establish reasonable and effective surgical method, improve the surgical technique and the success rate of re-operation.Methods:We retrospectly analysised the primary disease diagnosis and imaging materials at the first arthroscopic operation ,examination resultes and imaging materials at the second arthroscopic operation,summarized re-arthroscopic operation diagnosis, surgical methods and treatment outcome.Information:from the november of 2007 to the november of 2010,25 cases re-arthroscopic operation for initial postoperative pain and other symptoms, all patients second operation in our hospital. There were male 10 cases and female 15 cases;16 cases of left knee,16 cases of right knee,all patients average age at the second operation was 33 years (ranged from17 to 59 years);underwent knee re-arthroscopy after the first arthroseopy 6 weeks to 28 months, with an average of 10 months. Above all,19 cases made the first operation outside the hospital,6 cases first operated in our hospital.All patients gave lysholm subjective score before re-arthroscopic operation,once again after 6 months follow-up.These studies didn’t include the following:(1)There were diagnostic question during re-arthroscopy.(2)Joint replacement patients who shall be required due to.seriously osteoarthritis the patients didn’t agree to make joint replacement, they only requested joint cavity clean up.(3)The first arthroscopic opration, only diagnostic examination or washing and pathology biopsy examination by using arthroscopyResults:1.During the 25 patients that make the knee re-arthroscopic opration,the first arthroscopic preoperative、intraoperative missed diagnosis 5 cases,including meniscus 3 cases(osteoarthritis and the edge crack of the posterior horn of medial meniscus 1 case,loose bodies and meniscal posterior horn diastema 1 case,anterior cruciate ligament injury and meniscal posterior horn edge crack 1 case)、1 case of rheumatoid arthritis,1 case of synovial chondromatosis;transverse ligament injury of iatrogenic 1 case;recurrence of primary disease 6 case,including 2 cases of synovial chondromatosis, 3 cases of villonodular synovitis and 1 case of rheumatoid arthritis;5 cases of postoperative complications,including 2 cases of meniscal cyst, 1 case of reactive synovitis, 2 cases of joint stiffness;2 cases of Intraoperative mishandling,including 1 case of discoid meniscus residues and 1 case of intercondylar fossa syndrome after reconstruction of anterior cruciate ligament;combination of factors caused the other 6 cases re-operation,including 2 cases of osteochondritis dissecans,1 case of repair failed of meniscus bucket handle fracture, 1 case of re-fracture of anterior cruciate ligament reconstruction, 1 case of chronic synovitis,1 case of traumatic synovitis.The 25 patients who proceeded re-arthroscopic opration obtained further diagnosis and treatment.We followed up at least 6 months after re-arthroscopy, pain, locking, swelling were controlled, 2 cases of joint stiffness, joint function recovered。2.To compare with the second knee arthroscopic preoperative and intraoperative, the two groups lysholm subjective score was significantly different (P <0.01). We can know, knee joint function and activity level are improved significantly after re-arthroscopic opration.Conclusion : 1.The causes of knee re-arthroscopic opration including:①preoperative and intraoperative missed;②iatrogenic injury;③disease recurrence;④intraoperative mishandling;⑤complication;⑥other combination of factors(including the selection of indications for surgery, the patient’s own factors, trauma, etc).2.Timely and effectively rehabilitation is reasonable and effective way to prevent complications.3.The examination of preoperative MRI can help reduce the misdiagnosis rate, preoperative and postoperative knee lysholm score can help doctors to make subjective judgments on the extent of disease.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Joint Surgery
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