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Objective : The aim of this study was to evaluate the influence of partial medial meniscectomy on tibiofemoral joint space width (JSW). Design : Thirty-seven patients (mean age: 51 years), suffering from medial meniscal lesions, (post-traumatic ( n =22) or degenerative ( n =15)), and requiring arthroscopic partial meniscectomy, were enrolled in a prospective, controlled study. Bilateral weight-bearing radiographs in extended and flexed position were performed in the same Radiology Unit just before and 2 days after meniscectomy. During arthroscopy, the extent of meniscectomy was evaluated in percentage and medial chondropathy was quantified using the Societe Francaise d'Arthroscopie (SFA) scoring system (SFA score: 0–100). Medial chondropathy was absent or mild (mean SFA score: 8±13). Meniscectomy removed an average of 61% of the posterior third of the medial meniscus, 51% of the middle third and 22% of the anterior third. Radiographs, before and after meniscectomy, were read singly and were analyzed by a single reader unaware of patient identity and date of radiographs. Medial JSW was measured at the narrowest point of the medial compartment using a 0.1mm graduated magnifying glass. Results : Comparison of JSW before and after meniscectomy did not show any statistically significant difference (mm): 0.01±0.43 ( p =0.83) and −0.05±0.56 ( p =0.66) in the extended and flexed views, respectively. Conclusion : This preliminary study suggests that partial medial meniscectomy does not influence tibiofemoral JSW on weight-bearing X-rays. Consequently, joint space narrowing appearing after partial meniscectomy should lead to seeking postmeniscectomy cartilage degradation rather than being attributed to removal of the meniscus.

Background: Several scoring systems have been proposed in order to quantify the degree of cartilage damage observed by arthroscopy of the knee in patients with osteoarthritis.Objective: To evaluate the inter-observer reliability of five different scoring systems of arthroscopic evaluation for chondropathy in osteoarthritis of the knee and to evaluate the utility of a training session between different observations on these scoring systems.Methods: Videotapes of knee arthroscopies on five patients with osteoarthritis demonstrating different levels of severity of cartilage damage of the medial tibiofemoral compartment were analyzed by nine observers prior to (pre-training evaluation) and 2 months after a 6 h training session (post-training evaluation) by the following scoring systems: (1) cartilage deterioration by a 100 mm visual analogue scale (VAS), (2) overall assessment of degeneration in the entire medial compartment (cartilage, meniscus, osteophyte) using a 100 mm VAS, (3) French Society of Arthroscopy (SFA) Scoring System, (4) SFA Grading System, (5) American College of Rheumatology (ACR) Scoring System.Results: At the pre-training evaluation, the SFA grading system produced the highest coefficient of reliability (r=0.94), the other systems recording levels of 0.80 for four of the five scoring systems, with lack of improvement in the ACR Scoring System.Conclusion: There was an improved and acceptable inter-observer reliability for at least 2 months follow-up in four of five evaluated scoring systems of arthroscopically graded osteoarthritis of the knee following a training session. A scoring system using a 100 mm VAS may produce the best inter-observer reliability. These results show that scoring chondropathy is possible and demonstrate the importance of training in the analysis of articular cartilage breakdown.

SummaryObjective:Several reported studies suggest that repeated intra-articular injections of hyaluronan result in sustained relief from pain and functional disability in patients with knee osteoarthritis. Several in vivo data suggest that hyaluronan might have a beneficial structural effect in osteoarthritis. The objective of the study was to evaluate the potential structure-modifying effects of Hyalgan (500–730 kDa molecular weight), a highly-purified sodium hyaluronate.Design:Patients with painful knee osteoarthritis (ACR criteria) were enrolled in a prospective, controlled study of 1-year duration. After randomization, either conventional therapy or three cycles (every 3 months) of three intra-articular injections of Hyalgan (once a week during 2 weeks) were given. Clinical outcome was added using pain visual analog score (VAS), functional impairment: Lequesne's index, quality of life: arthritis impact measurement scale (AIMS2) and structural outcome using X-rays: joint space narrowing and arthroscopy: global assessment using VAS, SFA scoring and grading systems.Results:Of the 39 recruited patients, 36 completed the 1-year trial (19 in the Hyalgan group and 17 in the control group). There was no difference between groups at entry. Between-group comparison for changes in clinical parameters reached statistical significance for the quality of life index (AIMS2: −0.4 ± 0.7 vs +0.2 ± 0.9 in the Hyalgan and control groups respectively, P < 0.05). Deterioration in the structural parameters was less in the Hyalgan group, with a statistically significant difference for two of the three evaluated parameters (overall assessment of chondropathy: +5.1 ± 12.7 vs 16.7 ± 18.3, P = 0.016; SFA scoring system: +3.7 ± 7.3 vs +9.0 ± 11.5, P = 0.05) in the Hyalgan and control groups, respectively.Conclusions:This study supports existing data concerning the favorable symptomatic effect of intra-articular injections of Hyalgan in osteoarthritis of the knee and suggests that repeated intra-articular injections of Hyalgan might delay the structural progression of the disease. Other studies are required to confirm these results and to determine the long-term monitoring of osteoarthritic patients using such local therapy.