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The purpose of this study was to review the outcome of the arthroscopic treatment of localized pigmented villonodular synovitis of the knee and to determine the recurrence rate with clinical and magnetic resonance imaging evaluation at midterm follow-up. Thirty consecutive patients diagnosed with localized pigmented villonodular synovitis of the knee were treated arthroscopically between 1990 and 2008. Clinical assessment was made with the use of Lysholm Knee Scale, and radiologic assessment was done by plain radiographs and magnetic resonance imaging of the knee. Recurrence rate of the disease was also estimated. The average follow-up was 75 months (range 12–144). The median age of the patients was 46 years (range 23–71). Symptoms were discomfort of the knee (100%), swelling (90%), locking (50%), pain (10%) and palpable mass (15%). A history of knee trauma was present in 10% of the patients. The nodules were localized in the gutters (45%), suprapatellar pouch (26%), patellar fat pad (13%), posterior compartment of the knee (13%) and in the femoral notch (9%). The median Lysholm Knee Score was 56.5 (range 53–60) and 85.5 (83–88) preoperatively and at final follow-up, respectively. No postoperative complications occurred. Arthroscopy is a safe and effective procedure for the treatment of localized pigmented villonodular synovitis of the knee. Magnetic resonance imaging is essential to diagnose this pathologic condition and to define accurately its localization and treatment strategy.

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.

The purpose of this study was to evaluate the performance (simplicity, reproducibility, relevance) of chondroscopy as a method for evaluating cartilage damage. Chondroscopy consisted in endoscopic evaluation of the knee using a 2.7-mm Storz arthroscope under local anesthesia and recorded on videotape. Scoring of chondropathy was based on physician's overall assessment using a 100-mm-length visual analogue scale (VAS) and size and grade of cartilage lesions. Reproducibility was evaluated by variability (coefficient of variation [CV]) in the reading of chondroscopic evaluations of five patients five times by one physician and one time each by four different physicians. The correlations between scoring of chondropathy (VAS) and radiological articular joint space narrowing, demographic data (sex, age, weight), and disease characteristics (localization, etiology, activity) were studied in 84 outpatients fulfilling the American College of Rheumatology criteria for the diagnosis of osteoarthritis of the knee. The grade and size of the lesions were both correlated with the physician's overall assessment (r = 0.713 and r = 0.816, respectively). These two variables accounted for 72% of the variance of the VAS (multiple regression analysis). Intraobserver reproducibility was better than interobserver reproducibility (CV, 9% and 37%, respectively). There was a strong correlation between the scoring of chondropathy (VAS) and radiological joint space narrowing (r = .646, P.0001). Moreover, in 17 of 33 patients without radiological joint space narrowing, VAS was20 mm. At variance, the body mass index was the single clinical variable found to correlate with the scoring of chondropathy (r = .282, P.001).(ABSTRACT TRUNCATED AT 250 WORDS)