The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than onethird of the adult meniscus, healing potential in the settin...The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than onethird of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive Mc Murray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on nonsteroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients re-fractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.展开更多
Dysplasia epiphysealis hemimelica(DEH),or Trevor’s disease,is an osteocartilaginous epiphyseal overgrowth typically occurring in children.The literature reports6 adult cases and none describe recurrence requiring add...Dysplasia epiphysealis hemimelica(DEH),or Trevor’s disease,is an osteocartilaginous epiphyseal overgrowth typically occurring in children.The literature reports6 adult cases and none describe recurrence requiring additional procedures.We present a new-onset proximal tibial DEH in an adult recurring approximately 3 years after open excision.A 39-year-old female presented with a history of right knee pain,swelling,and instability.Physical examination revealed a firm proximal tibial mass.Computed tomography(CT)imaging showed an exophytic,lobulated,sclerotic mass involving the anterolateral margin of the lateral tibial plateau.Magnetic resonance imaging was suggestive of an osteochondroma.The patient underwent curettage of the lesion due to its periarticular location.Histology revealed benign and reactive bone and cartilage consistent with periosteal chondroma.Two and a half years later,the patient presented with a firm,palpable mass larger than the initial lesion.CT revealed a lateral tibial plateau sclerotic mass consistent with recurrent intraarticular DEH.A complete excision was performed and histology showed sclerotic bone with overlying cartilage consistent with exostosis.DEH is a rare epiphyseal osteocartilaginous outgrowth frequently occurring in the long bones of children less than 8 years old.DEH resembles an osteochondroma due to its pediatric presentation and similar histologic appearance.Adultonset cases comprise less than 1%of reported cases.Recurrence rate after surgical intervention is unknown.Only 1 such case,occurring in a child,has been described.Clinicians contemplating operative treatment for DEH should note the potential for recurrence and consider complete excision.A follow-up period of several years may be warranted to identify recurrent lesions.展开更多
文摘The symptomatic degenerative meniscus continues to be a source of discomfort for a significant number of patients. With vascular penetration of less than onethird of the adult meniscus, healing potential in the setting of chronic degeneration remains low. Continued hoop and shear stresses upon the degenerative meniscus results in gross failure, often in the form of complex tears in the posterior horn and midbody. Patient history and physical examination are critical to determine the true source of pain, particularly with the significant incidence of simultaneous articular pathology. Joint line tenderness, a positive Mc Murray test, and mechanical catching or locking can be highly suggestive of a meniscal source of knee pain and dysfunction. Radiographs and magnetic resonance imaging are frequently utilized to examine for osteoarthritis and to verify the presence of meniscal tears, in addition to ruling out other sources of pain. Non-operative therapy focused on nonsteroidal anti-inflammatory drugs and physical therapy may be able to provide pain relief as well as improve mechanical function of the knee joint. For patients re-fractory to conservative therapy, arthroscopic partial meniscectomy can provide short-term gains regarding pain relief, especially when combined with an effective, regular physiotherapy program. Patients with clear mechanical symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but surgery is not a guaranteed success, especially with concomitant articular pathology. Ultimately, the long-term outcomes of either treatment arm provide similar results for most patients. Further study is needed regarding the short and long-term outcomes regarding conservative and surgical therapy, with a particular focus on the economic impact of treatment as well.
基金Cooper University Hospital (Camden,NJ,United States) for supporting to this work
文摘Dysplasia epiphysealis hemimelica(DEH),or Trevor’s disease,is an osteocartilaginous epiphyseal overgrowth typically occurring in children.The literature reports6 adult cases and none describe recurrence requiring additional procedures.We present a new-onset proximal tibial DEH in an adult recurring approximately 3 years after open excision.A 39-year-old female presented with a history of right knee pain,swelling,and instability.Physical examination revealed a firm proximal tibial mass.Computed tomography(CT)imaging showed an exophytic,lobulated,sclerotic mass involving the anterolateral margin of the lateral tibial plateau.Magnetic resonance imaging was suggestive of an osteochondroma.The patient underwent curettage of the lesion due to its periarticular location.Histology revealed benign and reactive bone and cartilage consistent with periosteal chondroma.Two and a half years later,the patient presented with a firm,palpable mass larger than the initial lesion.CT revealed a lateral tibial plateau sclerotic mass consistent with recurrent intraarticular DEH.A complete excision was performed and histology showed sclerotic bone with overlying cartilage consistent with exostosis.DEH is a rare epiphyseal osteocartilaginous outgrowth frequently occurring in the long bones of children less than 8 years old.DEH resembles an osteochondroma due to its pediatric presentation and similar histologic appearance.Adultonset cases comprise less than 1%of reported cases.Recurrence rate after surgical intervention is unknown.Only 1 such case,occurring in a child,has been described.Clinicians contemplating operative treatment for DEH should note the potential for recurrence and consider complete excision.A follow-up period of several years may be warranted to identify recurrent lesions.
