Operative Treatment and Magnetic Resonance Imaging-Based Diagnostics of Knee Disorders in Military Conscripts

Event start date
Event start time
12.00
Place

Arvo building, auditorium F115, address: Lääkärinkatu 1.

Maria Holsen

Doctoral defence of Lic.Med. Maria Holsen

Operative Treatment and Magnetic Resonance Imaging-Based Diagnostics of Knee Disorders in Military Conscripts

The field of science of the dissertation is Surgery (orthopedics and traumatology).

The opponent is professor Juhana Leppilahti (University of Oulu). Professor Harri Pihlajamäki acts as the custos.

The language of the dissertation defence is Finnish.

Operative Treatment and Magnetic Resonance Imaging-Based Diagnostics of Knee Disorders in Military Conscripts

Knee pain is a common complaint among conscripts and physically active young adults in general. Several conditions of the knee can become painful as a result of either increased strenuous activity or blunt trauma to the knee, both abundantly present during the frequent and versatile physical training of compulsory military service. In most conditions causing knee pain, primary treatment is non-operative, but when pain persists operative treatment can provide relief of symptoms. We examined outcome after surgical intervention for osteochondritis dissecans, painful bipartite patella, and medial synovial plica of the knee in military conscripts. Further, for this population, the use of magnetic resonance imaging in preoperative diagnostics of medial synovial plicae, and articular cartilage lesions of the patella (also referred to as chondromalacia patellae) was evaluated.    

While reattachment of an osteochondritis dissecans fragment of the knee in adults is widely used, the optimal device for fixation remains controversial and lacking long-term results. We found excellent to good functional results for 28 young adults after arthroscopic fixation of an osteochondritis dissecans fragment, using bioabsorbable pins and nails, in an average 5.4 year follow up. Arthroscopic fixation with bioabsorbable nails seems to be a suitable method of repair for osteochondritis dissecans of the adult knee, and showed results superior to arthroscopic fixation with bioabsorbable pins.

To evaluate long-term results of excision of a symptomatic accessory bipartite patella fragment we followed 25 young adults for an average of 15 years. At follow-up functional results were excellent to good for all but one patient. When incapacitating pain persists despite nonoperative treatment, surgical excision seems to yield excellent to good functional outcome and swift recovery with no adverse sequelae.

Long-term results of arthroscopic resection of a medial plica, and the usefulness of clinical findings and magnetic resonance imaging for preoperative diagnostics were evaluated in 25 young adult patients. Functional outcome after a median of 6.6 years was excellent to good in 68%, fair in 20%, and poor in 12% of the patients. Resection of the medial plica of a symptomatic knee has good to excellent functional long-term outcome in the majority of cases, and the procedure is not associated with postoperative complications.

To evaluate the usefulness of magnetic resonance imaging in avoiding unnecessary arthroscopies for articular cartilage lesions of the patella we identified 74 consecutive conscripts, who had preoperative magnetic resonance imaging of the painful knee and a sole diagnosis of articular cartilage lesions of the patella based on arthroscopy. The sensitivity of 1.0 Tesla magnetic resonance imaging for detecting milder lesions was low and could not be used to confirm a diagnosis of articular cartilage lesions of the patella. Sensitivity was markedly higher for the detection of more severe lesions. We conclude that 1.0 Tesla magnetic resonance imaging seems more accurate in detecting severe articular cartilage lesions of the patella.

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The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2279, Tampere University Press, Tampere 2017. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1781, Tampere University Press 2017.

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