Purpose: The purpose of this study was to compare meniscal lesions observed arthroscopically with magnetic resonance imaging (MRI) descriptions.

Material and methods: MRI were read by one operator blinded to the arthroscopic findings. The operator noted the presence or absence of lesions, the topography of the lesion, and the Trillat classification. 188 menisci were studied in 94 patients.

Results: Arthroscopically there were 90 healthy menisci and MRI described 89 healthy menisci, giving an arthroscopic specificity of 98.9%. There were 98 meniscal lesions arthroscopically and 95 at MRI, giving 96.6% sensitivity. The medial meniscus was damaged in 78 cases and the lateral meniscus in 20. Arthroscopy and MRI found the same type of lesion in 62 of 98 cases, identified on the medial meniscus in 47 out of 78 and the lateral meniscus for 15 out of 20. MRI recognised 25/29 horizontal lesions but only one radial lesion of the medial meniscus among the seven cases identified arthroscopically. The topography was concordant in 18/98 cases. MRI oversized the lesion in 54/98 cases.

Discussion: MRI remains the gold standard complementary examination for the diagnosis of meniscal lesions, with high sensitivity and specificity. The precise anatomic description of the lesion provided by the MRI corresponds less well with the arthroscopic findings. Certain lesions appear to be easier to identify, particularly horizontal lesions, while others, particularly radial lesions, are more difficult to demonstrate.

Purpose: Multiple deformations of the lower limbs are common orthopaedic complications of central nervous system disease. Assessment is difficult. Intrathecal Liorésal® was proposed for the patients to establish the relative effects of spasticity and musculotendinos retraction and define a medico-surgical therapeutic strategy.

Material and methods: Between January 1999 and December 2000, 31 patients consulted for persistent knee flexion. Baclofen tests (75 – 100 μg Baclofen intrathecal) were performed in ten patients because the relative contribution of spasticity and retraction was difficult to assess. The anti-spasticity effect was observed within the first hour, with a maximal effect between the second and fourth hour. Motor function, joint motion, and function were tested during this time interval. The test was repeated approximately three days later, sometimes with higher doses depending on the level of the anti-spastic effect. Residual orthopaedic limitations were explained by musculotendinous retractions.

Results: For the ten evaluated patients, three presented musculotendinous retractions amendable by surgical treatment (tendon lengthening, proximal disinsertion), sometimes in combination with arthrolysis. For the seven patients who had hypertonic spastic contractions, medical treatment was given with, for three patients, continuous intrathecal Lioresal via pump delivery. There was a correlation between the deformation assessed after the test and the test conducted under general anaesthesia during the procedure in all patients.

Discussion: Other methods for evaluating orthopaedic deformities of the lower limbs can be used. Selective motor blocks using local anasethetics are generally reserved for patients with localised stiffness or when it may be difficult to achieve in certain patients (hip flexion). Mobilisation under general anaesthesia is another solution, but does not allow an assessment of functional gain, particularly if the goal is walking. The intrathecal Baclofen test not only allows an accurate assessment of orthopaedic retraction, but also an assessment of the functional impact of the spasticity, sometimes useful for verticalisation or walking.

Conclusion: The Baclofen intrathecal test is a simple test with a particular place in the preoperative and functional assessment of neuro-orthpaedic stiffness of the lower limbs.