Introduction: Meniscal tears are common and arise as a result of mainly trauma either isolated or on top of longstanding degeneration. The symptoms are restrictive and prompt diagnosis and intervention restores function and improves prognosis dramatically with long-term symptomatic relief

Purpose: Routinely diagnosing meniscal pathology via MRI is becoming commonplace, even on the background of a clear meniscal history and examination. MRI is useful in excluding tumours but evidence suggests that this can be done with an up-to-date plain x-ray. The aim of this study is to evaluate the routine practice of two knee surgeons in a District General Hospital commonly performing knee arthroscopies.

Method: A retrospective case note analysis 18/01/2007 to 2/12/2008. Patients were selected from the arthroscopy lists of two knee surgeons one largely MRI scanning the other proceeding more on clinical acumen to arthroscopy. Cohort cross-examined, isolating those with a clinical suspicion of meniscal pathology with an intention to treat on initial presentation. Suspected concurrent ACL pathology were excluded. This gave us a group of patients with likely meniscal injury that would ultimately be likely to be scoped so we could retrospectively evaluate the usefulness of MRI, in addition to clinical suspicion in detecting meniscal pathology. Clinical suspicion assumed on presence/absence of 5 key meniscal features i.e Pain, Locking, Effusion, Joint line tenderness (medial and lateral), McMurrays test positive (medial and lateral).

Results: The results in summary:

124 arthroscopy patients

Mean age of the cohort was 47.7 (19–81) mostly male 2.5:1

2 patients not scanned had a negative arthroscopy

Some specific and some sensitive signs and symptoms

Pain and Joint line tenderness – high sensitivity

McMurray’s and Locking – high specificity

Combine into a scoring system (/5)

Shows good positive correlation with specificity (up to 97%)

Shows good negative correlation with sensitivity

Both with increasing score

MRI scanning delays operation by a mean of 45 days (6 ½ weeks)

Total cost of investigating and treating meniscal pathology estimated at £202,500 per year

Costs can be reduced by using a cut off score for scanning of 3/5

Conclusion:

○ MRI showed excellent sensitivity and specificity for meniscal tears

○ Should be reserved for those with boarder-line clinical scores < 3/5 whom cannot be either operated on directly or have meniscal pathology confidently excluded on clinical grounds with ~83% certainty if > 4/5.

○ Clinical findings, in combination, can accurately guide treatment

○ Some signs display high specificity and others high sensitivity. ~83% certainty if > 4/5.

○ Border-line cases falling short on inclusion criteria should be investigated further (MRI) but:

Long waiting times will delay arthroscopy by 45 days (6½ weeks).

Background: goal of our study was to predict the size of intramedullary nail using forearm as reference. Intra-medullary nailing has become favoured treatment for femoral shaft fractures. An implant of the correct size is needed to achieve the desired results. Preoperative templating is useful and well established for trauma and elective surgery to ensure availablity of a suitable implant of correct size preoperatively. Various ways have been described to estimate the nail length. Most commonly used is to x-ray the other limb or directly measure the reamer under x-ray. However these methods involve use of x-rays and information is not well-timed. We describe a simple technique, which can be used to predict the length of femur and therefore have the intra medullary nail of appropriate length available.

METHOD: measurements were taken on 100 volunteers from the tip of olecranon to the tip of little finger and tip of greater trochanter to palpable joint line on the lateral side of the knee. Two observers took the measurements on both sides. We used an ordinary plastic tape measure for ease of use and reproducibility.

RESULTS: statistical analysis revealed a very strong correlation (with pearson correlation factor of 1) between the two lengths. Difference between the two means was 0.16 Mm.

CONCLUSION: forearm reference represents maximum nail length required. It provides a useful method of estimation of femoral length. It can be easily applied in clinical practice with a tape measure alone without resort to x-rays and other expensive and possibly harmful means.