| ORTHOPEDIC SURGERY |
Locked knee: Is immediate surgery needed?
Purpose : In order to evaluate the pathological findings of locked knees, a retrospective study was performed.
Method and patients : 850 knee arthroscopies performed on soldiers in the Sport injuries and arthroscopic unit at our hospital were reviewed. The operations took place between the years 1990 -1998. 183 of the patients presented with block to full extension.
Results : Medial meniscus tear was diagnosed in 38% locked knees (69/183). This pathology was diagnosed in 24% unlocked knees (161/667). The difference was statistically significant (chi square test level 0.001). 55% of the medial meniscus tears in the locked knees were Bucket handle type (38/69) as opposed to 31% (50/161) in the unlocked knee (p<0.001). The anterior cruciate ligament (ACL) was found torn in 54% of the locked knees (100/183) compared with 39% of the unlocked knees (chi square test level 0.001). The lateral meniscus was found torn in 17% of the locked knees (31/183), very similar to the occurrence in the other group (122/667=18%). The rest of the diagnoses in the locked knee group were: Chondromalacia of patella (8), synovitis (4), femoral condyle chondromalacia (3), osteochondritis dissecans (1) and osteochondral fracture (1). In 15% (28/183) no pathology was found (surgeon wrote "IDK"). In 55% arthroscopies of locked knee (100/183) no surgical intervention was carried out (other than "Diagnostic arthroscopy"). That ratio did not differ significantly from the unlocked group (412/667=61%).
Conclusion : Block to full extension is a valuable clinical sign of organic joint internal pathology (mainly ACL and medial meniscus injuries). Since significant portion of locked knee, in this specific population of soldiers, merit merely diagnostic arthroscopy, a more conservative management is warranted that includes a period of physiotherapy, non weight bearing and imaging (MRI).
ASSAF HAROFEH
MEDICAL CENTER
Affiliated
to the Sackler Faculty of Medicine,
Tel Aviv
University
P.O. Beer Yaacov, Zerifin 70300, Israel
Tel: 972-8-9779500
Fax: 972-8-9779502
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