412 ABSTRACTS

Conclusion: Wrist arthroscopy is a useful diagnos- tic and therapeutic tool for ligament tears in patients with a stable carpus and no significant cartilage degen- eration. The presence of TFCC injury with or without accompanying ligament injury may still be success- fully managed in most cases by arthroscopic debride- ment.

Early Glenohumeral Osteoarthritis Diagnosed at Arthroscopy for Impingement Syndrome and Rota- tor Cuff Disease. Louis U. Bigliani, Donald Lewis, Julian S. Arroyo, Roger G. Pollock, and Evan L. Fla- tow. New York, New York, U.S.A.

Introduction: Subacromial impingement syndrome is a common cause of anterior shoulder pain. We en- countered a group of patients with the diagnosis of impingement who were found at the time of arthros- copy to have early glenohumeral osteoarthritis (OA) which was not diagnosed preoperatively.

Methods: Three hundred thirty (330) patients un- dergoing shoulder arthroscopy for the diagnosis of im- pingement syndrome and/or partial-thickness rotator cuff tears between 1986 and 1995 were reviewed. All patients failed conservative treatment including NSAID' s, physical therapy, and subacromial injections for an average of 6 months (range, 3 to 24 months). Twenty-three (23) patients (7%) were discovered to have concomitant glenohumeral OA at the time of arthroscopic inspection of the joint. The average age of these patients was 59 years (range, 32 to 80) and 16 had surgery on the dominant shoulder. The average preoperative ASES pain score was 7.1 (range, 3-10). There were no aspects of the history or physical exami- nation which differentiated these patients from those without glenohumeral OA. In addition, neither plain radiographs nor MRI demonstrated glenohumeral OA preoperatively. All patients had arthroscopic debride- ment of hypertrophic synovium, loose bodies, cartilage flaps, and labral fraying. In addition, 13 patients with subacromial spurs and/or partial-thickness cuff tears had formal arthroscopic subacromial decompressions (ASD), 8 without subacromial spurs and/or partial- thickness cuff tears had soft-tissue subacromial de- bridement only, and 2 with no evidence of impinge- ment syndrome at arthroscopy had glenohumeral debridement alone.

Results: Overall, 5 patients (22%) had excellent re- suits, 15 (65%) satisfactory, and 3 (12%)unsatisfactory

at an average follow-up of 2.4 years (range, 1 to 6 years). The average postoperative ASES pain score improved to 3.0 (range, 0-9). Excellent/satisfactory re- suits were achieved in 11/13 patients (85%) who had formal ASDs, 7/8 (87%) who had soft-tissue subacro- mial debridement procedures, and both patients who had isolated glenohumeral debridement at this early follow-up.

Discussion: Subacromial impingement syndrome is not the only cause of anterior shoulder pain. Glenohu- meral OA may co-exist with impingement, and its pres- ence is often difficult to diagnose clinically. In addi- tion, in the early stages of cartilage degeneration before reactive bone changes occur, plain radiographs and/or MRI often do not identify the pathology. Glenohu- meral arthroscopy is the most reliable means of diag- nosing concomitant glenohumeral OA in patients who undergo subacromial decompression for impingement syndrome.

Meniscal Impingement Syndrome. David A. Mc- Guire, F. Alan Barber, and Stephen D. Hendricks. An- chorage, Alaska, and Piano, Texas, U.S.A.

Purpose: The meniscal impingement syndrome consists of three elements; impaction on the anterior medial femoral condyle by the leading edge of the medial meniscus, articular cartilage damage of at least Outerbridge grade two, and knee hyperextension of at least five degrees.

Materials and Methods: This report reviews this condition in a series of 33 knees with an average fol- lowup of thirty-three months, The time from onset of symptoms until surgery averaged forty-two months. Treatment consisted of a thorough arthroscopic knee evaluation and debridement of the articular cartilage fragmentation and any impinging synovitis. Postopera- tive rehabilitation includes extension block bracing, hamstring strengthening, and close chain exercise.

Results: With the surgical intervention and physical therapy regimen, there was improvement in the Tegner scores and a reduction in postoperative knee hyperex- tension.

Discussion and Conclusions: Identification of this uncommon condition requires a complete evaluation of the medial femoral condyle in patients with knee hyperextension. Intervention will slow and or reduce the progression of degenerative joint disease associated with osteochondral injuries.

Arthroscopy, Vol 13, No 3, 1997