Aspiration and injection of the knee joint is a commonly performed medical procedure. Injection of corticosteroid for the treatment of osteoarthritis is the most common reason for knee joint injection, and is performed as an office procedure. Debate exists among practitioners as to the 'best' approach portal for knee injection. This paper examines the various approach portals for injection and/or aspiration of the knee joint, as well as the accuracy of each approach. Searches were made of electronic databases, and appropriate papers were identified and hand-searched. Although there is some evidence that particular approach portals may be more efficacious in the presence of specific knee joint pathologies, generally, in experienced hands, it is of no clinical consequence as to which approach portal is utilised for aspiration or injection of the knee joint. No approach portal is 100% accurate, and the accuracy of injection of the knee joint may be enhanced by the use of techniques such as ultrasound. Practitioners are reminded that they should continuously refine and practice their preferred technique. Knee joint aspiration and injection is a common, simple, and generally safe office procedure.
Hand ; Knee Joint ; Knee ; Osteoarthritis ; Pathology ; Ultrasonography

A sixty-eight-year-old female presented with suddenly developed pain in the left knee joint. On the first visit, there was severe tenderness on the anterolateral aspect of the knee joint with active flexion and extension limited by pain. Radiographs revealed multiple round calcific masses in the anterolateral aspect of the knee joint. Under the impression of intraarticular lesions, we performed arthroscopic examination of the knee joint, which revealed no intraarticular pathology. The masses were found in the extracapsular soft tissue and we performed excisional biopsy of the masses completely. The masses were confirmed as tumoral calcinosis by histopathologic examination. It rarely occurs around the knee joint and is usually asymptomatic. Idiopathic tumoral calcinosis with acute symptoms must be differentiated from other pathologic conditions such as gout or infection. The clinical manifestation of this case was opposed to the previous reports. So we report a rare case of idiopathic tumoral calcinosis of the knee joint with acute symptoms.
Biopsy ; Calcinosis* ; Female ; Gout ; Humans ; Knee Joint* ; Knee* ; Pathology

The role played by synovial plica in internal derangement of the knee has been increased recently. A clinical application of arthroscopy of the one hundred eighty patients were performed, and eighteen patients with a symptomatic plica were successfully managed and followed by arthroscopic surgery at the department of orthopaedic surgery, Soon Chun Hyang University Hospital from May 1983 to May 1984. The results were summerized as follows; 1. Arthroscopy is the most accurate diagnostic and operative methods for the investigation of the incidence, pathology, clinical significance and treatment of the synovial plica. 2. The incidence of the mediopatellar plica in our view was 41% that is, 74 of 180 symptomatic knee. 3. Arthroscopy is a practical and valuable procedure with minimal associated morbidity or complication. 4. The increased accuracy of diagnosis help to avoid unnecessary operations and to be basic methods of treatment on a better knowledge of the pathology.
Arthroscopy ; Diagnosis ; Humans ; Incidence ; Knee ; Pathology ; Pathology, Clinical

OBJECTIVETo investigate clinical characteristics and pathological changes of tissue surrounding prosthesis after hip and knee arthroplasty.

METHODSA total of 67 patients receiving hip and knee arthroplasty were included in the study and pathological changes of the revision specimens were evaluated by microscopic examination.

RESULTSOf 67 patients, there were 25 males and 42 females (ratio of 0.6) with a mean age of 64 years. There were 42 cases of revision hip prosthesis and 25 cases of knee prosthesis. The primary causes for the revision varied, including 20 cases of infection (29.9%, within 3 months in 9 cases,3 to 24 months in 3 cases and over 24 months in 8 cases), 14 cases of pain (20.9%), 13 cases of loosening of the prosthesis (19:4%), 9 cases of joint stiffness (13.4%), 8 cases of prosthetic dislocation (11.9%), and 3 cases of prosthesis fracture (4.5%). Pathological findings in the tissue surrounding the prostheses included debris reaction, histiocytes, acute inflammatory, chronic non-specific inflammation, pigmented villonodular synovitis (PVNS), "pseudomembranous", calcification, necrosis, sequestrum, etc. These histological changes were frequently admixed.

CONCLUSIONSVarious reasons may lead to hip and knee revision arthroplasty. The main pathological findings include infection, debris granulomas, chronic non-specific inflammatory changes, PVNS. The surgical pathology of the prosthesis provids guidances for clinical treatment and basic research.

Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Female ; Hip Joint ; pathology ; Humans ; Knee Joint ; pathology ; Knee Prosthesis ; Male ; Middle Aged ; Reoperation ; Synovitis, Pigmented Villonodular ; pathology

PURPOSE: To evaluate the mucoid degeneration (MD) of the anterior cruciate ligament (ACL) of the knee by correlation of MRI findings with pathology, in the patients with osteoarthritis (OA). MATERIALS AND METHODS: This study included 17 patients (mean 68.8 years old) who underwent preoperative MRI. In proton density-weighted sagittal and coronal images ACLs were evaluated for the thickness and signal intensity (SI). Total knee replacement arthroplasty was performed and the pathologic findings of ACL were evaluated. MD was classified as 3 grades according to the degenerated amount in microscopy. Thickness and SI was evaluated as normal or increased on MRI. RESULTS: All of the 4 patients who showed thickened ACL showed increased SI on MRI. All of the 8 patients with increased SI of the ACL on MRI had MD in the ACL. However, remained 9 patients also had MD, in spite of their normal thickness and SI on MRI. Calcification was seen in 5 patients. CONCLUSION: Eight cases who showed ACL thickening or increased SI on MRI were well correlated with MD, however, because the other nine cases who showed normal thickness and normal SI of ACL on MRI also showed MD in pathology, normal MRI finding should not exclude the possibility of MD of ACL.
Anterior Cruciate Ligament* ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Humans ; Knee* ; Magnetic Resonance Imaging* ; Microscopy ; Osteoarthritis* ; Pathology ; Protons

Magnetization Transfer (MT) imaging generates contrast dependent on the phenomenon of magnetization exchange between free water proton and restricted proton in macromolecules. In biological materials in knee, MT or cross-relaxation is commonly modeled using two spin pools identified by their different T2 relaxation times. Two models for cross-relaxation emphasize the role of proton chemical exchange between protons of water and exchangeable protons on macromolecules, as well as through dipole-dipole interaction between the water and macromolecule protons. The most essential tool in medical image manipulation is the ability to adjust the contrast and intensity. Thus, it is desirable to adjust the contrast and intensity of an image interactively in the real time. The proton density (PD) and T2-weighted SE MR images allow the depiction of knee structures and can demonstrate defects and gross morphologic changes. The PD- and T2-weighted images also show the cartilage internal pathology due to the more intermediate signal of the knee joint in these sequences. Suppression of fat extends the dynamic range of tissue contrast, removes chemical shift artifacts, and decreases motion-related ghost artifacts. Like fat saturation, phase sensitive methods are also based on the difference in precession frequencies of water and fat. In this study, phase sensitive methods look at the phase difference that is accumulated in time as a result of Larmor frequency differences rather than using this difference directly. Although how MT work was given with clinical evidence that leads to quantitative model for MT in tissues, the mathematical formalism used to describe the MT effect applies to explaining to evaluate knee disorder, such as anterior cruciate ligament (ACL) tear and meniscal tear. Calculation of the effect of the effect of the MT saturation is given in the magnetization transfer ratio (MTR) which is a quantitative measure of the relative decrease in signal intensity due to the MT pulse.
Anterior Cruciate Ligament ; Artifacts ; Cartilage ; Knee Joint ; Knee* ; Pathology ; Protons ; Relaxation ; Water

PURPOSE: To determine the sonographic findings of degenerative change in femoral articular cartilage of the knee by comparative study of specimen sonography and pathology. MATERIALS AND METHODS: We obtained 40 specimens of cartilage of the femur (20 medial and 20 lateral condylar) from 20 patients with osteoarthritis of the knee who had undergone total knee replacement. The specimens were placed in a saline-filled container and sonography was performed using a 10MHz linear transducer. Sonographic abnormalities were evaluated at the cartilage surface, within the cartilage, and at the bone-cartilage interface, and were compared with the corresponding pathologic findings. In addition, cartilage thickness was measured at a representative portion of each femoral cartilage specimen and was compared with the thickness determined by sonography. RESULTS: 'Dot 'lesions, irregularity or loss of the hyperechoic line, were demonstrated by sonography at the saline-cartilage interface of 14 cartilages. Pathologic examination showed that these findings corresponded to cleft, detachment, erosion, and degeneration. Irregularities in the hyperechoic line at the bone-cartilage interface were revealed by sonography in eight cartilages and were related to irregularity or loss of tidemark, downward displacement of the cartilage, and subchondral callus formation. Dot lesions, corresponding to cleft and degeneration, were noted within one cartilage. Cartilage thickness measured on specimen and by sonography showed no significant difference (p=0.446). CONCLUSION: Specimen sonography suggested that articular cartilage underwent degenerative histopathological change. Cartilage thickness measured by sonography exactly reflected real thickness.
Arthroplasty, Replacement, Knee ; Bony Callus ; Cartilage ; Cartilage, Articular* ; Femur ; Humans ; Knee* ; Osteoarthritis ; Pathology* ; Transducers ; Ultrasonography

PURPOSE: We assessed the clinical outcome of contralateral arthroscopic meniscectomy performed with unilateral total knee arthroplasty (TKA). MATERIALS AND METHODS: From May 1999 to June 2006, 23 patients underwent unilateral total knee arthroplasty and contralateral arthroscopic meniscectomy at the same time. All patients were women and followed for at least 36 months, except 2 patients who died. For clinical assessment, range of motion of the knee joint, Hospital for Special Surgery (HSS) knee score and the Lysholm knee score were evaluated preoperatively and at the last follow-up. At arthroscopy, meniscal pathology and cartilage changes were recorded and classified according to the Outerbridge scale. Progression of osteoarthritis in the contralateral knee to subsequent TKA was also assessed. RESULTS: The mean age of the 21 patients was 67.1 years and the mean follow-up period was 5.7 years. All of the patients were diagnosed with osteoarthritis and had Outerbridge grade 3 or 4 cartilage changes. Eight of the 21 patients had subsequent TKA at an average of 3.1 years after the index operation. The other 13 patients had no further surgery and clinical results including the HSS knee score and the Lysholm score were improved from 74.5 and 60.6 preoperatively to 90.8 and 82.4 postoperatively, respectively (p<0.001). CONCLUSIONS: Contralateral arthroscopic meniscectomy performed simultaneously with unilateral TKA produces relatively good results regardless of the presence of cartilage degeneration.
Arthroplasty ; Arthroscopy ; Cartilage ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; Knee ; Osteoarthritis ; Pathology ; Range of Motion, Articular

PURPOSE: The purpose of this study was to report clinical results of open excision of extra-articular ganglion cysts around the knee joint combined with arthroscopic management of intra-articular pathologies if present. MATERIALS AND METHODS: Of the total 107 cases of cystic lesions around the knee, 23 cases of extra-articular ganglion cysts were reviewed between January 2006 and July 2011. There were 13 males and 10 females with a mean age of 48 years (range, 30 to 73 years). The mean follow-up duration was 40 months (range, 30 to 60 months). Preoperative magnetic resonance imaging (MRI) scan was done in all cases. Open surgical excision of the cyst was performed after arthroscopic management of intra-articular pathologies in all but 1 case. At the last follow-up, Lysholm and International Knee Documentation Committee (IKDC) scores were evaluated and MRI was conducted to detect recurrence. RESULTS: The mean Lysholm and IKDC scores showed significant improvement (p=0.005 and 0.013, respectively).The location of the cysts was anterior in 9, lateral in 7, medial in 6, and posterosuperior in 1. Intra-articular pathologies were found in 16/23 cases (69.6%). In 10/23 cases (43%), the cyst was connected to the knee joint. Three months postoperative MRI did not show any recurrence of ganglion cysts except for 1 case. CONCLUSIONS: In the treatment of extra-articular ganglion cysts, MRI can be useful for detecting intra-articular lesions and connecting orifices, and arthroscopic management of intra-articular pathologies with open excision of the cyst should be considered as a viable treatment option.
Female ; Follow-Up Studies ; Ganglion Cysts ; Humans ; Knee Joint ; Knee ; Magnetic Resonance Imaging ; Male ; Pathology ; Recurrence

PURPOSE: The pattern of symptoms of knee osteoarthritis has been thought to be indicative of specific compartment involvement. This study investigated whether there was a true correlation between patellofemoral joint (PFJ) symptoms and unicompartmental patellofemoral arthritis. MATERIALS AND METHODS: A prospective analysis of 34 patients rendered to be suffering from PFJ osteoarthritis and subsequently undergoing unicompartmental patellofemoral arthroplasty (PFA) was performed. A control cohort of 32 patients suffering from medial tibiofemoral joint (MTFJ) osteoarthritis was included in the analysis. Four questions derived from the Oxford knee score questionnaire, traditionally deemed to be indicative of PFJ osteoarthritis, were combined to create a PFJ subscore and statistically analyzed for their potential relationship with PFJ osteoarthritis and outcomes following PFA. RESULTS: The PFJ subscore indicated slightly worse pathology in patients undergoing PFA compared to MTFJ replacement, but the difference was not significant (9.7 and 9.6, respectively; p=0.851). The improvement in PFJ symptoms was higher in those undergoing PFA compared to MTFJ surgery; however, the difference was not statistically significant (3.7 and 2.2 respectively, p=0.074). CONCLUSIONS: We were unable to prove that these symptoms were predictive of PFJ pathology in the preoperative setting, nor were they useful in interpreting which symptoms would likely improve following PFA.
Arthritis ; Arthroplasty ; Cohort Studies ; Humans ; Joints ; Knee ; Osteoarthritis ; Osteoarthritis, Knee ; Patellofemoral Joint ; Pathology ; Prospective Studies