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proposer des gestes de réinsertion-suture associés à une saucéri-sation très économique. L’objectif de cette étude est d’évaluerl’impact réel d’un tel geste sur le capital méniscal.Méthode.— Cette étude prospective porte sur un groupe de 9 genoux(8 patients), opérés d’un ménisque discoïde avec claquementen rapport avec une désinsertion méniscocapsulaire antérieure(n = 7 type MC-A) ou postérieure (n = 2 type MC-P). Une mesureIRM de la surface cartilagineuse tibiale latérale couverte par leménisque est réalisée en par segmentation à partir du logicielMITK3M3 en préopératoire et à un an de recul postopératoire. Lesmêmes mesures sont faites sur un groupe témoin de 10 genouxsains de patients appariées par l’âge. Les rapports de surfacetibial/surface méniscale sur genoux pathologiques pré et postopéra-toire sont comparés aux mêmes rapports mesurés sur genoux sains.Résultats.— L’ensemble des 8 patients a pu reprendre les activi-tés sportives à 6 mois postopératoire, seuls 3 genoux manifestaientquelques douleurs occasionnelles. À un an de recul, aucun n’avaitde ressaut. Le rapport moyen des surfaces ménisque latéral sur car-tilage tibial dans le groupe témoin est de 63,7 %. En préopératoire,ce rapport moyen est de 72,5 % en cas de ménisque discoïde. Il estde 45 % en préopératoire.Discussion.— Malgré une volonté d’être très conservateur, la résec-tion méniscale semble plus généreuse qu’on n’aurait pu l’imaginer ;ceci peut-être lié aux difficultés per opératoires d’apprécier leslimites de la méniscoplastie.Conclusion.— La préservation méniscale autorisée par les gestes desaucérisation—suture est satisfaisante mais toute relative. L’avenirpourrait tendre vers une méniscoplastie centrale encore plus éco-nomique.

http://dx.doi.org/10.1016/j.rcot.2013.10.075

66Evaluation of acceleratedrehabilitation protocol afterarthroscopic meniscus repairÉvaluation d’un protocole de rééducation accélérée aprèsréparation méniscaleJ. Deszczynski , R. Jopowicz , K. Slynarski ,M. Wernicka , J. Desczynski , A. StolarczykVarsovie, Poland

Purpose.— The aim of this study was to compare the results of theaccelerated and standard rehabilitation protocol after arthroscopicrepair of the meniscus of the knee and lower extremity functionalstatus. Depending on postoperative start of the axial load. Standardrehabilitation programs suggest that during the first four weeks toreduce loading to protect the repair area and increase the potentialhealing of damaged meniscus.Methods.— The participants of the study were 40 patients afterarthroscopic meniscal repair surgery. They were randomly dividedinto two groups of 20 people. Group A received indications to walkwithout weight bearing operated for a period of four weeks (stan-dard rehabilitation program). Group B received indications to walkwith weight bearing on the operated limb axis to limit the painfrom the first day after surgery (accelerated rehabilitation pro-gram). Patients were subjected to three functional tests. The daybefore surgery, and 8 weeks after surgery using BIODEX SYSTEM 4(Company of TechnoMex): Priopriocepcia (specifying the angle ofknee flexion), isometric work (voltage mm. Quadriceps), isokineticwork (performing flexion/snap against resistance machines). Ope-rated patients underwent clinical examination and imaging studiesprior to surgery, on the first day after surgery at 2 weeks and at 2,3 and 6 months after surgery. Clinical evaluation was based on thescales IKDC 2000, KOOS, VAS pain level, Tegner and SF-36 for activityscale. Rating imaging based on magnetic resonance imaging (MRI)and ultrasound examination of dynamic (US) knee joints.

Results.— In the group with standard rehabilitation program recor-ded weaker results in tests of working isometric and isokinetic mm.quadriceps. Group of accelerated rehabilitation program in bothtests had similar or even better results in comparison with testsperformed before surgery. The test priopriocepci there were nostatistical difference. Results Tegner activity scale was significan-tly better in the group with accelerated rehabilitation protocol. Theresults of other scales of subjective and dynamic imaging evaluationof meniscus healing showed no statistically significant differences.Conclusion.— Early initiation of axial load after arthroscopic menis-cal repair has a positive effect on maintaining and even improvingthe work of the quadriceps. This allows patients a faster return tophysical activities they enjoyed prior to arthroscopy. During the sixmonths of observation, there was no difference in the healing pro-cess of the meniscus between the accelerated and standard protocoloperation.

http://dx.doi.org/10.1016/j.rcot.2013.10.076

67Accuracy of knee ultrasoundassessment revealed in arthroscopy. Aprospective cohort studyComparaison des évaluations échographique et arthroscopique dugenou : une étude de cohorte prospective. Une étude de cohorteprospectiveB. Dobosz , J. Dutka , P. Skowronek , T. SoryszCracovie, Poland

Background.— Due to observed misuse of musculosceletal ultra-sound diagnostics its limitations needs to be revealed. The aim ofthis study was to assess the ultrasonographic features of knee jointsin relation to clinical and arthroscopic evaluation in patients ope-rated due to and also to evaluate the accuracy of ultrasound in thediagnosis of local joint activity.Methods.— This study included 50 patients with mostly post-traumatic injury of the knee, which were planned for kneearthroscopy. All patients were subjected to full history taking,careful clinical examination. The knee joints of all patients wereexamined ultrasonography (USG)on the same day of clinical exami-nation using ultrasound to detect synovial thickness, meniscal andligament lesions and cartilage of the femur.Results.— The study demonstrated that the level of correlationdiffer remarkably depending on the evaluated structure. Althoughfor assessment PCL (70%) the correlation rate was equal for bothmethods ACL evaluation with use of USG was not accurate (20%)confronted to 80% in clinical examination. The meniscal USG eva-luation has also poor correlation rate 40% lateral, 30% medial.Nevertheless, the synovial overgrowth evaluated with ultrasoundwas positive in 70%. Moreover collateral ligaments examination withUSG has 90% positive correlation, 10% more compared to clinicalevaluation.Conclusion.— Knee ultrasound diagnostics has limitations and ingeneral is less accurate than proper clinical examination althoughit has an advantage in collateral ligament assessment and synovialhypertrophy.

http://dx.doi.org/10.1016/j.rcot.2013.10.077

68Résultats à 7 ans après traitementavec trochléoplastie de creusementde l’instabilité patellaire objective enprésence de dysplasie de trochlée dehaut gradeSeven years follow up after treatment of objective patellarinstability with deepening sulcus trochleoplasty