Echographic synovialgram as a stress indicator after abrasive knee arthroscopy

Summary

Background: The intensity of rehabilitation and physical strain after arthroscopic abrasion on several segments of the knee depends on the stage of healing and on anatomical and functional repair, remodelling, reconditioning, and convalescence. The clinical evaluation of healing itself is basic. One of the markers of healing is the sonographic evaluation of the articular exudate –⁠ sonographic synovialgram. Goal: To show the dynamics of irritating articular exudation assessed by sonographic characteristics (sonographic synovialgram) in relation to arthroscopic reconstructive abrasion in a chronological relationship at the stage of repair, remodelling, reconditioning, and convalescence. Based on the sonographic synovialgram, predict the percentage of physical exertion after arthroscopic knee abrasion. Clinical material: We retrospectively evaluated the echographic synovialgram after abrasive reconstructive knee plastic surgery, which was performed on three or more anatomical structures of the knee (meniscus, cartilage, synovia, ligaments, plica, subchondral bone, osteophytes, recesses, corpus fibroadiposum, pannus cicatricosus) aged 40–59 years with X-ray signs of Kellgren-Lawrence arthrosis grade I and II. The clinical symptomatology of knee pain grade 5/10 and above was present for over 12 months. Articular exudate was assessed by ultrasound in the suprapatellar recessus before surgery, then after surgery at 2 weeks, 6 weeks, 16 weeks, and 26 weeks. Outcomes: Preoperative irritating sonosynovialgram: exudate-free –⁠ 0; 0%, synovialgram gr. I –⁠ 13; 16%, synovialgram gr. II –18; 22%, synovialgram gr. III –⁠ 37; 45%, and synovialgram gr. IV –⁠ 14; 17%. Postoperative irritant sonosynovialgram 2 weeks after surgery: exudate-free –⁠ 2; 2%, synovialgram gr. I –⁠ 18; 22%, synovialgram gr. II –⁠ 36; 44%, synovialgram gr. III –⁠ 23; 28%, and synovialgram gr. IV –⁠ 3; 4%. Postoperative irritant sonosynovialgram 6 weeks after surgery: exudate-free –⁠ 4; 5%, synovialgram gr. I –⁠ 17; 21%, synovialgram gr. II –⁠ 41; 50%, synovialgram gr. III –⁠ 18; 22%, and synovialgram gr. IV –⁠ 2; 2%. Postoperative irritant sonosynovialgram 16 weeks after surgery: exudate-free –⁠ 16; 19%, synovialgram gr. I –⁠ 39; 48%, synovialgram gr. II –⁠ 20; 24%, synovialgram gr. III –⁠ 7; 9%, and synovialgram gr. IV –⁠ 0; 0%. Postoperative irritant sonosynovialgram 26 weeks after surgery: exudate-free 56; 68%, synovialgram gr. I –⁠ 22; 27%, synovialgram gr. II –⁠ 3; 4%, synovialgram gr. III –⁠ 1; 1% and synovialgram gr. IV –⁠ 0; 0%. In the pictures, we present typical pictorial case reports of individual stages of the sonographic synovialgram. Conclusion: Based on the analysis of the irritation sonosynovialgram, we can more accurately determine the ability of physical exertion after complex abrasive reconstructive knee surgery in patients aged 40–59 years with signs of Kellgren-Lawrence arthrosis gr. I and II. In this way, we can determine the burden and perioperative prognosis of physical strain after complex abrasive chondroproplasty as follows: Function genus perioperative and prognosis quo ad functionam –⁠ plastica abrasiva: 2 weeks –⁠ 20% load, 6 weeks –⁠ 60% load, 16 weeks –⁠ 80% load, and 26 weeks –⁠ 100% load.

Keywords:

sonographic synovialgram – articular exudate – abrasive arthroscopy – post-arthroscopic rehabilitation