The degree of severity of an injury of the knee joint is estimated on the basis of the history given by the patient, stability testing and hemarthrosis, but without using MRI and CT scan, the accurate diagnosis is difficult by plain radiograph
only. The
early diagnosis and appropriate treatment of the injuries are very important in order to prevent disability. The objective of this study was to define the role of early diagnostic and therapeutic knee arthroscopy under local anesthesia for
patients
with
an acute hemarthrosis without instability. Arthroscopy under ocal anesthesia was performed in twenty-three patients with an acute hemarthrosis form April 1993 to September 1994. All patients were males and their mean age was 22.6 years (between
21
and
29 years of age). Main cause of injuries was sports. Mean duration between trauma and operation was 5.9 dyas9range from 1 to 14 days) and mean duration between admission and operation was 3 days(range from adm. Day to 8 days). 30ml of 0.25%
bupivacaine
mixed with epinephrine(1:200,000) was injected into the knee joint as a local anesthetics at twenty minutes before operation. The portals of entry were infiltrated with 10-15ml of 1% lidocaine and epinephrine (1:200,000).
Injury of the anterior cruciate ligament was found in 10 cases(43.5%) and meniscal tears were noted in 15 patients(65.2%). 3 patients had an osteochondral fracture and 4 patients had a eapsular tear. Combined injuries were found in 9
patients(39.1%).
Partial or subtotal meniscectomies were performed in 12 cases of the 15 meniscal injuries and multiple drillings were performed in 3 cases of osteochondral fracture.
In the 6 cases of injury of anterior cruciate ligament that require surgical treatment, primary repairs under tgeneral anesthesia were performed in 3 cases and secondary reconstructive operations were commanded in the remained 3 cases. Mean time
of
operation was 48 minutes. No side effect of local anesthesia was found during intra or postoperative period. We conclude that a traumatic hemarthrosis suggests a significant knee injury and arthoscopy under local anesthesia is simple, safe and
economic
diagnostic and therapeutic method.
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