Aim

Our collaborative study aims to demonstrate that acute partial Achilles Tendon Tears (ATTs) are not separate diagnostic entities from full ATTs. and should be thought of as a continuum rather than binary partial or full.

A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group. 3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted. 26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=<0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=<0.0001). Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears

Introduction. The human wrist is a highly complex joint, offering extensive motion across various planes. This study investigates scapholunate ligament (SLL) injuries’ impact on wrist stability and arthritis risks using cadaveric experiments and the finite element (FE) method. It aims to validate experimental findings with FE analysis results. Method. The study utilized eight wrist specimens on a custom rig to investigate Scapho-Lunate dissociation. Contact pressure and flexion were measured using sensors. A CT-based 3D geometry reconstruction approach was used to create the geometries needed for the FE analysis. The study used the Friedman test with pairwise comparisons to assess if differences between testing conditions were statistically significant. Result. The study found significant variations in scaphoid and lunate bone movement based on ligament condition. Full tears increased scapholunate distance in the distal-proximal direction and decreased in the medial-lateral direction. Lunate angles shifted from flexion to extension with fully torn ligaments. Conversely, the scaphoid shifted significantly from extension to flexion with full tears. A proximal movement was observed in the distal-proximal direction in all groups, with significant differences in the partial tear group. Lateral deviation of the scaphoid and lunate occurred with ligament damage, being more pronounced in the partial tear group. All groups exhibited statistically significant movement in the volar direction, with the full tear group showing the least movement. Also, radiocarpal joint and finger contact pressure and contact area were studied. Whereas the differences in contact area were not significant, scapholunate ligament tears resulted in significantly decreased finger contact pressures. FEA confirmed these findings, showing notable peak radiocarpal contact pressure differences between intact and fully torn ligaments. Conclusion. Our study found that SLL damage alters wrist stability, potentially leading to early arthritis. The FEA model confirmed these findings, indicating the potential for the clinical use of computer models from CT scans for treatment planning

Introduction. There is a challenge to detect partial tear of the ACL, the number of bundle injured and the proportion of fibers torn. The MRI was shown efficient to individualize the two anteromedial (AM) and posterolateral (PL) bundles of the ACL. The purpose of this study was to assess the ability of the MRI to detect partial tears of the ACL on axial views to display the AM and PL bundles. Materials and methods. This retrospective study included 48 patients (19 partial tears of the ACL, 16 complete rupture of the ACL and 13 normal knee) who underwent both arthroscopy and MRI examinations of the knee. The conventional MRI protocol included one sagittal T1- weighted sequence and 3 proton-density fat sat. The images from MRI were analysis by a radiologist specialized in musculoskeletal imaging who was blinding to the arthroscopic findings. The criteria for the analysis of MRI were divided into primary (those involving the ACL himself) and secondary signs (associated abnormalities). The primary signs included the horizontalisation of the ACL (ACL axis), the global ACL signal intensity and the signal intensity of each AM and PL bundle. The secondary signs included bone bruise, osteochondral impaction, popliteus muscle injury, medial collateral ligament injury and joint effusion. The ACL was classified as normal, partially or totally torn. The rupture of the AM and PL bundle was specified. Results. In our study, MRI was found to have a 75% sensitivity and a 73% specificity for the diagnosis of partial tears of the ACL. The sensitivity to detect AM bundle lesion was 88% but the specificity was 50%. The lack of horizontalisation of the ACL was a very good sign, for partial tears of the ACL, with a sensitivity of 84% and a specificity of 81% (p<0.05). Regarding the secondary signs, there was no significant difference to distinguish partial and complete tear. However, we found that there was a greater probability to find a partial tear of the ACL with the lack of joint effusion, bone bruise and medial collateral ligament injury. Quantifying the proportion of injured fibers was unsuccessful and was found as a failure of the MRI. Conclusions. MRI exhibited lower sensitivity and specificity for partial tear than for complete rupture of the ACL. However 3 important arguments can guide us: the lack of horizontalisation of the ACL, a continuous ACL signal, the display of one of two bundles on the axial view

Aim. The present study aimed to assess the accuracy of preoperative departmental ultrasound scans in identifying rotator cuff tears at our institution. Methods. Preoperative ultrasound scan reports were obtained from 64 consecutive patients who subsequently underwent arthroscopic subacromial decompression and/or rotator cuff repair. Data was collected retrospectively using our 2010 database. The ultrasound reports were compared with the arthroscopic findings. The presence or absence of partial and full thickness rotator cuff tears was recorded. Results. Ultrasound correctly identified 30/43 (70%) of all tears, 18/30 (60%) of full thickness tears but only 1/13 (8%) of partial tears seen at arthroscopy. Of the remaining 12 partial tears seen at surgery, 6 were misdiagnosed as full thickness tears on ultrasound and 6 were not picked up at all. Five partial thickness tears were repaired and the rest were debrided. If both full and partial thickness tears are counted as true positives, ultrasound had a sensitivity of 70%, a specificity of 67%, a positive predictive value of 81%, a negative predictive value of 51% and an overall accuracy of 69%. If only partial tears are counted as true positives sensitivity decreases to 8% and positive predictive value to 10%. Conclusion. In this series a preoperative departmental ultrasound scan identified 70% of the actual rotator cuff tears present at arthroscopy. However ultrasound was not accurate in identifying partial thickness tears or distinguishing them from full thickness defects. Due to this relatively low sensitivity, we question the usefulness of routine preoperative departmental ultrasound scans in the evaluation of suspected cuff tears

Introduction and purpose: Since 1834 when Smith first described rotator cuff tears we have come far in the treatment of this condition. The greater availability of arthroscopic surgical procedures requires the greatest possible precision in preoperative diagnoses. Our purpose is to determine the accuracy (sensitivity and specificity), in our environment, of the two main diagnostic techniques we use, namely ultrasound and magnetic resonance. Materials and methods: We reviewed 100 arthroscopic shoulder procedures performed in our centre. We compared retrospectively the intraoperative findings with the reports of the available images of each patient (US and MRI). We focused our attention exclusively on the tendon of the supraspinatus muscle. The sensitivity and specificity of both tests was compared in two different ways. In the first case, by considering as torn tendons those with complete tears (total thickness tears); in the second case, by considering as torn tendons those with complete or partial tears. Results: With magnetic resonance images we found a sensitivity of 78% and a specificity of 89% for total tears and a sensitivity of 92% and a specificity of 64% for partial tears. With ultrasound we found a sensitivity of 73% and a specificity of 83% for total tears and a sensitivity of 91% and a specificity of 78% for partial tears. Conclusions: Both diagnostic methods show comparable sensitivity and specificity levels, which were high in our environment for total tears. Specificity is less in the case of partial tears

Background: Up to one third of adults have been estimated to have rotator cuff tendon (RCT) tears. Larger RCT tears are associated with poorer scores and function, and are more likely to re-rupture after surgical repairs, hence there is a need for earlier identification and treatment. The aim of this study was to identify biomarkers of RCT tear pathologies to aid accurate identification and monitoring of disease progression. FTIR provides unique biochemical fingerprints of tissue specimens. All molecules are excited to higher vibrational states at specific wavelengths, which can be used to identify the chemical composition of tissues. Methods: The chemical composition of 55 formalin-fixed RCTs was measured from patients aged between 20 and 89. RCT tears were classified according to size (Post et al.); 10 each of small, medium, large and massive and 5 partial tears. These torn RCTs were compared to 10 uninjured RCTs. A diamond attenuated total reflectance accessory was used with a FTIR spectrometer to collect spectra for each sample. The spectra were reduced and classified using standard multivariate analysis; principal component analysis (PCA), partial least square (PLS) and discriminant function analysis (DFA). Data pre-processing was applied to ensure accurate quantitative data analysis. Results: Hierarchical cluster (HCA) demonstrated that normal and torn tendons could be clearly differentiated, and RCT could also be distinguished by their tear size. Partial tears were clearly distinguishable from normal RCT. Using a genetic algorithm we identified the following spectral regions of importance which accounted for most of the features which discriminated between normal and torn tendons:. 1030–1200cm-1: carbohydrates, phospholipids,. 1300–1700, 3000–3350cm-1: collagen structural conformation and. 2800–3000 cm-1: lipids. Partial tears were distinguishable from other stages of tendon pathology based on a spectral region which correlated with collagen III. Conclusions: FTIR can clearly distinguish normal and different sized RCT tears. This prospective non-randomized study indicates that the onset of RCT tear pathology is mainly due to an alteration of the collagen structural arrangements, with associated changes in lipids and carbohydrates. Partial tears show early onset of chemical changes, particularly in collagen III, which could be used to identify earlier stages of disease. The approach described is rapid and has the potential to be used per-operatively to determine the quality of the tendon and extent of disease, thus guiding surgical repairs or allowing monitoring of disease progression or response to treatments

Aim: The diagnosis of partial biceps tears cannot be made reliably with existing physical exam tests. Diagnostic arthroscopy is recommended if this diagnosis is suspected. The accuracy of the physical examination for biceps pathology remains controversial. The goal of this study was to investigate the validity and clinical usefulness of various physical tests used for diagnosing partial tears of the biceps tendon. Materials & Methods: The study was a prospective blinded study of 847 consecutive patients who underwent arthroscopic procedures for a variety of shoulder conditions. Forty subjects were found at the time of arthroscopy to have partial biceps tears (24 men and 16 women) with an average age of 59 YO (range from 18 to 83 YO). A pre-operative physical examination using 9 different commonly used tests was performed for all the patients. Statistical analysis included sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and likelihood ratios (LR) for these tests. Results: The prevalence rate of partial tears was 5 percent of all arthroscopic procedures. Associated conditions included rotator cuff tears (85 percent) and anterior instability (7.5 percent). The sensitivity, specificity, PPV, NPV and the LR for the Speed_s test were 50 percent, 67 percent, 8 percent and 96 percent and 1.51, respectively. None of the other tests was sensitive (less than 50 percent). The lift-off sign had a LR of 2.61 but had a sensitivity of only 28 percent. Conclusion: The diagnosis of partial biceps tears cannot be made reliably with existing physical exam tests. Diagnostic arthroscopy is recommended if this diagnosis is suspected

Introduction. Cruciate retaining knee replacements are only implanted into patients with “healthy” ligaments. However, partial anterior cruciate ligament (ACL) tears are difficult to diagnose with conventional MRI. Variations of signal intensity within the ligament are suggestive of injury but it is not possible to confirm damage or assess the collagen alignment within the ligaments. The potential use of Magic Angle Directional Imaging (MADI) as a collagen contrast mechanism is not new, but has remained a challenge. In theory, ligament tearing or joint degeneration would decrease tissue anisotropy and reduce the magic angle effect. Spontaneous cruciate ligament rupture is relatively common in dogs. This study presents results from ten canine knees. Methods. Ethical approval was obtained to collect knees from euthanized dogs requiring a postmortem (PM). A Siemens Verio 3T MRI scanner was used to scan a sphere containing the canine knees in 9 directions to the main magnetic field (B. 0. ) with an isotropic 3D-T1-FLASH sequence. After imaging, the knees were dissected and photographed. The images were registered and aligned to compare signal intensity variations. Segmentation using a thresholding technique identified voxels containing collagen. For each collagen-rich voxel the orientation vector was computed using Szeverenyi and Bydder's method. Each orientation vector reflects the net effect of all fibers comprised within a voxel. The assembly of all unit vectors represents the fiber orientation map and was visualised in ParaView using streamlines. The Alignment Index (AI) is defined as a ratio of the fraction of orientations within 20° (solid angle) centred in that direction to the same fraction in a random (flat) case. By computing AI for a regular gridded orientation space we can visualise differences in AI on a hemisphere. AI was normalised so that AI=0 indicates isotropic collagen alignment. Increasing AI values indicate increasingly aligned structures: AI=1 indicates that all collagen fibers are orientated within the cone of 20° centred at the selected direction. Results. Dogs cranial cruciate ligament (CCL) is similar to human ACL. It's composed of an anteromedial (AM) bundle and a posterolateral (PL) bundle. Two knees were damaged with partial CCL tears, the PL bundle was intact but the AM bundle was torn. Paraview streamlines of the CCL for healthy and damaged knees differ. The healthy knee has continuous fiber tracts with no ligament disruption. In the AM bundle fibers are discontinuous and the PL bundle fibers are continuous as expected in a partially torn CCL. The AI for healthy (mean AI=0.25) and damaged CCL (mean AI= 0.075) is significantly different (p<0.01). The damaged AM bundle has a more diffuse spread of less aligned fibers compared to the more concentrated and aligned PL fiber bundle. Conclusion. This study demonstrates the first visualisation of a CCL partial tear using MADI. Combined with AI, our scanning technique offers a tool to visualise and quantify changes in collagen fiber orientation. Thus, MRI can be used to improve the diagnosis and quantification of partial ligament tears in the knee

Purpose of the study: This work examined the clinical, radiological, and videoarthroscopic features of partial tears of the anterior cruciate ligament (ACL) and analysed results of ligament plasties. Material and method: Mean age was 32 years. Patients complained of instability accidents in 70% of cases. The Lachman test was noted soft endpoint to + or ++ in 90%. A palpable click was found in 60% but was considered severe in two cases only. Telos laxity was moderate (about 5 mm) in 80%. Mean time to surgery was relatively short (9 months). Arthroscopic exploration revealed rupture of the anteromedial head of the ACL with preservation of the posterolateral component. There was a meniscal injury in nine knees. Early in our experience we performed a total plasty for nine patients (six using hamstring tendons and three with the patellar tendon). At the present time, we spare the posterolateral head and make a partial plasty of the anteromedial head (11 knees: 3 harvesting a single tendon [gracilis] and eight using the gracilis and the semitendious) associated with lateral reinforcement in five. Results: Mean follow-up was 30 months; 30% of patients had knee pain. Three knees exhibited a soft endpoint (+) all after a total plasty. There were no cases of quadriceps motion deficit or amyotrophy. Discussion: The existence of partial tears of the ACL were confirmed in this series. This type of tear corresponds to an objective condition seen arthroscopically and also to precise clinical presentations and biological findings: minor signs of instability with moderate objective anterior instability to the order of 5 mm. Conclusion: Considering this work and a review of the literature, the diagnosis of partial tears of the ACL could be established from the physical examination and measurements of anterior knee laxity. Reconstruction of a single head provides better results than complete reconstruction which would sacrifice an intact portion of the ACL

Our aim was to determine the effect of denervation on repair-associated mRNA levels in the MCL after partial tear. Cohorts of rabbits underwent partial MCL tear with or without concomitant femoral nerve transection. Ligaments were harvested, RNA extracted and RT-PCR was performed using rabbit-specific primers for repair-associated molecules at three days, two wks, six wks and sixteen wks post-injury. Angiogenesis genes MMP3, MMP13, matrix components Collagen I and III and growth factors TGF-ß and NGF mRNA levels were increased in the denervated group at two-weeks post-injury (p< 0.05). Denervation significantly alters mRNA levels during the early stages of rabbit MCL healing. To determine the effect of denervation on repair-associated mRNA levels in the injured medial collateral ligament (MCL). Previous experiments revealed that denervation impairs healing of the MCL. We hypothesized that denervation would decrease repair-associated mRNA levels in the injured MCL when compared with normally innervated injured MCL. Adult, skeletally mature female rabbits were assigned to one of four groups: unoperated control, femoral nerve transection alone (denervated controls), MCL partial tear and denervated MCL partial tear. At three days, two weeks, six weeks or sixteen weeks post-surgery, cohorts of six rabbits from each experimental group were killed. Control rabbits were assessed at two weeks. Ligaments were harvested, RNA extracted and RT-PCR was performed using rabbit-specific primers. In the denervated injury group, mRNA levels of angiogenesis genes MMP-3 and MMP-13, matrix components Collagen I and III and growth factors TGF-ß and NGF had all increased at two-weeks post-injury, in comparison to non-denervated (p< 0.05). We also found increased levels of MMP-3 and NGF mRNA in the denervated group at sixteen weeks post injury (p< 0.05). The mRNA levels of the housekeeping gene GAPDH were increased in the denervated group only at three days post injury (p< 0.05). Of note, TGF-ß mRNA levels were significantly decreased in the denervated group at three days post injury (p< 0.05). Contrary to our initial hypothesis, denervation increases mRNA levels for many important molecules during the early stages of MCL healing. Additional research will be required to explain how and why denervation impairs ligament healing. No previous study has shown that innervation regulates mRNA levels in healing ligament

Background: The Achilles tendon is the strongest and thickest tendon in the human body, it is very commonly injured with significant clinical implications. The treatment of Achilles tendon rupture is a matter of controversy in orthopedics and sports medicine. Surgical repair compared with conservative treatment is debated constantly in the literature, without a conclusive decision. The diagnosis of Achilles tendon rupture is based usually on clinical examination, and may be reinforced by ultrasound or magnetic resonance imaging. The present study has been conducted in order to determine whether an ultrasound examination performed at the time of injury could be useful in deciding how to treat the patient. Patients: Over a period of 5 years we treated 26 patients who had a clinical presentation of ruptured Achilles tendon with ultrasound diagnosis of either a partial tear or a full tear. Patients who were diagnosed by ultrasound as having a full tendon tear were operated on, and were not included in this study. Eight patients had partial tear of the tendon, six had a tear of the musculotendinous region, and twelve had a proximal tear. All patients were treated by means of a cast or a dressing, with limitation of weight bearing. The follow-up period ranged between six months to three years after the injury, and included up-to-date functional evaluation. Results: Eighteen patients were available for evaluation. Excellent functional results were reported by five patients, twelve patients reported good results, and one patient complained of a bad result. None of our patients needed delayed surgery, and only one suffered from re-rupture of the tendon during his rehabilitation, and was treated conservatively with good results. No correlation was found between the location of the tear and the functional results. Conclusions: 1. Ultrasound is an important and accurate tool in the diagnosis of Achilles tendon tear and is helpful in choosing the appropriate treatment. 2. Partial tear of Achilles tendon is not an indication for operative treatment, even when the clinical examination (Thompson test) is positive. The outcome of conservative treatment in this situation is as good or even better than surgical treatment

Recent findings have identified the importance of previously undiagnosed or neglected meniscus lesions in association with anterior cruciate ligament (ACL) injuries (e.g. medial meniscus ramp lesions and posterior root tears of the lateral meniscus). There is increasing biomechanical evidence that they bear the potential to alter both anteroposterior and rotational laxity patterns in ACL injured knees. Few data exist with respect to the presence of these specific tear entities in large series of ACL injured patients. The purpose of the study was to analyze the meniscus tear pattern in a series of ACL injured knees with a special focus on ramp lesions of the medial meniscus and posterior root lesions of the lateral meniscus. The hypothesis was that a significant number of ACL injured patients would display these types of lesions. Data from 358 patients undergoing an ACL reconstruction (227 males /131 females, age: 28±10) were extracted from a center-based registry. The type of ACL tear (partial versus complete) as well as the presence of associated meniscus lesions were documented. Meniscus lesions were classified into the following categories: medial ramp lesions, lateral root lesions, medial ramp and lateral root lesion, other medial meniscus injuries, other lateral meniscus injuries, other bimeniscal injuries. Chi-square tests were used to determine whether the percentage of meniscal lesions differed between types of ACL tear, gender and age (below 21, 21–35, above 35). Significance was set at p < 0.05. Isolated ACL tears were present in 107 (30%) of the operated knees (31 partial; 327 complete). Complete ACL lesions were more likely to present an associated meniscus injury (321 out of 327, 71%) than partial tears (13 out of 31, 42%). The incidence of meniscus injuries which are associated with ACL tears is very high (70%). Previously undiagnosed or neglected meniscus injuries like medial ramp or lateral root tears could be identified in 35% of patients. As such, the hypothesis was confirmed that an important amount of ACL injured knees display this specific intraarticular soft tissue damage. A systematic evaluation of these lesions under arthroscopy should thus be performed and specific repair needs to be evaluated

Purpose: There is still debate on classification, pathogenesis, and treatment of partial non-full thickness tears of the rotator cuff. We assessed mid-term outcome after arthroscopic repair. Material and methods: Between 1990 and 1998, 208 partial tears of the rotator cuffs were treated in our unit. Eighty patients were reviewed by an examiner different and independent from the surgery team. The review included a physical examination, Constant score and radiography. The series included 42 men and 38 women, mean age 52 years (23–73) who were seen at a mean follow-up of 59 months (17–118). We identified four groups: group 1 included lesions of the deep articular aspect of the supraspinatus: 34 cases; group 2 included tears of the superficial aspect: 27 cases; group 3 included tears involving both the deep and superficial aspect without full-thickness tear on the preoperative arthrogram; and group 4 included lesions involving a partial tear of the supraspinatus associated with another articular lesion. Acromioplasty was performed in all cases associated with section of the acromiocoracoid ligament. Results: Absolute Constant score progressed from 53 points preoperatively to 80 points at last follow-up. Mean Constant score of the contralateral shoulder was 87 points. There was a significant difference between outcome in the first three groups where the mean age was 50 years and the fourth group (trauma context) where the mean age was 36 years. Constant score was 84.7, 92, 92, and 73 for groups 1, 2, 3 and 4 respectively. There was no statistically significant improvement compared with the preoperative Constant score (67 points). Radiographically, there was no change in the subacromial space. Superficial lesions were more frequently associated with type 3 acromial impingement. Discussion: Globally, we observed a deterioration of outcome with time compared with the first review, with 76% satisfactory results at five years. The same outcome was obtained with superficial and deep lesions. We are in agreement with others that it is necessary to identify a subgroup of patients under 40 years of age with a partial tear of the rotator cuff in a trauma context. For these patients, arthroscopic acromioplasty is not a satisfactory therapeutic approach. The causal lesion (posterosuperior impingement, rim injury or instability) should be treated

Ultrasound has become an essential adjunct to clinical examination when assessing a patient with suspected rotator cuff pathology. This prospective study was conducted to examine the accuracy of the scans performed by a surgeon over a period of four years. Out of 276 scanned patients we selected 143 who ultimately received an operation and we compared the findings with the ultrasound reports. The surgical findings included 77 full thickness tears, 24 partial thickness tears and 42 normal cuffs. Two small tears were missed and one partial thickness tear was reported as full thickness. This presents a 98.6% sensitivity and 99.3% specificity for full thickness tears. Three partial thickness tears were reported normal on ultrasound and eight normal cuffs as partial thickness tears. This presents a 97.9% sensitivity and 94.4% specificity for partial thickness tears. The size estimation of full thickness tears was more accurate for large/massive tears (96%) than moderate (82%) and small/pinhole tears (75%). The tear sizes were more often underestimated which may partly reflect disease progression during the unavoidable time lag between scan and surgery. We conclude that shoulder ultrasound performed by a sufficiently trained orthopaedic surgeon is a safe and reliable practice to identify rotator cuff tears

Postoperative knee stability is critical in determining the success after reconstruction; however, only posterior and anterior stability is assessed. Therefore, this study investigates medial and lateral rotational knee laxity changes after partial and complete PCL tear and after PCL allograft reconstruction. The extending Lachman test assessed knee instability in six fresh-frozen human cadaveric knees. Tibia rotation was measured for the native knee, after partial PCLT (pPCLT), after full PCLT (fPCLT), and then after PCLR tensioned at 30° and 90°. In addition, tests were performed for the medial and lateral sides. The tibia was pulled with 130N using a digital force gauge. A compression load of 50N was applied to the joint on the universal testing machine (MTS Systems) to induce contact. Three-dimensional tibial rotation was measured using a motion capture system (Optotrak). On average, the tibia rotation increased by 33%-42% after partial PCL tear, and by 62%-75% after full PCL tear when compared to the intact case. After PCL reconstruction, the medial tibia rotation decreased by 33% and 37% compared to the fPCL tear in the case that the allograft was tensioned at 30° and 90° of flexion, respectively. Similarly, lateral tibial rotation decreased by 15% and 2% for allograft tensioned at 30° and 90° of flexion respectively, compared to the full tear. Rotational decreases were statistically significant (p<0.005) at the lateral pulling after tensioning the allograft at 90°. PCLR with the graft tensioned at 30° and 90° both reduced medial knee laxity after PCLT. These results suggest that while both tensioning angles restored medial knee stability, tensioning the Achilles graft at 30° of knee flexion was more effective in restoring lateral knee stability throughout the range of motion from full extension to 90° flexion, offering a closer biomechanical resemblance to native knee function

Though retear rates following rotator cuff repair are well established, we set out to review current literature to determine when early retears occurred (defined as <12m following surgery), and examine which pre- and post-operative variables might affect outcome. Pubmed, Medline, and CINAHL were searched for literature published from 2011 to 2021 using specific search terms. The inclusion criteria were studies reporting retear rates within 12 months of initial surgical repair. Exclusionary criteria were studies that included partial thickness tears, and studies that did not use imaging modalities within 12 months to assess for retears. PRISMA guidelines were followed, identifying a total of 10 papers. A combined total of 3372 shoulders included (Mean age 56 −67 years). The most common modality used to identify early retears were ultrasound scan and MRI. 6 of the 10 studies completed imaging at 0-3 months, 6 studies imaged at 3-6 months and 6 studies imaged at 6-12 months. Across all studies, there was a 17% early retear rate (574 patients). Of these, 13% occurred by 3 months, whilst the peak for retears occurred at 3-6 months (82%) and 5% occurred at 6-12 months. The risk of retear was higher in larger tears and extensive tendon degeneration. All studies apart from one documented a return to work/sport at 6 months post-operatively. Postoperative rehabilitation does not appear to alter retear rate, although data is limited with only 1 of 10 studies allowing active range of movement before 6 weeks. Retorn tendons had poorer functional outcomes compared to intact tendons at 12m following initial repair. The majority of early retears occur at 3-6 months and this time period should be prioritised both in rehabilitation protocols and future research. Age, tear size, and tendon degeneration were found to influence likelihood of early retears

Two dimensional ultrasound of the shoulder joint has become a well established diagnostic tool. Difficult interpretation of ultrasonographic findings, however, suggests that ultrasound appears not to be an always reliable method, especially in partial thickness tears. The present study was performed to determine whether the use of three dimensional (3D) sonography further increases the diagnostic yield of ultrasound. On a total of 22 externally intact appearing rotator cuffs of cadaveric shoulder joints 7 full thickness and 15 partial thickness incisions were carried out on the M. supraspinatus, subscapularis and infraspinatus tendon. The specimens included the humeral head, the glenoid, the joint capsule and periarticular tendons. Ultrasound was performed on the shoulder specimens in a water basin with a 8.5 MHz curved array transducer (Combison 530D, Kretztechnik, Zipf, Austria). With three dimensional ultrasound rotator cuff lesions were more often correctly diagnosed (sensitivity of 77 %) than with conventional 2D sonography (sensitivity of 64 %). Specificity was 85 % and 69 %, respectively. In partial thickness tears in particular, 3D imaging was the superior method reaching a sensitivity and specifity of 73% and 77%, respectively compared to 53% and 61%, respectively with 2D ultrasound. The use of three dimensional ultrasound appears to have a higher diagnostic yield in partial thickness tears. One advantage is that the examiner must not move the transducer to obtain other planes. Changes in echogenicity can be observed in the complete volume and in any plane. In the diagnosis of partial tears these changes enabled the examiner to distinguish intact from ruptured tissue

In current practice in the UK there are three main approaches to investigating suspected scaphoid fractures not seen on initial plain film x-rays. Early MRI of all cases. Review all cases in clinic at two weeks with repeat x-rays. Hybrid model. Virtual Fracture Clinic (VFC) triage to reduce those who are seen in clinic at two weeks by:. ∘. Organising early MRI for those with high-risk presentation. ∘. Discharging those with an alternative more likely diagnosis. Our unit uses the VFC model. We aimed to evaluate its efficiency, safety, clinical outcomes and economic viability. All patients attending the emergency department with either a confirmed or suspected scaphoid fracture between March and December 2020 were included (n=305). Of these 297 were referred to the VFC: 33 had a confirmed fracture on x-ray and 264 had a suspected fracture. Of the suspected fractures reviewed in VFC 14% had an MRI organised directly owing to a high-risk presentation, 79% were brought for fracture clinic review and 17% discharged with an alternative diagnosis such as osteoarthritis. Of those subsequently reviewed in fracture clinic at two weeks: 9% were treated as scaphoid fractures (based on clinical suspicion and repeat x-rays), 17% had MRI or CT imaging organised, 5% did not attend and 69% were discharged. Overall, 17% of cases initially triaged, had further imaging – 41 MRIs and 5 CTs. MRI detected: 5% scaphoid fracture, 17% other fracture, 24% bone contusion, complete ligament tear 10%, partial ligament tear 39% and normal study 10%. The results of MRI minimally affected management. 3 patients were taken out of plaster early, 1 patient was immobilized who was not previously and no patients underwent operative management. In the following 12-month period one patient re-presented with a hand or wrist issue. This approach avoided 218 MRIs, equating to £24000 and 109 hours of scanner time. VFC triage and selective use of MRI scanning is a safe, efficient and cost-effective method for the management suspected scaphoid fractures. This can be implemented in units without the resource to MRI all suspected scaphoid fractures from the emergency department

Introduction:. Instability and synovitis of the lesser metatarsalphalangeal (MTP) joints is a significant cause of forefoot pain. Plantar plate imaging traditionally has been through MRI and fluoroscopic arthrography. We have described ultrasound arthrography as a less resource-intensive technique without radiation exposure. We report the correlation between ultrasound arthographic and surgical findings. Methods:. Patients with lesser MTP joint instability and pain underwent ultrasound arthrography by a consultant musculoskeletal radiologist. The main finding was the presence of a full or partial tear of the plantar plate. In some patients the location of the tear along with its size in the long and short axis was also reported. Authors who were not involved in the imaging or surgery reviewed the operation notes of patients who underwent surgery to identify. Whether a partial or full thickness tear was identified. Size and location of the tear. The accuracy of ultrasound arthrography was calculated using surgical findings as the standard. Results:. 53 patients with 55 joints underwent ultrasound arthrography, and of these 34 went on to have surgery. 23 patients had adequate documentation of surgical and ultrasound findings. Surgery confirmed plantar plate tears in 21 patients (91.3%) with 9 full thickness tears and 7 partial thickness tears confirmed both operatively and with ultrasound (in 5 patients the operation note did not specify completeness of tear). In 2 patients, in whom ultrasound demonstrated a partial thickness tear, no tear was found at surgery. The sensitivity of ultrasound arthrography for plantar plate tears is 100%, specificity is 0% (although based on few patients), and positive predictive value of 91.3%. Conclusion:. Ultrasound arthrography has a high sensitivity, but low specificity for plantar plate tears, comparable with ultrasound in previous studies. It allows differentiation of partial and full thickness tears which may be important for treatment