Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in rotator cuff tendons. Subacromial bursitis is always accompanied by symptomatic rotator cuff tear (RCT). However, no study has been reported on the presence of glutamate in subacromial bursa and on its involvement of shoulder pain in patients who had RCT. The purposes of this study were to determine whether the glutamate expression in subacromial bursa is associated with the presence of RCT and with the severity of shoulder pain accompanying RCT. Subacromial bursal tissues were harvested from patients who underwent arthroscopic rotator cuff tendon repair or glenoid labral repair with intact rotator cuff tendon. Glutamate tissue concentrations were measured, using a glutamate assay kit. Expressions of glutamate and its receptors in subacromial bursae were histologically determined. The sizes of RCT were determined by arthroscopic findings, using the DeOrio and Cofield classification. The severity of shoulder pain was determined, using visual analog scale (VAS). Any associations between glutamate concentrations and the size of RCT were evaluated, using logistic regression analysis. The correlation between glutamate concentrations and the severity of pain was determined, using the Pearson correlation coefficient. Differences with a probability <0.05 were considered statistically significant. Glutamate concentrations showed significant differences between the torn tendon group and the intact tendon group (P = 0.009). Concentrations of glutamate significantly increased according to increases in tear size (P < 0.001). In histological studies, the expressions of glutamate and of its ionotropic and metabotropic receptors have been confirmed in subacromial bursa. Glutamate concentrations were significantly correlated with pain on VAS (Rho=0.56 and P =0.01). The expression of glutamate in subacromial bursa is significantly associated with the presence of RCT and significantly correlated with its accompanying shoulder pain. Acknowledgements: This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A3A01018955 and 2017R1D1A1B03035232)

In this study, we evaluated the labrum tear using radial sequence 3D Multiple Echo Recombined Gradient Echo (MERGE) MRI without arthrography based on modified Czerny's classification, comparing with actual arthroscopic findings. A total of 61 hips including 27 hips of femoroacetabular impingement (FAI), 19 hips of borderline development dysplasia of the hip (BDDH) and 15 hips of early stage osteoarthritis (OA) were enrolled this retrospective study. MRI findings evaluated in each three regions of interest; anterior region, anterolateral region, and lateral region. The cases with severe degeneration that is not concordant with any original Czerny's classification is defined as stage4. We compared MRI findings with arthroscopic findings and calculated the sensitivity, specificity, and likelihood ratio in terms of the existence of labrum tear. MRI findings revealed labrum tear more frequently in anterolateral than lateral (p<0.001). Especially in FAI group, labrum tear was more frequently observed by MRI in anterolateral than lateral (p=0.006). In comparison with MRI findings and arthroscopic findings, the sensitivity was 97%, specificity was 79% and likelihood ratio was 4.59 as average of all regions in terms of the existence of labrum tear. In each region, sensitivity and specificity was 97% and 50% in anterior, 97% and 100% specificity in anterolateral, 94% and 81% in lateral, respectively. Thus, MERGE MRI revealed excellent sensitivity and specificity for diagnosis of labrum tear, especially in anterolateral region. The cases with severely degenerated labrum were classified as newly defined stage 4, which was recognized frequently in OA cases

Magnetic resonance imaging (MRI) is the gold standard for the diagnosis of the pathologies affecting the glenohumeral joint and the rotator cuff diseases. MRI allows to highlight anatomic discontinuities of both muscles and tendons. However, MRI diagnostic accuracy has not proven to be highly sensitive in distinguishing between a partial-thickness tear and a full-thickness rotator cuff tear. The purpose of this study was to determine if MRI under axial traction can be helpful in increasing MRI sensitivity to identify partial-thickness rotator cuff tears. The study included 10 patients (4 males and 6 females) who had clinical examination and MRI suggesting a partial-thickness rotator cuff tear. They were candidates for shoulder arthroscopy because of persistent symptoms after at least three months of conservative treatment. The patients underwent a new MRI (under axial traction: MRI-AT) with a 4-kg weight applied to the affected arm. Then the patients underwent arthroscopy to confirm the diagnosis. Patients with a suspected full-thickness rotator cuff tear were excluded from the study. Patients’ average age was 52.4 years, and the dominant side was affected in 77.7% of the cases. Preoperative Constant-Murley Score was 57. MRI-AT showed that 3 patients were affected by a complete tear of the rotator cuff, 3 patients by a partial-thickness rotator cuff tear and 4 patients had no lesion. The analysis of data showed that: under axial traction the subacromial space increased by 0,2 mm (P value = 0,001075), the superior glenohumeral space decreased by 2.4 mm (P value = 0,07414), the inferior glenohumeral space increased by 0.3 mm (P value = 0,02942), the acromial angle decreased by 1.9° (P value = 0,0002104) and the acromion-glenohumeral angle decreased by 0.3° (P-value = 0,01974). Two experienced evaluators analyzed previous standard MRI and MRI-AT scans in a double-blinded fashion, with inter-rater evaluation of all the images and measures. Intraclass correlation coefficient (ICC) has been utilized to assess the reliability of the measures performed by different operators. ICC always resulted in more than 0.7, showing a high concordance among values in the same group. A comparative evaluation between standard MRI and MRI-AT has been conducted to highlight possible discrepancies and this has been compared to intraoperative findings. Concordance of the values was 89% between standard MRI and MRI-AT and 100% between MRI under axial traction and intraoperative findings. This study showed a high correlation between the diagnosis achieved with MRI-AT and the intraoperative arthroscopic findings. The use of MRI-AT in clinical practice may improve the diagnostic sensitivity of this method to detect a partial-thickness rotator cuff tear

Purpose. Injuries of the meniscal attachments can lead to meniscal extrusion. We hypothesized that the extent of lateral meniscal extrusion (LME) was associated with the severity of the lateral meniscus posterior root tear (LMPRT). This study aimed to evaluate the relationship between preoperative LME and arthroscopic findings of LMPRT in knees with anterior cruciate ligament (ACL) injury. Methods. Thirty-four knees that had LMPRTs with concomitant ACL injuries on arthroscopy were evaluated. Patients were divided into two groups, partial and complete root tears, via arthroscopic findings at the time of ACL reconstruction. We retrospectively measured preoperative LMEs using magnetic resonance imaging (MRI). Statistical analysis was performed using the Mann-Whitney U-test and Chi-square test. Results. Twenty-three knees had partial LMPRTs (type 1). Complete LMPRTs were observed in 11 knees (type 2, 2 knees; type 3, 2 knees; and type 4, 7 knees). In the partial LMPRT group, the average LME was 0.43±0.78 mm. In the complete LMPRT group, the average extrusion was 1.99±0.62 mm. A significant difference between these groups was observed in the preoperative LMEs (P<0.01). The receiver operating curve analysis identified an optimal cutoff point of 1.05 mm for the preoperative LME. This LME cutoff had a sensitivity of 100% and specificity of 85% for complete LMPRT. Conclusion. This study demonstrated that preoperative LMEs were larger in complete LMPRTs associated with ACL injuries than in partial LMPRTs. Our results suggest that preoperative MRI-detected LME may be a useful indicator for estimating LMPRT severity in knees with ACL injury

Introduction. The highest incidence of recurrent shoulder instability is in young patients, surgical repair can reduce recurrent instability and improve shoulder function. This has led to an increasing rate of stabilisation and use of MRI to identify associated injuries in first time dislocations. MRA has the benefit of distending the joint and is becoming increasingly used. The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. Methods. A retrospective analysis of patients undergoing both magnetic resonance arthrography and arthroscopy after a traumatic anterior shoulder dislocation between January 2011 and 2014. Images were interpreted by eight musculoskeletal radiologists and arthroscopic findings were obtained from surgical notes and used as a reference. The sensitivity, specificity and positive predictive value for the different injuries were calculated. Results. 60 patients were reviewed; 88% were male, mean age was 28 years (range 18 to 50) and 27% were primary dislocations. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83–0.95) and 0.94 (CI 0.9–0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44–0.96) and SLAP lesions 0.5 (CI 0.14–0.86). Conclusion. MRA has a high sensitivity when used to identify associated injuries in shoulder dislocation although in 8 patients (13%) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good but identification of GHL and rotator cuff injuries was poor. Level of Evidence. IV. Conflict of Interests. The authors confirm that they have no relevant financial disclosures or conflicts of interest. Ethical approval was not sought as this was a systematic review

The outcome of periacetabular osteotomy in dysplastic hips is dependent on the absence of preoperative osteoarthritis [OA]. The purpose of this study was to analyze whether Tonnis grading is a reliable predictor of OA in patients with hip dysplasia. Thirty patients were identified who had undergone hip arthroscopy surgery to assess their suitability for periacetabular osteotomy. Radiographs were assessed for anterior centre edge angle, lateral centre edge angle, Tonnis angle and Tonnis grade for OA changes. The radiographic grading of OA was compared with arthroscopic findings. Results. The average age at the time of arthroscopy was 34.97 [16 – 53yrs] (28 females). Tonnis grade did not correlate with arthroscopic findings (p=0.082). There was a trend for patients with a higher Tonnis grade to have more OA changes. Of the 30 patients, all 3 with grade 0 were fit for periacetabular osteotomy, while only 8 out of 24 with grade I, and 1 out of 3 with grade II were fit for periacetabular osteotomy. This study reports that even when radiographic grading showed minimal OA changes, arthroscopy findings indicated significant OA changes. Hence radiographic grading is a poor indicator of OA and other diagnostic modality should be sought before proceeding with joint preserving surgery in this highly selected subgroup of dysplastic hips

Magnetic resonance imaging (MRI) is a useful diagnostic tool in evaluating meniscus pathology in the knee. Data from available literature suggests sensitivity and specificity rates around 90% when compared to the gold standard findings at knee arthroscopy. We sought to evaluate the sensitivity, specificity and precision rate (positive predictive value) of MRI at diagnosing meniscus tears within our unit. A retrospective audit of a total of 79 MRI reports and arthroscopic findings spanning a one year period was carried out. There were 66 positive MRI reports and 13 negative reports. There were 6 false positives 4 false negatives when compared to arthroscopic findings. The sensitivity of MRI for detecting meniscus tears was 93.7% with 60 out of 64 tears detected. All 4 false negatives also had at least grade III osteoarthritic changes at arthroscopy. Specificity was rather low at 60% with MRI reporting 6 tears (false positives) out of 15 patients who had no tears found at arthroscopy. The positive predictive value (precision rate) of MRI detecting tears was 90.9%. This data shows that MRI in our unit has a comparable high sensitivity to that in various literature making it a useful tool at ruling out disease with a negative result in the clinical setting. A more useful parameter in the clinical setting is its high precision rate when faced with a positive result. However, its specificity is much lower than that in most published data. A total of 6 tears on MRI turned out not to be on arthroscopy meaning patients could have been subjected to an avoidable invasive procedure in the absence of any other indication. This highlights the importance of obtaining reports from experienced musculoskeletal radiologists and the need for surgeons to review MRI images and match them to clinical information prior to subjecting patients to surgery

Advantages of arthroscopic surgery in orthopaedic practice are well documented. The use and scope of ankle arthroscopy has evolved in the last decade. Its role in both the evaluation and treatment of chronic ankle pain has become more important with identification of newer pathologies. We aimed to identify the indications and complications of ankle arthroscopy in chronic ankle pain and to correlate the arthroscopic findings with pre-operative MRI/CT. A retrospective analysis of all procedures done in our unit from 2005-2009. Patient records, X- rays and scans were reviewed. 77 patients were included in the study (46 male/31 female). The commonest age group was the 4. th. decade. There was a male preponderance in the younger age group (<50y), and a female preponderance in the older age groups (>50y). The commonest indication was impingement syndrome (44%/mean age 38y), followed by osteochondral lesions of the talus (23%/mean age 36y) and Osteoarthritis (22%/mean age56y). Other pathology included synovitis, Rheumatoid Arthritis, instability, AVN and combined pathologies. Pre-op MRI scans correlated with arthroscopic findings in 59%. The pathology most missed by MRI was impingement. 1 patient developed wound infection and another iatrogenic tendon rupture. 78% reported improvement in their symptoms following the procedure. Ankle arthroscopy is a safe and effective procedure. It is particularly useful in the diagnosis and treatment of impingement syndromes and osteochondral lesions. Although there are serious recognised complications, their incidence is low. Patients with chronic symptoms and normal MRI/CT may have treatable pathology on arthroscopy

The medical model of history, examination and investigation forms the bedrock of diagnosis and management of all patients. The essence is the recognition of patterns of symptoms and signs. In the modern era there are an increasing number of non-medical resources ranging from web-based information, computer diagnostic aids and non-specialist healthcare professionals to provide a diagnosis and commence management of a wide range of conditions, including knee problems. We analysed the quality and patterns of clinical presentation in order to answer the question how closely clinical symptoms and examination findings correlate to diagnosis based on MRI scan and/or arthroscopic findings. The analysis was a dataset of a consecutive series of patients, aged 18 to 45, with no past history of knee problems or end stage arthritis, presenting to a single specialist triage physiotherapist, working within an integrated knee service, who fully completed a standardised knee assessment proforma of presenting symptoms and signs at a large district general hospital. The study comprises 86 patients and 98 knees. We analysed this data based on diagnostic findings of MRI scan or arthroscopy to provide definitive intra-articular diagnosis. Based on standard textbook descriptions of common presentations, we went on to define the patients' presentation history and examination as typical or atypical, with typical meaning the symptoms and signs correlated with the diagnosis. The null hypothesis is that patients have a high chance of typical presentations for common knee conditions. In the 75% of patients with a significant intra-articular pathology we found the majority had chondral rather than meniscal tears 1.7 to 1. Forty four percent of patients had atypical symptoms and 71% had atypical clinical signs, 30% and only 26% of the cohort had both typical symptoms and signs together, reflecting a surprisingly low positive predictive probability of symptoms and signs in this group of patients, particularly those with chondral lesions which was 44%. In this cohort, 57% of the cohort has 3 or more multiple diagnoses. In the diagnostically normal group, 43% had symptoms and signs typical for a meniscal tear. We conclude that clinical symptoms and signs surprisingly inaccurate in guiding intra-articular pathology within the knee, even in a sub-set considered the easy and accurate to assess. The number of multiple diagnoses and the incidence of false positive results also means that simplistic interpretations of non-definitive diagnoses and linear causation of pain pathways should be treated cautiously

Objective of the study. To determine if the location and pattern of knee pain as described by the patients using the knee pain map was comparable with the intra articular pathology found on arthroscopy as well as to facilitate diagnosis based on pain. Methods. There were Sixty consecutive patients with acute and chronic knee pain participating in the study and they subsequently underwent arthroscopy of the knee joint as therapeutic or diagnostic procedure in day surgery. Those patients with extra articular pathologies, referred pain hip, back and foot were excluded from the study. All the participants were consented for the study; subjective data was recorded on the standardised knee pain map that included visual analogue pain scale preoperatively on the day of admission for arthroscopy. The findings of the arthroscopy including EUA were recorded on the on standard arthroscopy forms used in our department by the operating surgeon. Results. Patients on the knee pain map most often recorded sharp/stabbing pain (72%), followed by diffuse dull pain (14.5%), mixed dull and sharp pain (10 %) and burning pain (3.5%). 78 % of the localising pain pattern recorded on the knee pain map by the patients corresponded to the intra articular lesion found during knee arthroscopy. 18 % of the pain mapping location and pattern were not very specific to the intrarticular arthroscopic lesions and the rest were non specific. Conclusions. The majority of the patients could map the knee pain location and pattern correlating to the knee arthroscopic findings. The results from our study indicate that knee pain mapping can be used as a reliable tool to assist the clinician to determine the specific knee pain patterns correlating with discrete pathologic findings knee intra articular lesion