Abstract. Objectives. Investigate
Anterior shoulder instability results in labral and osseous glenoid injuries. With a large osseous defect, there is a risk of recurrent dislocation of the joint, and therefore the patient must undergo surgical correction. An MRI evaluation of the patient helps to assess the soft tissue injury. Currently, the volumetric three-dimensional (3D) reconstructed CT image is the standard for measuring glenoid bone loss and the glenoid index. However, it has the disadvantage of exposing the patient to radiation and additional expenses. This study aims to compare the values of the glenoid index using MRI and CT. The present study was a two-year cross-sectional study of patients with shoulder pain, trauma, and dislocation in a tertiary hospital in Karnataka. The sagittal proton density (PD) section of the glenoid and enface 3D reconstructed images of the scapula were used to calculate glenoid bone loss and the glenoid index. The baseline data were analyzed using descriptive statistics, and the Chi-square test was used to test the association of various complications with selected variables of interest.Introduction
Method
The anatomy of the human body has been studied for centuries. Despite this, recent articles have announced the presence of a new knee ligament- the anterolateral ligament. It has been the subject of much discussion and media commentary. Previous anatomical studies indicate its presence, and describe its location, origin, course and insertion. Magnetic resonance imaging (MRI) is the best and most commonly used investigation to assess the ligamentous structure of the knee. To date, most MRI knee reports make no mention of the anterolateral ligament. The aim of this study was to assess for the presence of the anterolateral ligament using MRI, and to describe the structure if visualised. All right knee MRIs performed on a Siemens Magnetom Espree 1.5 Tesla scanner in Merlin Park Hospital over a 4 year period were retrospectively analysed. Patients born before 1970, or with reported abnormalities were excluded. The normal MRIs were then analysed by a consultant radiologist specialising in musculoskeletal imaging. Measurements on origin, insertion, course and length were noted.Background
Methods
Our aim was to evaluate the indications for patients undergoing magnetic resonance imaging (MRI) of the knee prior to referral to an orthopaedic specialist, and ascertain whether these scans altered initial management. We retrospectively reviewed all referrals received by a single specialist knee surgeon over a 1-year period. Patient demographics, relevant history, examination findings and past surgical procedures were documented. Patients having undergone MRI prior to referral were identified and indications for the scans recorded. These were reviewed against The NHS guidelines for Primary Care Physicians to identify if the imaging performed was appropriate in each case.Aims and objectives
Materials and Method
Magnetic resonance imaging (MRI) continues to become more widely accessible as an investigation, with an increasing number of scans being performed in the outpatient setting for suspected shoulder pathology. We performed a retrospective review of all shoulder MRI scans performed in an orthopaedic outpatient setting in a district general hospital between October 2010 and October 2011. We also reviewed the medical notes for these patients. 75 MRI Shoulder scans were performed on 74 patients. In 5 cases (7%), no other form of imaging was performed prior to MRI scan. 11 patients (15%) had no provisional diagnosis included in the referral. The nature of referral, indication for MRI and subsequent management of these patients was also examined. Our findings may support the use of guidelines for requesting MRI scans of the shoulder in outpatients.
Magnetic resonance imaging (MRI) is one of the most widely used investigations for knee pain as it provides detailed assessment of the bone and soft tissues. The aim of this study was to report the frequency of each diagnosis identified on MRI scans of the knee and explore the relationship between MRI results and onward treatment. Consecutive MRI reports from a large NHS trust performed in 2017 were included in this study. The hospital electronic system was consulted to identify whether a patient underwent x-ray prior to the MRI, attended an outpatient appointment or underwent surgery.Abstract
Objectives
Methods
The biomechanical evaluation of tendon repair with collagen-based scaffolds in rat model is a common method to determine the functional outcome of the tested material. We introduced a magnetic resonance imaging (MRI) approach to verify the biomechanical test data. In present study different collagen scaffolds for tendon repair were examined. Two collagen test materials: based on bovine stabilized collagen, chemically cross-linked with oriented collagenous fibres (material 1) and based on porcine dermal extracellular matrix, with no cross-linking (material 2) were compared. The animal study was approved by the local review board. Surgery was performed on male Sprague-Dawley rats with a body weight of 400 ± 19 g. Each rat underwent a 5 mm transection of the right Achilles tendon. The M. plantaris tendon was removed. The remaining tendon ends were re-joined with a 5 mm scaffold of either the material 1 or 2. Each scaffold material was sutured into place with two single stiches (Vicryl 4–0, Ethicon) each end. A total of 16 rats (n= 8 each group) were observed for 28 days follow up. The animals were sacrificed and hind limbs were transected proximal to the knee joint. MRI was performed using a 7 Tesla scanner (BioSpec 70/30, Bruker). T2-weighted TurboRARE sequences with an in-plane resolution of 0.12 mm and a slice thickness of 0.7 mm were analysed. All soft and hard tissues were removed from the Achilles tendon-calcaneus-foot complex before biomechanical testing. Subsequently, the specimens were fixed in a materials testing machine (Z1.0, Zwick, Ulm, Germany) for tensile testing. All tendons were preloaded with 1 N and subsequently stretched at a rate of 1 mm/s until complete failure was observed. Non-operated tendons were used as a control (n=4). After 28 postoperative days, MRI demonstrated that four scaffolds (material 1: n=2, material 2: n=2) were slightly dislocated in the proximal part of hind limb. In total five failures of reconstruction could be detected in the tendon repairs (material 1: n=3, material 2: n=2). Tendons augmented with the bovine material 1 showed a maximum tensile load of 57.9 ± 17.9 N and tendons with porcine scaffold material 2 of 63.1 ± 19.5 N. The native tendons demonstrated only slightly higher loads of 76.6 ± 11.6 N. Maximum failure load of the tendon-scaffold construct in both groups did not differ significantly (p < 0.05). Stiffness of the tendons treated with the bovine scaffold (9.9 ± 3.6 N/mm) and with the porcine scaffold (10.7 ± 2.7 N/mm) showed no differences. Stiffness of the native healthy tendon of the contralateral site was significantly higher (20.2 ± 6.6 N/mm, p < 0.05). No differences in the mechanical properties between samples of both scaffold groups could be detected, regardless of whether the repaired tendon defect has failed or the scaffold has been dislocated. The results show that MRI is important as an auxiliary tool to verify the biomechanical outcome of tendon repair in animal models.
In osteonecrosis of the femoral head (ONFH), reduction in the size, or complete resolution of the necrotic lesion has been reported to occur spontaneously without any specific treatment. Recently, there was a report that the reduction was time-dependent. We evaluated the change in the size of necrotic lesions of ONFH using magnetic resonance imaging (MRI) more than 10 years after the initial diagnosis. Fifteen hips in 13 patients with atraumatic ONFH who had been followed-up for more than 10 years were enrolled in this study. They were categorized into two groups; A Simple Observation Group and a Multiple Drilling Group. The Simple Observation Group included 6 hips in 5 patients treated non-operatively. There were 3 men and 2 women who had an average age of 42 years at the time of their initial diagnosis. Initial Ficat and Arlet stages were I in 2 cases, IIA in 3 cases, and IIB in 1 case. The Multiple Drilling Group included 9 hips in 9 patients treated surgically with multiple drilling. They were all men who had an average age of 38 years at the time of operation. There were 2 cases of stage I and 7 cases of stage IIA. The necrotic lesion size change was evaluated by comparing the last follow-up MRI images with the initial images. All of the coronal, sagittal, and axial plane images were reviewed by 2 orthopaedic surgeons and a radiologist. The lesion size change was determined by means of consensus of the reviewers. The lesion size change was defined when it was detected in more than 2 planes.Introduction
Methods
Recent studies have suggested that full-limb radiographs are more accurate and sensitive than short film radiographs for pre-operative measurement of the anatomical angles required to achieve optimal knee alignment in Total Knee Arthroplasty (TKA). However, there are drawbacks associated with their use including excess radiation to the pelvic organs, the need for specialised radiography equipment and increased cost. Given these drawbacks, we compared the use of MRI scans, a commonly performed pre-operative investigation, with short film knee radiographs for measurement of knee alignment. To investigate whether knee alignment measurements made on MRI scans correlate with those measured on short film knee radiographs in patients with osteoarthritic knees.Background
Objective
The aim of this study is to assess the discrepancy between weight bearing long leg radiographs and supine MRI alignment. There is currently increasing interest in the use of MRI to assess knee alignment and develop custom made cutting blocks utilising this data. However in almost all units MRI scans are performed supine and it is recognised that knee alignment can alter with weight bearing. 46 patients underwent MRI scans as pre-operative planning for Biomet signature total knee replacement and the measure of varus or valgus deformity on MRI was obtained from the plan produced by Biomet Signature software system. 41 of these patients had long leg weight bearing radiographs performed. 37 of these radiographs were amenable to measuring the knee alignment on the picture archiving and communication system (PACS). These measurements were performed by two assessors and inter-observer reliability was satisfactory. There was a significant difference between the alignment as measured on supine MRI compared with weight bearing long leg films. In knee arthroplasty one of the aims is to correct the biomechanical axis of the knee and one of the appeals of custom made cutting blocks is that this can be achieved more easily. However it is important to realise that alignment is not a static value and thus correcting supine alignment may not necessarily result in correction of weight bearing alignment.
Background. Autologous Chondrocyte Implantation (ACI) is frequently used to treat chondral defects in the knee with a good long-term outcome. This is contraindicatd in meniscal deficient knees. Allogenic Menicsal Transplantation (AMT) has been shown to give good symptomatic relief in meniscus deficient knees. However this is contraindicated in advanced cartilage degeneration. We hypothesized that combination of these two might be a solution for bone-on-bone arthritis in young individuals. Methods. We studied a consecutive series of 12 patients who underwent combined ACI and AMT between 1998 and 2005. Pre operative and post operative comparisons of lysholm scores were recorded.
Abstract. Objectives. The syndesmosis joint, located between the tibia and fibula, is critical to maintaining the stability and function of the ankle joint. Damage to the ligaments that support this joint can lead to ankle instability, chronic pain, and a range of other debilitating conditions. Understanding the kinematics of a healthy joint is critical to better quantify the effects of instability and pathology. However, measuring this movement is challenging due to the anatomical structure of the syndesmosis joint. Biplane Video Xray (BVX) combined with
Although multifunctional delivery systems can potentially improve safety and efficacy of therapeutic protein delivery in the biological treatment of injured tissues, ability to track and manipulate protein delivery systems in vivo to ensure localization at the treatment site is still a concern. We hypothesized that incorporating superparamagnetic iron oxide (SPIO) into calcium phosphate (CaP) coated β-tricalcium phosphate (β-TCP) microparticles would allow for
The modified Hedgehog technique was previously used to reattach pure chondral shear-off fragments in the pediatric knee. In the modified Hedgehog technique, the calcified side of chondral fragments is multiple times incised and trimmed obliquely for an interlocking fit in the defect site. Fibrin glue with or without sutures is subsequently applied to fix the fragment to the defect. This preliminary report further elucidates the potential of the technique by evaluation of its application in young adults using patient reported outcome measures (PROMs) and high-field
Background. Despite the known multifactorial nature of scaphoid wrist fracture non-union, a possible genetic predisposition for the development of this complication remains unknown. This pilot study aimed to address this issue by performing Single Nucleotide Polymorphisms (SNPs) analysis of specific genes known to regulate fracture healing. Materials and Methods. We reviewed 120 patients in a retrospective case-control study from the Hand Surgery Department of Asepeyo Hospital. The case group comprised 60 patients with confirmed scaphoid wrist non-union, diagnosed by
Pyomyositis is a primary pyogenic infection in skeletal muscle, often progressing to abscess formation. It is rare in temperate climates and generally deep-seated within the pelvis with non-specific clinical features, making diagnosis difficult.
We report an unusual case of knee disease where calcific tendonitis occurring in both quadriceps and patellar tendon simultaneously in the same knee. A 47 year old female presented to orthopaedics outpatient clinic with acute onset of swelling and knee pain with no history of trauma. She was found to have a moderate effusion of the knee joint with mild tenderness over the mid quadriceps tendon. Active flexion of the knee joint was painful with a range of motion between 0-90 degrees. She is otherwise healthy with no past medical history. Plain radiographs and
Used routinely in maxillofacial reconstructive surgery, the chondrocostal graft is also applied to hand surgery in traumatic or pathologic indications. The purpose of this overview was to analyze at long-term follow-up the radiological and histological evolution of this autograft, in hand and wrist surgery. We extrapolated this autograft technique to the elbow by using perichondrium. Since 1992, 148 patients have undergone chondrocostal autograft: 116 osteoarthritis of the thumb carpometacarpal joint, 18 radioscaphoid arthritis, 6 articular malunions of the distal radius, 4 kienbock's disease, and 4 traumatic loss of cartilage of the proximal interphalangeal (PIP) joint. Perichondrium autografts were used in 3 patients with elbow osteoarthritis.
Summary. Nearly one-third of patients in this series with an ACL rupture requiring reconstruction had evidence of MPFL injury. This should be considered when patients are seen, and when MRI scans are reviewed/reported. Introduction. The Medial Patello-Femoral Ligament (MPFL) is the largest component of the medial parapatellar ligamentous complex. The senior surgeon felt that there was an anecdotally high rate of MPFL injury amongst his patients undergoing Anterior Cruciate Ligament (ACL) repair, but no discussion of this in the present literature. Method. A literature search was performed; although there were both scanty radiographic and anatomical studies of the MPFL, we found no literature looking at ACL and MPFL concurrent injury rates. The
Introduction. Isolated midcarpal motion during radioulnar deviation could be approximated to be a rotation in a plane of a radiodorsal/ulnopalmar rotation of the wrist, which may coincide with a motion plane of one of the most essential human wrist motions, known as the dart-throwing motion. This has been studied before in normal volunteers using
