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

ACL (anterior cruciate ligament) partial tears include various types of lesions, and an high rate of these lesions evolve into complete tears. Most of the techniques described in literature for the surgical treatment of chronic partial ACL tears, don't spare the intact portion of the ligament. Aim of this study was to perform a prospective analysis of the results obtained by augmentation surgery using gracilis and semitendinosus tendons to treat partial sub-acute lesions of the ACL. This technique requires an “over the top” femoral passage, which enables salvage and strengthening of the intact bundle of ACL. The study included 97 patients treated consecutively at our Institute from 1993 to 2004 with a mean injury-surgery interval of 23 weeks (12–39). Patients were followed up by clinical and instrumental assessment criteria at 3 months, 1 year and 5 years after surgery. Clinical assessment was performed with the IKDC form. Subjective and functional parameters were assessed by the Tegner activity scale. Instrumental evaluation was done using the KT-2000 instrument: the 30 pound passive test and the manual maximum displacement test were performed. We obtained good to excellent results in 95.9% of cases. We didn't observed recurrences in ligamentous laxity. We believe that the described technique has the advantage of being little invasive, compatible with the ACL anatomy, and enables very rapid functional recovery and return to sport

Shoulder pain or loss of normal range of motion is a frequent complaint in the outpatient clinic. Of these presentations, rotator cuff injury is a common cause. This can range from mild, transient inflammation of the tendons, to partial tears of tendons, or even full thickness tears. Disruption of the tendons can occur from forceful forward throwing actions undertaken in some sports, for example baseball pitching, more commonly in the UK however, chronic impingement can lead eventually to a tendon tear-usually seen in an older population. Current methods of investigation of such injuries after clinical history and examination, includes plain film radiography, ultrasonography, magnetic resonance imaging and arthrography. We decided to look at how ultrasound can be used in the district general hospital for investigation of such injuries. Aims. To determine the accuracy of ultrasound as an investigative tool for clinically suspected rotator cuff tears. Methods. Seventy-five consecutive ultrasonographic study reports, in patients who subsequently underwent arthroscopic examination, were scrutinised and correlated with surgical findings. From this, sensitivity and specificity of ultrasound at this district general hospital were calculated. In addition, this data was compiled for each of the three Consultant Radiologists in order to assess the operator dependent nature of ultrasound. Results. Of the 74 cases analysed, 43 (58.1%) had full correlation with the arthroscopy findings, 13 (17.6%) had mixed correlation, and 18 cases (24.3%) had no correlation between the ultrasound and arthroscopy report. The sensitivity and specificity of ultrasound at our institution was 0.76 and 0.8 respectively with regards to a tear being detected at ultrasound and then visualised during surgery. Conclusions. There is no current national guidance as to which imaging modality should be first line following clinical examination. Magnetic resonance arthrography, widely thought of as being the gold standard investigation, is not only expensive and possible only in certain centres, but is also invasive, time consuming, and has many relative contraindications. Ultrasound offers a clinical advantage by allowing the radiologist to speak to the patient and assess their range of motion whilst performing the study. This interaction is lost totally in MRI, CT and even MR arthrography. Our study shows that ultrasonography can be quite accurate in identifying a rotator cuff tear. Although it is operator-dependent, ultrasound should be considered more often as a first-line imaging tool for suspected rotator cuff tears as it is relatively inexpensive, quick, and most importantly dynamic