Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study.

Meniscal tears are the most common orthopaedic injuries, with chronic lesions comprising up to 56% of cases. In these situations, no benefit with surgical treatment is observed. Thus, the purpose of this study was to investigate the effectiveness and safety of percutaneous intrameniscal platelet rich plasma (PRP) application to complement repair of a chronic meniscal lesion. This single centre, prospective, randomized, double-blind, placebo-controlled study included 72 patients. All subjects underwent meniscal trephination with or without concomitant PRP injection. Meniscal non-union observed in magnetic resonance arthrography or arthroscopy were considered as failures. Patient related outcome measures (PROMs) were assessed. The failure rate was significantly higher in the control group than in the PRP augmented group (70% vs. 48%, P = 0.04). Kaplan-Meyer analysis for arthroscopy-free survival showed significant reduction in the number of performed arthroscopies in the PRP augmented group. A notably higher percentage of patients treated with PRP achieved minimal clinically significant difference in visual analogue scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) symptom scores. Our trial indicates that percutaneous meniscal trephination augmented with PRP results in a significant improvement in the rate of chronic meniscal tear healing and this procedure decreases the necessity for arthroscopy in the future (8% vs. 28%, P = 0.032).

Ultrasound elastography as a potential method to evaluate entrapment neuropathies in elite athletes: a mini-review.

Entrapment neuropathies constitute a significant albeit still neglected problem in athletes. Currently available diagnostic options in patients with suspected neuropathies, nerve conduction studies, and magnetic resonance imaging have some drawbacks, mostly related to their invasive character, high cost, and limited availability. This paper reviews published articles documenting the use of ultrasound elastography, a novel technique to determine tissue strain, in the evaluation of nerve stiffness in entrapment neuropathy, and it discusses potential pros and cons of this method in the examination of elite athletes. Based on the review of literature, ultrasound elastography - especially shear wave elastography - seems suitable for the evaluation of entrapment neuropathies in elite athletes. Published evidence from the general population suggests that most common entrapment neuropathies (carpal tunnel syndrome, ulnar neuropathy of the elbow, ulnar tunnel syndrome) are associated with a significant increase in the stiffness of affected nerves, which can be accurately detected with ultrasound elastography. Before adding ultrasound elastography to the armamentarium of diagnostic tests used routinely in athletes, its accuracy in the detection of entrapment neuropathies needs to be verified in this specific group, and the reference values for peripheral nerve strain in sportspersons need to be determined.

Retroperitoneal Ganglioneuroma Mimicking a Kidney Tumor. Case Report.

BACKGROUND: Ganglioneuroma (GN) is a rare benign tumor arising from the neural crest cells. The reported incidence of GN is one per million population. As a primary retroperitoneal tumor, it constitutes only a small percentage of 0.72 to 1.6%. GN can arise de novo or as a result of maturation of a neuroblastoma either spontaneously or after chemotherapy. The most common location is the posterior paraspinal mediastinum, retroperitoneum, neck and adrenal gland. However, GN can potentially occur anywhere along the peripheral autonomic ganglion sites. Most ganglioneuromas are asymptomatic and found incidentally. CASE REPORT: We present a case of retroperitoneal ganglioneuroma that mimicked renal mass on imaging. The tumor was incidentally discovered during an abdominal ultrasound examination 43-year-old male patient without clinical symptoms. Complete surgical resection was subsequently performed and histopathological examination of the retroperitoneal mass revealed GN. CONCLUSIONS: Retroperitoneal ganglioneuroma is a rare bening tumor, generally asymptomatic, which grows slowly, and appears large when it is identified. Preoperative diagnosis can be challenging, particularly in asymptomatic case. Histopathological examination is currently the mainstay of diagnosis. In the case presented herein GN stricktly adjoined to the left kidney mimicking renal mass.

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis.

BACKGROUND: Infectious spondylodiscitis is characterized by the involvement of two adjacent vertebrae and the intervening disc. Incidence rate of the disease is estimated at 0.4-2 cases per 100000 per year. Staphylococcus aureus is the most common infectious agent causing pyogenic spondylodiscitis. Non-pyogenic infections of the spine are most frequently caused by Mycobacterium tuberculosis, and fungi. Clinical symptoms are nonspecific. Early diagnosis and appropriate treatment can prevent unfavorable irreversible sequela for the patient. Significant developments in techniques of imaging of pathological tissues raised expectations among the clinicians regarding possibility to distinguish between tuberculous spondylodiscitis and pyogenic spondylodiscitis on MR images. The aim of this study was to identify and differentiate between features of tuberculous and pyogenic spondylodiscitis on MR images. MATERIAL/METHODS: We performed retrospective analysis of MR images obtained from 34 patients with confirmed spondylodiscitis (18 with pyogenic spondylodiscitis, and 16 with tuberculous spondylodiscitis). Data acquisition was performed using 1.5 T MRI scanners where images were obtained using similar protocols. T2 TIRM and T1-weighted images with and without contrast enhancement were subject to assessment in coronal, axial and sagittal planes. RESULTS: Characteristic features of pyogenic spondylodiscitis include: involvement of the lumbar spine, ill-defined paraspinal abnormal contrast enhancement, diffuse/homogeneous contrast enhancement of vertebral bodies, low-grade destruction of vertebral bodies, hyperintense/homogeneous signal from the vertebral bodies on T2 TIRM images. Prevailing features of tuberculous spondylodiscitis included: involvement of the thoracic spine, involvement of 2 or more adjacent vertebral bodies, severe destruction of the vertebral body, focal/heterogeneous contrast enhancement of vertebral bodies, heterogeneous signal from the vertebral bodies on T2 TIRM images, well-defined paraspinal abnormal contrast enhancement, paraspinal and epidural abscesses, meningeal enhancement at the affected spine level. CONCLUSIONS: Comparison of MR images of patients diagnosed with pyogenic spondylodiscitis and tuberculous spondylodiscitis allowed identification of individual characteristics for preliminary differentiation between TB and infectious spondylodiscitis and thereby enabling proper treatment.