Monomicrobial Joint Infection by Leclercia adecarboxylata in an Immunocompetent Patient After Knee Arthroscopy: A Case Report.

CASE: A 54-year-old immunocompetent man presented to the office with severe right knee pain and swelling 27 days after knee arthroscopy. Additional diagnostics identified a monomicrobial infection of the right knee joint by the bacterium Leclercia adecarboxylata, which was later confirmed by repeated aspiration of the joint and culture of the aspirated fluid. CONCLUSION: This case report details a postoperative monomicrobial infection with L. adecarboxylata after a knee arthroscopy in an immunocompetent host. Although infection by this bacterium is rare, this case demonstrates the possibility of L. adecarboxylata infection in the knee joint after orthopaedic surgery.

Accuracy of palpation-directed intra-articular glenohumeral injection confirmed by magnetic resonance arthrography.

PURPOSE: The aim of this study was to determine the accuracy of anatomic palpation-directed injections in the office setting. METHODS: Two hundred twenty-six shoulders in 208 patients were studied using a 0.2-Tesla extremity scanner after the injection of gadolinium-diethylene triamine pentaacetic acid-saline. All patients were injected in a sterile fashion by a single board-certified shoulder surgeon using an anterior approach by palpating the rotator interval anterior to the acromioclavicular joint and angling the needle 45° lateral and 45° caudad. All injections, successful or otherwise, were single injections. Magnetic resonance (MR) arthrograms were retrospectively read by 2 musculoskeletal fellowship-trained, board certified radiologists to determine whether the injection was in the glenohumeral joint. RESULTS: Two hundred one of the 226 injections were successful (88.9%). Of the 25 unsuccessful injections, the contrast material extravasated out of the capsule in 5 cases and into the subscapularis tendon in 10 cases. The contrast material was injected into the subacromial space in 9 cases, into the rotator interval fat in 9 cases, and into extracapsular tissue in 6 cases. There was insufficient volume of contrast material in 10 cases. The accuracy rate was 88.9%. There were no complications. CONCLUSIONS: The palpation-directed rotator interval anterior approach technique for intra-articular glenohumeral MR arthrogram injections performed by a single surgeon was 88.9% accurate. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Analysis of Low-Field MRI Scanners for Evaluation of Shoulder Pathology Based on Arthroscopy.

BACKGROUND: Many studies have compared the diagnostic capabilities of low-field magnetic resonance imaging (MRI) scanners to high-field MRI scanners; however, few have evaluated the low-field MRI diagnoses compared with intraoperative findings. PURPOSE: To determine the accuracy and sensitivity of low-field MRI scanners in diagnosing lesions of the rotator cuff and glenoid labrum. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Over a 2-year period, MRI examinations without intra-articular contrast were performed on 79 patients for shoulder pathologies using an in-office 0.2-T extremity scanner. The MRI examinations were read by board-certified, musculoskeletal fellowship-trained radiologists. All patients underwent shoulder arthroscopy performed by a single sports fellowship-trained orthopaedic surgeon within a mean time of 56 days (range, 8-188 days) after the MRI examination. The mean patient age was 54 years (range, 18-81 years). Operative notes from the shoulder arthroscopies were then retrospectively reviewed by a single blinded observer, and the intraoperative findings were compared with the MRI reports. RESULTS: For partial-thickness rotator cuff tears, the sensitivity, specificity, positive predictive value, and negative predictive value were 85%, 89%, 79%, and 92%, respectively. For full-thickness rotator cuff tears, the respective values were 97%, 100%, 100%, and 98%. For anterior labral lesions, the values were 86%, 99%, 86%, and 99%, and for superior labral anterior-posterior (SLAP) lesions, the values were 20%, 100%, 100%, and 79%, respectively. CONCLUSION: Low-field MRI is an accurate tool for evaluation of partial- and full-thickness rotator cuff tears; however, it is not effective in diagnosing SLAP lesions. More information is needed to properly assess its ability to diagnose anterior and posterior labral lesions.

Analysis of Low-Field Magnetic Resonance Imaging Scanners for Evaluation of Knee Pathology Based on Arthroscopy.

BACKGROUND: In recent years, few studies have evaluated low-field magnetic resonance imaging (MRI) diagnoses compared with intraoperative findings of the knee. PURPOSE: To determine the accuracy and sensitivity of low-field MRI scanners in diagnosing pathology of the menisci, cruciate ligaments, and osteochondral surfaces. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: MRI examinations without intra-articular contrast were performed on 379 patients for knee pathologies over a 4-year period. The MRI examinations were done using a 0.2-tesla scanner utilizing a dedicated knee coil and read by 1 of 3 board-certified, musculoskeletal fellowship-trained radiologists. Within a mean time of 50 days after MRI, all patients underwent knee arthroscopy performed by 1 of 2 sports fellowship-trained orthopaedic surgeons. Operative notes from the knee arthroscopies were then reviewed by a single independent observer, and the intraoperative findings were compared with the MRI reports. RESULTS: For medial meniscus tears, the sensitivity, specificity, positive predictive value, and negative predictive value were 83%, 81%, 89%, and 71%, respectively. For lateral meniscus tears, the values were 51%, 93%, 84%, and 73%, respectively. For anterior cruciate ligament (ACL) tears, the values were 85%, 94%, 69%, and 97%, respectively. For osteochondral lesions, the values were 8%, 99%, 29%, and 94%, respectively. For posterior cruciate ligament (PCL) tears, the specificity and negative predictive value were 99% and 100%, respectively. CONCLUSION: Low-field MRI was an accurate tool for evaluation of medial meniscus and ACL tears. However, within the study population, it is not as effective in diagnosing lateral meniscus tears and showed a poor ability to detect osteochondral lesions. More information is needed to properly assess its ability to diagnose PCL tears.

Revision anterior capsular shoulder stabilization using hamstring tendon autograft and tibialis tendon allograft reinforcement: minimum two-year follow-up.

Surgical treatment of anterior shoulder capsular deficiency has been a challenge for orthopaedic surgeons dealing with failed anterior shoulder stabilization procedures. We have used hamstring tendon autograft or tibialis tendon allograft to reinforce deficient anterior capsular tissue in patients with failed anterior shoulder stabilization. We performed a clinical follow-up of 15 patients at a minimum of 2 years after surgery, using the American Shoulder and Elbow Surgeons questionnaire, a physical examination, and radiographs. Thirteen patients were satisfied with their surgery. The mean American Shoulder and Elbow Surgeons score was 73, (range, 7-100). There were no postoperative dislocations. The operative shoulder had decreased range of motion compared with the contralateral shoulder. The operative arm lacked 10 degrees of forward flexion, 21 degrees of external rotation at the side, 24 degrees of external rotation with the arm in abduction, and 4 spinal levels of internal rotation. Two patients required total shoulder arthroplasty for painful glenohumeral arthritis. Clinical failure was related to glenohumeral arthritis or residual anterior shoulder apprehension. Our results support the use of hamstring autograft or tibialis anterior allograft for the reconstruction of the anterior capsule during revision shoulder stabilization surgery.