Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 5.691
Filter
1.
Semin Musculoskelet Radiol ; 28(3): 318-326, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38768596

ABSTRACT

The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique popliteal ligament), the semimembranosus tendon and its expansions, the posteromedial joint capsule, and the posterior horn of the medial meniscus. Injuries to the structures of the PMC frequently occur in acute knee trauma in association with other ligamentous or meniscal tears. The correct assessment of PMC injuries is crucial because the deficiency of these supporting structures can lead to anteromedial rotation instability or the failure of cruciate ligaments grafts. This article reviews the anatomy and biomechanics of the PMC to aid radiologists in identifying injuries potentially involving PMC components.


Subject(s)
Knee Injuries , Ligaments, Articular , Humans , Knee Injuries/diagnostic imaging , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/injuries , Magnetic Resonance Imaging/methods , Knee Joint/diagnostic imaging , Biomechanical Phenomena
2.
Semin Musculoskelet Radiol ; 28(3): 305-317, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38768595

ABSTRACT

The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.


Subject(s)
Knee Injuries , Knee Joint , Magnetic Resonance Imaging , Humans , Knee Joint/diagnostic imaging , Knee Injuries/diagnostic imaging , Magnetic Resonance Imaging/methods , Biomechanical Phenomena , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/injuries , Joint Instability/diagnostic imaging
3.
Med Eng Phys ; 128: 104172, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38789217

ABSTRACT

Scapholunate interosseous ligament injuries are a major cause of wrist instability and can be difficult to diagnose radiographically. To improve early diagnosis of scapholunate ligament injuries, we compared injury detection between bilateral routine clinical radiographs, static CT, and dynamic four-dimensional CT (4DCT) during wrist flexion-extension and radioulnar deviation. Participants with unilateral scapholunate ligament injuries were recruited to a prospective clinical trial investigating the diagnostic utility of 4DCT imaging for ligamentous wrist injury. Twenty-one participants underwent arthroscopic surgery to confirm scapholunate ligament injury. Arthrokinematics, defined as distributions of interosseous proximities across radioscaphoid and scapholunate articular surfaces at different positions within the motion cycle, were used as CT-derived biomarkers. Preoperative radiographs, static CT, and extrema of 4DCT were compared between uninjured and injured wrists using Wilcoxon signed rank or Kolmogorov-Smirnov tests. Median interosseous proximities at the scapholunate interval were significantly greater in the injured versus the uninjured wrists at static-neutral and maximum flexion, extension, radial deviation, and ulnar deviation. Mean cumulative distribution functions at the radioscaphoid joint were not significantly different between wrists but were significantly shifted at the scapholunate interval towards increased interosseous proximities in injured versus uninjured wrists in all positions. Median and cumulative distribution scapholunate proximities from static-neutral and 4DCT-derived extrema reflect injury status.


Subject(s)
Four-Dimensional Computed Tomography , Humans , Male , Prospective Studies , Female , Adult , Four-Dimensional Computed Tomography/methods , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/injuries , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/injuries , Lunate Bone/diagnostic imaging , Middle Aged , Biomechanical Phenomena , Ligaments/diagnostic imaging , Ligaments/injuries , Young Adult , Kinetics , Wrist Injuries/diagnostic imaging , Tomography, X-Ray Computed , Wrist Joint/diagnostic imaging , Wrist Joint/physiopathology
4.
J Hand Surg Asian Pac Vol ; 29(3): 256-260, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38726495

ABSTRACT

Volar dislocation of the distal radioulnar joint is a rare injury that is often missed at initial presentation. We report a 21-year-old male patient who presented 2 months after sustaining this injury. He was successfully managed by open reduction and reconstruction of the dorsal radioulnar ligament using a partial distally based extensor carpi ulnaris tendon strip. A literature review showed only a few reported cases with varied methods for management. The technique utilised is analysed in comparison to the others. Level of Evidence: Level V (Therapeutic).


Subject(s)
Joint Dislocations , Wrist Injuries , Humans , Male , Young Adult , Joint Dislocations/surgery , Joint Dislocations/diagnostic imaging , Wrist Injuries/surgery , Wrist Injuries/diagnostic imaging , Tendons/surgery , Wrist Joint/surgery , Ligaments, Articular/surgery , Ligaments, Articular/injuries
5.
Eur J Radiol ; 175: 111471, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38636411

ABSTRACT

PURPOSE: With the slice thickness routinely used in elbow MRI, small or subtle lesions may be overlooked or misinterpreted as insignificant. To compare 1 mm slice thickness MRI (1 mm MRI) with deep learning reconstruction (DLR) to 3 mm slice thickness MRI (3 mm MRI) without/with DLR, and 1 mm MRI without DLR regarding image quality and diagnostic performance for elbow tendons and ligaments. METHODS: This retrospective study included 53 patients between February 2021 and January 2022, who underwent 3 T elbow MRI, including T2-weighted fat-saturated coronal 3 mm and 1 mm MRI without/with DLR. Two radiologists independently assessed four MRI scans for image quality and artefacts, and identified the pathologies of the five elbow tendons and ligaments. In 19 patients underwent elbow surgery after elbow MRI, diagnostic performance was evaluated using surgical records as a reference standard. RESULTS: For both readers, 3 mm MRI with DLR had significant higher image quality scores than 3 mm MRI without DLR and 1 mm MRI with DLR (all P < 0.01). For common extensor tendon and elbow ligament pathologies, 1 mm MRI with DLR showed the highest number of pathologies for both readers. The 1 mm MRI with DLR had the highest kappa values for all tendons and ligaments. For reader 1, 1 mm MRI with DLR showed superior diagnostic performance than 3 mm MRI without/with DLR. For reader 2, 1 mm MRI with DLR showed the highest diagnostic performance; however, there was no significant difference. CONCLUSIONS: One mm MRI with DLR showed the highest diagnostic performance for evaluating elbow tendon and ligament pathologies, with similar subjective image qualities and artefacts.


Subject(s)
Deep Learning , Elbow Joint , Magnetic Resonance Imaging , Humans , Magnetic Resonance Imaging/methods , Male , Female , Retrospective Studies , Middle Aged , Adult , Elbow Joint/diagnostic imaging , Aged , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/injuries , Ligaments/diagnostic imaging , Young Adult , Tendons/diagnostic imaging
7.
Orthop Surg ; 16(6): 1308-1316, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38644618

ABSTRACT

OBJECTIVES: Multiple ligament knee injuries (MLKIs) are disruptive injuries, however, there are controversies in the results of acute and delayed reconstruction. Also, clinical outcomes between patients older or younger than 40 have not been compared in MLKIs. This study was designed to investigate the influence of age and timing of reconstruction on the outcomes of single-stage reconstruction of MLKIs. METHODS: The patients who underwent reconstruction of multiple injured ligaments because of MLKIs between May 2013 and July 2019 were added to the cohort. The postoperative complications, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) 2000 score, Tegner activity level, patient satisfaction, and SF-36 score were compared between young (≤ 40 years old, n = 41) and old patients (n = 61); acute (≤ 3 weeks after injury, n = 75) and delayed reconstruction (n = 27), using Mann-Whitney U test or χ2 test. RESULTS: A total of 102 MLKI patients managed by single-stage multi-ligament reconstruction were retrospectively reviewed. Patients were followed up after surgery for a mean of 7.3 years (5.2-10.7 years). At the last follow-up, no significant difference was found in knee ROM, functional scores, and patient-reported outcomes between patients older or younger than 40; acute and delayed reconstruction (p > 0.05). The rate of complications in the delayed reconstruction group was higher than that of the acute reconstruction group (22.2% vs 5.3%, p < 0.05). The IKDC objective scores reached grade A in 63.7%-80.4% of patients, and grade B in 11.8%-23.5% patients. CONCLUSION: The single-stage reconstruction of MLKIs can obtain comparative long-term functional and objective outcomes regardless of patients older or younger than 40; acute and delayed reconstruction, however, delayed reconstruction is related to a high rate of postoperative complications.


Subject(s)
Knee Injuries , Humans , Adult , Male , Female , Retrospective Studies , Follow-Up Studies , Middle Aged , Age Factors , Knee Injuries/surgery , Young Adult , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Plastic Surgery Procedures/methods , Time Factors , Adolescent , Time-to-Treatment , Range of Motion, Articular
8.
Medicine (Baltimore) ; 103(4): e37011, 2024 Jan 26.
Article in English | MEDLINE | ID: mdl-38277575

ABSTRACT

RATIONALE: Medial malleolus injuries mainly comprise of fractures and deltoid ligament ruptures. Medial malleolus fractures, as a kind of common ankle fractures, could occur separately or be accompanied by lateral and posterior malleolus fractures. It is generally agreed that medial malleolus fracture and deltoid ligament rupture could not occur simultaneously. PATIENT CONCERNS: In our study, we report a case of 36 year-old man diagnosed with trimalleolar fracture accompanying ankle dislocation initially. The patient was admitted to our hospital due to traffic accident. DIAGNOSIS: The patient was diagnosed with trimalleolar fracture accompanying ankle dislocation initially. We missed the diagnosis of accompanied deltoid ligament due to the arthralgia of medial ankle and the widened medial articular space in X-ray after operation. INTERVENTION: As we missed the diagnosis of accompanied deltoid ligament, we only selected open reduction and internal fixation for trimalleolar fracture at first. After we realized the existence of deltoid ligament rupture, the patient refuse further diagnosis and treatment in our hospital. OUTCOMES: During the rehabilitation exercise, the patient had medial arthralgia in his right ankle. He complained it and refuse further diagnosis and treatment in our hospital. LESSONS: The newfound injury pattern, medial malleolus fracture accompanying deltoid ligament rupture, has not been reported in previous studies. The injury pattern needs further researches to explore the mechanism and it should be taken seriously in clinical practice.


Subject(s)
Ankle Fractures , Ankle Injuries , Male , Humans , Adult , Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Ankle Injuries/complications , Ankle Injuries/diagnostic imaging , Ankle Injuries/surgery , Ligaments , Ankle Joint/surgery , Fracture Fixation, Internal , Arthralgia , Ligaments, Articular/surgery , Ligaments, Articular/injuries
9.
Injury ; 55(3): 111348, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38290382

ABSTRACT

INTRODUCTION: In isolated type B fibular fractures, the decision whether to operate or treat conservatively is principally based on congruency and stability of the ankle joint. The purpose of the current study is to examine the additional diagnostic value of the weight-bearing radiograph (WBR) in assessing stability of potentially unstable type B fibular fractures. MATERIALS AND METHODS: In this retrospective cohort study, patients were selected based on who presented an isolated type B fracture of the fibula. Unstable fractures were directly planned for surgery. Other patients underwent additional weight-bearing imaging 4-7 days after initial trauma, on which definitive treatment was based. The medial clear space (MCS) was compared between the WBR and the conventional radiograph. RESULTS: A total of 70 patients were included in the period January 2018-December 2021. The average MCS on conventional mortise radiograph was 3.56 mm compared to 3.02 mm on the WBR(p<0.05). The superior clear space (SCS) was equal between both groups (respectively 3.12 mm and 3.08 mm, p = 0.44). All 70 patients were initially treated conservatively with immediate weight-bearing in a brace or soft cast. One patient had the need for open repair and internal fixation due to non-union. DISCUSSION: Different techniques for the assessment of deep deltoid ligament integrity exist, such as the MRI, the ultrasonography and different kinds of stress test radiographs. As fractured ankles don't need direct fixation and operative treatment can be postponed, a stepped approach for the assessment of deep deltoid ligament (DDL) integrity can be of assistance in assessing ankle stability. In isolated type B fibular fractures a stepped approach, using the weight-bearing radiograph can be of additional value in assessing the stability. It is a low cost, prevents unnecessary surgery and contributes to a quick weight-bearing non-operative treatment.


Subject(s)
Ankle Fractures , Fibula , Humans , Retrospective Studies , Fibula/injuries , Ankle Fractures/diagnostic imaging , Ankle Fractures/surgery , Ligaments, Articular/injuries , Weight-Bearing , Ankle Joint
10.
Musculoskelet Surg ; 108(1): 69-75, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37227663

ABSTRACT

PURPOSE: Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury. MATERIALS AND METHODS: Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery. RESULTS: All patients had a mean follow-up of 54 months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3 months after the initial surgery. CONCLUSIONS: The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.


Subject(s)
Triangular Fibrocartilage , Wrist Injuries , Humans , Wrist/pathology , Triangular Fibrocartilage/diagnostic imaging , Triangular Fibrocartilage/surgery , Triangular Fibrocartilage/injuries , Shoulder/pathology , Wrist Injuries/diagnostic imaging , Wrist Injuries/surgery , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Wrist Joint/diagnostic imaging , Wrist Joint/surgery , Arthroscopy/methods , Pain, Postoperative , Retrospective Studies , Treatment Outcome
11.
Skeletal Radiol ; 53(3): 499-506, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37668679

ABSTRACT

OBJECTIVE: The main objective of this study was to understand the role of skeletal maturity in the different patterns of osteochondral and ligamentous injuries after an acute lateral patellar dislocation. MATERIALS AND METHODS: Two radiologists independently reviewed MRIs of 212 knees performed after an acute lateral patellar dislocation to evaluate the presence of high-grade patellar osteochondral injury, femoral osteochondral injury, and medial patellofemoral ligament injury. The association of skeletal maturity (indicated by a closed distal femoral physis), age, sex, and first-time versus recurrent dislocation with each of these various lesions was analyzed using Chi-square or T test, and multivariable logistic regression with estimation of odds ratios (OR). RESULTS: Skeletal maturity was significantly associated with high-grade patellar osteochondral injury [OR=2.72 (95% CI 1.00, 7.36); p=0.049] and femoral-side MPFL tear [OR=2.34 (95% CI 1.05, 5.25); p=0.039]. Skeletal immaturity was significantly associated with patellar-side MPFL tear [OR=0.35 (95% CI 0.14, 0.90); p=0.029]. CONCLUSION: Patterns of injury to the patella and medial patellofemoral ligament vary notably between the skeletally immature and mature, and these variations may be explained by the inherent weakness of the patellar secondary physis.


Subject(s)
Lacerations , Patellar Dislocation , Patellofemoral Joint , Humans , Patellar Dislocation/diagnostic imaging , Patella/diagnostic imaging , Patella/pathology , Knee Joint/diagnostic imaging , Knee Joint/pathology , Femur , Ligaments, Articular/injuries , Rupture/complications
12.
Skeletal Radiol ; 53(3): 555-566, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37704830

ABSTRACT

OBJECTIVE: To compare MRI features of medial and lateral patellar stabilizers in patients with and without patellar instability. METHODS: Retrospective study of 196 patients (mean age, 33.1 ± 18.5 years; 119 women) after diagnosis of patellar instability (cohort-1, acute patellar dislocation; cohort-2, chronic patellar maltracking) or no patellar instability (cohort-3, acute ACL rupture; cohort-4, chronic medial meniscus tear). On MRI, four medial and four lateral stabilizers were evaluated for visibility and injury by three readers independently. Inter- and intra-reader agreement was determined. RESULTS: Medial and lateral patellofemoral ligaments (MPFL and LPFL) were mostly or fully visualized in all cases (100%). Of the secondary patellar stabilizers, the medial patellotibial ligament was mostly or fully visualized in 166 cases (84.7%). Other secondary stabilizers were mostly or fully visualized in only a minority of cases (range, 0.5-32.1%). Injury scores for all four medial stabilizers were higher in patients with acute patellar dislocation than the other 3 cohorts (p < .05). Visibility inter- and intra-reader agreement was good for medial stabilizers (κ 0.61-0.78) and moderate-to-good for lateral stabilizers (κ 0.40-0.72). Injury inter- and intra-reader agreement was moderate-to-excellent for medial stabilizers (κ 0.43-0.90) and poor-to-moderate for lateral stabilizers (κ 0-0.50). CONCLUSION: The MPFL and LPFL were well visualized on MRI while the secondary stabilizers were less frequently visualized. The secondary stabilizers were more frequently visualized medially than laterally, and patellotibial ligaments were more frequently visualized compared to the other secondary stabilizers. Injury to the medial stabilizers was more common with acute patellar dislocation than with chronic patellar maltracking or other knee injuries.


Subject(s)
Joint Instability , Patellar Dislocation , Patellar Ligament , Patellofemoral Joint , Humans , Female , Adolescent , Young Adult , Adult , Middle Aged , Patellar Dislocation/diagnostic imaging , Reproducibility of Results , Joint Instability/diagnostic imaging , Retrospective Studies , Patella , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/injuries , Magnetic Resonance Imaging , Rupture/complications , Patellar Ligament/diagnostic imaging
13.
J Am Acad Orthop Surg ; 32(1): e13-e23, 2024 Jan 01.
Article in English | MEDLINE | ID: mdl-37476845

ABSTRACT

Historically, the posterolateral corner (PLC) of the knee has been labelled as the "dark side" of the knee. The PLC is not a single structure but a confluence of multiple structures, including the lateral collateral ligament, popliteus muscle-tendon unit, and popliteofibular ligament. Understanding the individual components and their function is important to successfully identify these injuries. PLC injuries are commonly associated with cruciate injuries, and its early recognition is important to achieve successful outcomes. Injury to the PLC should be treated on a case-by-case basis, and an appropriate algorithm is required to manage them. Multiple surgical techniques ranging from primary repair to anatomic reconstruction have been reported in managing these injuries. We present the latest literature on the anatomy, biomechanics, clinical presentation, imaging, available techniques, and current management recommendations. There is a special focus on the pathoanatomy, which will help guide the treatment of these injuries.


Subject(s)
Knee Injuries , Posterior Cruciate Ligament , Humans , Knee Injuries/diagnosis , Knee Injuries/surgery , Knee Joint/surgery , Ligaments, Articular/injuries , Tendons , Leg , Posterior Cruciate Ligament/surgery
14.
Skeletal Radiol ; 53(3): 445-454, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37584757

ABSTRACT

OBJECTIVE: The purpose of this systematic review was to summarize the results of original research studies evaluating the characteristics and performance of deep learning models for detection of knee ligament and meniscus tears on MRI. MATERIALS AND METHODS: We searched PubMed for studies published as of February 2, 2022 for original studies evaluating development and evaluation of deep learning models for MRI diagnosis of knee ligament or meniscus tears. We summarized study details according to multiple criteria including baseline article details, model creation, deep learning details, and model evaluation. RESULTS: 19 studies were included with radiology departments leading the publications in deep learning development and implementation for detecting knee injuries via MRI. Among the studies, there was a lack of standard reporting and inconsistently described development details. However, all included studies reported consistently high model performance that significantly supplemented human reader performance. CONCLUSION: From our review, we found radiology departments have been leading deep learning development for injury detection on knee MRIs. Although studies inconsistently described DL model development details, all reported high model performance, indicating great promise for DL in knee MRI analysis.


Subject(s)
Anterior Cruciate Ligament Injuries , Artificial Intelligence , Ligaments, Articular , Meniscus , Humans , Anterior Cruciate Ligament Injuries/diagnostic imaging , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/injuries , Magnetic Resonance Imaging/methods , Meniscus/diagnostic imaging , Meniscus/injuries
15.
Eur J Orthop Surg Traumatol ; 34(2): 1037-1044, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37897667

ABSTRACT

Injury to the scapholunate complex is the cause of scapholunate instability which can lead to radiocarpal and medio-carpal osteoarthritis. Several ligamentoplasty techniques have been reported for the treatment of chronic scapholunate instability before the osteoarthritis stage. The objective of this study was to assess the short-term results of an "all dorsal scapholunate repair" ligamentoplasty. We report the clinical, radiological and functional results of a retrospective study including 21 patients, operated between June 2019 and December 2020 for a stage 3 or 4 scapholunate instability according to the Garcia Elias classification. With a follow-up of 14.2 months, the pain was 0.1/10 according to the VAS at rest and 4/10 during exercise. Wrist strength was measured at 65% of the opposite side. The flexion-extension range of motion was 105°. Radiologically, there was a reduction of the diastasis and scapholunate angle. Osteolysis areas around the anchors were described in 47% of patients. The mean QuickDASH was 29.2/100, PRWE 24/100 and Mayo wrist score 67.8/100. Eighty-one percent of patients were satisfied. Seventeen patients had returned to work 5.2 months postoperatively. In the case of work-related injury, the functional scores were poorer, with a delayed return to work. This technique provides encouraging results in the short term. Most patients were improved compared to preoperative state. The work-related injury appears to be a poor prognostic factor. A longer-term study is imperative to confirm the maintenance over time of the correction of carpal malalignment and the evolution of the osteolysis areas.Level of evidence: Level IV Retrospective study.


Subject(s)
Joint Instability , Lunate Bone , Occupational Injuries , Osteoarthritis , Osteolysis , Scaphoid Bone , Humans , Lunate Bone/diagnostic imaging , Lunate Bone/surgery , Lunate Bone/injuries , Scaphoid Bone/diagnostic imaging , Scaphoid Bone/surgery , Scaphoid Bone/injuries , Retrospective Studies , Occupational Injuries/complications , Joint Instability/etiology , Joint Instability/surgery , Wrist Joint/diagnostic imaging , Wrist Joint/surgery , Ligaments, Articular/injuries
16.
Foot Ankle Int ; 45(1): 80-85, 2024 01.
Article in English | MEDLINE | ID: mdl-37902238

ABSTRACT

BACKGROUND: The diagnosis and treatment of distal tibiofibular syndesmosis (DTFS) injury can be challenging, especially in cases of subtle instability that may be masked on 2-dimensional conventional radiographs. Weightbearing computed tomography (WBCT) has recently emerged as a useful diagnostic tool allowing direct assessment of distal tibiofibular area widening. The purpose of the current study was to examine and report normal threshold values for DTFS area measurements in a cohort of healthy volunteers, assessing the ankles in natural weightbearing position and under subject-driven external rotation stress. METHODS: In this prospective study, we enrolled 25 healthy volunteers without a history of DTFS injury or high ankle sprain, previous foot and ankle surgery, or current ankle pain. Subjects with any prior ankle injuries were excluded. Study participants underwent bilateral standing nonstress and external rotation stress WBCT scans. The DTFS area (mm2) was semiautomatically quantified on axial-plane WBCT images 1 cm proximal to the apex of the talar dome using validated software. Syndesmosis area values were compared between "unstressed" and "stressed" ankles, as well as left and right ankles. Statistical analysis was performed using independent t tests/Wilcoxon analysis with statistical significance defined as P <.05. RESULTS: The study cohort consisted of 50 ankles in 25 patients (12 males, 48%) with a mean age of 28.7 ± 9.3 years. In the unstressed ankle, the mean pooled DTFS area was determined to be 103.8 + 20.8 mm2. The mean syndesmosis area of unstressed left ankles (104.2 + 19.5 mm2) was similar to unstressed right ankles (109.2 + 17.2 mm2) in the cohort (P = .117). With external rotation stress, the DTFS area of left ankles (mean difference -0.304 mm2, CI -12.1 to 11.5; P = .082), right ankles (mean difference -5.5 mm2, CI 16.7-5.7; P = .132), and all ankles (mean difference -2.9 mm2, CI -10.8 to 5.1; P = .324) remained similar. CONCLUSION: This study presents normal values and range for DTFS area calculation. In uninjured ankles with expected intact ligaments, subject-driven external rotation stress did not result in significant widening of the DTFS space as imaged on with WBCT. LEVEL OF EVIDENCE: Level II, cross-sectional study.


Subject(s)
Ankle Injuries , Joint Instability , Male , Humans , Young Adult , Adult , Ankle Joint/diagnostic imaging , Reference Values , Cross-Sectional Studies , Prospective Studies , Ankle Injuries/diagnostic imaging , Ankle Injuries/surgery , Ligaments, Articular/injuries , Joint Instability/diagnostic imaging , Joint Instability/surgery
17.
Med Sci (Basel) ; 11(4)2023 11 28.
Article in English | MEDLINE | ID: mdl-38132916

ABSTRACT

(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria. A total of 284 patients and 230 knees were included. Seventy-five percent of patients were graded to have excellent-good clinical outcomes using the Crosby and Insall Grading System. International Knee Documentation Committee score and Knee injury and Osteoarthritis Outcome Score scores showed 59% and 60% post-operative improvement, respectively; (4) Conclusions: All studies showed improvement in post-operative functional outcomes and report no serious adverse events. The 6 mm, LARS (Orthomedic Ltd., Dollard-des-Ormeaux, QC, Canada) proved to have the most improvement in post-operative outcomes when used as a double bundle graft.


Subject(s)
Joint Instability , Patellar Dislocation , Patellofemoral Joint , Humans , Patellofemoral Joint/surgery , Joint Instability/surgery , Knee Joint/surgery , Patellar Dislocation/surgery , Ligaments, Articular/injuries , Ligaments, Articular/surgery
18.
Sci Rep ; 13(1): 20844, 2023 11 27.
Article in English | MEDLINE | ID: mdl-38012256

ABSTRACT

Preservation of syndesmotic ligaments is crucial for preventing adverse sequelae at the donor site following free fibula osteocutaneous flap harvesting. This study sought to determine the relationship between distal tibiofibular ligaments and the fibular segment to identify radiological landmarks that facilitate safe and precise flap. The distances between the distal tibiofibular ligaments (anterior inferior tibiofibular ligament [AITFL], posterior inferior tibiofibular ligament [PITFL]) and the fibular segment, as well as the lower border of the interosseous membrane, were measured on magnetic resonance imaging (MRI) scans of 296 patients without any perceivable ankle abnormalities. The mean distances (± SD) between the distal end of the fibula and the AITFL, PITFL, and lower interosseous membrane border were 3.0 ± 0.4 cm, 2.6 ± 0.4 cm, and 3.9 ± 0.6 cm, respectively. The distance between the talar dome and the PITFL exhibited a range of 0.0-0.5 cm. Our findings support preserving a distal fibular remnant of at least 4 cm to avoid injury to the syndesmotic ligament throughout fibula osteocutaneous flap harvesting. The talar dome could serve as a useful radiological landmark for identifying the upper border of PITFL during preoperative evaluation, and thus facilitating precise and safe flap procurement.


Subject(s)
Fibula , Free Tissue Flaps , Humans , Fibula/diagnostic imaging , Fibula/surgery , Ankle Joint/diagnostic imaging , Ankle Joint/surgery , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Magnetic Resonance Imaging , Cadaver
19.
Knee Surg Sports Traumatol Arthrosc ; 31(12): 6080-6087, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37955675

ABSTRACT

PURPOSE: The aim of this study was to assess the biomechanical effects of subtalar ligament injury and reconstruction on stability of the subtalar joint in all three spatial planes. METHODS: Fifteen fresh frozen cadaveric legs were used, with transfixed tibiotalar joints to isolate motion to the subtalar joint. An arthrometer fixed to the lateral aspect of the calcaneus measured angular displacement in all three spatial planes on the inversion and eversion stress tests. Stress manoeuvres were tested with the intact joint, and then repeated after sequentially sectioning the inferior extensor retinaculum (IER), cervical ligament (CL), interosseous talocalcaneal ligament (ITCL), arthroscopic graft reconstruction of the ITCL, and sectioning of the calcaneo-fibular ligament (CFL). RESULTS: Sectioning the ITCL significantly increased angular displacement upon inversion and eversion in the coronal and sagittal planes. Reconstruction of the ITCL significantly improved angular stability against eversion in the axial and sagittal planes, and against inversion in the axial and coronal planes, at the zero time point after reconstruction. After sectioning the CFL, resistance to eversion decreased significantly in all three planes. CONCLUSION: Progressive injury of ligamentous stabilisers, particularly the ITCL, led to increasing angular displacement of the subtalar joint measured with the inversion and eversion stress tests, used in clinical practice. Reconstruction of the ITCL using tendon graft significantly stabilised the subtalar joint in the axial and sagittal planes against eversion and in the axial and coronal planes against inversion, immediately after surgery.


Subject(s)
Joint Instability , Subtalar Joint , Humans , Subtalar Joint/surgery , Biomechanical Phenomena , Cadaver , Ankle Joint/surgery , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Joint Instability/surgery , Allografts
20.
J Orthop Surg Res ; 18(1): 822, 2023 Nov 01.
Article in English | MEDLINE | ID: mdl-37915023

ABSTRACT

PURPOSE: The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations. METHODS: A systematic literature review was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China national knowledge infrastructure from inception to December 22, 2022, according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies regarding risk factors for OCIs after patellar dislocations were included. Literature search, data extraction, and quality assessment were performed independently by two authors. RESULTS: A total of 16 studies with 1945 patients were included. The risk factors for OCIs after patellar dislocation were categorized into four main categories, including demographic characteristics, patellar depth and position, femoral trochlear morphology, and other risk factors in this study. Five and three studies supported the idea that male sex and skeletal maturation may be risk factors, respectively. Normal femoral trochlea (two studies) and complete medial patellofemoral ligament (MPFL) injuries (two studies) may be associated with the development of OCIs. Three studies show that ligamentous laxity or joint hypermobility may prevent OCIs. Patellar depth and position (eight studies) may not be associated with the development of OCIs. CONCLUSIONS: Based on the available evidence, an increased risk of OCIs following patellar dislocation may be associated with male sex and skeletal maturation. Furthermore, normal femoral trochlea and complete MPFL injuries may increase the risk of OCIs, while factors such as ligamentous laxity or joint hypermobility may reduce the risk. LEVEL OF EVIDENCE: Level IV, systematic review of Level II and IV studies.


Subject(s)
Intra-Articular Fractures , Joint Instability , Patellar Dislocation , Patellofemoral Joint , Humans , Male , Patellar Dislocation/complications , Patellar Dislocation/epidemiology , Joint Instability/etiology , Patella/injuries , Knee Joint , Femur , Ligaments, Articular/injuries , Intra-Articular Fractures/complications , Risk Factors
SELECTION OF CITATIONS
SEARCH DETAIL
...