Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial.

We performed a randomized, double-blinded, placebo-controlled study (ISRCTN24203769) to assess the effectiveness of low-level laser therapy (LLLT) in patients with meniscal pathology, including only symptomatic patients with tiny focus of grade 3 attenuation (seen only on 0.7 thickness sequences) or intrasubstance tears with spot of grade 3 signal intensity approaching the articular surface. None of the patients in the study group underwent arthroscopy or new magnetic resonance imaging investigation. Paired-samples t test was used to detect significant changes in subjective knee pain over the experimental period within groups, and ANOVA was used to detect any significant differences between the two groups. Pain was significantly improved for the LLLT group than for the placebo group (F = 154, p < 0.0001). Pain scores were significantly better after LLLT. Four (12.5 %) patients did not respond to LLLT. At baseline, the average Lysholm score was 77 ± 4.6 for the LLLT group and 77.2 ± 2.6 for the placebo group (p > 0.05). Four weeks after LLLT or placebo therapy, the laser group reported an average Lysholm score of 82.5 ± 4.6, and the placebo group scored 79.0 ± 1.9. At 6 months, the laser group had an average Lysholm score of 82.2 ± 5.7, and after 1 year, they scored 81.6 ± 6.6 (F = 14.82923, p = 0.002). Treatment with LLLT was associated with a significant decrease of symptoms compared to the placebo group: it should be considered in patients with meniscal tears who do not wish to undergo surgery.

Surgical repair of muscle laceration: biomechanical properties at 6 years follow-up.

Muscle injuries are challenging problems for surgeons. Muscle trauma is commonly treated conservatively with excellent outcome results while surgical repair is advocated for larger tears/lacerations, where the optimal goal is restore of function. Repair of muscle belly lacerations is technically demanding because the sutures pull out and the likelihood of clinical failure is high. Different suture techniques have been described but still the best suture is debated. We show a case of a pure vastus medialis muscle laceration surgically repaired at 6 years of follow-up.

Ultrasound as a primary evaluation tool of bone stress injuries in elite track and field athletes.

BACKGROUND: Little is known about therapeutic ultrasound (TUS) to diagnose bone stress injuries. HYPOTHESIS: Therapeutic ultrasound is an accurate, cost-efficient alternative to other imaging methods for primary assessment of bone stress injuries. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: One hundred thirteen elite track and field athletes (mean age, 20.1 years; range, 17-28 years) underwent TUS and magnetic resonance imaging (MRI) for clinical suspicion of a bone stress injury. A 5-stage MRI grading system was used to classify bone stress injuries. Sensitivity, specificity, accuracy, and positive and negative predictive values of TUS were calculated using MRI as the standard for diagnosis. RESULTS: At MRI, of 113 assessed patients, 3 (2.7%) had grade 0 injuries, 12 (10.6%) had grade 1, 15 (13.3%) had grade 2, 77 (68.2%) had grade 3, and 6 (5.3%) had grade 4. At TUS, no injury was detected in 22 of 113 patients: 2 with grade 0 injury, 8 with grade 1, 8 with grade 2, and 4 with grade 3. Using MRI as the gold standard, TUS showed 81.8% sensitivity, 66.6% specificity, 99.0% positive predictive value, 13.4% negative predictive value, and 81.4% accuracy. CONCLUSION: Therapeutic ultrasound is a reproducible procedure that is reliable to diagnose bone stress injuries.

Unilateral agenesis of the internal carotid artery presented as transient ischaemic attack: a case report.

Dysgenesis of the internal carotid artery (ICA) is a rare vascular disorder with a variety of different grades (agenesis, aplasia, and hypoplasia). The left internal carotid artery is reported to be affected by dysgenesis three times more often than the right one. Most of the patients with dysgenesis of the internal carotid artery are asymptomatic. We report a case of a patient with right internal carotid artery agenesis presented to our hospital as transient ischaemic attack. CT scans at skull base level with bone settings showed absence of the right carotid canal, consistent with congenital agenesis of the internal carotid artery. MR imaging of the brain revealed signal void of the intracranial portion of right internal carotid artery. Maximum intensity projection reconstruction confirmed the agenesis of the right ICA, with the right middle cerebral artery fed through a dilated posterior communicating artery and the right anterior cerebral artery supplied by the anterior communicating artery (fetal type of collateral flow). In patients with agenesis of the internal carotid artery non-invasive imaging techniques are currently the mainstay of diagnosis.

Posterior thigh muscle injuries in elite track and field athletes.

INTRODUCTION: Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value. HYPOTHESIS: Knee active range of motion deficit 48 hours after a unilateral posterior thigh muscle injury correlates with time to full recovery. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred sixty-five track and field athletes with acute, first-time, unilateral posterior thigh muscle injuries were prospectively evaluated regarding knee active range of motion deficit. This was compared with the uninjured side 48 hours after injury. A control group was also examined. Ultrasound was used to image the muscle lesion. All athletes were managed nonoperatively with the same rehabilitation protocol. The "full rehabilitation time" (interval from the injury to full athletic activities) was recorded. RESULTS: Range of motion of the affected leg was decreased in the 165 injured athletes compared with the uninjured side and the control group. Sonography identified abnormalities in 55% (90 of 165) of the injured athletes. The biceps femoris was the most commonly affected muscle (68 of 90 [75%]). The musculotendinous junction (proximal or distal) was involved in 93% (85 of 90) of lesions. Eighty-one percent (133 of 165) of athletes had active range of motion deficit of less than 20 degrees, and had returned to full performance at 2 weeks. In 6 of 165 athletes (3.6%), with active range of motion deficit of more than 30 degrees, recovery time exceeded 6 weeks, with a significant correlation between full rehabilitation time and active range of motion deficit (chi(2) = 152.560; P = .0001). CONCLUSION: Knee active range of motion deficit is an objective and accurate measurement, predicting recovery time in elite athletes.

Ultrasonographic evaluation of plantar fasciitis after low-level laser therapy: results of a double-blind, randomized, placebo-controlled trial.

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on plantar fasciitis documented by the ultrasonographic appearance of the aponeurosis and by patients' pain scores. Thirty individuals with diagnosis of unilateral plantar fasciitis were enrolled in a randomized, double-blind, placebo-controlled trial, but 25 participants completed the therapeutic protocol. The contralateral asymptomatic fascia was used as control. After enrolment, symptomatic individuals were randomly assigned to receive LLLT, or identical placebo, for 6 weeks. Ultrasonography was performed at baseline and after completion of therapy. The subjective subcalcaneal pain was recorded at baseline and after treatment on a visual analogue scale (VAS). After LLLT, plantar fascia thickness in both groups showed significant change over the experimental period and there was a difference (before treatment and after treatment) in plantar fascia thickness between the two groups. However, plantar fascia thickness was insignificant (mean 3.627 +/- 0.977 mm) when compared with that in the placebo group (mean 4.380 +/- 1.0042 mm). Pain estimation on the visual analogue scale had improved significantly in all test situations (after night rest, daily activities) after LLLT when compared with that of the placebo group. (P=0.006 and P=0.01, respectively). Additionally, when the difference in pain scores was compared between the two groups, the change was statistically significant (after night rest P=0.000; daily activities P=0.001). In summary, while ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis, 904 nm gallium-arsenide (GaAs) infrared laser may contribute to healing and pain reduction in plantar fasciitis.