Degenerative Joint Changes Research Articles

Degenerative facet joint changes in lumbar percutaneous pedicle screw fixation without fusion

BackgroundAim of the study was to evaluate degenerative lumbar facet-joints changes after percutaneous pedicle screw fixation (PPSF) in the treatment of lumbar fractures. Materials and methodsThirty patients underwent short PPSF without fusion. CT-scan was performed in the pre- and post-operative time at four, eight and 12 months. The six zygapophyseal joints adjacent the fracture's level were evaluated. ResultsAt four months patients showed no differences between pre- and post-operative joint radiographic aspect. At eight and 12 months, CT-scan demonstrated a progressive degeneration only in the middle joints respectively in 21.42% and in 76.92% of the cases. All 10 disrupted facet joints showed progressive degenerative changes at eight and 12 months. ConclusionLumbar percutaneous fixation without fusion induces little degenerations essentially collocated in the middle joints close to fracture level at eight and 12 months. In the proximal and distal joints adjacent the screws degenerative changes can be seen only when associated to pedicle-screw encroachment. Level of evidenceLevel IV retrospective study.

Surgical treatment of cavus foot in Charcot-Marie-tooth disease: a review of twenty-four cases: AAOS exhibit selection.

Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The imbalance involving intrinsic and extrinsic muscles has been suggested as the main pathogenetic cause of cavus foot in this disease. The goal of surgical treatment is to correct the deformity to obtain a plantigrade foot. In the presence of a flexible deformity and the absence of degenerative arthritis, preserving as much as possible of the overall range of motion of the foot and ankle is advisable. Twenty-four cavus feet in twelve patients with Charcot-Marie-Tooth disease were included in the study. Clinical evaluation was summarized with the Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, Meary angle, Hibb angle, and absence of degenerative joint changes. Only patients who had a flexible deformity, with varus of the heel reducible in the Coleman-Andreasi test, and did not have degenerative joint arthritis were included in this study. Surgical treatment consisted in plantar fasciotomy, midtarsal osteotomy, extensor hallucis longus tendon transfer to the first metatarsal (Jones procedure), and dorsiflexion osteotomy of the first metatarsal. Mean follow-up was six years (range, two to thirteen years). The mean Maryland Foot Score was 72 preoperatively and 86 postoperatively. The postoperative result was rated as excellent in twelve feet (50%), good in ten (42%), and fair in two (8%). Mean calcaneal pitch was 34° preoperatively and 24° at the time of the latest follow-up, the mean Hibb angle was 121° preoperatively and 136° postoperatively, and the mean Meary angle was 25° preoperatively and 2° postoperatively. Plantar fasciotomy, midtarsal osteotomy, the Jones procedure, and dorsiflexion osteotomy of the first metatarsal yielded adequate correction of flexible cavus feet in patients with Charcot-Marie-Tooth disease in the absence of fixed hindfoot deformity. The fact that the improvement in the outcome score was only modest may be attributable to the lack of motor balance.

Lumbosacral Transitional Vertebrae, Canine Hip Dysplasia, and Sacroiliac Joint Degenerative Changes on Ventrodorsal Radiographs of the Pelvis in Police Working German Shepherd Dogs

Lumbosacral transitional vertebrae (LTV) frequently occur in German shepherd dogs. The aim of the study was to evaluate the prevalence and interdependence between LTV and canine hip dysplasia (CHD) as well as sacroiliac joint degenerative changes visualized on ventrodorsal radiographs of the pelvis in both working and companion German shepherd dogs. The presence of LTV was found in 12% of working dogs and in 33% of companion dogs. Similar incidence of hip dysplasia in both the groups was found. It has been shown that dogs with LTV have a higher frequency of severe CHD. A higher percentage of sacroiliac joint degenerative changes was observed in dogs with no signs of LTV and in working dogs.

Systematics of glenohumoral and acromioclavicular arthritis

A common risk factor for osteoarthritis (OA) of the glenohumeral joint is instability and is often observed as a sequel to dislocation. Altered biomechanics will ultimately result in joint degeneration including osteophyte development at the lower margin of the humerus, glenoidal cartilage loss and surface deformity. An OA of the glenohumeral joint is often coexistent with soft tissue derangement of the shoulder. In advanced stages defects of the rotator cuff and OA of the glenohumeral joint may accelerate disease progression. Degenerative changes of the acromioclavicular joint (AC joint) are commonly seen in older persons with only modest correlation with clinical symptoms. Symptomatic OA of the AC joint is often concomitantly observed with degenerative changes of the glenohumeral joint. Standard radiographs are the basis of a structural assessment of shoulder OA but lack correlation with clinical symptoms and are insensitive for the detection of early degenerative changes. Magnetic resonance imaging (MRI) provides increased sensitivity for the detection of cartilage defects and reveals relevant soft tissue changes, such as lesions of the glenoid labrum and capsuloligamentous structures, which are seen in conjunction with instability. It is also the method of choice to detect clinically relevant bone marrow edema-like lesions or synovial changes that are associated with symptomatic OA. Standard radiographs are not applicable for detection of early degenerative changes. Once OA is suspected clinically, MRI is the method of choice for further structural assessment. The administration of an intravenous contrast agent is useful for assessing synovitis, which commonly correlates with clinical disease manifestations. For preoperative and surgical planning of joint replacement, MRI or CT should be used.

Wiskosuplementacja w zapobieganiu i leczeniu zmian zwyrodnieniowych stawów

Osteoarthritis (OA) is one of the most common musculoskeletal disorders. It limits patients’ functionality and life satisfaction significantly. Although there are numerous types of therapy, the success rate of conservative treatment is limited, and it is often necessary to introduce surgical treatment. Therefore, new effective methods of therapy for OA are being tested and submitted. Endogenous hyaluronic acid (HA) is a natural ingredient of many tissues in the human organism, including synovial fluid. Viscosupplementation with the usage of HA is a relatively new method for treating degenerative joint changes. By virtue of its good safety profile and simplicity of application, it is increasingly used as an alternative or addition to classic conservative treatment. In this work, we attempted to summarise the current state of knowledge of HA usage in OA treatment based on literature.

Medium-term results of single-stage posteromedial release and triple arthrodesis in treatment of neglected clubfoot deformity in adults.

This study aimed to evaluate the implementation, in a single session, of both massive posteromedial release and triple arthrodesis for rigid neglected clubfoot deformities in adult patients, and its effects on clinical and radiological results. The procedures were performed in one session on 15 feet of 11 patients [7 male, 4 female; mean age 26 (range: 15 to 50)]. Staples were used for fixation in all patients. For clinical assessment, the AOFAS (American Orthopaedic Foot and Ankle Society) ankle- hindfoot scale was used. Anteroposterior/lateral side talocalcaneal and talus-1st metatarsal angles were used as radiographic parameters. The mean follow-up was 7.5 years (range: 6 to 11). The mean AOFAS score rose from a preoperative 39 (range: 15 to 52) to 88 (range: 76 to 94) in the final follow up (p<0.0001). Among the 15 feet, 9 were evaluated as excellent, 5 as good, and 1 as fair. Significant clinical improvement was obtained between preoperative and postoperative surgical periods (p<0.05). Significant improvements were observed in radiographic parameters (p<0.0001). At final follow-up, radiographic values were within normal physiological limits. Average union time was 12.4 (range: 7 to 36) weeks. While pseudoarthrosis was not observed in any patients, delayed union developed in 2 cases, and talus avascular necrosis in 1. In the preoperative period, 5 patients had various degrees of degenerative changes. Nine patients developed degenerative changes in different joints and of different degrees. The authors believe that massive soft tissue release and triple arthrodesis performed in a single session yields satisfactory results cosmetically and functionally in neglected clubfoot cases with severe deformities.

Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities.

This current concepts review outlines the role of different imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available.

Acromial stress fractures: correlation with acromioclavicular osteoarthritis and acromiohumeral distance.

Fractures around the acromion are a known complication of reverse total shoulder arthroplasty. The literature provides limited data on the risk factors associated with this complication as well as the ultimate outcomes after nonoperative treatment. The goal of this study was to report clinical outcomes in patients with acromial fractures after nonoperatively treated reverse total shoulder arthroplasty. The authors performed a retrospective review of 125 patients undergoing reverse total shoulder arthroplasty that included several acromial stress fractures in the postoperative period. They prospectively compared radiographic data, including acromiohumeral distance, the presence of acromioclavicular joint arthritis, clinical measures of motion, visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE) score, in 2 groups based on the presence or absence of fracture in the postoperative period. Fourteen patients (11.2%) had an acromial fracture after reverse total shoulder arthroplasty at an average of 5.1 months postoperatively. Patients who had fractures had worse postoperative forward elevation before fracture (116.6 vs 143.5; P=.02) and greater pain relief after reverse shoulder replacement, before fracture (P=.04). No significant difference was found between groups when the degree of arm lengthening was compared (27.6 vs 26.2 mm), and no difference was found in the prevalence of degenerative acromioclavicular joint changes identified preoperatively (66.4% vs 77.3%). After conservative management, most patients who had an acromial fracture returned to a functional level that was comparable to that achieved before fracture.

English

Variation in the articular facet of the sustenticulum tali have been described by many authors. Most researchers view these differences in facet configuration as anatomical variations of no functional significance. Bruckner (1987), for the first time argued that these facet configurations affect joint stability. The purpose of this study was to determine the talar facet configuration of calcanei in India, measure the angle between the anterior and middle facet planes of these calcanei, and assess the relation between the above parameters and the degenerative changes in the subtalar joints. Study was conducted in 220 calcanei of unknown age & sex. The facet patterns observed were fused anterior and middle facets (Type I), three separate facets (Type II), absence of the anterior facet (Type III) and three merged facets (Type IV). Osteoarthritic changes studied are lipping, eburnation on visual inspection and subchondral sclerosis on radiographs. Present study reveals that the talar facet configuration of calcanei and the angle between the anterior and middle facets influence the stability of the subtalar joints and development of osteoarthritis.

Degenerative changes of the sacroiliac joint after spinal fusion: an evidence-based systematic review.

The rate of fusion surgery of the lumbar spine has remarkably increased over the past 30 years. We performed a comprehensive search of studies addressing the assessment of sacroiliac joint (SIJ) after lumbar spinal fusion surgery on PubMed, OVID/Medline, Cochrane, CINAHL, Google scholar and Embase. The fusion of spinal segments leads to degenerative changes in the mobile segments above or below the fused spine, because of the increase of the stresses imposed on the adjacent levels. There is no consensus about prevalence and potential risk factors contributing to SIJ degenerative changes in patients undergoing fusion surgery. Studies using radiographic evaluation to detect degenerative changes of the SIJ are being performed. No definitive estimation about the prevalence of degenerative changes of the SIJ after fusion surgery can be provided. Further studies are required to identify the risk factors involved in post-fusion degenerative changes of the SIJ.

Late volar plate repair for chronic, post-traumatic hyperextension deformity of the proximal interphalangeal joint of the little finger

A chronic traumatic hyperextension of the proximal interphalangeal (PIP) joint can result from traumatic volar plate (VP) disruption. For the treatment of this disorder, reconstruction procedures have been traditionally recommended, because the condition of the VP was not considered susceptible to repair due to retraction or attenuation. The purpose of this paper is to present the operative technique and report the clinical results of late VP repair. Late VP repair was performed for chronic, post-traumatic hyperextension deformity of the PIP joint of the little finger resulting from VP disruption in seven consecutive patients. The range of motion and the lateral stability of the PIP joint were evaluated. The radiographic images were also used to evaluate the alignment and degenerative changes of the PIP joint. Clinical results were classified according to Catalano’s criteria. Intraoperative findings showed that the VP could be mobilised and repaired in all cases. The hyperextension was well corrected, and none showed recurrence of the initial deformity. Average flexion of the PIP joint was 92° (range = 75–98°), and flexion contracture was 9° (range = 0–20°). On clinical evaluation, there were two excellent, three good, and two fair results. The postoperative radiographs revealed no degenerative change in the PIP joint in six patients. Late VP repair is a successful and reliable alternative and more physiologic than other reconstruction methods. One should first consider late VP repair, despite a long interval between injury and repair.

Prevalence of degenerative changes of the atlanto-axial joints

Background contextDegeneration of the atlantodens and atlanto-axial joints is associated with cervical spine pain and may also be associated with an increased risk of dens fracture. However, there is paucity of literature describing the prevalence of specific degenerative changes in the atlantodens and atlanto-axial facet joints. PurposeTo document age-related degenerative changes of the cervical spine in a large cohort of patients. Study design/settingThis is a retrospective cohort study. Patient sampleAdult trauma patients were admitted to our Level 1 trauma center. Outcome measuresOsteoarthritis of the atlantodens and atlanto-axial facet joints of the cervical spine and the presence of intraosseous cyst and calcific synovitis, as determined by computed tomography (CT) scans. MethodsWe conducted a retrospective study of 1,543 adult trauma patients who received a cervical spine CT scan. The anterior atlantodens joint interval was measured. The presence or absence of intraosseous cysts and calcific synovitis was recorded. Degeneration of the atlantodens and atlanto-axial facet joints at age intervals was quantified. ResultsThe atlantodens interval narrowed linearly with age (R2=0.992, p<.001). The prevalence of intraosseous cysts increased exponentially with age from 4.2% to 37.4%, and calcific synovitis increased from 0% to 11.1%. Intraosseous cyst formation generally began in the second and third decades of life and synovitis in the fifth and sixth decades of life. Facet joints also demonstrated age-related changes; however, the rate of degenerative changes was lower than in the atlantodens joint. ConclusionsTo our knowledge, this is the first study that documents specific changes of both atlantodens and atlanto-axial facet joints as a function of age in a large cohort of 1,543 patients. These changes increased exponentially with age and may contribute to pain and limitation in motion. In light of our findings and recent studies demonstrating the association between degeneration and dens fracture in elderly, cervical spine radiographs of elderly patients should be carefully assessed for these changes.

Comparative Study on Immediate Versus Delayed Meniscus Allograft Transplantation

Background: Meniscus allograft transplantation (MAT) is generally used for patients who sustain symptoms after meniscectomy, which could be called delayed MAT. Meniscus allograft transplantation for patients immediately after meniscectomy has not been reported. Hypothesis: Compared with the conventional delayed MAT, immediate MAT might provide better clinical results and reduce joint degeneration. Study Design: Cohort study; Level of evidence, 3. Methods: The study was performed with 18 transplanted menisci (6 medial, 12 lateral) from 16 patients. Eight menisci were transplanted immediately after meniscectomy (IM group); 10 menisci, from patients who complained of knee symptoms at a mean time of 35 months (range, 9-92 months) after total meniscectomy, underwent delayed transplantation (DE group). Fourteen patients undergoing meniscectomy during the same period were included as controls (ME group). Degenerative changes in knee joints were evaluated by plain radiographs and magnetic resonance imaging (MRI). Allograft extrusion and relative percentage of extrusion were measured on MRI. Other outcome assessments included preoperative and postoperative International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores; visual analog scale (VAS) for pain; and range of motion and isokinetic muscle strength evaluation. Results: The mean length of follow-up was 50.8 months (range, 44-62 months) for the IM group, 72.0 months (range, 44-94 months) for the DE group, and 54.3 months (range, 45-62 months) for the ME group. A statistically significant difference in favor of the IM and ME groups was found on the VAS (0.4 [IM group] vs 1.1 [ME group] vs 2.5 [DE group]) and muscle strength (P < .05). The mean IKDC score in the IM group was significantly higher than that in the DE group (93 [range, 85-99] vs 74 [range, 38-95], respectively; P < .05). The IM group showed significantly less preoperative to postoperative cartilage degeneration changes on radiographs and MRI when compared with the DE and ME groups (Kellgren-Lawrence score changes: 0.25 [IM group] vs 1.0 [DE group] vs 1.7 [ME group]; Yulish score changes: 0.25 [IM group] vs 1.0 [DE group] vs 1.1 [ME group]; P < .05). Extrusion of the allograft was observed in the body of the menisci in all patients. No significant difference was found in terms of the Lysholm score, Tegner score, joint narrowing, or meniscus extrusion (P > .05). Conclusion: Compared with delayed MAT, immediate MAT led to more satisfactory subjective results, less joint degeneration, and less muscle strength deficits. The short-term results of delayed meniscus transplantation were close to those of meniscectomy.

Strength of the porcine proximal femoral epiphyseal plate: the effect of different loading directions and the role of the perichondrial fibrocartilaginous complex and epiphyseal tubercle - an experimental biomechanical study.

BackgroundThe high loads on adolescent athletes’ musculoskeletal system are known to cause morphological and degenerative changes in bone, intervertebral discs and joints. It has been suggested that the cam deformity of the proximal femoral head originates from a subclinical slipped capital femoral epiphysis (SCFE) as a result of non-physiological loading. The perichondrial fibrocartilaginous complex (PFC) and the epiphyseal tubercle are believed to stabilise the proximal femoral epiphysis, but their role is still unclear. The aim of the present study was to develop an experimental, biomechanical model to evaluate the strength of the porcine proximal femoral epiphysis in different loading directions and, furthermore, to investigate the stabilising role of the PFC and the epiphyseal tubercle.MethodsA descriptive laboratory study. An in-vitro model was developed and nine young (5 months) porcine proximal femoral epiphyses were loaded to failure; three in the anterior-posterior direction, three in the lateral-medial direction and three in the vertical direction. The injured proximal femoral epiphyses were then examined both macroscopically and histologically.ResultsAnterior and lateral loading of the proximal femoral epiphysis resulted in failure of the epiphyseal plate, while vertical loading resulted in a fracture epiphyseolysis. The epiphysis was weakest when exposed to a lateral load and strongest when exposed to a vertical load. Despite histological epiphyseolysis, the PFC was intact in 15 of 27 (56%) slices. In histological examinations, the epiphyseal tubercle appears to halt the slide of the epiphysis.ConclusionsWe have developed an experimental, biomechanical model to measure the strength of the proximal femoral epiphyseal plate in different loading directions. The strength of the proximal femur was weakest through the epiphyseal plate. The epiphysis was weakest when exposed to a lateral load and strongest when exposed to a vertical load. The epiphyseal tubercle and the PFC stabilise the epiphysis when the epiphyseal plate is damaged. The findings in the present study indicate that overloading the hips in growing individuals can disrupt the epiphyseal plate. These findings may have implications when it comes to understanding the pathogenesis of cam deformity of the hip.

GLYCOSAMINOGLYCAN CHANGES IN REGENERATIVE MENISCI OF THE IMMATURE RABBITS — HISTOLOGICAL AND SPECTROPHOTOMETRIC QUANTITATION

Purpose: This study was conducted primarily to compare the contents and distribution of Glycosaminoglycan (GAG) in the normal and regenerated menisci, and partly to elucidate the role of GAG in the meniscus to fulfill its function. Method: A total of 60 immature rabbits, weighing 300–400 gm and aged 4 weeks, were used for the study. Total medial meniscectomy in the right knee joint was performed in all rabbits. The medial menisci of the left knee joints were used as control. After 16, 20, 24 and 28 weeks postoperatively, the amount of GAG in normal and regenerated menisci were measured. For the measurement of quantity and distribution of GAG contents, photon absorptiometry and Safranin O staining method were used. Results: (1) In 48 of the 60 medial meniscectomized knees, menisci were regenerated in various sizes with degenerative changes of joints, especially on tibial side. (2) In normal menisci, GAG was distributed at inner and middle 1/3, while GAG in regenerated menisci was diffusely found in the entire width. (3) The concentration of GAG per 1 mg of regenerated menisci were 4.36 ± 1.68, 4.58 ± 1.14, 4.65 ± 2.21, 4.60 ± 2.06 μg in each 16, 20, 24, and 28 week groups, while those of normal menisci were 9.10 ± 2.09, 9.75 ± 3.97, 11.80 ± 8.44 and 14.51 ± 8.91 μg. (4) In normal menisci, the amount of GAG was gradually increased as rabbit got older. However, there was no statistical differences of quantitative amount of GAG of regenerated menisci among the 16, 20, 24, and 28 weeks groups during the observation periods (p &gt; 0.05). (5) There was a distinctive difference in Safranin O stainability by every 4 μg increase of GAG in both 1 mg of normal and regenerated menisci. Conclusion: This study showed the quantitative change of GAG between normal and regenerated menisci, and comparative analysis of GAG contents in the menisci by biochemical method and histological method were found to be useful tools.

Meniscal repair.

The meniscus has several important roles, such as transmission of the load, absorption of the shock in the knee joint, acting as a secondary anteroposterior stabilizer of the knee joint, and contributing to proprioception of the knee joint. Degenerative changes of the knee joint develop in the long-term follow-up even after partial meniscectomy. Thus, there has been growing interest in meniscal repair. In addition, with increased understanding of the important roles of the meniscal root and advancement of diagnostic methods, efforts have been made to ensure preservation of the meniscal roots. In this review article, we will discuss operative techniques and clinical outcomes of arthroscopic repair of the meniscus and the meniscal root and postoperative rehabilitation and complications as well.

Minimally-invasive posterior lumbar stabilization for degenerative low back pain and sciatica. A review

The most diffused surgical techniques for stabilization of the painful degenerated and instable lumbar spine, represented by transpedicular screws and rods instrumentation with or without interbody cages or disk replacements, require widely open and/or difficult and poorly anatomical accesses. However, such surgical techniques and approaches, although still considered “standard of care”, are burdened by high costs, long recovery times and several potential complications. Hence the effort to open new minimally-invasive surgical approaches to eliminate painful abnormal motion. The surgical and radiological communities are exploring, since more than a decade, alternative, minimally-invasive or even percutaneous techniques to fuse and lock an instable lumbar segment. Another promising line of research is represented by the so-called dynamic stabilization (non-fusion or motion preservation back surgery), which aims to provide stabilization to the lumbar spinal units (SUs), while maintaining their mobility and function. Risk of potential complications of traditional fusion methods (infection, CSF leaks, harvest site pain, instrumentation failure) are reduced, particularly transitional disease (i.e., the biomechanical stresses imposed on the adjacent segments, resulting in delayed degenerative changes in adjacent facet joints and discs). Dynamic stabilization modifies the distribution of loads within the SU, moving them away from sensitive (painful) areas of the SU. Basic biomechanics of the SU will be discussed, to clarify the mode of action of the different posterior stabilization devices. Most devices are minimally invasive or percutaneous, thus accessible to radiologists’ interventional practice. Devices will be described, together with indications for patient selection, surgical approaches and possible complications.

Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction.

Objective:The aim was to assess the accuracy of three-dimensional anatomical reductions achieved by open method of treatment in cases of displaced unilateral mandibular subcondylar fractures using preoperative (pre op) and postoperative (post op) computed tomography (CT) scans.Materials and Methods:In this prospective study, 10 patients with unilateral sub condylar fractures confirmed by an orthopantomogram were included. A pre op and post op CT after 1 week of surgical procedure was taken in axial, coronal and sagittal plane along with three-dimensional reconstruction. Standard anatomical parameters, which undergo changes due to fractures of the mandibular condyle were measured in pre and post op CT scans in three planes and statistically analysed for the accuracy of the reduction comparing the following variables: (a) Pre op fractured and nonfractured side (b) post op fractured and nonfractured side (c) pre op fractured and post op fractured side. P < 0.05 was considered as significant.Results:Three-dimensional anatomical reduction was possible in 9 out of 10 cases (90%). The statistical analysis of each parameter in three variables revealed (P < 0.05) that there was a gross change in the dimensions of the parameters obtained in pre op fractured and nonfractured side. When these parameters were assessed in post op CT for the three variables there was no statistical difference between the post op fractured side and non fractured side. The same parameters were analysed for the three variables in pre op fractured and post op fractured side and found significant statistical difference suggesting a considerable change in the dimensions of the fractured side post operatively.Conclusion:The statistical and clinical results in our study emphasised that it is possible to fix the condyle in three-dimensional anatomical positions with open method of treatment and avoid post op degenerative joint changes. CT is the ideal imaging tool and should be used on a regular basis for cases of condylar fractures.

Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study.

This study determines the frequency and relationship between disk position and degenerative bone changes in temporomandibular joints in children and adolescent patients with internal derangement. Study design: TMJ, MRI of 88 patients were analyzed (average age: 14.7 years-old, range age: 10-18 years-old), female n = 65 (73.9%) and male n = 23 (26.1%). Images obtained were used to determine the frequency of disk position, joint effusion (JE) and degenerative bone changes (OA). Images were assessed by a calibrated radiologist (Kappa = 0.82). No significant association was found between disk displacement with reduction and degenerative bone changes (Chi2 = 9.894; OR = 0.375; p = 0.0017), nor disk without displacement (Chi2 = 9.448; OR = 0.223; p = 0.0021). A significant association was found between disk displacement without reduction and degenerative bone changes (Chi2 = 30.951; OR = 6.304; p = 0.0001). There is a significant association between disk displacement without reduction and degenerative bone changes (p = 0.0001) in children and adolescent patients with TMD.

L’élargissement sous arthroscopie du collet d’un kyste méniscal améliore les symptômes chez un adolescent : à propos d’un cas

Intrameniscal cysts begin with the flow of synovial fluid from a meniscal tear in one direction, enlarging probably as a result of an on-and-off valve mechanism of the tear flap. The current available literature focuses primarily on the necessity for surgery, however a large meniscus resection to remove cysts may place an additional burden on menisci, leading ultimately to knee joint degenerative changes. In this article, we present a rare case of intrameniscal cysts with an isolated horizontal meniscal tear in an adolescent, and describe a new arthroscopic procedure for treating this type of intrameniscal cyst. We performed arthroscopic partial release of the meniscal tear check-valve mechanism, preventing further intrameniscal cyst expansion. The patient's clinical symptoms improved, and this procedure may also be useful in treating intrameniscal cysts with an isolated horizontal meniscal tear and can be considered as an option to preserve meniscal function and minimize degenerative arthritis in young athletes.