Diagnosis Of Tears Research Articles

Diagnostic value of magnetic resonance imaging and magnetic resonance arthrography for assessing acetabular labral tears: A systematic review and meta-analysis.

This study aimed to systematically evaluate the value of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the diagnosis of acetabular labral tears. Databases including PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on magnetic resonance in the diagnosis of acetabular labral tears from inception to September 1, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RevMan 5.3, Meta Disc 1.4, and Stata SE 15.0 were used to investigate the diagnostic value of magnetic resonance in patients with acetabular labral tears. A total of 29 articles were included, involving 1385 participants and 1367 hips. The results of the meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, area under the curve of the summary receiver operating characteristic, and Q* of MRI for diagnosing acetabular labral tears were 0.77 (95% confidence interval [CI], 0.75-0.80), 0.74 (95% CI, 0.68-0.80), 2.19 (95% CI, 1.76-2.73), 0.48 (95% CI, 0.36-0.65), 4.86 (95% CI, 3.44-6.86), 0.75, and 0.69, respectively. The pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, area under the curve of the summary receiver operating characteristic, and Q* of MRA for diagnosing acetabular labral tears were 0.87 (95% CI, 0.84-0.89), 0.64 (95% CI, 0.57-0.71), 2.23 (95% CI, 1.57-3.16), 0.21 (95% CI, 0.16-0.27), 10.47 (95% CI, 7.09-15.48), 0.89, and 0.82, respectively. MRI has high diagnostic efficacy for acetabular labral tears, and MRA has even higher diagnostic efficacy. Due to the limited quality and quantity of the included studies, the above results should be further validated.

Handheld Ultrasound Does not Replace Magnetic Resonance Imaging for Diagnosis of Rotator Cuff Tears

The purpose of this study was to examine the reliability and validity of handheld ultrasound (HHUS) alone versus conventional ultrasound (US) or magnetic resonance imaging (MRI) for diagnosis of rotator cuff tears and versus MRI plus computed tomography (CT) for diagnosis of fatty infiltration. Adult patients with shoulder complaints were included in this study. HHUS of the shoulder was performed twice by an orthopedic surgeon and once by a radiologist. RCTs, tear width, retraction and FI were measured. Inter- and intrarater reliability of the HHUS was calculated using a Cohen's kappa coefficient. Criterion and concurrent validity were calculated using a Spearman's correlation coefficient. Sixty-one patients (64 shoulders) were included in this study. Intra-rater agreement of HHUS for assessment of RCTs (к= 0.914, supraspinatus) and FI (к= 0.844, supraspinatus) was moderate to strong. Interrater agreement was none to minimal for the diagnosis of RCTs (к= 0.465, supraspinatus) and FI (к= 0.346, supraspinatus). Concurrent validity of HHUS compared to MRI was fair for diagnosis of RCTs (r= 0.377, supraspinatus) and fair-to-moderate FI (r= 0.608, supraspinatus). HHUS shows a sensitivity of 81.1% and specificity of 62.5% for diagnosis of supraspinatus tears, 60% and 93.1% for subscapularis tears, 55.6% and 88.9% for infraspinatus tears. On the basis of findings in this study, we conclude that HHUS is an aid in diagnosis of RCTs and higher degrees of FI in patients who are not obese, but it does not replace MRI as the gold standard. Further clinical studies on the application of HHUS comparing HHUS devices in larger patient populations and healthy patients are required to identify its utility in clinical practice. Level III.

Diagnostic Accuracy and Agreement between Magnetic Resonance Imaging and Ultrasound Finding for the Diagnosis of Rotator Cuff Tears

Objective: To determine the diagnostic accuracy and agreement between ultrasound and magnetic resonance (MR) imaging in determining rotator cuff tears.
 Study Design: Cross-sectional study.
 Place and Duration of the Study: Armed Forces Institute of Radiology and Imaging, Pak Emirates Military Hospital,Rawalpindi Pakistan, from Jul 2018 to Jan 2019.
 Methodology: Patients of either gender with a traumatic shoulder injury duration of less than 15 days were consecutively included. Rotator cuff tear on ultrasonography was diagnosed on the presence of a hypoechoic discontinuity in the tendon and accentuation of cartilage shadow, giving a 'double cortex' view while on MRI, the hyper-intense signal area within the tendon on T2W, fat-suppressed and GRE sequences, corresponding to fluid signal seen.
 Results: Of 88 patients, the mean age was 54.022±5.19 years. Ultrasound diagnosed rotator cuff tears in 42(47.7%) patients, and MRI diagnosed rotator cuff tears in 44(50.0%) patients. Diagnostic accuracy of ultrasound taking MR imaging as the gold standard showed sensitivity as 81.82%, specificity as 77.27%, negative predicted value as 78.26%, positive predicted value as 80.95%, and overall diagnostic accuracy as 79.55%. A moderate agreement was found between ultrasound and MRI findings (p-value=0.591).
 Conclusion: The findings of the current study showed significant moderate agreement between ultrasound and MR imaging in the determination of rotator-cuff tears.

Two Novel Clinical Tests for the Diagnosis of Hip Labral Tears

Background: There are few well-studied clinical tests for the diagnosis of hip labral tears. As the differential diagnosis for hip pain is broad, accurate clinical examination is important in guiding advanced imaging and identifying patients who may benefit from surgical management. Purpose: To determine the diagnostic accuracy of 2 novel clinical tests for the diagnosis of hip labral tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Clinical examination findings including the Arlington, twist, and flexion-adduction-internal rotation (FADIR)/impingement tests as performed by a fellowship-trained orthopaedic surgeon specializing in hip arthroscopy were obtained from retrospective chart review. The Arlington test ranges the hip from flexion-abduction-external rotation to FADIR while applying subtle internal rotation and external rotation motion. The twist test involves internal rotation and external rotation of the hip while weightbearing. Diagnostic accuracy statistics for each of the tests were calculated using magnetic resonance arthrography as the reference standard. Results: A total of 283 patients were included in the study with a mean age of 40.7 years (range, 13-77 years) and 66.4% were women. The Arlington test was found to have a sensitivity of 0.94 (95% CI, 0.90-0.96), specificity of 0.33 (95% CI, 0.16-0.56), positive predictive value (PPV) of 0.95 (95% CI, 0.92-0.97), and negative predictive value (NPV) of 0.26 (95% CI, 0.13-0.46). The twist test was found to have a sensitivity of 0.68 (95% CI, 0.62-0.73), specificity of 0.72 (95% CI, 0.49-0.88), PPV of 0.97 (95% CI, 0.94-0.99), and NPV of 0.13 (95% CI, 0.08-0.21). The FADIR/impingement test was found to have a sensitivity of 0.43 (95% CI, 0.37-0.49), specificity of 0.56 (95% CI, 0.34-0.75), PPV of 0.93 (95% CI, 0.87-0.97), and NPV of 0.06 (95% CI, 0.03-0.11). The Arlington test was significantly more sensitive than both the twist and FADIR/impingement tests (P < .05), while the twist test was significantly more specific than the Arlington test (P < .05). Conclusion: The Arlington test is more sensitive than the traditional FADIR/impingement test, while the twist test is more specific than the FADIR/impingement test in diagnosing hip labral tears in the hands of an experienced orthopaedic surgeon.

Detection of Shoulder Rotator Cuff Tears from X-Ray Image by Using Convolutional Neural Network

Shoulder rotator cuff tears are common disabilities of the shoulder joint caused by daily activities, sports injuries, and aging. Magnetic resonance imaging is widely used to diagnose rotator cuff tears, but radiography is a more rapid and popular imaging technique. In this study, we proposed a detection method using convolutional neural networks (CNN) on X-ray images of the shoulder for simpler diagnosis of rotator cuff tears. 139 subjects, classified into two classes according to the severity of the tear, were compared in terms of detection accuracy between five regions of interest on the shoulder and two combinations of CNN models, with a maximum accuracy of 79.3% accuracy.

Clinical Tests show High Diagnostic Accuracy in the Assessment of Degenerative Full-Thickness Rotator Cuff Tears

Introduction Currently, the diagnosis of full-thickness rotator cuff tears (FTCT) relies heavily on imaging. We suggest that clinical examination can reliably be used as a substitute for diagnostic imaging, particularly in relatively older patients who are undergoing conservative management. Our study evaluates the diagnostic value of 5 clinical tests in the assessment of FTCT in secondary care. Methods 115 patients were examined by a consultant shoulder surgeon for suspected FTCT and underwent diagnostic imaging. Clinical examination included the Empty Can test, Resisted External Rotation test, External Rotation Lag test, Belly-press test and Lift-off test. 52 of these patients were referred for shoulder arthroscopy, while the rest were managed conservatively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of these tests were calculated, comparing clinical results with arthroscopic findings. Results We show that in combination these 5 special tests have high diagnostic value for FTCT, with an overall accuracy of 90%. Both the Empty Can test and the Resisted External Rotation test had a sensitivity of 97%. While the External Rotation Lag test had poor accuracy, it was 100% successful at ruling-in tears. The Belly-press and Lift-off tests were 100% sensitive and specific for full-thickness tears of the subscapularis. Discussion and Conclusion Clinical tests for the diagnosis of full-thickness rotator cuff tears have high diagnostic value, comparable to imaging modalities explored in the literature. Overreliance on MRI and ultrasonography may not be justified, particularly in a relatively older population when a rotator cuff tear repair is not scheduled.

Combined 3D Endoanal Ultrasound and Transperineal Ultrasound Improves the Detection of Anal Sphincter Defects.

Anal sphincter injury, mainly due to obstetric or iatrogenic etiology, is the most common cause of fecal incontinence (FI). Three-dimensional endoanal ultrasound (3D EAUS) is used for assessment of the integrity and the degree of anal muscle injury. However, 3D EAUS accuracy may be hampered by regional acoustic effects, such as intravaginal air. Therefore, our aim was to examine whether a combination of transperineal ultrasound (TPUS) and 3D EAUS would improve the accuracy of detection of anal sphincter injury. We prospectively performed 3D EAUS followed by TPUS in every patient evaluated for FI in our clinic between January 2020 and January 2021. The diagnosis of anal muscle defects was assessed in each ultrasound technique by two experienced observers that were blinded to each other's assessments. Interobserver agreement for the results of the 3D EAUS and the TPUS exams was examined. A final diagnosis of anal sphincter defect was based on the results of both ultrasound methods. Discordant results were re-analyzed by the two ultrasonographers for a final consensus on the presence or absence of defects. A total of 108 patients underwent ultrasonographic assessment due to FI (mean age 69 ± 13). Interobserver agreement for the diagnosis of tear on EAUS and TPUS was high (83%) with Cohen's kappa of 0.62. EAUS confirmed anal muscle defects in 56 patients (52%), while TPUS confirmed them in 62 patients (57%). The final consensus agreed on the diagnosis of 63 (58%) muscular defects and 45 (42%) normal exams. The Cohen's kappa coefficient of agreement between the results of the 3D EAUS and the final consensus was 0.63. The combination of 3D EAUS and TPUS improved the detection of anal muscular defects. The application of both techniques for the assessment of the anal integrity should be considered in every patient going through ultrasonographic assessment for anal muscular injury.

Deep Learning Diagnosis and Classification of Rotator Cuff Tears on Shoulder MRI.

Detection of rotator cuff tears, a common cause of shoulder disability, can be time-consuming and subject to reader variability. Deep learning (DL) has the potential to increase radiologist accuracy and consistency. The aim of this study was to develop a prototype DL model for detection and classification of rotator cuff tears on shoulder magnetic resonance imaging into no tear, partial-thickness tear, or full-thickness tear. This Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study included a total of 11,925 noncontrast shoulder magnetic resonance imaging scans from 2 institutions, with 11,405 for development and 520 dedicated for final testing. A DL ensemble algorithm was developed that used 4 series as input from each examination: fluid-sensitive sequences in 3 planes and a sagittal oblique T1-weighted sequence. Radiology reports served as ground truth for training with categories of no tear, partial tear, or full-thickness tear. A multireader study was conducted for the test set ground truth, which was determined by the majority vote of 3 readers per case. The ensemble comprised 4 parallel 3D ResNet50 convolutional neural network architectures trained via transfer learning and then adapted to the targeted domain. The final tear-type prediction was determined as the class with the highest probability, after averaging the class probabilities of the 4 individual models. The AUC overall for supraspinatus, infraspinatus, and subscapularis tendon tears was 0.93, 0.89, and 0.90, respectively. The model performed best for full-thickness supraspinatus, infraspinatus, and subscapularis tears with AUCs of 0.98, 0.99, and 0.95, respectively. Multisequence input demonstrated higher AUCs than single-sequence input for infraspinatus and subscapularis tendon tears, whereas coronal oblique fluid-sensitive and multisequence input showed similar AUCs for supraspinatus tendon tears. Model accuracy for tear types and overall accuracy were similar to that of the clinical readers. Deep learning diagnosis of rotator cuff tears is feasible with excellent diagnostic performance, particularly for full-thickness tears, with model accuracy similar to subspecialty-trained musculoskeletal radiologists.

Development of artificial intelligence-based clinical decision support system for diagnosis of meniscal injury using magnetic resonance images

BackgroundMagnetic resonance imaging (MRI) examinations are often necessary for the diagnosis of meniscal injuries. Due to the quantity and detail of the images in an MRI examination, a careful reading of MR images is time-consuming even for experienced physicians. The use of artificial intelligence (AI) models for interpreting MR images may address this problem. ObjectiveThis study aimed to utilize MR images and arthroscopic findings as a dataset to develop an AI model that can help detect meniscal lesions, and thus aid in the diagnosis of meniscus injuries. MethodOur dataset comprised data from 811 knee MRI studies. MR images were labeled and annotated by two orthopedic surgeons. The training pipeline had two parts. First, Scaled-YOLOv4 was used to detect the position of the meniscus. Second, the EfficientNet-B7 model structure was used to detect meniscal tears. A brief report demonstrating the probability and the position of a normal or torn meniscus was then generated by the AI-based clinical decision support system. ResultThe Scaled-YOLOv4 model had areas under the curve (AUCs) of 0.948 and 0.963 in the sagittal and coronal views, respectively. The EfficientNet-B7 model yielded AUCs of 0.984 and 0.972 in the sagittal and coronal views, respectively. High AUCs were achieved both in meniscus localization and meniscal tear detection. DiscussionIn this study, we utilized arthroscopic findings, obtained using the optimal meniscal tear diagnosis method, as our ground truth label. Nevertheless, this approach did not provide better model performance than that based on MRI clinical reports. ConclusionsThe contributions of this paper include the following points. First, an AI-based clinical decision support system was established to detect meniscal injury based on a deep learning model algorithm. High sensitivity and specificity were achieved by the model system. The model may have substantially facilitated the diagnosis of meniscal injuries from MR images. Second, through the AI detection system, clinicians can obtain a structured report of meniscus rupture, which enables physicians to interpret images more quickly and saves time for physicians to read images.

Superior Labrum Anterior – Posterior (SLAP) Lesion: Consideration and Controversies

SLAP tears are a common pathology, observed in 26% of patients undergoing shoulder arthroscopy. First described by Andrews et al, SLAP tears were then further subclassified by Snyder et al. The variable relationship between the anterosuperior labrum and the glenohumeral ligaments has important implications for the evaluation and treatment of SLAP lesions. These normal variants include a sublabral recess / foramen (3.3%), a sublabral foramen with a cord-like MGHL (8.6%) and an absent anterosuperior labrum with a cord-like MGHL (i.e. Buford complex, 1.5%). Frequently accepted mechanisms of injury include forceful traction loads to the arm, direct compression loads, and repetitive overhead throwing activities. SLAP lesions are difficult to examine accurately, because that most SLAP lesions occur concomitantly with other shoulder injuries (e.g. glenohumeral instability, rotator cuff tears, biceps tendon ruptures), and they typically have no specific associated pain pattern. Several provocative tests for SLAP tears have been described, however, none of these tests has been found to be highly accurate for diagnosis of SLAP tears. The definitive diagnosis of SLAP lesions is best made through diagnostic arthroscopy. Treatment of these lesions is directed according to its type. Treatment ranges from non-operative management to surgical management including SLAP repair, biceps tenotomy, and biceps tenodesis. The management of Type-II SLAP (most common) of the shoulder remains a controversial topic. Whether to repair a shoulder SLAP lesion or perform a biceps tenodesis depends on a multitude of factors: patient age, activity or work level, type of SLAP tear, location of SLAP tear, and quality of labral tissue. Determining which procedure to perform does not have such a simple, one-size-fits-all solution.

Can subcoracoid effusion be a more specific finding for subscapularis tear among rotator cuff pathologies on magnetic resonance imaging?

Magnetic resonance imaging (MRI) is a well-known, noninvasive diagnostic method for rotator cuff tendon pathologies that are not very sensitive for subscapularis tendon tears. Subcoracoid effusion (SE) is an easily recognizable radiologic sign on MRI. In this study, we aimed to examine the relationship of SE with rotator cuff tear and to investigate whether SE could be a supportive finding in the diagnosis of subscapularis tear in preoperative MRI. Our hypothesis was that SE was a more specific finding of subscapularis tear than other rotator cuff tears. The data of patients who underwent shoulder arthroscopy in our clinic between 2017 and 2021 were analyzed retrospectively. Four groups were included in the study: patients with a rotator cuff tear accompanied by a subscapularis tear (group 1, n=273), patients with isolated subscapularis tear (group 2, n=57), patients with rotator cuff tear with intact subscapularis tendon (group 3, n=190), and patients without any rotator cuff pathology (group 4, n=263). Arthroscopic video records and MRIs of all patients were evaluated retrospectively. Subscapularis tendon tears were classified according to the Lafosse classification. There was a statistically significant difference between the groups in terms of the presence of SE on MRI (P=.001). The presence of SE in group 1 and group 2 was statistically significantly higher than that in both group 3 and group 4 (P=.001), and there was no significant difference between group 3 and group 4 (P>.05). A significant relationship was found between Lafosse classification and SE (P=.001). When the diagnostic powers of the detection of SSC tear and the presence of SE on MRI for SSC tear were compared, Kappa values were 0.615 (P=.001) and 0.701 (P=.001), and overall diagnostic accuracy rates were 80.3% and 85.5%, respectively. We conclude that SE is a more specific finding for subscapularis tears than other rotator cuff pathologies. We suggest that SE on MRI should also be considered in patients with a rotator cuff tear in whom a subscapularis tear was not detected in preoperative MRI and that the subscapularis tendon should be carefully evaluated during surgery in cases where the effusion is positive.

Ultrasound of Shoulder Joint Another Diagnostic Modality

Shoulder is an important joint, in fact the most important joint which needs an ultrasound evaluation for not only the diagnosis of the pathology but also its follow-up during treatment. Ultrasound is also an important modality needed for the treatment of joint pathologies like fluid aspiration or intra-articular injections. It is gaining more importance now, due to availability of the high-end digital ultrasound machines with their superior image quality, using high frequency ultrasound probes. So that now even very superficial and very thin muscle fibers, tendons and ligaments can be very well visualized. Diagnosis of small tears, inflammations and small fluid collections can now be made easily. In this paper there is technique for the ultrasound of the shoulder joint with a discussion and review of its importance. J Bangladesh Coll Phys Surg 2023; 41: 82-88

Comparison between clinical examination and magnetic resonance imaging in accurately diagnosing meniscal tears

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The primary goal of this study was to examine the correlation between clinical results, MRI scans, and Arthroscopic findings in the case of meniscal injury. We compared various parameters between clinical findings and MRI findings in case of suspected meniscus injury cases keeping Arthroscopy findings as the gold standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients coming to our OPD with complaints of knee pain were examined by an experienced orthopaedic surgeon. The sample size of our study was 60 cases. All suspected meniscal tear cases underwent clinical examination, MRI scanning and Arthroscopic examination to assess the relationship between clinical findings and MRI findings, keeping Arthroscopy findings as a gold standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For the diagnosis of medial and lateral meniscus tears, a clinical evaluation carried out by an experienced orthopaedic surgeon exhibited greater sensitivity, specificity, precision, and negative and positive predictive values than MRI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A clinical evaluation by an experienced orthopaedic surgeon yielded superior outcomes than an MRI for diagnosing meniscal injuries. MRI is indicated in case of complex knee injuries.&lt;/p&gt;

High diagnostic accuracy of magnetic resonance imaging in detecting subscapularis tendon tears by focusing on the most superior portion of the subscapularis tendon

This study aimed to test the hypothesis that identifying the exact location of the most superior portion of the subscapularis tendon using magnetic resonance imaging (MRI) provides high diagnostic accuracy in detecting subscapularis tendon tears. This study included 157 patients who underwent primary arthroscopic rotator cuff repair between 2014 and 2017. All patients underwent conventional 1.5-T MRI in our hospital, within 3months before surgery. We retrospectively compared the diagnosis of subscapularis tendon tears using MRI based on an anatomical concept focusing on the superior-most insertion point of the subscapularis tendon with intraoperative arthroscopic findings. Subscapularis tendon tears were detected in 80 (51.0%) of the 157 patients during arthroscopic evaluation. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the MRI examination were 90, 83, 85, 89, and 87%, respectively. With a kappa score of 0.83, the concordance rate between the two raters was almost perfect (95% confidence interval, 0.75-0.92). The sensitivities of the oblique-sagittal and axial sequences were 84 and 79%, respectively. Preoperative MRI evaluation focusing on the most superior portion of the subscapularis tendon demonstrated high diagnostic accuracy in detecting subscapularis tendon tears. To find the most superior portion of the subscapularis tendon tears, it was essential to check the slice at the level of the lesser tubercle tip and its adjacent slice. In addition, the combined observation of oblique-sagittal and axial sequences helped to detect subscapularis tendon tears with higher sensitivity.

Management of Third and Fourth-Degree Perineal Tears After Vaginal Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/079, December 2020).

Purpose This guideline provides recommendations for the diagnosis, treatment and follow-up care of 3rd and 4th degree perineal tears which occur during vaginal birth. The aim is to improve the management of 3rd and 4th degree perineal tears and reduce the immediate and long-term damage. The guideline is intended for midwives, obstetricians and physicians involved in caring for high-grade perineal tears. Methods A selective search of the literature was carried out. Consensus about the recommendations and statements was achieved as part of a structured process during a consensus conference with neutral moderation. Recommendations After every vaginal birth, a careful inspection and/or palpation by the obstetrician and/or the midwife must be carried out to exclude a 3rd or 4th degree perineal tear. Vaginal and anorectal palpation is essential to assess the extent of birth trauma. The surgical team must also include a specialist physician with the appropriate expertise (preferably an obstetrician or a gynecologist or a specialist for coloproctology) who must be on call. In exceptional cases, treatment may also be delayed for up to 12 hours postpartum to ensure that a specialist is available to treat the individual layers affected by trauma. As neither the end-to-end technique nor the overlapping technique have been found to offer better results for the management of tears of the external anal sphincter, the surgeon must use the method with which he/she is most familiar. Creation of a bowel stoma during primary management of a perineal tear is not indicated. Daily cleaning of the area under running water is recommended, particularly after bowel movements. Cleaning may be carried out either by rinsing or alternate cold and warm water douches. Therapy should also include the postoperative use of laxatives over a period of at least 2 weeks. The patient must be informed about the impact of the injury on subsequent births as well as the possibility of anal incontinence.

Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery.

To utilise a large cross-sectional database to analyse the effects of time duration between diagnosis of anterior cruciate ligament (ACL) tear and ACL reconstruction (ACLR) on concomitant procedures performed and subsequent surgery within 2years. An analysis from 2015 to 2018 was performed using the Mariner PearlDiver Patient Records Database. Current Procedural Terminology (CPT), and International Classification of Diseases (ICD-10) codes identified patients with a diagnosis of ACL tear who underwent subsequent ACLR. Patients were stratified in biweekly and bimonthly increments based on the time duration between initial diagnosis of ACL tear and surgical treatment. Chi-squared analysis was used to compare categorical variables, and trend analysis was performed with Cochran-Armitage independence testing. Of 11,867 patients who underwent ACLR, 76.1% underwent surgery within 2months of injury diagnosis. Patients aged 10-19 were most likely to undergo surgery within 2months of injury diagnosis (83.5%, P < 0.0001). As duration from injury diagnosis to ACLR increased from < 2months to > 6months, rates of concomitant meniscectomy increased from 9.1% to 20.5% (P < 0.0001). The overall 2-year subsequent surgery rate was 5.3%. The incidence of revision ACLR was highest for patients who underwent surgery > 6months after diagnosis (P < 0.0001), whilst the incidence of ipsilateral lysis of adhesions and manipulation under anaesthesia (MUA) was highest for patients who underwent surgery < 2months after diagnosis (P < 0.0001). ACLR at 6-8weeks after diagnosis demonstrated the lowest risk for concomitant procedures as well as 2-year subsequent surgery. The majority of patients undergo ACL reconstruction within 2months of initial ACL tear diagnosis. Delayed surgery greater than 6months after the diagnosis of an ACL rupture leads to increased need for concomitant meniscectomy as well as higher risk for revision ACLR within 2years, but immediate surgery may increase risk for knee arthrofibrosis. IV.

Multidisciplinary treatment and functional outcome evaluation of combined injuries of nerves, vessels, and flexor tendons: spaghetti wrist.

In this study, we aimed to evaluate the effectiveness of the modified Kessler technique in managing spaghetti wrist lacerations by multidisciplinary treatment. Patients who were operated and followed up with the diagnosis of spaghetti wrist tears in our clinic between January 2012 and December 2020 were included in the study. In the postoperative follow-ups, the parameters evaluating the functionality of the patients were examined. Patients were 105 male (86.7%) and 16 women (13.2%), with a mean age of 36.83 ± 16.38 years. At the final follow-up, functional outcomes were assessed. The most common injury mechanism was glass-related injuries (35.5%). The mean starting surgery time of the patients was 4.64±2.98 hours. The most frequently involved structures were the palmaris longus with a rate of 51% and the flexor digitorum superficialis with a rate of 45%. There were significant differences regarding intrinsic function and grip strength between male and female patients (p = 0.04, p = 0.21, respectively). There were significant differences regarding sensation and grip strength between smoker and nonsmoker patients (p = 0.03, p = 0.01, respectively). The number of the damaged structures was negatively correlated with postsurgical functional outcomes of four tests, including tendon function, opposition, intrinsic function, and grip strength. The physical therapy period was correlated to hand function tests (r = 0.756, p < 0.05). Nerve damage was negatively correlated with sensation (p = 0.011, r = -0.932). The modified Kessler technique is reliable with functional outcomes for spaghetti wrist injuries involving tendons, nerves, and arteries. Meticulous and early surgical treatment within the first 8 hours of spaghetti wrist injury and early initiation and long-term physical therapy are vital in patients' functional outcomes.

Quality Assessment of YouTube Content on SLAP Tears

ABSTRACT Objectives Superior labrum anterior posterior (SLAP) tears can cause shoulder pain, disability, instability, and humeral head translation. YouTube has become an increasingly popular source of medical information, but little is currently known in terms of quality control of the uploaded content. The purpose of this study was to assess the quality of YouTube videos related to the diagnosis and treatment of Superior Labrum Anterior Posterior (SLAP) tears. Methods YouTube was queried in August 2021 using the two predetermined keywords: ‘SLAP tear’ and ‘superior labral tear.’ The first 50 videos were analyzed by two independent reviewers and scored using 3 scoring systems: Global Quality Scale (GQS), the Journal of the American Medical Association (JAMA), and the Shoulder-Specific Score (SSS) to determine video accuracy and reliability. Title, number of views, video duration, video source, content type, views/day, number of likes, number of dislikes, days since upload, like ratio (Like × 100/ [Like + Dislike]) and Video Power Index (VPI) (Like ratio × View ratio/100) were all recorded and analyzed. Results The scores of most videos were low, with a mean JAMA score of 2.5 (1–4, SD 0.73), a mean GQS of 2.66 (0.5–4.5, SD 0.99) and a mean SSS of 7.13 (0–18, SD 4.39). There were significantly higher mean scores for JAMA, GQS, and SSS in the academic and independent physician categories, with a mean JAMA score of 3.11, GQS score of 3.39, and SSS score of 11 for academic sources and a mean JAMA score of 2.83, GQS score of 3.23, and SSS score of 9.23 for independent physician sources. JAMA score was significantly and positively correlated with video duration (r = 0.405, p = 0.006). Views, likes, dislikes, publication dates, and VPI were not significantly correlated with any scoring scale. Conclusion YouTube videos on the diagnosis and management of SLAP tears have low overall quality and reliability scores. Independent physician and academic institution sources received higher mean scores for JAMA, GQS, and SSS. Video quality was not correlated with number of views.

End-to-end deep learning model for segmentation and severity staging of anterior cruciate ligament injuries from MRI

PurposeThe purpose of this study was to develop a semi-supervised segmentation and classification deep learning model for the diagnosis of anterior cruciate ligament (ACL) tears on MRI based on a semi-supervised framework, double-linear layers U-Net (DCLU-Net). Materials and methodsA total of 297 participants who underwent of total of 303 MRI examination of the knee with fat-saturated proton density (PD) fast spin-echo (FSE) sequence in the sagittal plane were included. There were 214 men and 83 women, with a mean age of 37.46 ± 1.40 (standard deviation) years (range: 29–44 years). Of these, 107 participants had intact ACL (36%), 98 had partially torn ACL (33%), and 92 had fully ruptured ACL (31%). The DCLU-Net was combined with radiomic features for enhancing performances in the diagnosis of ACL tear. The different evaluation metrics for both classification (accuracy, sensitivity, accuracy) and segmentation (mean Dice similarity coefficient and root mean square error) were compared individually for each image class across the three phases of the model, with each value being compared to its respective value from the previous phase. Findings at arthroscopic knee surgery were used as the standard of reference. ResultsWith the addition of radiomic features, the final model yielded accuracies of 90% (95% CI: 83–92), 82% (95% CI: 73–86), and 92% (95% CI: 87–94) for classifying ACL as intact, partially torn and fully ruptured, respectively. The DCLU-Net achieved mean Dice similarity coefficient and root mean square error of 0.78 (95% CI: 0.71–0.80) and 0.05 (95% CI: 0.06–0.07), respectively, when segmenting the three ACL conditions with pseudo data (P < 0.001). ConclusionA dual-modules deep learning model with segmentation and classification capabilities was successfully developed. In addition, the use of semi-supervised techniques significantly reduced the amount of manual segmentation data without compromising performance.

Quantitative MRI indicators and features for partial subscapularis tendon tears on conventional shoulder MRI

BackgroundDiagnosing partial subscapularis (SSC) tendon tears still faces challenges. A failure rate of massive posterosuperior rotator cuff tear repair will be highly increased when extending more than one-third of SSC tendon. This study aims to investigate the quantitative indicators and features of partial SSC tears on conventional shoulder MRI and improve the preoperative diagnostic accuracy.Materials and methodsFour hundred and thirty-seven patients underwent MRI and arthroscopy were retrospectively reviewed; 89 patients with partial SSC tears in case group and 50 patients with normal SSC in control group were included. Six MRI features with the explicit definition of some quantitative indicators were evaluated.ResultsFissure sign showed the highest diagnostic efficiency for the partial SSC tears, with a specificity of 92%, sensitivity of 75.3%, and accuracy of 81.3%. Thinning of SSC, fluid collection under the coraco-glenoid arch (CGA), and combined SSP complete tear also showed high specificity of 86%, 80%, and 80%, respectively, while the sensitivity and accuracy were moderate, with a sensitivity of 38.2%, 50.6%, and 48.3%, respectively, an accuracy of 55.4%, 61.2%, and 59.7%, respectively. The specificity, sensitivity, and accuracy of lesser tuberosity cysts were all moderate with values of 68%, 56.2%, and 60%, respectively. However, fat accumulation under the CGA showed no significant difference between the partial SSC tears group and the control group.ConclusionSeveral specific MRI features with quantitative indicators defined in this study can be used to improve the accuracy of preoperative MRI diagnosis of partial SSC tears.