History Of Knee Trauma Research Articles

The Epidemiology of Posttraumatic Osteoarthritis of the Knee in the United States: An Analysis of 948,853 Patients From 2000 to 2022.

Posttraumatic osteoarthritis of the knee (PTOAK) is a known sequela of bony and soft-tissue articular knee injuries, although its historically reported prevalence is highly variable with no recent population-based studies. The TriNetX/US Collaborative Network database was queried to identify adult patients diagnosed with a history of knee trauma using ICD-10-CM coding. Primary outcomes measured were yearly incidence proportion (IP), incidence rate (IR), and prevalence of knee osteoarthritis in the United States from 2000 to 2022. Chi square analyses were conducted to compare outcomes across categorical data. Regression modeling was performed to project PTOAK epidemiology to 2030. Statistical significance was held at P < 0.05 for all analyses. Nine hundred forty-eight thousand eight hundred fifty-three patients meeting criteria were identified. As of 2022, the IP of PTOAK was 5.93%, IR was 2.26 × 10 -4 cases/person-day, and prevalence was 21.1%. By strata in 2022, posttraumatic knee OA is most prevalent among the 54 to 59-year-old age group (50.9%), 60 to 64-year-old age group (50.3%), 50 to 54-year-old age group (49.7%), female patients (24.2%), and White patients (23.1%). Regression analyses revealed that the IP, IR, and prevalence of PTOAK have increased exponentially from 2000 to 2022. By 2030, the model predicts that the IP will further increase to 10.7% (95% PI = 9.79% to 11.7%), IR will be 3.79 × 10 -4 cases/person-day (95% PI = 3.28 × 10 -4 to 4.29 × 10 -4 ), and prevalence of PTOAK in the United States will be 40.6% (95% PI = 39.1% to 42.0%). These findings echo earlier, smaller scale studies but reveal an alarming rise in PTOAK prevalence, potentially doubling by 2030. The financial burden of knee OA treatment in the United States is already substantial, costing between $5.7 and $15 billion USD annually. This projected increase in prevalence could further increase healthcare expenditures by $1 to 3 billion by 2030. These results emphasize the need for additional research into factors contributing to PTOAK, evidence-based preventive public health interventions, and the development of multidisciplinary system-based care delivery optimization pathways.

Construction and validation of a functional diagnostic score in anterior cruciate ligament ruptures of the knee in the immediate post-traumatic period. Preliminary results of a multicenter prospective study

IntroductionKnee ligament injuries are frequent and their number is constantly increasing with the development of sports activities. Dynamic knee maneuvers usually make it possible to diagnose anterior cruciate ligament (ACL) injuries but they remain difficult to perform in the early post-traumatic phase. This leads to the almost systematic use of MRI scans, many of which turn out to be superfluous. The aim of this study was to construct a screening score based solely on history-taking, in order to help diagnose ACL injuries, and to define thresholds that could help inform recommendations for MRI usage. The hypothesis was that this score could distinguish a population of patients with a ruptured ACL from a population of patients with other knee injuries. Material and methodsThis prospective multicenter study included 166 patients. Patients were included if they were between 18 and 55 years of age, with knee trauma that had occurred in the last 10 days, and without a bone fracture on standard radiographs. They were excluded if the trauma required immediate surgical management and if they had a history of knee trauma. The screening score was completed by the physician. The score included the following items: assessment of pain, immediate post-traumatic functional impairment, notion of a “pop”, feeling of instability and presence of a swelling. An MRI was systematically performed and the patient consulted a referring physician to compare the initial score with the diagnosis. ResultsEighty-six patients had an injured ACL and 80 had a healthy ACL. Two thresholds could be identified. For a score lower than 4, the risk of an ACL injury was low with a sensitivity of 96% and a negative predictive value of 87%. For a score above 8, the ACL injury was highly probable with a specificity of 88% and a positive predictive value of 83%. Discussion/conclusionThe score was able to distinguish a population of patients with a ruptured ACL from a population of patients with other knee injuries. These preliminary results confirm that the selected items are relevant and that the score can help improve the diagnostic orientation of patients with recent knee trauma. Increasing the sample size in combination with an analysis of influencing factors will determine whether the performance of this score can be refined. Level of evidenceII prospective multicenter study.

Effect of Autologous Conditioned Plasma Injections in Patients With Knee Osteoarthritis.

Autologous conditioned plasma (ACP) is a commercially available platelet concentrate with promising results from clinical trials. To evaluate the clinical outcome after 3 consecutive injections of ACP in patients with knee osteoarthritis (OA) and study the influence of ACP composition and different patient factors as predictors of treatment effect. Case series; Level of evidence, 4. This prospective case series included 260 patients (307 knees) who received ACP treatment for knee OA. The mean patient age was 51 ± 10 years. Improvement up to 12 months' follow-up was measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). ACP composition was analyzed in 100 patients. The predictive value of age, sex, history of knee trauma, Kellgren-Lawrence OA grade, body mass index, and ACP composition was evaluated using generalized estimating equations. The mean overall KOOS improved from 38 ± 14 at baseline to 45 ± 18 at 3 months, 45 ± 18 at 6 months, and 43 ± 18 at 12 months (all P < .05); 40% of patients achieved an improvement above the minimal clinically important difference (MCID) of 8 after 6 months and 33% after 12 months. The variation in ACP composition did not correlate with KOOS (P > .05). Older age led to a greater clinical benefit (β = 0.27; P = .05), whereas bilateral treatment predicted worse outcomes (β = -5.6; P < .05). The improvement in KOOS after treatment with ACP did not reach the MCID in most study patients. Older age was a predictor for better outcomes. The composition of ACP varied between patients but did not predict outcomes within the evaluated range. The study findings show the limited benefit of ACP treatment for knee OA and call for caution with routine use in clinical practice.

Revisiting femoral cartilage thickness in cases with Hashimoto's thyroiditis in thyroidology: a single institute experience.

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis or autoimmune thyroiditis, is a considerable part of the spectrum of chronic autoimmune thyroid gland disorders which is pathologically associated with various degrees of lymphocytic infiltration. The purpose of the present study was to evaluate whether cartilage thickness is affected in patients with Hashimoto's thyroiditis or not in thyroidology. A total of 61 individuals had been evaluated in this case-control study, including 32 euthyroid Hashimoto's thyroiditis patients and 29 healthy subjects comparable in age, sex, and body mass index. The patients with a history of knee trauma or knee surgery, an additional systemic disease such as diabetes mellitus, or an inflammatory disease like rheumatoid arthritis, systemic lupus erythematosus, and scleroderma had not been included in the study. The thickness of the femoral articular cartilage was measured using B-mode ultrasonography, and the right lateral condyle, right intercondylar area, right medial condyle, left medial condyle, left intercondylar area, and left lateral condyle were also measured. No statistically significant difference between patients with Hashimoto's thyroiditis diagnosis and healthy controls in terms of age, age groups, gender, and body mass index (p>0.05). As a consequence, no obvious connection between autoimmune markers and cartilage thickness in patients with Hashimoto's thyroiditis was recognized. Although the diverse manifestation of Hashimoto's thyroiditis could be observed, it seems to be no liaison between thyroid autoimmunity and cartilage thickness.

Dynamic Ultrasound Assessment of the Anterior Tibial Translation for Anterior Cruciate Ligament Tears Diagnostic.

The aim of our study was to investigate the accuracy of dynamic ultrasound assessment of the anterior tibial translation, in diagnosing anterior cruciate ligament tears, and to assess its test–retest reliability. Twenty-three patients (32 ± 8.42 years; 69.56% males) with a history of knee trauma and knee instability participated in the study. Knee ultrasound was performed by an experienced orthopedic surgeon. The anterior tibial translation was measured in both knees and differences between the injured and uninjured knee were calculated. Side-to-side differences > 1 mm were considered a positive diagnosis of an ACL tear. The anterior tibial translation values were 3.34 ± 1.48 mm in injured knees and 0.86 ± 0.78 mm in uninjured knees. Side-to-side differences > 1 mm were found in 22 cases (95.65%). The diagnosis accuracy was 91.30% (95%CI: 71.96–98.92%) and sensitivity 95.45% (95%CI: 77.15–99.88%). The intraclass correlation coefficient showed an excellent test–retest reliability (ICC3,1 = 0.97 for the side-to-side difference in anterior tibial translation). The study highlights the accuracy and reliability of the dynamic ultrasound assessment of the anterior tibial translation in the diagnosis of unilateral anterior cruciate ligament tears. Ultrasound assessment is an accessible imaging tool that can provide valuable information and should be used together with physical examination in suspected cases of ACL injuries.

Primary Medial Gastrocnemius Vein Aneurysm With Thrombosis

A venous aneurysm (VA) in a calf muscle is extremely rare. In this case study, a primary medial gastrocnemius vein aneurysm (MGVA) with thrombosis is reported. A female patient presented with left medial knee pain for 2 weeks. Radiograph demonstrated severe osteoarthritis of the medial compartment of the left knee. Sonography of the knee incidentally detected a focal saccular dilation in one of the gastrocnemius veins, within the medial head of the gastrocnemius (MHG). The diameter of the dilation was almost three times its connected normal vein. Two-thirds of the saccular dilation was occupied by hyperechoic content. Duplex sonography confirmed that the dilation was a saccular MGVA with thrombosis. The patient had no history of knee trauma, surgery, or inflammation. A small Baker’s cyst, medial to the MHG, was also excluded from the cause of the MGVA. These suggest that this MGVA was of a primary cause. The complications of a MGVA are briefly discussed as part of this case study.

Bucket-handle meniscal tears in children under the age of 10: a literature review.

Background and aim of the work:Traumatic meniscal tears are raising in skeletally immature patients due to increasing participation in sport activities. Nonetheless, meniscal tears remain a rare injury in children, with a lack of evidence regarding treatment and outcome. The aim of the study is to review the literature on BHMT in children aged under 10 years.Methods:Two independent reviewers conducted a systematic search of Embase, Medline and Pubmed databases to report a summary of literature evidence about epidemiology, clinical presentation, diagnosis, treatment and outcome of BHMTs in children under the age of 10.Result:Eight papers have been considered, including seven case reports and one case series, for a total amount of 21 cases of BHMTs in children under 10 years. Complete clinical information was retrieved for 12 cases, which were analyzed in detail. The injury occurred in the medial meniscus in 8 cases (66,7%), while in 4 cases (33,3%) on a lateral discoid meniscus. The mean reported age is 4,6 years (range 2 years - 9 years), with prevalence of the female sex (62,5%).Conclusion:BHMT is an uncommon lesion in children under 10 years old. It can be suspected after a history of knee trauma in patients with knee pain, effusion and locking. MRI is the best technique for the diagnosis. Current strategy of treatment is to preserve the meniscus through different arthroscopic suture techniques, unless the lesion occurs on a discoid meniscus. (www.actabiomedica.it)

Factors associated with gonarthrosis in patients older than 40 years treated at the Hospital Santa Rosa in 2018

espanolObjetivo: Determinar los factores asociados a gonartrosis en pacientes mayores de 40 anos del Hospital Santa Rosa en 2018.Materiales y metodos: Se realizo un estudio analitico de casos y controles (61 casos y 122 controles) de pacientes mayores de 40 anos con diagnostico de gonartrosis y sin diagnostico de gonartrosis atendidos en el Hospital Santa Rosa en 2018. En ambos grupos se evaluaron los factores asociados edad, sexo, estado nutricional, hipertension arterial, diabetes mellitustipo 2, ocupacion, traumatismo de rodilla, lumbalgia, sindrome metabolico y tabaquismo. Para el analisis estadistico se emplearon la prueba de X2 y OR (regresion logistica) para el analisis estadistico. Resultados: El 88,5 % de los pacientes con gonartrosis fue del sexo femenino. De los pacientes con esta enfermedad, el 68,9 % tenian como ocupacion ama de casa; el rango de edad mas frecuente fue de 60 a 69 en los casos (45,9 %) y 50 a 59 (37,7 %) en los controles. Se encontro una asociacion significativa entre el riesgo de padecer gonartrosis y el haber presentado lumbalgia (OR = 6,395, IC 95% 3,163 – 12,929) y el sexo femenino (OR = 3, 905; IC 95% 1,632 – 9,342). En cuanto al antecedente de traumatismo de rodilla y el tabaquismo, no mostraron significancia. Conclusiones: Se concluye que el sexo femenino y la lumbalgia estan implicados en la aparicion y progresion de la gonartrosis. La edad y la ocupacion tuvieron una asociacion significativa con la presencia de esta enfermedad. EnglishObjective: To determine the factors associated with gonarthrosis in patients older than 40 years of the Hospital Santa Rosa in 2018.Materials and methods: An analytical, case-control (61 cases and 122 controls) study was carried out in patients older than 40 years of age with and without a diagnosis of gonarthrosis treated at the Hospital Santa Rosa in 2018. In both groups, associated factors such as age, sex, nutritional status, hypertension, type 2 diabetes mellitus, occupation, kneetrauma, low back pain, metabolic syndrome and smoking were evaluated. Pearson's chi-squared test and OR (logistic regression) were used for the statistical analysis. Results: Eighty-eight point five percent (88.5 %) of the patients with gonarthrosis were females. Out of the patients withthis disease, 68.9 % were housewives; the most frequent age range was 60 to 69 years in the case group (45.9 %) and 50 to 59 years in the control group (37.7 %). A significant association was found between the risk of suffering from gonarthrosis and having suffered low back pain (OR = 6.395; 95 % CI = 3.163 – 12.929) and being female (OR = 3.905; 95 % CI = 1.632 –9.342). Regarding the history of knee trauma and smoking, they did not show significance. Conclusions: It is concluded that females and low back pain are involved in the onset and progression of gonarthrosis. Ageand occupation had a significant association with the occurrence of this disease.

Role of MR Imaging in Evaluation of Traumatic Knee Lesions,

Background: MRI is an accurate, noninvasive imaging modality for evaluation of knee injuries, and determines the patient management, saving them from unnecessary arthroscopy, Aim and objectives: to emphasize the role of Magnetic Resonance imaging in the assessment of traumatic lesions of the knee joint. Subjects and methods: a cross sectional study including thirty patients with history of knee trauma, referred to perform knee MRI. The duration of the study ranged from 6-12 months (Dec. 2018 to Dec. 2019). Results: The current study showed regarding MRI findings of the studied group, that joint effusion was the commonest finding in between our study group (80%). This was followed by ACL injury (63.3%) and PHMM injury (56.7%). LCL was the least structure to be injured (3.3%). Conclusion: MRI is an extremely useful imaging modality for evaluation of knee injuries. It gives valuable information to the referring orthopaedician for planning the line of treatment in terms of conservative management or surgery. MRI is not only a diagnostic tool but also helps in correlation of injury with biomechanical forces involved in trauma and follow up post-operative patients.

Intra-articular injection with Autologous Conditioned Plasma does not lead to a clinically relevant improvement of knee osteoarthritis: a prospective case series of 140 patients with 1-year follow-up

Background and purpose — Platelet-rich plasma (PRP) is broadly used in the treatment of knee osteoarthritis, but clinical outcomes are highly variable. We evaluated the effectiveness of intra-articular injections with Autologous Conditioned Plasma (ACP), a commercially available form of platelet-rich plasma, in a tertiary referral center. Second, we aimed to identify which patient factors are associated with clinical outcome. Patients and methods — 140 patients (158 knees) with knee osteoarthritis (Kellgren and Lawrence grade 0–4) were treated with 3 intra-articular injections of ACP. The Knee Injury and Osteoarthritis Outcome Score (KOOS), pain (Numeric Rating Scale; NRS), and general health (EuroQol 5 Dimensions; EQ5D) were assessed at baseline and 3, 6, and 12 months’ follow-up. The effect of sex, age, BMI, Kellgren and Lawrence grade, history of knee trauma, and baseline KOOS on clinical outcome at 6 and 12 months was determined using linear regression. Results — Mean KOOS increased from 37 at baseline to 44 at 3 months, 45 at 6 months, and 43 at 12 months’ follow-up. Mean NRS-pain decreased from 6.2 at baseline to 5.3 at 3 months, 5.2 at 6 months, and 5.3 at 12 months. EQ5D did not change significantly. There were no predictors of clinical outcome. Interpretation — ACP does not lead to a clinically relevant improvement (exceeding the minimal clinically important difference) in patients suffering from knee osteoarthritis. None of the investigated factors predicts clinical outcome.

Arthroscopic reconstruction of medial patellofemoral ligament combined with medial displacement of lateral hemitibial tuberosity for treatment of recurrent dislocation of patella

To observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella. Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability. All incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation ( P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation ( P<0.05). According to Lysholm score, the patients' knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%. Arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.

Correlation between MRI knee and arthroscopy in knee joint injuries

In absence of joint effusion, meniscal degeneration and tears may actually decrease in SI on T2 WI. On T2* GRE images however, intrasubstance degeneration and tears generate increased SI. Hence GRE sequence is extremely sensitive to the spectrum of meniscal degeneration and tears. The FSE may underestimate the extent or Grades of MR SI thus mask the tears, which is because of a ghosting artifact or an increase in magnetization transfer as described by Rubin and colleagues. To understand the significance of increased SI in meniscal abnormalities, Stoller et al. developed a MR grading system of meniscal abnormalities and correlated with pathological model. Purposive random technique was used to select minimum of Thirty cases with history of knee trauma which are referred for MRI to Department of Radiodiagnosis; Medical College. MRI (Hitachi Aperto 0.4 Tesla) study has been done using Tl, T2, PD, fat suppression and gradient echo sequences in various planes. Images were studied for meniscal, cruciate ligament, collateral ligaments tear, fluid collections in and around the joint and also for any signal changes in the surrounding bones, muscles and tendons. Then these cases were subjected to arthroscopy.

A study on MRI appearance in injuries of knee

The menisci serve the important function of shock absorption, distribution of nutrient synovial fluid within the joint, load transmission and stability. The normal adult meniscus is homogenously low in signal intensity on all sequences. Children have intrasubstance signal within their menisci. The normal menisci on MRI, show triangular appearance and sharp central tip. In sagittal plane, on peripheral sections the anterior and posterior horns of menisci unite, forming a bowtie appearance. Purposive random technique is used to select minimum of Thirty cases with history of knee trauma which are referred for MRI to Department of Radiodiagnosis; Medical College. MRI (Hitachi Aperto 0.4 Tesla) study has been done using Tl, T2, PD, fat suppression and gradient echo sequences in various planes. The study had 30 patients out of which 20 were males and 10 were females with age ranging from 14 to 47 years with mean age of 26.5 years.to 40 age group comprises the maximum number of patients which suffered knee injuries. Right knee joint commonly involved to left.

Clinical manifestation and arthroscopic treatment of symptomatic posterior cruciate ligament cyst

BackgroundGanglion cyst of cruciate ligaments is a rare lesion; the prevalence is 0.3–0.8%. The purpose of this study was to present clinical features of symptomatic posterior cruciate ligament (PCL) cyst, introduce the arthroscopic excision technique, and evaluate the clinical outcome.MethodsA series of 11 patients with symptomatic PCL cyst from November 2012 to December 2014 were involved in this retrospective study. Detailed medical history collecting and physical examination were conducted. Magnetic resonance imaging (MRI) scan was used to confirm the diagnosis. Arthroscopic resection was performed, and the sample of the cyst was taken for pathologic examination. The follow-up averaged 30.7 months. International Knee Documentation Committee (IKDC) score, the range of motion (ROM), and MRI evaluations were obtained pre- and postoperatively to assess the surgical outcome. SPSS software was used for statistics analysis.ResultsEight males and 3 females with 6 left knees and 5 right knees were enrolled, the mean age was 34.4 years, and the duration of symptom was 19.0 months. All cases had a definite history of knee trauma or injury. The most common symptom was knee pain at flexion or in flexion-associated activities. MRI revealed the location and size of the cyst in each case. Pathologic examination showed the cyst wall was composed of dense fibroconnective tissue and widespread thick bundles of collagen, which is similar to the structure of ganglion cyst. At the final follow-up, MRI evaluation showed no cyst recurrence. The preoperative ROM and IKDC score were 2.3° to 108.6° and 40.5 ± 11.3, respectively, compared with the postoperative ROM and IKDC score which were 0° to 134.1° and 85.5 ± 4.8 (p < 0.05) separately.ConclusionsWe conclude that the etiology of symptomatic PCL cyst is most likely associated with trauma, pain on flexion is a typical manifestation of symptomatic PCL cyst, MRI evaluation is an ideal examination for the diagnosis, and arthroscopic resection of symptomatic PCL cysts has a good outcome with no recurrence.

Appropriateness of magnetic resonance imaging requested by primary care physicians for patients with knee pain.

To evaluate the appropriateness of magnetic resonance imaging (MRI) of the knee requested by primary care physicians. Retrospective observational study. Six primary care centres in the Elche Department of Health of the Valencian Community, Spain. Three hundred patients with knee pain who were prescribed MRI. Data were collected from the electronic clinical history, which allowed us to assess the appropriateness and inappropriateness of the MRI requests for the knee based on the American College of Radiology (ACR) criteria. A multivariate logistic regression model was used to identify factors associated with an inappropriate request. About 45% (41-49%) of knee MRI prescriptions were assessed as inappropriate. The frequency was higher in female patients (odds ratio, OR = 1.96; P = 0.03). A history of knee trauma and urgent use of MRI were associated with a lower frequency of inappropriate requests (OR = 0.14, P < 0.001 and OR = 0.32, P = 0.03, respectively). In 82% of cases, the request for MRI was deemed inappropriate because it was used as the initial imaging test. The availability of a previous radiograph of the knee significantly reduced the rate of inappropriate requests (OR = 0.05, P < 0.001); only 47% of the patients had a previous radiograph. The percentage of inappropriate knee MRI prescriptions is high. Protocols should be put in place to improve the appropriateness of MRI requests by promoting understanding of the appropriate use of MRI among primary care physicians.

Relationship between Clinical, MRI, and Arthroscopic Findings: A Guide to Correct Diagnosis of Meniscal Tears.

Purpose The aim of this prospective study was to compare and correlate clinical, MRI, and arthroscopic findings in cases of suspected meniscal tears. Using arthroscopic findings as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of clinical investigation and MRI were evaluated to determine if is possible, after a careful examination, to bypass MRI and perform directly arthroscopy in suspected cases. Methods A total of 80 patients with a history of knee trauma, preoperative RX, and MRI underwent arthroscopy over an 8-month period at our department. All patients had a clinical examination performed by an experienced knee surgeon. These examiners evaluated and recorded the results of three tests: medial and lateral joint line tenderness test, McMurray's test, and Apley's test. The injury was classified as a meniscal tear if there were at least two positive tests. Finally, using the arthroscopic findings as the gold standard, sensibility, specificity, accuracy, positive and negative predictive values of clinical examination, and MRI were evaluated and compared. Results Clinical examination performed by an experienced knee surgeon reported better sensitivity (91 vs. 85%), specificity (87 vs. 75%), accuracy (90 vs. 82%), positive predictive value (94 vs. 88%), and negative predictive value (81 vs. 71%) than MRI for medial meniscal tears. These parameters showed minimal differences for lateral meniscal tears. Conclusion Clinical examination performed by an experienced knee surgeon provided equal or better results to diagnose meniscal injuries in comparison to MRI. MRI is not necessary to confirm these lesions and should not be used as the primary diagnostic tool. Level of Evidence Level II, prospective study.

Changes in Cartilage and Tendon Composition of Patients With Type I Diabetes Mellitus: Identification by Quantitative Sodium Magnetic Resonance Imaging at 7 T.

The aim of this study was to investigate possible biochemical alterations in tendons and cartilage caused by type 1 diabetes mellitus (DM1), using quantitative in vivo 7 T sodium magnetic resonance (MR) imaging. The institutional review board approved this prospective study, and written informed consent was obtained. Eight DM1 patients with no history of knee trauma and 9 healthy age- and weight-matched volunteers were examined at 7 T using dedicated knee coils.All participants underwent morphological and sodium MR imaging. Region-of-interest analysis was performed manually for the non-weight-bearing area of the femoral condyle cartilage and for the patella tendon. Two readers read the image data sets independently, twice, for intrareader and interreader agreement. Normalized mean sodium signal intensity (NMSI) values were compared between patients and volunteers for each reader using analysis of variance. On morphological images, cartilage in the non-weight-bearing area and the patellar tendon was intact in all patients. On sodium MR imaging, bivariate analysis of variance showed significantly lower mean NMSI values in the cartilage (P = 0.008) and significantly higher values in the tendons (P = 0.025) of patients compared with those of volunteers. Our study showed significantly different NMSI values between DM1 patients and matched volunteers. Differences observed in the cartilage and tendon might be associated with a DM1-related alteration of biochemical composition that occurs before it can be visualized on morphological MR sequences.

Trombólisis sistémica exitosa en un paciente con tromboembolismo pulmonar masivo, luego de reanimación cardiocerebropulmonar prolongada. Informe de caso

Massive pulmonary thromboembolism is an entity with significant morbidity and mortality if not treated early. We describe the case of a young man with a history of knee trauma who was admitted to the emergency room complaining of sudden onset of dyspnea and syncope. During clinical evaluation, he had 5 episodes of cardiac arrest and required prolonged cardio pulmonary and cerebral resuscitation, the diagnosis of massive pulmonary thromboembolism was confirmed by echocardiography and computed tomographic pulmonary angiography. Despite prolonged cardio pulmonary and cerebral resuscitation is considered a relative contraindication to systemic thrombolysis, latter was performed, with remarkable clinical improvement without sequelae at discharge.

Successful systemic thrombolysis in a patient with massive pulmonary thromboembolism after prolonged cardio pulmonary and cerebral resuscitation. Case report

Massive pulmonary thromboembolism is a condition with high morbidity and mortality if not treated early. A case of a young man with a history of knee trauma that was admitted to the emergency department with sudden dyspnea and syncope is discussed. During the clinical evaluation the patient experienced 5 episodes of cardiac arrest that required prolonged cardiopulmonary-cerebral resuscitation. The diagnosis of massive pulmonary thromboembolism was confirmed by echocardiography and thoracic CT angiography. Although prolonged cardiopulmonary-cerebral resuscitation is a relative contraindication for systemic thrombolysis, the patient experienced remarkable clinical improvement with no sequelae upon hospital discharge.

PREVALENSI DAN DISTRIBUSI OSTEOARTRITIS LUTUT BERDASARKAN KARAKTERISTIK SOSIO-DEMOGRAFI DAN FAKTOR RISIKO DI WILAYAH KERJA PUSKESMAS SUSUT I, KECAMATAN SUSUT, KABUPATEN BANGLI PADA TAHUN 2014

An aging process will increase human morbidity caused by degenerative diseases and disability. Based on data in Policlinic of Rheumatology Sanglah Hospital in 2001-2002, Osteoarthritis was the highest case (37%) with proportion of Knee Osteoarthritis was 97%. In Susut I Primary Health Care, which is located in Bangli, Rheumatic placed the second rank from the list of top 10 diseases in 2013. This research used cross sectional descriptive method. Sample were elderly who are more than 50 years old and total of sample was 78 which are taken by multistage random sampling method from Banjar Susut Kaja, Susut Village, Susut Subdisctric, Bangli Regency, April 2014. The prevalence of Knee Osteoarthritis in elderly who are more than 50 years old in Susut Village in April 2014 was 62,8%. According to socio-demography characteristic , knee osteoarthritis occured more in respondents who are 50-70 years old (61.2%), women (57.1%), and had physical job (farmer, cattleman, labor and army) (65.3%). While, according to risk factors, knee osteoarthritis occured more in respondents who had underweight-normal body mass index (59.2%), with history of workload due to medium-hard (71.4%), with biomechanics factors where respondents who bring goods while worked (71.4%), and the weight of goods estimated more than 25 kg (79.6%), work frequencies with goods more than 4 times a week (53.1%), respondents who had work duration more than 17 years (91.8%), and respondents who had up and down pathway and also using stairs (77.6%). Knee osteoarthritis occured more in respondents without history of knee trauma (87.8%).Â