Joint Line Tenderness Research Articles

Diagnostic value of clinical tests and Mri for meniscal injury in patients with anterior cruciate ligament injury: Case series study.

Introduction and importanceMeniscal tear is one of the most common knee injuries and knee surgery procedures. It is frequently associated with an anterior cruciate ligament (ACL) injury. We conducted this study, on patients with ACL reconstruction surgeries, which were occasionally accompanied by meniscal tears, in order to determine the diagnostic value of clinical examinations for meniscal tear, both individually and in combination, in correlations to magnetic resonance imaging (MRI) scans, with the goal of improving clinical diagnosis for patients with meniscal injuries in particular, as well as meniscal injuries associated with cruciate ligament knee injuries.Case presentation50 patients were thoroughly clinically examined, using Joint line tenderness, Thessaly test, McMurray's test, Apley's test followed by MRI, before their scheduled ACL reconstruction arthroscopic surgeries. The meniscal tears were then identified during the procedure, and were treated, if necessary. The data before and after the surgery was taken into calculating, with arthroscopic findings serving as the gold standard. Results: the sensitivity, specificity and accuracy of each clinical tests and MRI scans respectively were: for medial meniscus, Joint line tenderness (70%; 53,3%; 60%); McMurray's test (80%; 73,3%: 76%); Apley's test (65%; 70%; 68%); Thessaly test(70%; 76,7%; 74%); MRI (90%; 83,3%; 86%); lateral meniscus: Joint line tenderness (73%; 66,7%; 70%); McMurray's test (69,2%; 75%: 72%); Apley's test (69,2%; 70,8%; 70%); Thessaly test (73,1%; 75%; 74%); MRI (88,5%; 87,5%; 88%). However, when combining at least two positive tests into a single composite test, the diagnostic value is considerably enhanced with sensitivity, specificity and accuracy of 85%, 73,3%, 78% for medial meniscus, 92,3%, 87,5%, 90% for lateral meniscus.Clinical discussionClinical tests are essential for diagnosis of meniscal tears, although inconsistent. A composite test consisting of at least two positive tests can considerably enhance the diagnostic value, even comparable to MRI scans. However, after the clinical examination, MRI is still necessary for the diagnostic process of meniscal injuries in particular, as well as meniscal injuries associated with cruciate ligament knee injuries.ConclusionThe combination of clinical tests and MRI images will give a precise diagnosis as well as surgical indication for meniscus injury in patients with anterior cruciate ligament tear.

An adult case of spontaneous healing of concurrent osteochondritis dissecans of the lateral femoral condyle after saucerization with meniscal repair for discoid lateral meniscus: A case report.

BackgroundThe treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear.Case presentationA 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points.ConclusionsWe experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.

Tenderness of the knee is associated with thinning of the articular cartilage evaluated with ultrasonography in a community-based cohort: The Nagahama study.

This study aimed to elucidate the association between joint line tenderness (JLT) of the knee and knee joint structural changes evaluated with ultrasonography (US) for the early diagnosis of knee osteoarthritis (KOA). This cross-sectional study included 121 participants (age 71.7 ± 5.8 years, 75 women) from a community-based population. Bilateral structural changes in the knee joint were evaluated with US, and the presence or absence of JLT was evaluated using a pressure algometer. Logistic regression analysis was performed to evaluate the odds ratios (ORs) of US findings for the presence of JLT. Moreover, when the analysis was limited to knees with pre-/early radiographic KOA, the ORs were also calculated using logistic regression analysis. Among the 242 knees, 38 had medial JLT, which was significantly associated with female sex (OR 11.87) and loss of cartilage thickness of the distal medial femoral condyle (CTh-MFC) (OR 0.12). Among 96 knees with Kellgren-Lawrence grade ≤ 2, 18 knees had medial JLT, which was also significantly associated with loss of CTh-MFC (OR 0.07) and medial osteophytes (OR 2.01). JLT is significantly associated with thinning of the femoral cartilage and larger osteophytes in elderly patients, even in those with pre-/early radiographic KOA.

Cuboid Avulsion Fracture Following Ankle Inversion Injury

A 27-year-old man reported to a physical therapist via direct access with severe left lateral midfoot pain during weight bearing. Due to joint-line tenderness, severe pain with weight bearing, and lack of findings consistent with his mechanism of injury, the patient was referred to an orthopaedic physician with a recommendation for imaging of the foot. Radiographs revealed an avulsion fracture of the cuboid. JOSPT Cases 2021;1(3):174–175. doi:10.2519/josptcases.2021.10195

Repair of a Complete Radial Tear of the Lateral Meniscus

Background: Recognizing and repairing a lateral meniscus complete radial tear is critical, as this tear pattern makes the meniscus nonfunctional for load sharing of axial forces, and the convex shape of the lateral tibial plateau increases contact pressure. Indications: The diagnosis of a lateral meniscus complete radial tear was supported by joint effusion, lateral joint line tenderness, positive McMurray test, and magnetic resonance imaging findings. Arthroscopy confirmed the complete radial tear. Technique Description: During the procedure, a self-capturing suture passer was used to pass a size 0 high-strength suture through the meniscus. To start the repair, the free ends of the suture were passed from top to bottom on both sides of the tear. These free ends were then crossed on the bottom of the meniscus to create an X configuration and passed from the bottom to top slightly further back from the first suture passes. A spinal needle and a chia were used from outside-in to create a side-to-side suture across the tear to reinforce the repair, and a knot was then tied on the outer capsule. The chia was used once again to shuttle the size 0 sutures to the exterior portion of the knee and the knots were tied on top of the capsule. Results: Postoperatively, patients are 25% weightbearing with a 0° to 90° range of motion restriction for 6 weeks, with no deep squatting for 3 months. With an isolated radial tear repair, the patient can expect to return to sport by 5 months. Radial tear repair outcomes demonstrate reduced lateral meniscus extrusion, complete meniscus healing in 86.4% of patients, and significantly improved International Knee Documentation Committee, Lysholm, and Tegner scores. Discussion/Conclusion: Repairing a complete radial tear of the lateral meniscus restores the function of the meniscus. This surgical technique provides a high rate of complete meniscus healing and excellent patient satisfaction.

MAGNETIC RESONANCE IMAGING OF LATERAL MENISCAL POSTERIOR ROOT TEARS IN THE ADOLESCENT KNEE: IS THE DIAGNOSIS MISSED, MENTIONED, OR MADE?

Background:The meniscal roots play a vital role in maintaining proper knee kinematics. Neglected meniscal root tears place excess stress on the articular cartilage and increase the risk of premature osteoarthritis. As opposed to medial meniscal root tears, lateral meniscal posterior root tears (LMPRTs) are more likely to be associated with anterior cruciate ligament (ACL) pathology. Failure to identify and address meniscal root tears may place undue loads on ACL grafts and lead to inferior post-surgical outcomes.Purpose:To examine preoperative knee magnetic resonance imaging (MRI) radiologist interpretations for the identification of lateral meniscal root pathology in children and adolescents.Methods:We performed a retrospective review of children and adolescents that underwnent knee arthroscopy between 3/1/2010 and 4/1/2020 and had an arthroscopically confirmed LMPRT. Arthroscopic findings were compared to the reading radiologist’s preoperative MRI interpretations. LMPRTs were graded using the LaPrade classification. ANOVA was performed to assess if body mass index (BMI), open physes, time from injury to MRI, time from MRI to surgery, MRI magnet field strength, musculoskeletal radiologist designation, insurance type and tear grade were associated with the preoperative MRI identification of a LMPRT.Results:During the study period, 1285 knee arthroscopies were performed. 607 of which were ACL reconstructions. 54 children were found to have a LMPRT arthroscopically and all were associated with an ACL tear 54/607 (9%). One patient had 2 preoperative MRIs for a total of 55 MRIs in 54 pateints. Average age was 16 years (range 14-21). Preoperative MRI diagnosis of a LMPRT was made in only 14/55 (25%) and missed in 22/55 (40%). In 19/55 (35%), pathology of the lateral meniscus nonspecific to the root was mentioned. Lateral joint line tenderness was present in 23/54 (46%). There was no statistical significance found in regards to patient BMI, skeletal maturity, time from injury to MRI, time from MRI to surgery, MRI magnet strength, if the radiologist was musculoskeletal fellowship-trained, or insurance type, with a reliable diagnosis. (Table)Conclusion:The final interpretation of preoperative MRIs did not provide a clear definitive diagnosis of a LMPRT in 75 % in patients. As the intraoperative management of LMPRTs can be involved and diverge from standard meniscal work, preoperative diagnosis would be advantageous. All LMPRTs in this study were associated with a concomitant ACL tear. Surgeons caring for ACL tears in children and adolescents should be prepared to treat a LMPRT regardless of a inconclusive MRI interpretation for meniscal root pathology.

Posterior knee arthroscopy facilitates the safe and effective all-inside repair of locked bucket-handle medial meniscal tear using a suture hook technique.

This study reported the outcomes of locked bucket-handle medial meniscal tear (BHMMT) repairs using an arthroscopic posterior approach during anterior cruciate ligament (ACL) reconstruction. Between 2011 and 2014, 48 patients with BHMMTs and ACL tears who met the eligibility criteria were enrolled in the present study. BHMMTs were assessed using a posterolateral transseptal portal and repaired using a posteromedial portal. Transportal ACL reconstruction was performed using hamstrings autograft. Patients were assessed based on their IKDC and Lysholm scores and Tegner activity level. Meniscal healing was clinically evaluated based on the absence of swelling, joint line tenderness, locking, and catching; McMurray test results; and the need for meniscectomy. According to follow-up assessments, the average IKDC and Lysholm scores improved significantly after 3-5years (P < 0.001) CONCLUSION: Excellent clinical outcomes were obtained when locked BHMMTs were repaired using an all-inside suture technique that employed posteromedial and posterolateral transseptal portals. IV.

An interpretable deep learning model to predict symptomatic knee osteoarthritis

Purpose: Purpose- Early prediction of knee osteoarthritis may help to initiate potential interventions or treatments sooner, which can result in preventing or delaying knee osteoarthritis development. In this study, we aim to develop a deep learning (DL) prediction model to predict the incident symptomatic radiographic knee osteoarthritis over the next 78 months using radiographs at baseline. Methods: 427 knee radiography images from the Osteoarthritis Initiative (OAI) dataset were used to train and validate our model, with a mean age of 55.7 (SD: 3.2, range: 50 - 62) years and a mean BMI of 31.7 (SD: 3.7, range: 26.1 - 47.1) kg/m2. All subjects had Kellgren-Lawrence (KL) grades of 0 or 1 without symptoms at baseline. Incident symptomatic knee osteoarthritis was defined as knee pain and a definite tibiofemoral osteophyte in the same knee developed at 78-month follow up. Attention scores and probability of symptomatic knee osteoarthritis from radiography images were first extracted using an interpretable hierarchical attention-based convolutional neural network (CNN) model. The proposed model leveraged a transfer learning approach based on VGG-16 architecture. A 5-fold stratified cross-validation was used to evaluate and tune the neural network with 20% of training data as validation set in each fold. Twelve clinical variables including: age, body mass index (BMI), gender, KL grade, varus malalignment, history of knee injury, mild symptoms, presence of Heberden nodes, joint line tenderness, crepitus, morning stiffness and postmenopausal status, along with the attention and probability scores from our trained CNN, were then fed into a logistic regression model to predict the 78-month probability of knee osteoarthritis incident for each individual. The developed model was evaluated using an independent test set of 108 baseline knee radiographs from the OAI dataset (age, BMI, KL distribution, no symptoms at baseline). Results: The developed multi-modal model using radiographs and 12 clinical variables demonstrated an area under the receiver operating characteristic curve (AUC) of 0.91 (Figure 1), which outperforms the results reported in the literature using deep learning based methods. Moreover, the proposed model is interpretable, which can detect the specific location of potential abnormalities within knee images using the learned attention scores (Figure 2). Conclusions: A novel deep learning-based predictive model that takes knee radiographs and clinical variables as inputs was developed. It can predict the risk of symptomatic knee osteoarthritis incident over the next 6.5 years with a high AUC value. The attention maps on knee images confirm that the model predictions at baseline match the knee progression pattern in the course of the disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Anti-Mullerian hormone was a serum biomarker for early knee osteoarthritis - Iwaki cohort study

Anti-Mullerian hormone was a serum biomarker for early knee osteoarthritis - Iwaki cohort study

All zones arthroscopic meniscal repair - medium term follow-up

Introduction: The menisci are crucial structures of the knee in maintaining function. Meniscal repair has gained importance as meniscectomy causes early arthritis. Arthroscopic repair of meniscus has become the mainstay of management replacing open surgery, because of decreased duration of surgical procedure and better accessibility to the tear location. Methods: This study prospectively evaluated functional outcome in 34 patients who underwent arthroscopic meniscal repair. Tears involving outer (red-red), middle and inner (white-white) zone were included for repair. Complex and degenerative tears were excluded from repair. Follow-up consisted of clinical assessment by using Barrett’s criteria and comparison of pre-operative and post-operative Lysholm knee score. In the absence of joint-line tenderness or effusion, and if the McMurray test was negative, it was considered that the repaired meniscus has healed. Results: After a minimum of 1.5 year follow-up, 32/34 of the cases that underwent meniscal repair were asymptomatic for meniscal tears. The mean Lysholm score increased to 95.2 as compared with the preoperative mean value of 61. Arthroscopic meniscal repair was not associated with any neurovascular or other major complications. Conclusion: Stabilizing the meniscal tear by arthroscopy in all three zones appears to be an effective procedure. Keywords: Meniscal repair, White-white zone, Arthroscopy.

Towards classification criteria for early-stage knee osteoarthritis: A population-based study to enrich for progressors

ObjectiveTo facilitate a greater likelihood of favorable response to new disease-modifying therapies, recruitment of patients at an earlier stage of their disease into clinical trials may be an attractive strategy. Hence, there is a need to develop widely accepted classification criteria for early-stage knee osteoarthritis (OA). We have proposed a set of classification criteria for early-stage knee OA (2018 classification criteria) now being further refined. Here, we test the draft criteria for enrichment for clinical and structural progression. DesignPerformance of the 2018 classification criteria for early stage knee OA was tested using data from the Osteoarthritis Initiative (OAI). The OAI comprises data of 4796 men and women aged 45–79 years with or at risk for knee OA at baseline. Based on the 2018 classification criteria, a knee with Kellgren & Lawrence (K&L) grade of 0-I, two out of four Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales equal or less than 85, and presence of at least one of joint line tenderness or crepitus, was considered as early-stage knee OA. Knees with K&L grade 0-I that did not fulfill the 2018 criteria, were considered as controls. Logistic regression analysis was used to evaluate the predictive performance of the criteria set for structural as well as clinical progression. We further explored the discriminatory capability of criteria by including the average KOOS4 score, and relevant clinical examination findings such as the presence of effusion and/or Heberden's nodes. ResultsWe identified 1315 (27%) knees from OAI fulfilling the 2018 early-stage knee OA classification criteria. The female to male ratio was higher in the early knee OA group compared to controls. The early-stage knee OA group were on average slightly younger and had higher body mass index vs controls (mean [SD] age: 59.2 [8.9] years vs. 60.2 [9.1] and mean [SD] BMI 28.3 [7.0] vs. 26.8 [6.0]). By applying the 2018 criteria, there was a substantial enrichment compared to controls at 48 and 96 months for both structural (OR=1.1–1.4, and AUC=0.72–0.74) and clinical progressors (OR=2.1–2.5, 95% and AUC=0.66). Expanding the clinical examination findings by including joint effusion and/or Heberden's nodes improved the enrichment for both structural and clinical progressors (OR=4.2, 95% confidence interval=3.2–5.5 and OR=3.3, 95% confidence interval=2.8–3.5, respectively). Replacing scoring of the 4 separate KOOS domains by a KOOS4 score performed comparably. ConclusionsThe proposed 2018 early-stage knee OA classification criteria showed encouraging performance characteristics with regard to an enrichment for structural and clinical progression using longitudinal OAI data. Our results indicate that the addition of clinical findings improves the performance of previous criteria to define early-stage disease and risk for progression.

Annals for Educators - 20 October 2020

Annals for Educators - 20 October 2020

Accuracy of clinical diagnosis in meniscal tears

Introduction: Meniscal injuries of the knee are common indications for arthroscopic knee surgery. Most of the meniscal tears can be diagnosed by clinical evaluation alone. This study aims to test the accuracy of the commonly performed tests for meniscal tears in our set up.&#x0D; Method: This was a prospective observational study of 32 symptomatic knees that underwent clinical evaluation followed by arthroscopy. The sensitivity, specificity and diagnostic accuracy of three clinical tests (McMurray’s test, Apley’s compression test and Joint line tenderness) were calculated against arthroscopic findings.&#x0D; Result: Among clinical tests, maximum sensitivity (94.44%) was with Joint Line Tenderness for Medial Meniscus Tear (MMT) and minimum (54.54%) with Apley’s Compression Test for Lateral meniscus Tear (LMT). Specificity was maximum (90.48%) with Joint Line Tenderness for LMT and minimum (64.28%) with Apley’s Compression Test for MMT. Diagnostic accuracy was maximum (90.6%) with McMurray’s test for LMT and minimum (75%) with Apley’s Compression Test for MMT and LMT.&#x0D; Conclusion: All three clinical tests (McMurray’s, Apley’s compression and Joint line tenderness) were found reliable for diagnosing meniscus tears. Joint Line Tenderness had the best diagnostic accuracy followed by McMurray’s test.

Comparison of Thessaly Test with Joint Line Tenderness and McMurray Test in the Diagnosis of Meniscal Tears.

Introduction:Meniscus injuries are the most frequent problem of the knee. The aim of this study was to investigate the accuracy of the Thessaly test and comparing it with those of McMurray and Joint-line tenderness tests for diagnosing meniscal tears.Materials and methods: This study was designed as a prospective observational one done in an outpatient clinic at a university hospital. 106 patients with knee pain and 82 age-matched control were included during study period (from February 2014 to January 2015). Each patient was clinically examined with McMurray, Thessaly, and joint line tenderness tests. Then, the findings were matched by MRI and arthroscopic findings. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated as main outcomes.Results:Based on MRI, Thessaly was the most sensitive for medial meniscus tears (56.2%), while McMurray and joint-line tenderness were more specific (89.1% and 88.0%, respectively). For lateral meniscus tears, McMurray was the most sensitive (56.2%) and all were specific (McMurray 89.6%, Thessaly 88.4%, joint-line tenderness 90.2%). With arthroscopy, Thessaly was the most sensitive for medial meniscus (76.6%), while McMurray and joint-line tenderness were more specific (81.0%, and 81.0%). Agreement with arthroscopy was the highest with McMurray (for medial meniscus kappa=0.40, p<0.001, and for lateral meniscus kappa=0.38, p=0.002).Conclusion:The Thessaly can be used to screen for medial meniscus tears. McMurray and joint-line tenderness should be used for suspected medial meniscus tears. For lateral meniscus, McMurray is appropriate for screening and all the tests are useful in clinic.

Atraumatic Knee Swelling - Runner

HISTORY: 38-year-old male runner with 4 months of left knee pain and swelling that he noticed worsened with running. He remembers no particular injury, increase in mileage, change in footwear, or systemic symptoms such as night sweats, weight loss, or other joint swelling. He was seen in urgent care with his exam showing an effusion and painful range of motion. He was diagnosed with a knee sprain, MRI ordered, and referred to sports medicine. In our clinic, he complained about anterolateral knee pain, persistent knee effusion, and inability to train because of pain and swelling. He denied locking or giving way. PHYSICAL EXAMINATION: Left knee with 1-2+ non-warm effusion, range of motion 0-130 degrees, lateral patellar facet tenderness, medial joint line tenderness, Lachman negative, valgus/varus testing stable, McMurray negative for click. DIFFERENTIAL DIAGNOSIS: 1. Medial meniscal tear 2. Patellar chondromalacia 3. Rheumatologic disorder 4. Pigmented nodular synovitis 5. Synovial chondromatosis TEST AND RESULTS: X-ray: small joint effusionMRI without contrast: large joint effusion, small medial meniscal tear, lateral patellar facet chondromalaciaArthrocentesis: 303,500 RBCs, 839 WBCs, no crystals; ESR 10, CRP 0.08, ANA negative, RF negative, Normal CBC; MRI with contrast: multiple round lesions on the medial posterior mid joint next to the proximal tibiofibular joint with peripheral enhancement consistent with pigmented villonodular synovitis vs infection FINAL WORKING DIAGNOSIS: 1. Pigmented villonodular synovitis 2. Medial meniscal tear 3. Patellar chondromalacia TREATMENT AND OUTCOMES: 1. Athlete was initially treated with physical therapy for the atraumatic meniscal tear. 2. Athlete had persistent effusion, with an aspiration that showed blood. This provoked review of prior MRI with concern of nodularity of synovium. Therefore an MRI with contrast was performed consistent with likely pigmented nodular synovitis. 3. Athlete evaluated by orthopedics for arthroscopy and synovial biopsy. Intraoperative findings included diffuse involvement of joint including anterior compartment, medial and lateral gutters, and the notch. Pathology consistent with pigmented villonodular synovitis. 4. Post op care complicated by poor progression of range of motion, current 10 to 70 degrees.

Associations of Joint Line Tenderness and Patellofemoral Grind With Long-Term Knee Joint Outcomes: Data From the Osteoarthritis Initiative.

To examine whether joint line tenderness and patellofemoral grind from physical examination were associated with cartilage volume loss, worsening of radiographic osteoarthritis, and the risk of total knee replacement. This study examined 4,353 Osteoarthritis Initiative participants. For each measurement of joint line tenderness and patellofemoral grind, the patterns were defined as no (none at baseline and at 1 year), fluctuating (present at either time point), and persistent (present at both time points). Cartilage volume loss and worsening of radiographic osteoarthritis over 4 years were assessed using magnetic resonance imaging and radiographs, and total knee replacement over 6 years was assessed. A total of 35.0% of participants had joint line tenderness, and 15.8% had patellofemoral grind. Baseline patellofemoral grind, but not joint line tenderness, was associated with increased cartilage volume loss (1.08% per year versus 0.96% per year; P = 0.02) and an increased risk of total knee replacement (odds ratio [OR] 1.55 [95% confidence interval (95% CI) 1.11-2.17]; P = 0.01). While the patterns of joint line tenderness were not significantly associated with joint outcomes, participants with persistent patellofemoral grind had an increased rate of cartilage volume loss (1.30% per year versus 0.90% per year; P < 0.001) and an increased risk of total knee replacement (OR 2.10 [95% CI 1.30-3.38]; P = 0.002) compared with those participants without patellofemoral grind. Patellofemoral grind, but not joint line tenderness, may represent a clinical marker associated with accelerated cartilage volume loss over 4 years and an increased risk of total knee replacement over 6 years. This simple clinical examination may provide clinicians with an inexpensive way to identify those at higher risk of disease progression who should be targeted for surveillance and management.

Arthroscopic side-to-side repair for complete radial posterior lateral meniscus root tears

BackgroundThe aim of this study was to determine the radiographic, second-look, and functional outcomes after arthroscopic side-to-side repair for complete radial posterior lateral meniscus root tears (PLMRTs).MethodsPatients who underwent arthroscopic side-to-side repair for complete radial PLMRTs were identified. Clinical assessment consisted of symptoms (locking, catching, giving way and effusion), examinations of joint-line tenderness and McMurray test, and subjective scores of International Knee Documentation Committee (IKDC), Lysholm, and Tegner. In addition, postoperative MRI scan and second-look arthroscopy were performed to assess the healing status of the repaired meniscus.ResultsTwenty-nine patients met the inclusion criteria. The mean age was 25.41 years. The mean follow-up period was 26.68 months. During the follow-up, none of the patients had symptoms of meniscal retear, lateral joint-line tenderness or a positive McMurray test. The postoperative subjective scores of IKDC, Lysholm, and Tegner improved significantly compared to the preoperative values (P = 0.01). Postoperative MRI scan showed that 28/29 (96.6%) patients achieved meniscus healing. Twenty-two patients underwent second-look arthroscopy, among whom 19 (86.4%) patients showed complete meniscus healing and 3 (13.6%) patients showed partial healing.ConclusionArthroscopic side-to-side repair was a valuable surgical repair technique for complete radial PLMRTs, which leaded to significant improvements in both objective and subjective functional outcomes with a high rate of meniscus healing.Level of evidenceLevel IV, case series.

MULTI-LIGAMENT KNEE RECONSTRUCTION AND NOVEL MENISCUS RADIAL REPAIR TECHNIQUE, WITH RETURN TO OLYMPIC LEVEL SKIING: A CASE REPORT

Multi-ligament knee injuries (MLKI) can be debilitating and often career ending injuries for athletes. Current literature reports on outcomes following these injuries for return to activities of daily life; however, there is a paucity of evidence evaluating the return to sport following a MLKI. The purpose of this case report is to describe the treatment and outcome following a MLKI and novel meniscus radial repair technique in which the athlete returned to compete in the 2018 Winter Olympic Games 14 months postoperatively. Case Report. A healthy 28-year-old female Olympic alpine skier who sustained a deep knee flexion with varus force injury to her right knee during a competitive skiing event. Examination and imaging revealed a completely torn anterior cruciate ligament (ACL) and lateral collateral ligament (LCL), complex radial tear of the lateral meniscus, medial meniscus tear, popliteofibular ligament tear, proximal tibiofibular joint ligament tear, and a common peroneal nerve neuropraxia. The athlete underwent an anatomic single-stage, multi-ligament knee reconstruction surgery which consisted of a novel meniscus radial repair technique. A return to snow progression was initiated at seven months postoperatively. At 10 months postoperatively, a physical exam revealed trace effusion, no joint line tenderness, and negative stability tests. A repeat MRI revealed adequate healing of the lateral meniscus radial repair. The athlete passed a functional sports test at 10-months postoperatively and was cleared to return to ski with no restrictions. At 12 months postoperatively, the athlete placed in an Olympic qualifying ski race. At 14 months postoperatively, the athlete competed in the 2018 Olympic Winter Games. This case report highlights the ability of an athlete to return to elite level of competition following an anatomic single-stage, multi-ligament knee reconstruction with a novel meniscus radial repair in a safe but timely manner. 4.

Giant Cell Tumor Masquerading as Lateral Meniscus Injury: A Case Report

Giant cell tumor (GCT) is a benign bone tumor with aggressive characteristics and capacity to metastasize. They are more common in the third decade of life and demonstrate a preference for being located in the epiphyseal region of long bones. They have a high local recurrence rate, which depends on the type of treatment and initial tumor presentation. Early detection of GCT is possible with proper clinical assessment and radiograph. However, due to its rarity, physicians may have neglected the possibility of bone tumor as one of the differential diagnosis for cases referred as “soft tissue injury”.We report a case of a 22-year-old lady who presented with seven-month-history of right knee pain, lateral joint line tenderness and positive McMurray test and initially treated as right lateral meniscus injury. However, the knee pain worsened over time and became persistent despite starting on physiotherapy and home-based-exercises. Upon subsequent visit two months later, she presented with tender bony swelling over the lateral tibial plateau and radiological examination revealed a lytic lesion over her proximal right tibia. Magnetic resonance imaging and histopathology testing confirmed the diagnosis of Giant cell tumor. This case report aims to increase the awareness of possible bone tumors in soft tissue injury cases and highlight the importance of detailed reassessment and reviewing diagnosis during each follow up.International Journal of Human and Health Sciences Vol. 04 No. 02 April’20 Page : 148-151

Accuracy of McMurray’s test, the modified version, and joint-line tenderness in diagnosing chronic meniscal tear in the knee joint: A cross-sectional study

Background: Special clinical tests play an important role in physical examination and are thought to diagnose meniscal injury. Among the special tests, the original McMurray’s test, the modified version of the McMurray’s test, and joint-line tenderness are commonly used in practice. There is limited research that takes into consideration the time of injury in the diagnostic accuracy of such clinical test. Therefore, in chronic meniscal injury, the diagnostic accuracy of tests is unclear and questionable. The purpose of this study was to determine the most accurate clinical tests to diagnose a chronic meniscal injury. Methods: Fifty patients were enrolled in this cross-sectional study from January 2016 to June 2017. The inclusion criteria were patients 16 yr old or older who had a chronic knee injury of at least 6 mo. All patients underwent physical examination then arthroscopy performed by the same surgeon. Five statistical parameters were calculated based on the formula: accuracy (%), sensitivity (%), specificity (%), positive predictive value (PPV %) and negative predictive value (NPV %). Results: The mean age was 25.7 yr (range, 16-44 yr; SD 6.8 yr). The modified McMurray’s test had the highest sensitivity for both medial (36.36%) and lateral lesions (35.29%). It also had the highest NPV (64.10% medial and 73.17% lateral) and PPV (72.73% medial and 66.67% lateral), as well as the highest accuracy at 66% (medial) and 72% (lateral). The original McMurray’s test had the lowest sensitivity for lateral lesions (18.75%); however, it had the highest specificity for both lesions (92.59% medial and 91.18% lateral). Joint-line tenderness had the lowest specificity at 89.29% (medial) and 87.88% (lateral), the lowest accuracy for medial lesions (60%), and the same accuracy as the original McMurray’s test (68%) for lateral lesions. Conclusions: The results indicate that the original McMurray’s test, the modified version, and joint-line tenderness have overall low sensitivity and high specificity in diagnosing chronic meniscal tears. This study also highlights that the modified McMurray’s test had a higher accuracy than the original McMurray’s test and joint-line tenderness. However, in clinical practice these tests should be used in combination for more accurate diagnosis of chronic meniscal tears. Level of Evidence: Level III.