Lateral Collateral Ligament Tears Research Articles

Prevalence of Knee Pain Pathologies Diagnosed By Musculoskeletal Ultrasound In Nepal Police Hospital

Introduction: One of the most frequent cause of orthopedic consultancy in Nepal Police Hospital is acute and chronic knee pain. The purpose of this study was to demonstrate how musculoskeletal ultrasonography aids in the low-cost identification of knee diseases and using ultrasound to compare with the contra lateral knee can be quite beneficial when developing a treatment plan.
 Methods: A cross sectional study was conducted on 260 patients with clinically confirmed knee pain. All patients were examined by using Sonasite ultrasound machine with linear probe (7-11MHz). The ultrasound examination of the knee started with examination of anterior aspect, followed by medial aspect, lateral aspect in supine position and then in prone position for examination of posterior aspects. The data were collected, tabulated and statistically analyzed using SPSS11.1. Categorical variables were presented in number and percentage, and continuous variables were presented as mean ± SD.
 Results: In our study, among the 260 cases there were 164 male patients (63.07%) and 96 females (36.93%) with their age ranged between 25-55 years with the mean age of 40 years. Among 260 cases, 103 patients (39.61%) with knee pain had normal finding and 157 patients (60.39%) had knee pathologies. We found joint effusion (8.91%), quadriceps tendinopathy (3.82%), patellar tendinopathy (1.91%), medial meniscal tear (11.46%), lateral meniscal tear (4.45%), synovial hyperplasia (5.73%), medial collateral ligament tear (10.82%), lateral collateral ligament tear (7%), baker,s cyst(2.54%) and osteophytes(43.31%).
 Conclusions: An efficient imaging technique that may be used as a screening tool for individuals experiencing knee pain is musculoskeletal ultrasound.

Increasing rates of ulnar collateral ligament repair outpace reconstruction in isolated injuries: review of a Texas surgical database

The gold standard of treatment for ulnar collateral ligament (UCL) injuries has been reconstruction. Despite early repair studies yielding less than satisfactory results, there has been recent renewed interest in UCL repair due to improved outcomes and new technologies. Data regarding clinical use of these procedures are lacking. The purpose of this study was to define the epidemiological trends of UCL repair and reconstruction surgery from 2010 to 2019, compare demographic characteristics of patients undergoing either procedure, and determine incidence of concomitant procedures in each surgical group as well as comparing respective patient-level charges. A retrospective database analysis of UCL surgeries was performed through the Texas Healthcare Information Collection database, a comprehensive and publicly available statewide billing dataset. Inclusion criteria were defined using Current Procedural Terminology billing codes for elbow UCL repair and reconstruction between 2010 through 2019, excluding patients who had concomitant elbow fractures or lateral collateral ligament tears indicative of high-energy trauma. Procedural volume changes, patient demographics, and commonly performed concomitant procedures including elbow arthroscopy, ulnar nerve surgery, and platelet-rich plasma injection were compared. Total patient-level charges were compared across groups. A total of 1664 patients were included, consisting of 484 UCL repairs and 1180 reconstructions. Total UCL surgeries increased eleven-fold when corrected for population growth from 2010 (N=25) to 2019 (N=315). In 2010, repair constituted 23% of all UCL tear surgeries and increased to 40% by the end of 2019. The annual frequency of UCL repair increased at a 5.4% faster rate than UCL reconstruction from 2010 to 2019 (P<.001). There were no significant differences between any demographic data between UCL repair and reconstruction except for rural surgical settings which demonstrated 1.8 times greater odds of undergoing reconstruction (P=.05). There were no differences among commonly associated procedures including ulnar nerve surgery (P=.217), elbow arthroscopy (P=.092), and platelet-rich plasma injection (P=.837) with no differences in patient-level charges at any time point (P=.47). While reconstruction remains more common, the annual frequency of UCL repair is increasing at a faster rate. Since were no demographic differences aside from surgical setting, it can be inferred that patients who were previously receiving reconstruction are instead undergoing repair. This highlights the need for future studies to further identify surgical indications for the two interventions.

Classifications in Brief: The Schenck Classification of Knee Dislocations.

Classifications in Brief: The Schenck Classification of Knee Dislocations.

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

Accuracy of internet images of ligamentous knee injuries

ABSTRACTBackground: The internet is an easily accessible resource for both providers and patients. Despite this, the internet is not peer reviewed, leaving searches subject to inaccuracies, especially with regards to medical information. The purpose of this study was to review internet images of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) tears using two popular search engines: Google and Bing.Methods: A search query was performed on both Google and Bing for the following terms: ‘ACL tear’, ‘PCL tear’, ‘MCL tear’ and ‘LCL tear’. The first 100 images of each individual search were analyzed by three independent orthopedists.Results: The inter-rater reliability was very good for PCL tear on Bing (Cronbach’s alpha = 0.89) and excellent (Cronbach’s alpha > 0.9) for the remainder of the search queries. When comparing Google to Bing, the only significant difference occurred in the ACL group, with Bing returning a significantly greater number of correct images 60%, 95% CI: 53.2 – 66.7%) compared to Google (45% correct, 95% CI: 38.1–51.8%), p = 0.034. With regards to the other ligaments Bing was more accurate than Google for PCL (39% versus 38%), and LCL (32% to 30%). Both sites were 48% accurate for MCL tear.Conclusion: Ultimately, our study revealed that physicians should take an active role in making high quality, easy to understand medical resources and anatomic diagrams available to their patients to avoid confusion and enhance understanding when querying the internet for additional information regarding their condition.

Prediction of Meniscal and Ligamentous Injuries in Lateral Tibial Plateau Fractures Based on Measurements of Lateral Plateau Widening on Multidetector Computed Tomography Scans.

Background The influence of increasing lateral plateau widening on the frequency of meniscal and ligamentous lesions in lateral tibial plateau fractures has been examined in very few studies using plain radiographs. Because the amount of this parameter cannot be measured accurately on plain radiographs, the purpose of this survey was to look for a possible correlation between the extent of lateral plateau widening, as measured on multidetector CT (MDCT) scans, and different soft-tissue injuries determined from magnetic resonance imaging (MRI). Materials and Methods 55 patients with a lateral tibial plateau fracture were included in this retrospective case series. Patient age averaged 52.6 years (SD = 18.0). The degree of lateral plateau widening was measured on CT images. MRIs were screened for meniscal and ligamentous injuries. Results We found a significant effect of increasing lateral plateau widening on the incidence of lateral meniscus lesions (P = 0.021), lateral collateral ligament tears (P = 0.047), and the overall quantity of meniscal and ligamentous lesions (P = 0.001). Discussion MRIs are not widely used as a diagnostic tool in lateral plateau fractures of the tibia. Reasons might be the costs and the fact that it is a time-consuming examination. The results of this study may help to estimate the probability of specific soft-tissue lesions in lateral tibial plateau fractures based on measurements of lateral plateau widening on MDCT scans, and they may guide the decision for additional MRI and/or arthroscopically assisted repair.

Lateral Collateral Ligament Injury About the Knee: Anatomy, Evaluation, and Management.

The lateral collateral ligament is the primary varus stabilizer of the tibiofemoral joint. Diagnosing an injury to this ligament can be challenging in the setting of multiligamentous trauma; however, failure to recognize these injuries can result in instability of the knee and unsatisfactory outcomes after cruciate ligament reconstruction. Recent literature exploring the anatomy and biomechanics of the lateral collateral ligament has enhanced our understanding and improved diagnosis and management of these injuries. Physical examination and imaging studies also are important in diagnosis and can facilitate classification of lateral collateral ligament tears, which affects treatment decisions. Nonsurgical, reparative, and reconstructive techniques can all be used to manage lateral collateral ligament injury about the knee; the optimal treatment is selected on the basis of injury severity.

Role of the lateral collateral ligament in posteromedial rotatory instability of the elbow

Posteromedial rotatory instability (PMRI) of the elbow consists of an anteromedial coronoid fracture with lateral collateral ligament (LCL) and posterior bundle of the medial collateral ligament (PMCL) tears. We hypothesized that the LCL tear is required for elbow subluxation/joint incongruity and that an elbow affected by an anteromedial subtype 2 coronoid fracture and a PMCL tear exhibits contact pressures different from both an intact elbow and an elbow affected by PMRI. Six cadaveric elbows were tested under gravity varus stress using a custom-made machine designed to simulate muscle loads and to passively flex the elbow from 0° to 90° and measure joint contact pressures. After testing of the intact specimen (INTACT-elbow), an anteromedial subtype 2 coronoid fracture with a PMCL tear (COR+PMCL-elbow) and a PMRI injury (PMRI-elbow), after adding an LCL tear, were tested. The highest values of mean contact pressure were used for the comparison among the 3 groups. Neither subluxation nor joint incongruity was observed in the COR+PMCL-elbow. The addition of an LCL detachment consistently caused subluxation and joint incongruity. Mean contact pressures were higher in the COR+PMCL-elbow compared with the INTACT-elbow (P < .03) but lower than in the PMRI-elbow (P < .001). The LCL lesion in PMRI is necessary for elbow subluxation and causes marked elevations in contact pressures. Even without subluxation, the COR+PMCL-elbow showed higher contact pressures compared with the INTACT-elbow. Treatment of PMRI should be directed toward prevention of joint incongruity, whether by surgical or nonsurgical means, to prevent high articular contact pressures.

Matrix-induced autologous chondrocyte implantation for treatment of femoral trochlea cartilage injury

To determine the short-term effectiveness of matrix-induced autologous chondrocyte implantation (MACI) for femoral trochlea cartilage injury. A retrospective analysis was performed on the clinical data of 10 patients with femoral trochlea cartilage injury treated with MACI between June 2012 and October 2014. There were 6 males and 4 females, aged from 15 to 48 years (mean, 33 years). The left knee was involved in 3 cases and the right knee in 7 cases. Nine patients had a history of trauma, and 1 case suffered from osteochondritis dissecans. Combined injuries included meniscus injury in 1 case, anterior cruciate ligament injury in 3 cases, and lateral collateral ligament tear in 2 cases. The mean lesion depth was 2.80 mm (range, 2-7 mm), with the mean defect size of 84.85 mm 2 (range, 28.26-153.86 mm 2). The mean duration of definite diagnosis was 14 days (range, 5 days to 3 months). By using arthroscopic biopsy, 200-300 mg healthy articular cartilage at non weight-bearing area of the knee femoral trochlea was collected as a source of seed cells, which were isolated and cultured to prepare MACI membrane. The adhesion activity, growth rate, and mechanical properties of the chondrocytes on the Bio-gide collagen scaffold were evaluated. In addition, the stretch rate, tensile strength, and suture strength of scaffold were tested. MACI membrane was implanted after 2 weeks to 6 months. The visual analogou scale (VAS), Lysholm score, and Tegner movement level score at preoperation and last follow-up were used to assess the function. The MACI membrane was successfully prepared, and the human chondrocytes adhered and grew well on the Bio-gide collagen scaffold. Mechanical test showed that MACI membrane had the stretch rate of 65.27%, the tensile strength of 26.81 MPa, and the suture strength of 6.49 N, indicating good mechanical properties. MACI membrane was successfully implanted. The mean operation time was 58.5 minutes (range, 43-99 minutes), and the mean hospitalization time was 7 days (range, 6-15 days). All incisions healed well. Ten cases were followed up 9 to 16 months (mean, 12 months). Four cases underwent iliac bone graft surgery. The mean healing time was 14 weeks (range, 12-16 weeks). No complications of osteochondrolysis, knee pain, nerve and vascular injury, deep vein thrombosis, and knee adhesion occurred during follow-up. The VAS score, Lysholm score, and Tegner score at last follow-up were significantly improved when compared with preoperative scores ( t=12.060, P=0.000; t=-9.200, P=0.000; t=-14.000, P=0.000). MACI for femoral trochlea cartilage injury has good short-term effectiveness, with less injury and fast function recovery.

Knee Injury-rugby

HISTORY: A 20 year old collegiate rugby player sustained a right knee injury. A defender struck the front of his right knee resulting in hyperextension and an audible pop. He was unable to ambulate off of the field. Initial exam revealed a dislocated knee which was reduced on the field. He was taken to the ED where a CT angiogram ruled out vascular injury. He was provided with an immobilizer, crutches and was referred to a sports medicine trained orthopedic surgeon. PHYSICAL EXAM: Examination in clinic demonstrated a marked effusion. Passive range of motion showed flexion to 50 degrees, and hyperextension into mild recurvatum. Varus and valgus stress revealed increased laxity for both. Lachman’s was markedly positive. He demonstrated a complete foot drop with 0/5 strength for dorsiflexion, eversion, and extensor hallicus longus (EHL). Plantarflexion and inversion had full strength. Sensory testing showed diminished light-touch over the lateral lower leg and the dorsum of the foot. DIFFERENTIAL DIAGNOSIS: 1. Anterior cruciate ligament (ACL) tear 2. Posterior cruciate ligament (PCL) tear 3. Medial collateral ligament (MCL) tear 4. Lateral collateral ligament (LCL) tear 5. Sciatic nerve injury 6. Common peroneal nerve injury 7. Superficial peroneal nerve injury 8. Deep peroneal nerve injury TESTS AND RESULTS: Right Knee MRI: -ACL tear -PCL tear -LCL tear -Popliteus tendon tear -Posterior lateral capsule tear -Both gastrocnemius tears -Posterior capsule tear FINAL WORKING DIAGNOSIS: -ACL tear, PCL tear, LCL tear, Popliteal tendon tear, posterior capsule tears, gastrocnemius tears, and a common peroneal nerve injury TREATMENT AND OUTCOMES: 1. The patient underwent arthroscopic reconstruction of his ACL and PCL, open LCL reconstruction, posterior lateral corner reconstruction, and a common peroneal nerve decompression. 2. He is undergoing physical therapy and he has advanced his range of motion back to normal. He continues to work on his quadriceps strength, hip flexor strength, balance and neuromotor control of the knee. 3. The patient experienced improved sensation in the peroneal nerve distribution and slight EHL activation at 52-days post surgery. This has continued to improve and the patient is able to dorsiflex, evert and activate his EHL against resistance at four months post surgery. Sensation is much improved.

Fracture pattern characteristics and associated injuries of high-energy, large fragment, partial articular radial head fractures: a preliminary imaging analysis.

BackgroundHigh-energy radial head injuries often present with a large partial articular displaced fragment with any number of surrounding injuries. The objective of the study was to determine the characteristics of large fragment, partial articular radial head fractures and determine any significant correlation with specific injury patterns.Materials and methodsPatients sustaining a radial head fracture from 2002−2010 were screened for participation. Twenty-five patients with documented partial articular radial head fractures were identified and completed the study. Our main outcome measurement was computed tomography (CT)-based analysis of the radial head fracture. The location of the radial head fracture fragment was evaluated from the axial CT scan in relation to the radial tuberosity used as a reference point. The fragment was characterized by location as anteromedial (AM), anterolateral (AL), posteromedial (PM) or posterolateral (PL) with the tuberosity referenced as straight posterior. All measurements were performed by a blinded, third party hand and upper extremity fellowship trained orthopedic surgeon. Fracture pattern, location, and size were then correlated with possible associated injuries obtained from prospective clinical data.ResultsThe radial head fracture fragments were most commonly within the AL quadrant (16/25; 64 %). Seven fracture fragments were in the AM quadrant and two in the PM quadrant. The fragment size averaged 42.5 % of the articular surface and spanned an average angle of 134.4°. Significant differences were noted between AM (49.5 %) and AL (40.3 %) fracture fragment size with the AM fragments being larger. Seventeen cases had associated coronoid fractures. Of the total 25 cases, 13 had fracture dislocations while 12 remained reduced following the injury. The rate of dislocation was highest in radial head fractures that involved the AM quadrant (6/7; 85.7 %) compared to the AL quadrant (7/16; 43.7 %). No dislocations were observed with PM fragments. Ten of the 13 (78 %) fracture dislocations had associated lateral collateral ligament (LCL)/medial collateral ligament tear. The most common associated injuries were coronoid fractures (68 %), dislocations (52 %), and LCL tears (44 %).ConclusionThe most common location for partial articular radial head fractures is the AL quadrant. The rate of elbow dislocation was highest in fractures involving the AM quadrant. Cases with large fragment, partial articular radial head fractures should undergo a CT scan; if associated with >30 % or >120° fracture arc, then the patient should be assessed closely for obvious or occult instability. These are key associations that hopefully greatly aid in the consultation and preoperative planning settings.Level of evidenceDiagnostic III.

How do spanning external fixators on knee dislocation patients affect the use of MRI and knee stability?

This study sought to determine the following: (1) Does the external fixator compromise quality of imaging obtained? (2) How do findings from the evaluation under anesthesia at the time of external fixator removal compare with the initial magnetic resonance imaging (MRI) findings? This was a retrospective study of a consecutive patient series at an academic level 1 trauma center. There were 19 consecutive patients with traumatic knee dislocations and spanning external fixator applied. Each patient had a knee MRI with the external fixator in place and examination at the time of external fixator removal. A review of knee stability at the time of external fixator removal with physical examination and stress fluoroscopy were performed. Our study revealed only minor incidence of poorly visualized structures. Clinical stability was present after fixator removal in only 11 of 14 medial collateral ligament tears, 4 of 16 lateral collateral ligament tears, 1 of 19 anterior cruciate ligament tears and 3 of 19 posterior cruciate ligament tears. MRI is a useful imaging modality in the setting of knee dislocations placed in spanning external fixators. Patients' knees largely remain unstable after external fixator removal.

Successful LCL reconstruction and PCL repair for LCL tear and PCL avulsion following total knee arthroplasty

Total knee arthroplasty represents a well-established and successful procedure; however, ligament incompetence is known to negatively affect surgical outcomes. Here we present an unusual case of early total knee arthroplasty failure secondary to femoral posterior cruciate ligament (PCL) avulsion and associated lateral collateral ligament (LCL) tear, treated successfully with primary PCL repair and LCL reconstruction. For LCL reconstruction, a peroneus longus allograft was passed through an anterior to posterior bony tunnel in the fibular head and docked into a horizontal femoral tunnel. Level of evidence Case report, Level IV.

Radiographer led supplementary anterior cruciate ligament MRI sequences: Technical report

AimsTo compare different supplementary MRI sequences of the ACL to arthroscopy and determine the diagnostic performance of each sequence. To ascertain whether radiographers could identify patients requiring supplementary MRI sequences of anterior cruciate ligament (ACL) tears, without a supervising radiologist. MethodsThe study had ethical approval and two hundred and thirty one consecutive prospective MRI patients with mechanical knee symptoms (77 females, 154 males, of mean age 43.5, range 18–82 years) gave written informed consent. They then had a knee arthroscopy within seven days of the MRI. This was a pragmatic study to see if the six general MRI radiographers, each with over four years experience, could evaluate the ACL on routine orthogonal sequences (sagittal T1, Gradient Echo T2, Coronal STIR and axial fat suppressed dual echo). If they identified no ACL, then two 3D volume sequences (Dual Echo Steady State and Fast Low Angle Shot) and 2D limited sagittal oblique T1 sequences were also performed. Patients requiring extra sequences, missed by the radiographers, were recalled. The MRI sequences were independently evaluated in a blinded fashion by two consultant radiologists and a specialist radiology registrar and compared to the subsequent knee arthroscopy, as the gold standard, to determine the diagnostic performance statistics. ResultsThe cohort was on the knee arthroscopy weighting list and comprised 205 patients with chronic, 20 acute and 6 acute on chronic mechanical knee symptoms. There were no posterior cruciate, medial, or lateral collateral ligament tears at arthroscopy, used as the gold standard. The arthroscopy was normal and the radiographers correctly did not scan the extra sequence in 140 patients (72%) who then had normal arthroscopies. The radiographers did perform additional ACL sequences in 63 patients (27%). Of these, 10 patients had a partial and 12 complete ACL tears. Only two patients (0.9%) were recalled for additional sequences by the radiologist, and one ACL was normal and one had a full thickness tear at arthroscopy. The ACL evaluation for complete tears and a normal ACL on the volume sequences had a sensitivity of 100%, specificity of 97% and accuracy of 97%, excluding partial tears. Volume sequences including partial tears, had specificities and accuracies over 94%, with substantial interobserver agreement (Kappa 0.86, 95% CI 0.71–1.0). The limited oblique T1 sequence had sensitivities and negative predictive value of over 90%, but low specificity and positive predictive values and slight interobserver reliability (Kappa 0.42, 95% CI 0.2–0.6). ConclusionsFirstly, we have shown pragmatically that experienced radiographers identified almost all cases requiring supplementary MRI ACL sequences, without over scanning or needing supervision. Secondly, either volume sequence (DESS or FLASH) could be used as the supplementary sequence, to evaluate the ACL, but a limited oblique T1 sequence of the intercondylar notch cannot be recommended.

Femoral Peel-Off Lesions in Acute Posterolateral Corner Injuries: Incidence, Classification, and Clinical Characteristics

The purpose of this study was to determine the incidence of acute avulsions of the popliteus tendon (PT) and lateral collateral ligament (LCL) of the femur (peel-off lesions) in knees with multiple injured ligaments. This study also describes the tear patterns and associations based on preoperative magnetic resonance imaging (MRI), physical examination, and arthroscopic inspection with injury patterns. This was a retrospective review of a consecutive series of 48 acute grade III posterolateral knee repairs and reconstructions. All office evaluations were reviewed to determine the preoperative MRI examination results, the findings on physical examination with the patient under anesthesia, and the intraoperative arthroscopic findings. In total, 19 patients (40%) were surgically verified as having peel-off lesions. Tears were typically categorized into 3 patterns: isolated PT tear (pattern 1) (4 of 19 [21%]), combined PT and LCL tears (pattern 2) (8 of 19 [42%]), and complex tears (associated intrasubstance- and/or fibula-based injuries) (pattern 3) (7 of 19 [37%]). Of the patients, 82% (14 of 17) showed conclusive MRI signs of femoral insertion separation and discontinuity. Examination with the patient under anesthesia showed tibial external rotation of greater than 10° in 84% of patients (16 of 19) and positive varus instability in 73% (11 of 15). Arthroscopic findings of acute avulsion and a positive lateral gutter drive-through sign were found in 94% (16 of 17). In a series of 48 grade III, consecutive, acute posterolateral corner surgery cases, we found that 19 patients (40%) had peel-off lesions. For adequate clinical identification, we recommend a comprehensive diagnostic protocol, including MRI, physical examination, and arthroscopic inspection, to avoid underdiagnosis of the lesion in multiple ligament-injured knees. The lateral gutter arthroscopic evaluation is particularly sensitive for detecting the lesion. Level IV, therapeutic case series.

Foot reanimation via nerve transfer to the peroneal nerve using the nerve branch to the lateral gastrocnemius: Case report

Injury to the peroneal nerve can be devastating to a patient's daily function. By paralyzing the ankle dorsiflexors, peroneal neuropathy results in foot drop. Gait difficulties and other functional limitations impede these patients on a daily basis. Knee and ankle injuries, lacerations, and compression are only a few of many etiologies which make peroneal nerve palsy the most common neuropathy of the lower limb. We present a case of peroneal nerve palsy secondary to an ACL and lateral collateral ligament tears. This 18 year old male underwent foot reanimation via nerve transfer to the peroneal nerve using the branch from the lateral gastrocenus to tibalias anterior muscle branch. The patient was followed and assessed for function during the subsequent two years. This case reports provides a synopsis of this patient's surgical treatment, as well as a glance into the literature surrounding peroneal nerve transfer.

Prevalence of Chondral Defects in Athletes' Knees

To determine the prevalence of full-thickness focal chondral defects in the athlete's knee. We conducted a systematic review of multiple databases, evaluating studies of the prevalence of articular cartilage defects in athletes. Because of the heterogeneity of data, a meta-analysis could not be performed. Eleven studies were identified for inclusion (931 subjects). All studies were level 4 evidence. Defects were diagnosed via magnetic resonance imaging, arthroscopy, or both. Forty percent of athletes were professionals (NBA and NFL). The overall prevalence of full-thickness focal chondral defects in athletes was 36% (range = 2.4%-75% between all studies). Fourteen percent of athletes were asymptomatic at the time of diagnosis. Patellofemoral defects (37%) were more common than femoral condyle (35%) and tibial plateau defects (25%). Medial condyle defects were more common than lateral (68% vs 32%), and patella defects were more common than trochlea (64% vs 36%). Meniscal tear (47%) was the most common concomitant knee pathological finding, followed by anterior cruciate ligament tear (30%) and then medial collateral ligament or lateral collateral ligament tear (14%). Full-thickness focal chondral defects in the knee are more common in athletes than among the general population. More than one-half of asymptomatic athletes have a full-thickness defect. Further study is needed to define more precisely the prevalence of these lesions in this population.

Lateral Elbow Tendinopathy

Background: Lateral elbow tendinopathy is a common condition often diagnosed by ultrasound. Debate exists regarding which ultrasound findings correlate with disease severity and prognosis. Hypothesis: Sonographic predictors for tendon healing in patients with lateral elbow tendinopathy can be found by correlating initial ultrasound findings with subsequent changes in pain and functional disability scores after a period of nonoperative management. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Sixty-two elbows (34 right, 28 left) in 62 patients (30 male, 32 female) with a clinical diagnosis of lateral elbow tendinopathy underwent sonographic evaluation of the common extensor origin after assessment with a validated outcome measure, the Patient-Rated Tennis Elbow Evaluation (PRTEE). After 6 months of nonoperative standardized treatment (physiotherapy with eccentric loading), the PRTEE questionnaire was repeated. Results: The mean pretreatment PRTEE was 78 (range, 51-97) and posttreatment score was 29 (range, 0-91). This difference in means was found to be significant (P < .0001). A positive correlation was identified between the presence of a lateral collateral ligament tear (P < .0001) and the size of the largest intrasubstance tear (P < .0001) and poor outcome. A negative correlation was identified with amount of hypoechogenicity (P = .0009). No correlation was found with age, sex, side, duration of symptoms, thickness of tendon, or amount of neovascularity. Conclusion: The size of intrasubstance tears and presence of a lateral collateral ligament tear on ultrasound can be used to assess lateral elbow tendinopathy severity, indicate those who may not respond to nonoperative therapy, and potentially guide more invasive treatment. Those patients with a large intrasubstance tear or tears identified on ultrasound are less likely to respond to nonoperative treatment. Presence of neovascularity has little correlation with change in pain severity or functional disability and may be a poor predictor of prognosis.

Knee Joint: Comprehensive Assessment with 3D Isotropic Resolution Fast Spin-Echo MR Imaging—Diagnostic Performance Compared with That of Conventional MR Imaging at 3.0 T

To determine whether a three-dimensional isotropic resolution fast spin-echo sequence (FSE-Cube) has similar diagnostic performance as a routine magnetic resonance (MR) imaging protocol for evaluating the cartilage, ligaments, menisci, and osseous structures of the knee joint in symptomatic patients at 3.0 T. This prospective, HIPAA-compliant, institutional review board-approved study was performed with a waiver of informed consent. FSE-Cube was added to the routine 3.0-T MR imaging protocol performed in 100 symptomatic patients (54 male patients with a median age of 32 years and 46 female patients with a median age of 33 years) who subsequently underwent arthroscopic knee surgery. All MR imaging studies were independently reviewed twice by two musculoskeletal radiologists. During the first review, the routine MR imaging protocol was used to detect cartilage lesions, ligament tears, meniscal tears, and bone marrow edema lesions. During the second review, FSE-Cube with multiplanar reformations was used to detect these joint abnormalities. With arthroscopic results as the reference standard, the sensitivity and specificity of FSE-Cube and the routine MR imaging protocol in the detection of cartilage lesions, anterior cruciate ligament tears, and meniscal tears were calculated. Permutation tests were used to compare sensitivity and specificity values. FSE-Cube had significantly higher sensitivity (P = .039) but significantly lower specificity (P = .003) than the routine MR imaging protocol for detecting cartilage lesions. There were no significant differences (P = .183-.999) in sensitivity and specificity between FSE-Cube and the routine MR imaging protocol in the detection of anterior cruciate ligament tears, medial meniscal tears, or lateral meniscal tears. FSE-Cube depicted 96.2% of medial collateral ligament tears, 100% of lateral collateral ligament tears, and 85.3% of bone marrow edema lesions identified on images obtained with the routine MR imaging protocol. FSE-Cube has similar diagnostic performance as a routine MR imaging protocol for detecting cartilage lesions, cruciate ligament tears, collateral ligament tears, meniscal tears, and bone marrow edema lesions within the knee joint at 3.0 T.

Ultrasound helps to direct surgery in elbow pathology

Ultrasound enables us to distinguish patients with elbow problems who will benefit from surgery from patients who need a continuation of conservative treatment. The use of ultrasound in the diagnosis of elbow pain early on when the patient first visits proves invaluable in the patient’s follow-up and treatment. Ultrasound may confirm the diagnosis of medial or lateral epicondylitis. This document can then be used as a baseline to judge the effects of treatment. However, the real purpose of using ultrasound in elbow pain is to exclude other diagnoses that may require surgery. Thickened synovial folds, loose bodies, tears of collateral ligaments can all mimic the pain and focal tenderness caused by extensor or flexor tendon degeneration. The detection of articular pathology changes the management. Surgery is readily used when a mechanical conflict interferes with the patient’s elbow function. With pain or dysfunction as the lead symptoms, we advocate ultrasound to detect: 1) loose bodies (detection/localization) (Frankel, Radiology, 1998) (Takahara, American Journal of Roentgenology, 2000); 2) ulnar and lateral collateral ligament tears (De Smet, Skeletal Radiol, 2002) (Sasaki, JBJS [Am], 2002); 3) lesions of the ulnar nerve (van Holsbeeck/Introcaso, Musculoskeletal Ultrasound, Mosby Yearbook, Elsevier Publishing Co); 4) retained foreign bodies (same ref.); 5) calcifications versus avulsions (same ref.); 6) joint inflammation or infection (same ref.).