Longitudinal Tear Research Articles

Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon

BackgroundWe compared the clinical course of rotator cuff tears between rotator cuff exercise and bone marrow aspirate concentration (BMAC)-platelet rich plasma (PRP) injection to identify the therapeutic effects of BMAC-PRP on partial tear of the rotator cuff tendon.MethodsTwenty-four patients with partial tear of the rotator cuff tendon participated in this study. Twelve patients underwent extraction of BMACs and PRP and received the injection of BMAC-PRP at the tear site under ultrasound guidance. Twelve patients in the control group were asked to perform the rotator cuff exercise for 3 months. Visual analog scale (VAS) and manual muscle test (MMT) scores of the supraspinatus muscle were measured, and the American Shoulder and Elbow Surgeons (ASES) score was recorded before, 3 weeks, and 3 months after injection. Tear size was measured by the greatest longitudinal tear length.ResultsThe change in the VAS differed between groups at 3 months (P = 0.039) but not at 3 weeks (P = 0.147). The ASES scores in the BMAC-PRP group changed from 39.4 ± 13.0 to 54.5 ± 11.5 at 3 weeks and 74.1 ± 8.5 at 3 months while those in the control group changed from 45.9 ± 12.4 to 56.3 ± 12.3 at 3 weeks (P = 0.712) and 62.2 ± 12.2 at 3 months (P = 0.011). The tear size decreased at 3 weeks or 3 months after the BMAC-PRP injection but was not significantly different from that in the control group.ConclusionsBMAC-PRP improved pain and shoulder function in patients with partial tear of the rotator cuff tendon.Trial registrationThe patients were registered in the institutional board registry of Samsung Medical Center (registry number 2014-07-173).

In vivo fluoroscopic kinematography of cranio-caudal stifle stability after tibial tuberosity advancement (TTA): a retrospective case series of 10 stifles.

It was the aim of the study to determine retrospectively cranio-caudal stifle instability following TTA (tibial tuberosity advancement) using fluoroscopic kinematography. Ten stifles (eight dogs, mean body weight 27.3 kg) with complete rupture of the cranial cruciate ligament and a mean follow-up of 12.8 weeks (5.4 - 28.4 weeks) after TTA underwent latero-lateral, uniplanar fluoroscopic kinematography while walking on a treadmill. Immediately before TTA, each stifle was explored arthroscopically and in the case of a longitudinal or bucket-handle tear of the caudal horn of the medial meniscus the unstable axial portion was resected. The high-speed fluoroscopic video sequences obtained were inspected visually for femoro-tibial translation (cranial drawer). The influence of postoperative patellar tendong angle (PTA), cage size and meniscal surgery on stifle stability was analyzed using logistic regression analysis. In three stifles, resection of unstable meniscal tissue was necessary. Fluoroscopically, nine out of ten stifles showed cranio-caudal instability. Three stifles were potentially overcorrected (post PTA < 90°), seven potentially undercorrected (post PTA > 90°). None of the three parameters analyzed had a significant influence on postoperative in vivo stability (p=0.0988). In conclusion, it appears that inadequate cranialization of the tibia tuberosity might be an expected result of the TTA procedure, as well as persistent cranio-caudal instability during walking. However, instability cannot solely be attributed to insufficient cranialization because three out of nine unstable stifles were sufficiently or even overcorrected (PTA ≤ 90°). Further in vivo studies are needed to resolve these conflicting findings.

Modelling peeling- and pressure-driven propagation of arterial dissection

An arterial dissection is a longitudinal tear in the vessel wall, which can create a false lumen for blood flow and may propagate quickly, leading to death. We employ a computational model for a dissection using the extended finite element method with a cohesive traction-separation law for the tear faces. The arterial wall is described by the anisotropic hyperelastic Holzapfel–Gasser–Ogden material model that accounts for collagen fibres and ground matrix, while the evolution of damage is governed by a linear cohesive traction-separation law. We simulate propagation in both peeling and pressure-loading tests. For peeling tests, we consider strips and discs cut from the arterial wall. Propagation is found to occur preferentially along the material axes with the greatest stiffness, which are determined by the fibre orientation. In the case of pressure-driven propagation, we examine a cylindrical model, with an initial tear in the shape of an arc. Long and shallow dissections lead to buckling of the inner wall between the true lumen and the dissection. The various buckling configurations closely match those seen in clinical CT scans. Our results also indicate that a deeper tear is more likely to propagate.

Risk of total/subtotal meniscectomy for respective medial and lateral meniscus injury: correlation with tear type, duration of complaint, age, gender and ACL rupture in 6034 Asian patients

BackgroundTo evaluate the risk factor associated with total or subtotal meniscectomy for respective medial and lateral meniscus injury.MethodsThe data of all the meniscus injured patients undergoing arthroscopy in our institute between January 15th, 2000 and December 31st, 2008 was collected and 6034 patients with 7241 injured menisci met the inclusion criteria. The mean patient age was 33.6 ± 14.9 years and there were 4785 males and 2456 females with 3568 medial and 3673 lateral menisci. The decision tree approach was applied to investigate the correlation of the tear type, the duration of complaint, age, gender, ACL rupture and total/subtotal meniscectomy for respective medial and lateral meniscus.ResultsThe tear type was associated with both medial (χ2 = 70.901, P < 0.001) and lateral (χ2 = 268.019, P < 0.001) total/subtotal meniscectomy. The strongest risk of total/subtotal meniscectomy of both medial and lateral meniscus tear was shown for the complex tear followed by the longitudinal, oblique, horizontal and radial tear of the medial meniscus and followed by horizontal, longitudinal, radial and oblique tear of the lateral meniscus. The risk of total/subtotal medial meniscectomy was significantly elevated for the patients with complex tear and the age of ≤40 years old (χ2 = 21.028, P < 0.001) and those with the oblique, horizontal or radial tear accompanied by ACL rupture (χ2 = 6.631, P = 0.01). Besides, the duration of complaint was also associated with total/subtotal meniscectomy of the medial longitudinal tear with ACL rupture (χ2 = 17.155, P < 0.001). On the other side, the risk of total/subtotal lateral meniscectomy was significantly elevated for the complex tear of the female patients (χ2 = 5.877, P = 0.015) with no ACL rupture (χ2 = 50.501, P < 0.001). The ACL rupture was associated with a decreased risk of total/subtotal meniscectomy for all the types of the lateral meniscus (complex: χ2 = 50.501, P < 0.001; horizontal: χ2 = 20.897, P < 0.001; oblique: χ2 = 27.413, P < 0.001; longitudinal and radial: χ2 = 110.85, P < 0.001).ConclusionAnalyzing data from a big sample available in an Asian patient database, we found different risk factors associated with total/subtotal meniscectomy for respective medial and lateral meniscus. Identifying patients at high risk for total/subtotal meniscectomy may allow for interventions after meniscus injury.

Novel flat and wide meniscal repair material improves the ultimate load of knot breakage in a porcine trans-capsular meniscal repair model

BackgroundIn the meniscal repair procedures, a high ultimate load capacity and low cyclic creep at the repair site are favorable and lead to good biological incorporation of the tear site after surgery. Previous biomechanical tensile tests of the meniscal sutures have identified the suture knot as the weakest point. We hypothesized that the strength of a suture knot depends on the suture shape, and therefore, we compared three differently shaped suture materials composed of the same material and quantity per length. The purpose of this study was to determine whether a novel flat and wide repair material (FWRM), which consists of braided multi-threads that are cross-sectionally flat and wide, improves the ultimate load of knot breakage in a biomechanical experiment using a porcine trans-capsular meniscal repair model.MethodsEighteen fresh-frozen porcine knees (n = 6 in each group) were used. A longitudinal tear in the middle segment of the medial meniscus was created and repaired with a trans-capsular inside-out method using the following suture materials: No. 2–0 braided polyester conventional suture, hollow suture, and FWRM. After the separation of the inner segment of the meniscus with leaving, the suture stability of the repaired menisci was biomechanically analyzed with a video camera system for widening after a cyclic load between 5 and 20 N was applied 300 times. Ultimate failure load and stiffness at 5 mm/ min were also analyzed.ResultsWe found no significant difference in suture widening after cyclic load tests [conventional suture, mean 0.51 mm (S.D. 0.39 mm); hollow suture, mean 0.23 mm (S.D. 0.11 mm); and FWRM, mean 0.54 mm (S.D. 0.08 mm)]. The failure mode in all specimens was knot breakage. Compared with those of the other groups, the ultimate failure load of FWRM was statistically significantly higher in the load-to-failure tests (conventional suture, mean 58.8 N [S.D. 8.25 N]; hollow suture, mean 79.4 N [S.D. 10.2 N]; and FWRM, mean 97.4 N [S.D. 3.65 N]; p < 0.05).ConclusionFWRM improves the ultimate load of knot breakage without altering stability. This material may contribute to safe and stable meniscus repair.

Meniscal repair: Technique.

Meniscal repair aims to achieve meniscal healing, avoiding the adverse effects of meniscectomy. Longitudinal vertical tears in a vascularized area are the reference indication. The technique generally uses hybrid all-inside implants. The outside-in technique has other indications in more anterior tears. Healing has been demonstrated on CT-arthrography and arthroscopy. Specific techniques have been developed for other pathological situations. Posterior meniscosynovial lesions in a context of chronic anterior laxity are identified by exploration of the posterior compartment, and fixed by all-inside hook suture. Horizontal lesions in young athletes can be treated by open meniscal suture. Radial tears, when deep, can be repaired. Root tears, when traumatic, can be treated by transosseous pullout reinsertion.

Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus

BackgroundDiscoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals.MethodsThree improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal.ResultsThis technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found.ConclusionsThis improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less damage to the anterior cruciate ligament, medial collateral ligament, and cartilage and requires a shorter procedural time.

Research on conditional characteristics vision real‐time detection system for conveyor belt longitudinal tear

Conveyor belt longitudinal tear is one of the most serious problems in coal mining. Existing systems cannot realise lossless and real-time detection for longitudinal tear of conveyor belt. Currently, visual detecting systems are proposed by many researchers and are becoming the future trend. A visual recognition system based on using laser and area light sources is designed in this study, which can recognise and count abrasions, incomplete-tears, and complete-tears. The advantage of the system is to prevent longitudinal tear based on multi-feature information. In the process of detecting conditional characteristics, laser and area light sources are responsible for enhancing contrast between conditional features and conveyor belt surface, meanwhile false corner filtration and single-point feature identification method are designed for improving recognition accuracy of the system. Compared with several current systems, the designed system has a better performance on recognising complex tear characteristics of conveyor belt, thus the problem of starting warning only based on single feature can be effectively avoided.

Endoscopic All-inside Repair of the Flexor Hallucis Longus Tendon in Posterior Ankle Impingement Patients

Longitudinal flexor hallucis longus (FHL) tendon tears are sometimes complicated by posterior ankle impingement syndrome (PAIS), especially in ballet dancers. In recent years, PAIS has been treated endoscopically, but it is difficult to suture FHL tendon tears endoscopically. In this report, we describe how to suture the FHL tendon endoscopically with the Meniscal Viper Repair system (Arthrex, Naples, FL). Without our endoscopic technique, when a patient is found to have a longitudinal tear of the FHL under endoscopy, we must choose to either neglect the tear or convert to an open repair. Open tendon suture techniques have reportedly had relatively good results but require a longer skin incision than endoscopic surgery for PAIS. Compared with the open repair, the advantages of our technique include earlier recovery, less pain, a lower rate of soft tissue complications, and improved healing through better preservation of the blood supply. This technique is an attractive and useful option because it is an easy and safe method for longitudinal FHL tendon tears.

Arthroscopic Shoelace Side-to-Side Repair Technique Using Ultratape for the Treatment of Longitudinal Midsubstance Rotator Cuff Tears

Shoulder arthroscopy is a promising tool for assessing and treating patients with a rotator cuff tear. Arthroscopic rotator cuff repair with suture anchor fixation such as the single-row, double-row, and suture bridge technique are popular procedures that can provide excellent clinical outcomes. On the other hand, longitudinal midsubstance, U-shape, or L-shape tears may benefit more from a side-to-side/margin convergence technique. Despite following the standard side-to-side/margin convergence technique, we continue to see disruption at the site of side-to-side suture margin even with strong sutures. Here, we show our preferred arthroscopic shoelace rotator cuff repair technique using the more durable body tape for a longitudinal U-shape rotator cuff tear.

Discoid lateral meniscus can be overlooked by magnetic resonance imaging in patients with meniscal tears.

MRI evaluation of torn lateral meniscus was compared with arthroscopy. This study calculates the sensitivity, specificity, and accuracy of MRI in determining the presence or absence of discoid lateral meniscus (DLM) for different tear types. MR imaging of 156 knees with arthroscopically confirmed lateral meniscus tears was analysed. There were 78 knees (70 patients) in non-DLM group and 78 knees (74 patients) in DLM group on arthroscopy as the reference standard. The presence of DLM on MRI was determined by an orthopaedic surgeon and a radiologist, who were blinded to the arthroscopic findings. The presence of discoid meniscus on MRI was determined by coronal and sagittal measurements, considering the tear pattern of lateral meniscus. The tear pattern was categorized into six types based on arthroscopic findings: horizontal, longitudinal, radial, combined radial, degenerative, and complex tear. The sensitivity, specificity, and accuracy of MRI were calculated for each type of lateral meniscus tear. In addition, we analysed the reason for non-detection of discoid meniscus on preoperative MRI. The sensitivity for determining the presence of discoid meniscus was 58% for radial tear, 57% for combined radial tear, and 65% for longitudinal tear, whereas the specificity was 100% for all tear groups. In the presence of radial or longitudinal tear, the accuracy of MRI was significantly lower than having no radial and longitudinal tear (p<0.001). The presence of discoid meniscus was not recognized on MRI because of large radial tear (12 knees), deformed bucket-handle tear (6 knees), and inverted flap tear (3 knees). MRI was not successful in determining the presence or absence of DLM in radial tear, combined radial tear, and longitudinal tear. When there are large radial tear, deformed bucket-handle tear, and inverted flap tear in lateral meniscus, it is recommended to consider the possibility of DLM. This information can help to make accurate diagnosis of DLM, which allows appropriate surgical planning and facilitates patient's information on poor prognosis of DLM. Level I.

Spontaneous bladder rupture: unusual presentation in a haemophilic child

A 4-year-old boy child presented with abdominal pain, haematuria, lower abdominal mass and urinary retention. There was no family history of bleeding. Ultrasound abdomen revealed an intravesical blood clot, rupture...

A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears

To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. Twelve male, nonpaired (n= 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P>.791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P<.005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P= .097 and P= .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P= .080 and P= .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P< .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P<.005 and P= .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged from 498 to 561mm2, 786 to 997N/mm2, and 1,990 to 2,215N/mm2, respectively. Contact area, mean contact pressure, and peak contact pressure were not significantly different between the all-inside and inside-out repair techniques at any tested flexion angle. Both techniques adequately restored native meniscus biomechanics near an intact level. An all-inside repair technique provided similar, native-state-restoring contact mechanics compared with an inside-out repair technique for the treatment of displaced bucket-handle tears of the medial meniscus. Thus, both techniques may adequately decrease the likelihood of cartilage degeneration.

Rehabilitation and Return to Play Following Meniscal Repair

The outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play (RTP). Athletes represent the most demanding subgroup of patients as they have high expectations to return to their preinjury level of activity and in doing so they place maximum stress on any meniscal repair. Physical therapy rehabilitation protocols and RTP decision-making remains controversial in the setting of meniscal repair. Protective protocols had been the mainstay of treatment for many years, however, newer research has shown no harm and quicker RTP for longitudinal and bucket-handle tears located close to the outer vascular zone of the periphery of the meniscus using accelerated rehabilitation. Protective protocols and slower RTP remain the most prudent choice in complex , horizontal and radial tears or those extending into the middle to central third of the more avascular zone of the meniscus. The authors have therefore, with evidence from current publications, developed 2 separate protocols to treat both peripheral and complex tears . One accelerated and one protective protocol is established. During the preoperative planning, it would be helpful for the surgeon, patient, and family to know what can be expected with regard to the surgical success of meniscal repair and the likelihood of RTP in this active population. A literature review on the outcome of meniscal repair related to RTP was performed and revealed that the majority of patients succeed to RTP at the same or similar to their preinjury level, between 4 and 6 months following meniscal repair. Factors that may affect the outcome and RTP along with rehabilitative considerations following meniscal repair are discussed.

Integrative binocular vision detection method based on infrared and visible light fusion for conveyor belts longitudinal tear

Real-time and reliable detection of conveyor belt longitudinal tear is an important task in mining operations. This paper presents a novel method of Integrative Binocular Vision Detection (IBVD) to detect the longitudinal tears of conveyor belts. Based on infrared and visible fusion, the IBVD sensor device collects the fusion images of the belt. After extracting the tear features by projection method, the progress of potential tears can be evaluated and the tears can be identified. The IBVD method is verified by an experiment platform fulfilling the acquisition, pro-processing and analysis of fusion images for tear detection. The fusion image processing time is less than 18ms, which satisfies the requirement of real-time online monitoring. Compared to the individual measurement technique of either infrared detection or visible light detection, the average accuracy of the IBVD method reaches up to 96%, the IBVD method is more reliable in tear detection.

Factors Affecting the Outcomes of Arthroscopically Repaired Traumatic Vertical Longitudinal Medial Meniscal Tears.

Background:Although numerous studies have assessed arthroscopic medial meniscal repairs, few studies have focused on factors affecting outcomes of vertical longitudinal and bucket-handle repairs.Purpose:To evaluate the factors affecting clinical outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle medial meniscal tears.Study Design:Case series; Level of evidence, 4.Methods:A total of 223 patients underwent arthroscopic repair for medial meniscal tears between 2007 and 2012; 140 patients had isolated tears or concurrent anterior cruciate ligament (ACL) reconstruction, and 80 patients (76 men, 4 women; mean age, 29.1 years; range, 18-49 years) had vertical longitudinal tears and were included in the study. Pre- and postoperative functional status was assessed using physical examinations with Lysholm and International Knee Documentation Committee (IKDC) scores. Barrett criteria were used for clinical assessment of meniscal healing, and magnetic resonance imaging (MRI) was used as the radiologic assessment method. The effects of tear location, length, chronicity, and type; suturing technique; concurrent ACL reconstruction; and patient age, sex, and smoking habits were also investigated.Results:The mean follow-up period was 51.2 ± 9.4 months (range, 34-85 months). The mean Lysholm and IKDC scores improved at final follow-up (both Ps <.001). According to clinical scores, Barrett criteria, and MRI, failure was noted in 12 patients (15%). There were no significant differences in age, tear length, tear type, concurrent ACL rupture, suturing technique, or location of the meniscal repair between the success and failure groups. Failure rates were higher for red-white zone tears than for red-red zone tears (10/30, 33.3% vs 2/50, 4%; P = .004). Tear chronicity significantly affected failure rates. Early repairs had higher healing rates than late repairs (100% vs 73.4%; P = .008). Failure rates were higher for smokers than for nonsmokers (9/24, 37.5% vs 3/56, 5.3%; P = .008).Conclusion:Peripheral tears and early repairs have better outcomes and patient satisfaction. Smoking adversely affects meniscal healing.

The knee meniscus: management of traumatic tears and degenerative lesions.

Meniscectomy is one of the most popular orthopaedic procedures, but long-term results are not entirely satisfactory and the concept of meniscal preservation has therefore progressed over the years. However, the meniscectomy rate remains too high even though robust scientific publications indicate the value of meniscal repair or non-removal in traumatic tears and non-operative treatment rather than meniscectomy in degenerative meniscal lesionsIn traumatic tears, the first-line choice is repair or non-removal. Longitudinal vertical tears are a proper indication for repair, especially in the red-white or red-red zones. Success rate is high and cartilage preservation has been proven. Non-removal can be discussed for stable asymptomatic lateral meniscal tears in conjunction with anterior cruciate ligament (ACL) reconstruction. Extended indications are now recommended for some specific conditions: horizontal cleavage tears in young athletes, hidden posterior capsulo-meniscal tears in ACL injuries, radial tears and root tears.Degenerative meniscal lesions are very common findings which can be considered as an early stage of osteoarthritis in middle-aged patients. Recent randomised studies found that arthroscopic partial meniscectomy (APM) has no superiority over non-operative treatment. Thus, non-operative treatment should be the first-line choice and APM should be considered in case of failure: three months has been accepted as a threshold in the ESSKA Meniscus Consensus Project presented in 2016. Earlier indications may be proposed in cases with considerable mechanical symptoms.The main message remains: save the meniscus!Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160056. Originally published online at www.efortopenreviews.org

Acute Peroneal Tendon Injuries in Sport

Peroneal tendon pathology is a common and underdiagnosed cause of lateral ankle pain. Acute injuries may occur in sport, but often go unrecognized at the initial time of injury. It is not uncommon for patients to experience a considerable delay before diagnosis of peroneal tendon injury. The anatomy of the peroneal tendons predisposes to acute injury via the same injury mechanisms that cause lateral ankle ligamentous injury. Acute peroneal instability typically occurs secondary to rapid ankle dorsiflexion and eversion. Chronic peroneal instability is often associated with recurrent lateral ankle instability. Repetitive instability may lead to peroneal tendon pathology, including longitudinal tears. Patients frequently complain of lateral ankle pain, with an insidious and gradual onset of pain, and symptoms are frequently the result of tendon instability, due to superior peroneal retinaculum injury. Treatment is frequently nonsurgical with initial immobilization, followed by gradual return to activity, including progressive motion, strengthening, and proprioceptive stability exercises. Failure of nonsurgical management may indicate surgical treatment, including tendon and instability repair. Surgical treatment has a greater than 90% success rate, with elimination of instability, relief of symptoms, return of function, and return to activities.

Recurrent rupture uterus after hysteroscopic resection of uterine septum: A case report

Abstract Uterine rupture is a catastrophic obstetrical emergency with unpleasant maternal and fetal outcomes. Operative hysteroscopic procedures can add more risk factor for occurrence of this tragedy. Here, we report a case of spontaneous recurrent rupture uterus at 32 weeks of gestation in a 28-year-old woman with previous history of hysteroscopic resection of uterine septum after development of acute abdomen. Repair of anterior uterine wall longitudinal tear was performed through emergency laparotomy. Surgeons should explain to their patients the hazards of probable risk of recurrent UR in the future pregnancy and to document this discussion in the medical records before proceeding to operative hysteroscopic procedures.

Prevalence and clinical significance of hypertrophic labrum in non-dysplastic hips.

Hypertrophic labrum in dysplastic hip has been frequently reported and is known as limbus in developmental dysplasia of the hip. However, hypertrophic labrum without hip dysplasia has not been reported to date. The purpose of this study was to define hypertrophic labrum and to investigate the prevalence and clinical significance of an abnormally hypertrophic labrum in non-dysplastic hips. Between 2007 and 2014, direct CT arthrography was performed in 464 patients (470 hips) who had chronic groin pain and positive impingement or Faber test. There were 189 male (192 hips) and 275 female (278 hips) patients. The mean age was 46.8 years (range, 16-74 years). The hypertrophic labrum was defined as a labrum wider than two standard deviations away from the mean. Surgical correlation of hypertrophic labrum was obtained in cases with hip arthroscopy by a single surgeon. Seventeen hips (3.6%) were found to have a hypertrophic labrum which had a mean width of 11.2mm (±1.1) (range, 9.8-14.1mm). The average width (±SD) of the labrum without hypertrophy was 5.5mm (±2.4) (range, 2-9.8mm). Arthroscopic findings of the hypertrophic labrum included fissure and longitudinal tear at the chondrolabral junction and they were associated with chondral abnormality adjacent to the lesion. Hypertrophic labrum without hip dysplasia is not rare with a high incidence of tears. Care should be taken during arthroscopic access to the hip joint in patients with this morphologic variation as iatrogenic damage can occur more easily. Case Series; Level IV.