Longitudinal Tear Research Articles

Medial meniscal extrusion and spontaneous osteonecrosis of the knee

PurposeCauses of spontaneous osteonecrosis of the knee (SONK) have not been clearly elucidated. This study investigated the relationship between medial meniscal extrusion and SONK. MethodsWe reviewed 108 SONK knees and determined their Aglietti stage. Meniscal extrusion is defined when it extends beyond the medial margin of tibial plateau and osteophytes are excluded for determining the margin. Both absolute extrusion (AE) and relative percentage of extrusion (RPE) were measured, and meniscal tear patterns were evaluated in the early stages of SONK (I and II). ResultsAll knees had meniscal extrusion. Stage I was detected in 39 knees; II, in 23; III, in 16; IV, in 18; and V, in 12. The mean AE and RPE were 4.2 mm and 42% in stage I, 5.0 mm and 52% in stage II, 6.8 mm and 71% in stage III, 7.0 mm and 69% in stage IV, and 7.8 mm and 80% in stage V, respectively. The knees in the early stages showed less AE and RPE than those in late stages IV (p < 0.05) and V (p < 0.01). Additionally, the level of AE (ρ = 0.63, p < 0.0001) and RPE (ρ = 0.58, p < 0.0001) correlated with the SONK stage. Of knees with early-stage SONK, 12 knees had no tear, 26 had horizontal tears, 1 had longitudinal tear, 6 had degenerative tears, 2 had radial tears, 1 had complex tear, and 14 had root tears. Neither AE nor RPE differed significantly among tear patterns. ConclusionsMeniscal extrusion was recognized even in early stages, with a significant correlation between the SONK stage and extrusion. Although the most frequent tear pattern in early-stage SONK was horizontal tear, 12 knees had meniscal extrusion with no tears. Therefore, meniscal extrusion, which indicates meniscal dysfunction, may be a cause of SONK and be related with the developmental stage of SONK.

Swine Vagina Under Planar Biaxial Loads: An Investigation of Large Deformations and Tears.

Vaginal tears are very common and can lead to severe complications such as hemorrhaging, fecal incontinence, urinary incontinence, and dyspareunia. Despite the implications of vaginal tears on women's health, there are currently no experimental studies on the tear behavior of vaginal tissue. In this study, planar equi-biaxial tests on square specimens of vaginal tissue, with sides oriented along the longitudinal direction (LD) and circumferential direction (CD), were conducted using swine as animal model. Three groups of specimens were mechanically tested: the NT group (n = 9), which had no pre-imposed tear, the longitudinal tear (LT) group (n = 9), and the circumferential tear (CT) group (n = 9), which had central pre-imposed elliptically shaped tears with major axes oriented in the LD and the CD, respectively. Through video recording during testing, axial strains were measured for the NT group using the digital image correlation (DIC) technique and axial displacements of hook clamps were measured for the NT, LT, and CT groups in the LD and CD. The swine vaginal tissue was found to be highly nonlinear and somewhat anisotropic. Up to normalized axial hook displacements of 1.15, no tears were observed to propagate, suggesting that the vagina has a high resistance to further tearing once a tear has occurred. However, in response to biaxial loading, the size of the tears for the CT group increased significantly more than the size of the tears for the LT group (p = 0.003). The microstructural organization of the vagina is likely the culprit for its tear resistance and orientation-dependent tear behavior. Further knowledge on the structure-function relationship of the vagina is needed to guide the development of new methods for preventing the severe complications of tearing.

Research on Audio-Visual Detection Method for Conveyor Belt Longitudinal Tear

As a key equipment for production and transportation, conveyor belts are widely used in the coal mining industry. Once the conveyor belt longitudinal tear occurs, it will seriously affect the production and even cause personal injury. Therefore, the longitudinal tear detection of the conveyor belt is extremely important. In this paper, the sound detection is introduced into the longitudinal tear detection of the conveyor belt, and an audio-visual detection method for conveyor belt longitudinal tear is proposed. Camera and microphone array are used to collect the image and sound signals of conveyor belt, and the conveyor belt is detected from both image and sound, respectively. Then the image and sound analysis results are combined to comprehensively judge the status of the conveyor belt. The experimental results show that the audio-visual detection method can accurately identify the normal, abnormal, and longitudinal tear of the conveyor belt. The detection accuracy is over 86.72% and the sensitivity of longitudinal tear detection is greater than 92.59%. The proposed audio-visual detection method is verified to meet the requirements of longitudinal tear detection of coal mining industry conveyor belts.

Discoid meniscus in children and adolescents: Correlation between morphology and meniscal tears

BackgroundSome authors have suggested that the diminished vascular blood supply, peripheral stability and thickness of the discoid meniscus (DM) would make it more prone to tears. The aims of this study are two-fold: (1) To analyse morphological characteristics by magnetic resonance (MRI), and (2) To correlate the size of the meniscus with the presence of meniscal tears. MethodsThe MRI of patients ≤18 years-old over a period of 5 years were reviewed, and patients with DM were identified. We analysed demographic data, location (medial or lateral), morphology (Watanabe), meniscal tears (Crues classification), pattern, displacement, and other associated findings. Meniscal height and thickness per width (TxW) were also calculated. The correlation between variables: morphology, height and TxW with the presence of meniscal tears were statistically analysed. ResultsSix hundred and eighty-five MRI (675 patients) were analysed. Forty-three knees (38 patients, 20 males) were found to have a DM (6.3%). The average age was 12.2±3.8 years (range: 4–18 years). Sixty-three percent had some type of meniscal injury. Patients with complete MD had a higher incidence of injuries (77.3 vs. 47.6%; P=.001). Longitudinal (bucket handle) and complex tears (n=11) only occurred in patients with complete DM. DM with tears presented a nonsignificant tendency to have higher meniscal height and higher TxW (6.29±1.26 vs. 5.75±.66mm; P=.20 and 107.5±36.02 vs. 91.54±16.5mm2; P=.162). ConclusionThe results of this series support the theory that a larger meniscal size would be one of the main predisposing factors for the DM to be injured. Study designCross-sectional study (Level of evidence: III).

Outcomes After the Operative Treatment of Bucket-Handle Meniscal Tears in Children and Adolescents.

Background:Bucket-handle meniscal tears (BHMTs), which we define as vertical longitudinal tears of the meniscus with displacement of the torn inner fragment toward the intercondylar notch region, are a well-recognized tear pattern. Optimizing the management of BHMTs in younger patients is important, as preserving meniscal tissue may limit future joint degeneration.Purpose/Hypothesis:The purpose of this study was to review the patient demographics, clinical presentation, operative details, outcomes, and risk factors for a reoperation associated with operatively treated BHMTs in a pediatric population. We hypothesized that the repair of BHMTs in adolescents would yield a higher reoperation rate than meniscectomy in our population.Study Design:Case-series; Level of evidence, 4.Methods:A departmental database was queried to identify all patients 19 years or younger who presented with a BHMT and underwent surgery between October 2002 and February 2013. Clinical, radiological, and surgical data were retrospectively collected, and risk factors for a reoperation and persistent pain were assessed in all patients with longer than or equal to 6 months of follow-up.Results:A total of 280 BHMTs were treated arthroscopically by 1 of 8 sports medicine fellowship–trained surgeons. The mean age at surgery was 15.5 ± 2.5 years (range, 2.1-19.2 years), and most patients were male (177/280; 63%). Most injuries occurred during sports (203/248; 82%) and involved the medial meniscus (157/280; 56%). Concurrent anterior cruciate ligament (ACL) surgery was performed in 103 cases (37%). Meniscal repair was performed in 181 cases (65%) and was more common in younger patients (P = .01) and for the lateral meniscus (P < .001). Among 185 (66%) cases with longer than or equal to 6 months of adequate follow-up data (which included 126 meniscal repairs [68%]), a meniscus-related reoperation occurred in 45 (24%) cases. A reoperation related to the original BHMT injury or surgery was more common after meniscal repair than after meniscectomy (40/126 [32%] vs 5/59 [8%], respectively) (P = .001) and less common with concurrent ACL surgery (P = .07), although this was not statistically significant. Among patients injured during sports and with adequate follow-up, all but 1 patient (176/177; 99%) returned to sports; a slower rate of return was seen in those undergoing meniscal repair (P = .002) and concurrent ACL surgery (P < .001). At final follow-up, 170 of 185 patients (92%) were pain free. For the 15 patients with persistent pain at final follow-up, no identifiable risk factors for persistent pain were identified.Conclusion:Most BHMTs in younger patients occurred in males and during sports and affected the medial meniscus. Concurrent ACL surgery was indicated in approximately one-third of cases and was associated with a lower reoperation rate and slower return to sports. Two-thirds of patients underwent meniscal repair, over two-thirds of whom did not require a reoperation during the study period, despite the high activity levels in this age group.

Approach to Meniscal Tear by Clinical Examination and Its Management: A Review

It’s quite difficult to diagnose the meniscus tear by clinical examination even the experienced orthopaedic surgeon, so this review has shortly focused on clinical examination and its treatment. How to overcome missed diagnosis of meniscus tear in clinical setting? This review article highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in Magnetic resonance imaging (MRI) and Arthroscopy. Although partial, subtotal and total meniscectomy is the choice for different types of meniscal tears, there are certain criteria to be meet for undergoing surgical treatment. The most common criteria for meniscal repair include: 1) A vertical longitudinal tear more than 1 cm in length located within vascular zone, 2) A tear which is unstable and displaceable into the joint, 3) An active informed and cooperative patient but younger than 40 years old, 4) A stable knee or wound stabilized with a ligamentous reconstruction. Chronically deformed or degenerative menisci are bottom-out candidates for repair. Most investigators report that only 10% to 15% of meniscal tears can be repaired and that most such repairs are done in association with an anterior cruciate ligament reconstruction. However, this article presents a review of the clinical relevant anatomic, function, repair and healing mechanism, description of the meniscus attachment as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus attachments.

An anatomical examination of iatrogenic nerve injury during inside out meniscus repair with flexion and extension of the knee.

In this study, we aim to assess the safe, risky and high-risky zones by measuring the proximity of the needles to the peroneal and saphenous nerves in millimeters for the repair of tears of the anterior, middle and posterior horns of the medial and lateral menisci at flexion and extension position during inside-out repair technique. First, a cadaveric study was conducted on 10 cadaver knees in which both (lateral and medial) menisci were divided into anterior, corpus and posterior with the longitudinal tear simulating in each section. The next phase involved the suture of the simulated tears of the menisci while the knee was at 90° of flexion and full extension. Finally, the distance from the exit points of the K-wire being inserted through meniscal anterior, corpus and posterior tears to the aforementioned nerves was measured with a digital caliper. The distance between K-wire exit points and neurovascular structures concerning corpus and anterior horn tear repair of both menisci were considered far away and not included. However, closer posterior menisci measurements were taken to avoid the risk of iatrogenic nerve injury. The measured distances for lateral meniscus posterior tears were recorded 11±5.2 mm at 90° of flexion and 8±4.5 mm at extension, whereas those recorded 17.3±5.7 mm at 90° of flexion and 13.7±4.7 mm at extension for medial meniscus. These variables were evaluated statistically using a paired t-test; the mean of t value was not considered statistically significant. Our results show that the inside-out technique at knee flexion is safe even in the posterior meniscus tears. However, safety distance can be increased with the higher flexion degrees of the knee. Lastly, in posterior meniscal tear repair, we recommend either retractor assisted mini-open technique at knee flexion, or all-inside suture technique, to avoid nerve injury risk in this zone. Although many surgeons do not prefer inside-out techniques for posterior menisci tears, inside-out posterior meniscal repair of both menisci is as safe as an all-inside technique using retractor assisted mini-open technique with the knee at higher than 90° flexion.

Topical Nitroglycerine Versus Lateral Sphincterectomy for Fissure in Ano: A Hospital Based Comparative Study

Background: Anal fissure is a common benign condition presenting as severe pain, constipations and bleeding per rectum. It is defined as longitudinal tear or defect in anal canal skin. Surgical treatment of this conditions requires hospital admission and complications, like bleeding, infection and to its severe extent continence disturbances. That warrants a new treatment modality as pharmacological sphincterotomy i. e topical GTN (glycerine trinitrate) whose effects are reversible, cost effective and simple.&#x0D; Objective: The objective is to compare the effectiveness of topical GTN over lateral sphincterotomy in terms of pain management and healing of fissure.&#x0D; Method: This was a comparative study carried out in the department of Surgery at Nepalgunj Medical College, Teaching Hospital. Two groups were created and 25 patients in each group were put randomly. First group (Group 1) used topical GTN whereas second group(Group 2) underwent lateral sphincterotomy for treatment of fissure. The two groups were reassessed at 4 and 8 weeks for pain and fissure healing.&#x0D; Result: Total number of patients was 50. Each group consisted of 25 patients. The male to female ratio in group 1 was 1:1.5 and in group 2 it was 1: 1.8. In group 1 patients after 4 weeks of application of GTN pain reduced from the mean of 80±15 at the time of presentation to 50±9.27. When these patients were seen after 8 weeks, the pain reduction on VAS was nil in 21 patients out of 25. In group 2 the mean score fell from 75±15 to 20±10 after 4 weeks and at 8weeks 23 out of 25 patients didn't have any pain. It was observed that the pain reduction and healing were faster in group 2 patients when evaluated after 4 weeks (p=0.0029). but at the end of 8 weeks both group patients were similar in terms of pain reduction and healing of fissure (p=.28).&#x0D; Conclusion: According to study local GTN application is as effective as lateral sphincterotomy with cost effectiveness, simple with tolerable side effect and no continence disturbances.

Menisco discoide en niños y adolescentes: correlación entre la morfología y la presencia de lesiones

BackgroundSome authors have suggested that the diminished vascular blood supply, peripheral stability and thickness of the discoid meniscus (DM) would make it more prone to tears. The aims of this study are two-fold: 1) To analyse morphological characteristics by magnetic resonance (MRI), and 2) To correlate the size of the meniscus with the presence of meniscal tears. MethodsThe MRI of patients ≤18 years-old over a period of 5 years were reviewed, and patients with DM were identified. We analysed demographic data, location (medial or lateral), morphology (Watanabe), meniscal tears (Crues classification), pattern, displacement, and other associated findings. Meniscal height and thickness per width (TxW) were also calculated. The correlation between variables: morphology, height and TxW with the presence of meniscal tears were statistically analysed. ResultsSix hundred and eighty-five MRI (675 patients) were analysed. Forty-three knees (38 patients, 20 males) were found to have a DM (6.3%). The average age was 12.2±3.8 years (range: 4-18 years). Sixty-three percent had some type of meniscal injury. Patients with complete MD had a higher incidence of injuries (77.3 vs. 47.6%; P=.001). Longitudinal (bucket handle) and complex tears (n ??=11) only occurred in patients with complete DM. DM with tears presented a nonsignificant tendency to have higher meniscal height and higher TxW (6.29±1.26 vs 5.75±.66mm; P=.20 and 107.5±36.02 vs. 91.54±16.5mm2; P=.162). ConclusionThe results of this series support the theory that a larger meniscal size would be one of the main predisposing factors for the DM to be injured. Study designCross-sectional study (Level of evidence: III).

Correlation of Meniscal Tear with Timing of Anterior Cruciate Ligament Reconstruction in Patients without Initially Concurrent Meniscal Tear.

The incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.

Predissection-derived geometric and distensibility indices reveal increased peak longitudinal stress and stiffness in patients sustaining acute type A aortic dissection: Implications for predicting dissection

ObjectiveTo assess ascending aortic distensibility and build geometry and distensibility-based patient-specific stress distribution maps in patients sustaining type A aortic dissection (TAAD) using predissection noninvasive imaging. MethodsReview of charts from patients undergoing surgical repair of TAAD (n = 351) led to the selection of a subset population (n = 7) with 2 or more predissection computed tomography angiography scans and echocardiograms at least 1 year before dissection. Ascending aortic wall biomechanical properties (aortic strain, distensibility, and stiffness) were compared with age- and size-matched nondissected nonaneurysmal controls. Patient-specific aortic strain served as an input in aortic geometry-based simulated 3-dimensional reconstructions to generate longitudinal and circumferential wall stress maps. Inspection of perioperative dissection scans and intraoperative visual examination confirmed primary tear locations. ResultsPredissection echocardiography revealed ascending aortas of patients sustaining TAAD to exhibit decreased aortic wall strain (14.50 ± 1.13% vs 8.49 ± 1.08%; P < .01), decreased distensibility (4.26 ± 0.44 vs 2.39 ± 0.33 10−6 cm2·dyne−1; P < .01), increased stiffness (3.84 ± 0.24 vs 7.48 ± 1.05; P < .001), and increased longitudinal wall stress (246 ± 22 vs 172 ± 37 kPa; P < .01). There was no significant difference in circumferential wall stress. Predissection computed tomography angiography models revealed overlap between regions of increased longitudinal wall stress and primary tear sites. ConclusionsUsing predissection imaging, we identified increased stiffness and longitudinal wall stress in ascending aortas of patients with dissection. Patient-specific imaging-derived biomechanical property maps like these may be instrumental toward designing better prediction models of aortic dissection potential.

Arthroscopic repair of the meniscus: Surgical management and clinical outcomes.

From the biomechanical and biological points of view, an arthroscopic meniscal repair (AMR) should always be considered as an option. However, AMR has a higher reoperation rate compared with arthroscopic partial meniscectomy, so it should be carefully indicated.Compared with meniscectomy, AMR outcomes are better and the incidence of osteoarthritis is lower when it is well indicated.Factors influencing healing and satisfactory results must be carefully evaluated before indicating an AMR.Tears in the peripheral third are more likely to heal than those in the inner thirds.Vertical peripheral longitudinal tears are the best scenario in terms of success when facing an AMR.‘Inside-out’ techniques were considered as the gold standard for large repairs on mid-body and posterior parts of the meniscus. However, recent studies do not demonstrate differences regarding failure rate, functional outcomes and complications, when compared with the ‘all-inside’ techniques.Some biological therapies try to enhance meniscal repair success but their efficacy needs further research. These are: mechanical stimulation, supplemental bone marrow stimulation, platelet rich plasma, stem cell therapy, and scaffolds and membranes.Meniscal root tear/avulsion dramatically compromises meniscal stability, accelerating cartilage degeneration. Several options for reattachment have been proposed, but no differences between them have been established. However, repair of these lesions is actually the reference of the treatment.Meniscal ramp lesions consist of disruption of the peripheral attachment of the meniscus. In contrast, with meniscal root tears, the treatment of reference has not yet been well established.Cite this article: EFORT Open Rev 2018;3:584-594. DOI: 10.1302/2058-5241.3.170059

Inside-Out Meniscal Repair in the Mid One-Third of the Menisci

Meniscal repair as an isolated surgical technique developed in the 1970s to treat peripheral longitudinal tears near the meniscosynovial junction. It rapidly evolved into an arthroscopically assisted technique. The development of a myriad of implants has led to evolution to all inside techniques. In the mid one-third of the menisci, classic inside-out meniscal suturing remains widely used due to the relative safety of avoiding important neurovascular structures, the ease of suture retrieval, and its low cost. In recent years, it has been demonstrated that repair of menisci can be extrapolated from just peripheral longitudinal tears to horizontal cleavage tears and deep radial tears. Classic inside-out suturing can be utilized in the mid one-third of the meniscus to repair these varied tear patterns.

Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?

Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. There are several treatment methods such as medical substances and surgical procedures. In this retrospective study, we aimed to evaluate the safe and adequate option of lateral internal sphincterotomy (LIS) in chronic anal fissure treatment. This study is a retrospective study in which 417 patients who were treated for chronic anal fissure were included. Of 417 patients included in the study, 228 (54.7%) were female and the mean±SD age was 36.1±8.96 years (ranging from 17 to 73 years). Major complaints of patients; pain, bleeding, constipation, pruritus, perianal discharge. Recurrence occurred in 15 patients (3.6%) (12 males, three females) and eight patients (1.9%) developed incontinence (four with gas, four with soiling and seven females, one male). The complaints of all patients with gas incontinence and a patient with fluid incontinence regressed, whereas three patients had permanent fluid incontinence. LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.

Predicting meniscal tear stability across knee-joint flexion using finite-element analysis

PurposeTo analyse the stress distribution through longitudinal and radial meniscal tears in three tear locations in weight-bearing conditions and use it to ascertain the impact of tear location and type on the potential for healing of meniscal tears.MethodsSubject-specific finite-element models of a healthy knee under static loading at 0°, 20°, and 30° knee flexion were developed from unloaded magnetic resonance images and weight-bearing, contrast-enhanced computed tomography images. Simulations were then run after introducing tears into the anterior, posterior, and midsections of the menisci.ResultsAbsolute differences between the displacements of anterior and posterior segments modelled in the intact state and those quantified from in vivo weight-bearing images were less than 0.5 mm. There were tear-location-dependent differences between hoop stress distributions along the inner and outer surfaces of longitudinal tears; the longitudinal tear surfaces were compressed together to the greatest degree in the lateral meniscus and were most consistently in compression on the midsections of both menisci. Radial tears resulted in an increase in stress at the tear apex and in a consistent small compression of the tear surfaces throughout the flexion range when in the posterior segment of the lateral meniscus.ConclusionsBoth the type of meniscal tear and its location within the meniscus influenced the stresses on the tear surfaces under weight bearing. Results agree with clinical observations and suggest reasons for the inverse correlation between longitudinal tear length and healing, the inferior healing ability of medial compared with lateral menisci, and the superior healing ability of radial tears in the posterior segment of the lateral meniscus compared with other radial tears. This study has shown that meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment of the menisci. This may be used in decision making regarding conservative or surgical management.

Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with rotator cuff tendon tear: A prospective, non-randomized, comparative, single-blind study

We compared the clinical course of rotator cuff tears between exercise and bone marrow aspirate concentration (BMAC)-platelet rich plasma (PRP) injection to identify the therapeutic effects of BMAC-PRP on rotator cuff tears. Twenty-four patients with partial rotator cuff tear participated in this study ( Fig. 1 ). Twelve patients underwent extraction of BMACs and PRP and received the injection of BMAC-PRP at the tear site under ultrasound guidance ( Fig. 2 ). 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, three weeks, and three months after injection. Tear size was measured by the greatest longitudinal tear length. The change in the VAS differed between groups at three months ( P = 0.039) but not at three weeks ( P = 0.147). The ASES scores in the BMAC-PRP group changed from 39.4 ± 13.0 to 54.5 ± 11.5 at three weeks and 74.1 ± 8.5 at three months while those in the control group changed from 45.9 ± 12.4 to 56.3 ± 12.3 at three weeks ( P = 0.712) and 62.2 ± 12.2 at three months ( P = 0.011). The tear size decreased at three weeks or three months after the BMAC-PRP injection but was not significantly different from that in the control group ( Fig. 3 ). BMAC-PRP improved pain and shoulder function in patients with rotator cuff tear.

Tenoscopic Debridement or Surgical Repair for Longitudinal Tears of the Equine Deep Digital Flexor Tendon Within the Digital Flexor Tendon Sheath?

&lt;strong&gt;PICO question&lt;/strong&gt;&lt;br /&gt;&lt;p&gt;In horses with longitudinal tears of the deep digital flexor tendon within the digital flexor tendon sheath, is surgical repair as effective as tenoscopic debridement alone for returning to previous level of performance?&lt;/p&gt;&lt;strong&gt;Clinical bottom line&lt;/strong&gt;&lt;br /&gt;&lt;p&gt;Current literature on the efficacy of surgical repair or tenoscopic debridement is limited. Criteria to define and evaluate performance outcomes is not uniform and confounded with multiple variables, merely representing low quality evidence that is difficult to draw meaningful conclusions from. However, the literature suggests tenoscopic debridement alone has been associated with improved outcomes. A more definitive conclusion cannot be made until higher quality evidence is made available on this topic.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /&gt;

Intrasheath Instability of the Peroneal Tendons: Dynamic Ultrasound Imaging.

Peroneal intrasheath instability is a painful snapping condition of the lateral ankle. It consists of a transient retromalleolar subluxation of the peroneal tendons without disruption of the superior peroneal retinaculum or evidence of a previous definite trauma. In type A intrasheath instability, the peroneus longus and brevis tendons are intact, and there is an intertendinous intrasheath switch. In type B intrasheath instability, the peroneus brevis tendon has a longitudinal split tear through which the peroneus longus subluxates. Both types can be missed on a physical examination because there is no displacement of the peroneal tendons over the lateral malleolus. Dynamic ultrasound is the imaging modality of choice for evaluating retromalleolar subluxation of the peroneal tendons. This review article aims to provide an overview of the anatomic basis for peroneal intrasheath instability and provide physicians with guidelines for its ultrasound assessment.

Longitudinal Rupture of Distal Corpus Cavernosum With Concomitant Urethral Injury: An Uncommon Result of a Common Mechanism

Fracture of the penis is a well-recognized yet relatively uncommon urologic event. Forceful, blunt trauma with lateral bending of the penis in an erect state typically results in a transverse rupture of the tunica albuginea of the corpus cavernosum. Longitudinal tears of the corpus cavernosum are by themselves considered infrequent. We present a rare case of a patient with longitudinal rupture of the distal corpus cavernosum with concomitant extension to the corpus spongiosum causing partial urethral disruption as a result of trauma during sexual intercourse.

Dual band infrared detection method based on mid-infrared and long infrared vision for conveyor belts longitudinal tear

In mining operation, the longitudinal tear detection of conveyor belt is of great significance to safety production. A novel method, named Dual Band Infrared Detection (DBID), is proposed to detect the longitudinal tear of conveyor belts in this paper. The DBID method is based on the collaboration of mid-infrared and long infrared vision. The DBID sensor device captures the lower surface images of conveyor belt. The feature of tear or scratch and tearing precursor can be extracted by analyzation of captured images. The DBID method is verified by experiments and practice, including the capturing of dual band infrared images (mid-infrared and long infrared images), image preprocessing, and tear detection. The DBID method is not only unlimited by visual condition, but also much more accurate and reliable compared with the Integrative Binocular Vision Detection (IBVD) method presented before which meets the requirement of real-time online detection.