Nontraumatic Lesions Research Articles

The Role of Magnetic Resonance Imaging in the Evaluation of Knee Pain.

Objectives This study aimed to characterize and compare the features of traumatic and non-traumatic lesions causing knee pain through magnetic resonance imaging (MRI). Method The study was conducted at a tertiary care center, with data sourced from patients visiting the outpatientand in-patient departments. It involved a descriptive cross-sectional research design focusing on patients referred for knee MRI scanning. The sample size was calculated using Cochran's formula as 112 for symptomatic patients with knee pain with a 95% confidence interval. The MRI findings in 112 patients were analyzed and associated with a history of trauma. Results The average age recorded was 35.38 years. Females made up 41.07% (n=46) of the sample, while males accounted for 58.93% (n=66).Among the participants, the majority (n=82; 71.43%) had a history of trauma, and the most common MRI finding wasjoint effusion (n=74; 66.1%). The second most common was anterior cruciate ligament (ACL) injuries (n=71; 63.4%), followed bymeniscus injury (n=40; 35.71%). The study confirms that those with history oftrauma are at a higher risk (p<0.05) of sustaining injuries like meniscus and ACL tears, collateral ligament damage, bone contusions, chondromalacia patella, and joint effusion. Conclusion In conclusion, the consistency of our findings with existing studies reinforces the pivotal role of MRI in the evaluation of knee pain. Despite its limitations, including cost and accessibility, MRI remains a gold standard for diagnosing a wide range of knee pathologies, offering unparalleled detail and accuracy that significantly enhance clinical decision-making and patient outcomes.

Hourglass-like fascicular constriction of the median nerve: case series

Background. The anterior interosseus nerve (AIN) syndrome is a rare pathology, with cause is discussed. The findings in isolated AIN patients are in the main trunk of median nerve. It is confirmed by neuroimaging data and intraoperative picture in the form of the construction of fascicles in the nerve.Aim. To describe the clinical and instrumental characteristics of patients with isolated non-traumatic lesion of AIN.Materials and methods. The clinical, electrophysiological and neuroimaging data of 7 patients with isolated nontraumatic lesion of AIN were retrospectively analyzed, three of whom underwent surgical treatment.Results. All patients complained of neuropathic pain in the affected upper limb, with an average intensity of 8 points according to visual analog scale and a duration of 1.5 to 4 weeks. Weakness of the flexor pollicis longus from 1 to 3 points on the MRC (Medical Research Council Weakness) scale was observed in all cases, weakness of flexion of the distal phalanx of the index finger in 6 patients from 1 to 3 points, which indicated an isolated lesion of the anterior interosseous nerve.Needle electromyogram revealed denervation in c in all cases, 5 patients – in the pronator teres.The fascicular constriction from 1 or 2 sections of the median nerve were detected at the shoulder level on the affected side by ultrasound in 6 patients. An increase in the cross-sectional area of the median nerve at the shoulder level in 2 cases we observed, in one case the changes were o bilateral and asymmetric. In 2 cases, an increase in cross-sectional area of С5 root was noted on the affected side by no more than 23 % of the normal value. A change in echogenicity and size decrease of the pronator quadratus, when compared with the opposite side, was noted in all cases.Conclusion. Patients with isolated AIN syndrome needs intensive evaluation to identify the localization of the level of damage to the median nerve.

Non-traumatic pathology of the clavicle in children

BACKGROUND: The clavicle in children is a site of multiple types of injuries, post traumatic pathology being predominant, and generally presents no diagnosis problems; in contrast non-traumatic lesions of the clavicle are rare and may pose a diagnostic and therapeutic problems for the orthopaedic surgeon.&#x0D; AIM: The objective is to show that the clavicle in children can be a site of infectious, congenital and tumor lesions involving the functional and vital prognosis of the child.&#x0D; MATERIALS AND METHODS: A retrospective study including 9 patients over an 9 year period from January 2013 to January 2022 was conducted. 4 boys and 5 girls were admitted in our institute with a mean age of 11.2 years (range 616 years). The right clavicle was affected in 8 patients, with no bilateral lesions.&#x0D; RESULTS: There was a predominance of tumor lesions (4 benign and one malignant). Two patients had a clavicular osteomyelitis. The diagnosis of congenital pseudarthrosis of the clavicle was noted in the other two patients.&#x0D; CONCLUSIONS: The aetiologies are variable, biopsy remains the key to establish the diagnosis in the majority of cases. Treatment varies according to the type of disease and may include symptomatic, expectant management, drugs therapy or surgical treatment.

Spontaneous biloma manifesting with massive upper gastrointestinal bleed: case report

Spontaneous biloma is a rare non-traumatic lesion in whi­ch the extrahepatic or intrahepatic bile duct perforates spontaneously with no discernable cause. We present a case of spontaneous biloma in a 68 years old male patient with cholelithiasis and concurrent choledocholithiasis, who presented with acute severe cholangitis. There was no history of abdominal surgery, instrumentation, or trauma in the past. Initial ultrasonography (USG) abdomen showed central intrahepatic dilation, cholelithiasis, and choledocholithiasis. A sizeable hypoechoic lesion with few internal septations was present adjacent to the left lobe of the liver, with USG suspicion of a hydatid cyst. The lesion was abutting and displacing the stomach anteromedially. The patient had an acute renal failure with hemodynamic instability at presentation. The patient was managed with emergency endoscopic drainage under ultrasound guidance and improved after that. On the fourth day, after endoscopic drainage, the patient had a massive upper gastrointestinal (UGI) bleed due to erosion and pressure necrosis of the gastric wall due to biloma. The patient was managed successfully with sleeve gastrectomy and de-roofing of the cyst.

A case of eosinophilic granuloma of lateral end of clavicle

Primary clavicular bone tumors account for 0.45 to 1.01% of all primary bone neoplasms. Neoplasm, infection, traumatic injury, and developmental anomalies are the most frequent causes of non-traumatic lesions of the clavicle in children in their first ten years. The majority of neoplasms in the clavicle are cancerous. A 4-year-old girl was brought in by her parents who had noticed a painful swelling above the right lateral end of the collarbone for the previous two months. The child received intermittent painkillers over the course of two months, but there was minimal investigation into the reason of the child´s pain and swelling. The discomfort was ongoing and dull hurting. Physical examination revealed a single, isolated soft tissue swelling that measured 3x3 cm, was firm but not erythematous, and did not fluctuate. A plain radiograph was taken, and it showed that the lateral clavicle had a lytic, expansile lesion. Magnetic resonance imaging (MRI) imaging was done which showed an abnormal lesion on lateral end of clavicle. When the cytological results of the ultrasound-guided (USG) fine needle aspiration (FNA) were analyzed, the smear showed a diffuse population of eosinophils with multinucleated histiocytic giant cells. We were able to make the diagnosis of a Solitary eosinophilic granuloma of the lateral end of the clavicle with the aid of imaging investigations and a histologic image. Patient was treated with intralesional infiltration methylprednisolone injection at local site every 6 months. At regular follow - up it was observed that the lesion size was reduced and the patient had a pain free lateral end of clavicle at the end of 2 years.

Radiographic foot alignment and morphological features of deltoid ligament in pediatric patients with medial osteochondral lesions of the talus.

The cause of osteochondral lesions of the talus (OLT) in patients without a history of trauma remains unclear, and almost all nontraumatic lesions appear to involve the medial talar dome. This study aimed to investigate the relationship between foot alignment, deltoid morphology, and medial OLT in pediatric patients. In total, 28 patients (31 feet) with medial OLT (17 boys, 11 girls, mean age: 14.9 years), and 50 patients without OLT (50 feet, 31 boys, 19 girls, mean age: 14.5 years) were included in this study. The OLT patients were subdivided into traumatic and nontraumatic groups. Radiographic parameters of the foot arch were measured on weight-bearing lateral images. The extent of the OLT was measured on computed tomographic images. The ratio of deep deltoid attachment length of the talus to talar height was examined as deltoid ligament position index (DPI) on coronal magnetic resonance imaging. Nontraumatic medial lesions were frequently observed in pediatric patients (54.8%) compared to traumatic lesions. The depression of the foot arch was commonly identified in pediatric patients with resistant medial lesions. The lesion size was moderately correlated with DPI (rho = 0.48; P = 0.0086). The attachment of the deep deltoid ligament to the medial talar dome was located more proximally in nontraumatic lesions than in traumatic lesions and the control group. Our findings suggest that a combination of foot alignment and the anatomic variations in the attachment of the deep deltoid ligament contributes to the incidence of nontraumatic medial OLT in the pediatric population. Level of evidence: level IV.

Intra-Orbital Lesions (Melanoma/Retinoblastoma) Radiological Findings Correlation on Ultrasound and MRI

Objective: The purpose of this study is to determine intra-orbital lesions by radiological findings correlation on ultrasound and MRI. Study Design: Prospective study Place and Duration: Radiology department of Sindh Govt Hospital Liaquatabad, Karachi and Jinnah hospital, Lahore for the duration from May 2021 to April 2022. Methods: There were 75 patients of both genders presented in this study. Included patients were aged between 2-50 years. A CT scan was performed on all patients with a clinical suspicion of ocular and orbital abnormalities referred from the ophthalmology department. Outcomes among all patients were determined in terms of radiological findings correlated with MRI and ultrasound. SPSS 22.0 was used to analyze complete data. Results: Among 75 cases, there were 43 (57.3%) males and 27 (42.7%) were males. Mean age of the patients was 21.8±4.42 years. Majority of the cases 70 (93.3%) were non traumatic and 5 (6.7%) cases were traumatic. Among 70 cases of non-traumatic lesions, the most common disease was neoplasm found in 32 (45.7%) cases, followed by infective and inflammatory lesions in 22 (31.4%) cases. We found that retinoblastoma was the most common non-traumatic lesion in 21 (30%) cases followed by endocrine orbitopathy and orbital cellulitis. Among 5 cases of traumatic lesions, frequency of fractures were 4 (80%), preseptal soft tissue swelling was found in 3 (60%) cases and retained foreign body (orbital and lid) in 2 (40%) cases. Conclusion: CT is used to diagnose lesions, plan surgery, and track patients with ocular and orbital diseases. MDCT is superior for bone assessment, calcification detection, and determining lesion site, extent, and configuration. MDCT is suitable for evaluating ocular and orbital lesions. Keywords: CT, Ultrasound, MRI, Orbital lesions, Ocular lesions

Technology-assisted balance assessment and rehabilitation in individuals with spinal cord injury: A systematic review.

Balance is a crucial function of basic Activities of Daily Living (ADL) and is often considered the priority in Spinal Cord Injury (SCI) patients' rehabilitation. Technological devices have been developed to support balance assessment and training, ensuring an earlier, intensive, and goal-oriented motor therapy. The aim of this systematic review is to explore the technology-assisted strategies to assess and rehabilitate balance function in persons with SCI. A systematic review was conducted in the databases PubMed, Scopus, IEEE Xplore, Cochrane Library, and Embase. Full reports on Randomized Clinical Trials (RCTs) of parallel-group or cross-over design and non-RCTs were included according to the following criteria: i) publication year from 1990 to 2021; ii) balance considered as a primary or secondary outcome; iii) population of individuals with SCI with age over 18 years old, regardless of traumatic or non-traumatic lesions, Time Since Injury, lesion level, Asia Impairment Scale score and gender. The methodological quality was determined for each included study according to the recognized Downs and Black (D&B) tool. Nineteen articles met the inclusion criteria and were included in the analysis. Four articles focused on balance assessment while 15 targeted rehabilitation interventions to improve balance by using Treadmill-Based Devices (TBD), OverGround Devices (OGD) and Tilt Table Devices (TTD). Statistically significant effects on balance can be found in TBD subcategory, in the hip-knee guidance subcategory of OGD and in the study of TTD category. Although different studies reported positive effects, improvements due to technology-assisted rehabilitation were not greater than those obtained by means of other rehabilitation therapies. The heterogeneity, low methodological quality, and the small number of the studies included do not allow general conclusions about the usefulness of technology-assisted balance assessment and training in individuals with SCI, even if significant improvements have been reported in some studies.

Should proximal ruptures of the anterior rectus femoris muscle be treated surgically?

PurposeNo therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle. The objective of this literature review is to determine a therapeutic course of action. MethodsWe conducted a literature review on the PubMed database using the following keywords (in French and English, respectively): "quadriceps/quadriceps", "droit antérieur/rectus femoris", "proximal/proximal", "chirurgie/surgical", "avulsion/avulsion". We collected 266 articles, 36 of them were selected, which were related to our topic: proximal rupture of the anterior rectus femoris. Patients with a proximal rupture of the rectus femoris, minor or major patient of traumatic origin were included in this study. Patients injured at another lesion level, or non-traumatic lesions of the proximal rectus femoris (tendinitis without ruptures, tumor or others) were excluded. For each patient, the indications, the type of treatment and the functional result were analyzed, with the time to recovery and the level of recovery from sports and professional activities (same sport/profession or not, same level or not) as the main criterion of judgment. Fisher exact test was used for statistical comparison. ResultsThe aims of conservative treatment are to be pain free for the patient, to fight hematoma and to rehabilitate the injury as quickly as possible. The surgical techniques are varied, with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendino-aponeurotic suture in place. The functional results are good for the majority of the treatments proposed, but the conservative treatment has a shorter recovery time (3 months vs. 4 months for the best surgical results). Highly displaced bone avulsion is the only indication for first-line surgical treatment. ConslusionThe main disadvantage of conservative treatment is the risk of residual pain beyond 3 months (10%), justifying an MRI to guide secondary surgical treatment. We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.

Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience

ObjectiveThe aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation. MethodsThis study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI). ResultsNT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome. ConclusionSCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.

Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation.

To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years' follow-up. A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient's mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. Neither pre- nor postoperative PROMs differed between groups (P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. Level III, retrospective comparative study.

Taking a crack at the dome: histopathology of a pachycephalosaurid (Dinosauria: Ornithischia) frontoparietal dome

Recent studies have identified numerous pathologies in the cranial domes of pachycephalosaurid dinosaurs. These studies utilized CT images of domes to identify secondary woven bone and sclerosis associated with the pathologies. These features were critical for diagnosing post-traumatic osteomyelitis, which supported the head-butting behaviour hypothesis. However, conventional CT image resolution may not be sufficient to identify secondary woven bone or sclerotic bone in fossil specimens. UALVP 8504 (cf. Foraminacephale brevis), a dome possessing putative bone lesions, was thin-sectioned and micro-CT scanned. Thin sections revealed the lesions are lytic, without any secondary woven bone or sclerosis, falsifying the diagnosis of osteomyelitis. The morphology and histology of the lesions of UALVP 8504 are not diagnostic and resemble both post-traumatic and non-traumatic lesions. However, UALVP 8504 possesses shifted vascular canals (repositioning via remodeling, which maintains anatomical position throughout ontogeny) that are decoupled from growth (), and drifting osteons (secondary osteons where resorption occurs longitudinally and transversely). These demonstrate that the dome has sustained external mechanical loading, likely resulting from an impact or multiple impacts, consistent with the head-butting hypothesis. These impacts may have damaged overlying soft tissues and formed the lesions along the surface. Therefore, we suspect that the pathologies in UALVP 8504 are post-traumatic.

Epidemiological Study of Patients with Spinal Cord Injury Treated in POLEM, a Specialized Clinic in São Paulo State – Brazil

Abstract Objective To analyze the epidemiological profile of patients with spinal cord injury treated at POLEM – Associação de Apoio às Pessoas com Lesão Medular (Association for Supporting People with Spinal Cord Injury). Method The population studied comprised 113 patients with spinal cord injury, of traumatic or nontraumatic etiology, and the data obtained were compared with those of other institutions. Results Of the 113 patients, 70.8% were male and 29.2% female. Traumatic lesions were responsible for 54% of the patients, and nontraumatic for 46%. Of the patients with traumatic injury, 90.2% were male, the main cause being traffic accidents. In nontraumatic lesions, women were the most affected, 51.9%; and dysraphism and myelitis were the main causes (31% and 21%, respectively). Conclusion The results showed an important incidence of spinal cord injury due to trauma, mainly affecting young individuals of productive age and low educational level, representing high economic and social costs. The data found in the present study are similar to those of other studies performed in our country.

Dual-Layer Detector CT With Virtual Noncalcium Imaging: Diagnostic Performance in Patients With Suspected Wrist Fractures.

OBJECTIVE. The purpose of this study was to evaluate the diagnostic utility of dual-layer CT (DLCT) for evaluating wrist injuries and to compare it with MRI. MATERIALS AND METHODS. The cases of 62 patients with suspected wrist fractures who underwent imaging with both DLCT and MRI from January 2018 through February 2019 were retrospectively reviewed. By means of a calcium suppression algorithm, virtual noncalcium (VNCa) image reconstruction was performed, and the images were reviewed by two readers to identify fractures, bone contusions, and nontraumatic lesions in the radius, ulna, and carpal bones. Sensitivity, specificity, PPV, and NPV were calculated and compared between standard CT and VNCa images with a combination of standard CT and MRI as the reference standard. RESULTS. Use of DLCT with VNCa reconstruction increased the sensitivity of diagnosis of fractures in the radius and carpal bones over that of standard CT alone; occult fractures were detected that were not seen with standard CT. The sensitivity and specificity for detecting radius fracture were 98.1% and 93.8% for DLCT and 96.3% and 93.8% for standard CT. For detecting carpal bone fracture, sensitivity and specificity were 100% and 98.9% for DLCT and 93.8% and 100% for standard CT. VNCa reconstruction also had good diagnostic accuracy with regard to diagnosing nonfracture bone contusions in carpal bones. The accuracy was comparable to that of MRI with sensitivity of 92.9% and specificity of 94.5%. Interreader agreement in interpreting VNCa images was generally good to excellent. CONCLUSION. DLCT with VNCa reconstruction is a promising tool for identifying occult wrist fractures and nonfracture contusion injuries in patients with wrist trauma.

Non-traumatic lesions of clavicle – A pictorial essay

The aim of this paper is to illustrate the various pathological lesions encountered in clavicle other than traumatic. Clavicle is not a common structure for investigation, except when trauma is suspected. However, whenever a pathological lesion is to be studied, conventional radiology is the first modality to adopt. There are no standard radiographic techniques to study the clavicle. Often it is seen on a conventional chest radiograph. Many systemic disorders reflect on clavicles. Cross sectional imaging helps very little except in neoplastic conditions. The imaging appearances are described in most of the lesions that are found in clavicle.

CT angiography of lower extremities from anatomy to traumatic and nontraumatic lesions: a pictorial review.

After the introduction and the quick improvement of multidetector computed tomography technology, computed tomographic angiography (CTA) has become the imaging examination of choice for the first assessment of patients affected by lower extremities acute disorders. The widespread availability of CT equipment, the high temporal and spatial resolution with post-processing reformation possibilities represent the main advantages of this technique, which can reliably identify different findings related to arterial vessel pathology, such as occlusion, dissection, active bleeding, and pseudoaneurysm. Radiologists should know the anatomy, the acquisition protocols, and the CTA appearances of the different vascular lesions. The right interpretation of CTA findings is essential to establish the best treatment management of each patient.

Ultrasonography: the third eye of hand surgeons.

High-resolution ultrasonography is an important tool used for the diagnosis and management of inflammatory arthritis of the hand and wrist. This imaging modality has also proven its utility in the evaluation of traumatic lesions of tendons, nerves, annular pulleys, ligaments, and carpal and digital injuries and for detecting foreign bodies and causes of joint locking. One of the great advantages is the possibility of getting an internal image of the involved anatomical structure in axial, coronal, and transversal planes, as well as the option for observing dynamic changes during motion. Examiners may view the structures in the way it suits them best. The objective of this article is to summarize the author's own experience, to point out the advantage of ultrasonography in diagnosing some selective traumatic and non-traumatic lesions, and to highlight its role in these conditions.

Rehabilitation of patients in late period after spinal cord injury: a meta-analysis of literature data

Material and Methods . The study design is a meta-analysis of publications with levels 1a, b, c, and 2a evidence and a level A recommendations. An electronic search was conducted in the PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord injury (more than 4 months after injury). Exclusion criteria were topic articles, clinical cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord. Results . The search returned 108 articles with publication date within 1997–2019. The inclusion criteria was met by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open prospective study was included in the review due to the particular treatment method used. The greatest evidence base for the rehabilitation of patients in the long-term period after spinal cord injury is presented for physical methods of rehabilitation. The most effective are locomotor training to develop skills of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the spinal tracts, the restoration of motor functions occurs due to the activation of supraspinal interneuronal connections. Epidural electrical stimulation of the lumbar thickening of the spinal cord activates a generator of voluntary movement of the limbs and, in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The constant use of electrostimulation blocks proprioceptive sensitivity and inhibits the recovery of spinal conductivity. Parameters of clinical application are not defined for areas of regenerative medicine. Conclusion . The main problem in rehabilitation of patients in late period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the initial status and treatment efficiency.

VALIDITY AND RELIABILITY OF THE MANCHESTER SCALE USED IN THE ORTHOPEDIC EMERGENCY DEPARTMENT.

ABSTRACTObjectives:To describe the clinical utility of the Manchester triage scale adapted for orthopedic emergency departments and to evaluate its validity in identifying patients with the need for hospital care and its reliability when reproduced by different professionals.Methods:Five triage flowcharts were developed based on the Manchester scale for the following orthopedic disorders: traumatic injuries, joint pain, vertebral pain, postoperative disorders, and musculoskeletal infections. A series of patients triaged by two orthopedists was analyzed to assess the concordance between the evaluators (reliability) and the validity of the Manchester scale as predictive of severity.Results:The reliability analysis included 231 patients, with an inter-observer agreement of 84% (Kappa = 0.77, p <0.001). The validity analysis included 138 patients. The risk category had a strong association with the need for hospital care in patients with trauma (OR = 6.57, p = 0.001) and was not significant for non-traumatic disorders (OR = 2.42; p = 0.208). The overall sensitivity and specificity were 64% and 76%, respectively.Conclusion:The evaluated system presented high reliability. Its validity was adequate, with good sensitivity for identifying patients requiring hospital care among those with traumatic lesions. However, the sensitivity was low for patients with non-traumatic lesions. Level of Evidence III, Retrospective Study.

Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review.

Mucoid degeneration and ganglion cyst are two distinct non-traumatic lesions of the anterior cruciate ligament (ACL) that most commonly occur discretely but occasionally coexist. They are relatively uncommon, and their exact aetiopathogenesis is still not clear. ACL ganglion cyst occurs more frequently among relatively younger patients compared to mucoid degeneration. They could be asymptomatic and discovered incidentally while evaluating the knee for other pathologies. Symptomatic cases of the two conditions present with nonspecific chronic pain, painful limitation of terminal flexion and extension, and mechanical block (among other symptoms), similar to that of other internal derangement pathologies of the knee. Magnetic resonance imaging is the investigation of choice, and diagnostic criteria are defined. Arthroscopic management of these conditions efficiently provides an improvement in symptoms without instability. Computed tomography scan guided aspiration is also useful in selected cases of ACL ganglion cyst. ACL ganglion cyst and mucoid degeneration should be considered in the differential diagnosis of chronic knee pain and stiffness of unspecified etiology.