Posterior Tears Research Articles

Posterior Horn Lateral Meniscal Oblique Radial Tear in Acute Anterior Cruciate Ligament Reconstruction Incidence and Outcomes After All-Inside Repair: Clinical and Second-Look Arthroscopic Evaluation

Background: The term posterior horn lateral meniscal oblique radial tear (LMORT) has emerged to characterize the tear patterns of the lateral meniscus in many patients with acute anterior cruciate ligament (ACL) injury. There is a lack of data regarding the exact incidence according to the types of LMORT and clinical outcomes. Purposes: (1) To investigate the incidence of LMORT according to type in patients with acute ACL reconstruction (ACLR) and (2) to identify healing status after repair of LMORT via second-look arthroscopy and clinical outcomes. Study Design: Case series; Level of evidence: 4. Methods: Patients who underwent primary ACLR within 6 months of injury were retrospectively reviewed. The LMORT was classified into 4 types based on the severity and distance from the root: type 1 (partial tear <10 mm from the root), type 2 (complete tear <10 mm from the root), type 3 (partial tear >10 mm from the root), type 4a (complete tear >10 mm from the root), and type 4b (type 4a with longitudinal tear at the meniscocapsular junction). Only patients with LMORT were isolated, and the clinical outcomes were compared according to the healing status of LMORT in second-look arthroscopy. Results: Of 635 patients with ACLR, LMORT was identified in 97 patients (15.3%), and type 4 LMORT accounted for the largest proportion (n = 62; 32.6%) of 190 lateral meniscal tears. In 79 patients with LMORT who satisfied the 2-year follow-up period, all patient-reported outcomes (PROs), including the Lysholm (preoperative, 64.1; postoperative, 88.2) and International Knee Documentation Committee subjective (preoperative, 50.5; postoperative, 82.9) scores, were significantly improved (P < .001) 31.8 months postoperatively. Of the 61 patients who underwent second-look arthroscopy, 49 (80.3%) were classified into the complete healing group. There was no significant difference in postoperative PROs between the complete and partial healing groups. Conclusion: The incidence of LMORT was 15.3% in patients with acute ACL injury, and type 4 LMORT was the most common type. Complete healing of LMORT was achieved in 80.3% of patients who underwent second-look arthroscopy, and the PROs were significantly improved postoperatively. Good clinical results can be achieved if the LMORT is repaired as much as possible during ACLR.

Risk factors for the development of Superior Labrum Anterior to Posterior (SLAP) tears in physically demanding occupations: a systematic review and meta-analysis

Background: Currently, available evidence indicates people in physically demanding occupations (e.g., military or sport) may be at a higher risk of injury to the labrum than other occupations, with mechanisms involving acute forceful trauma or sustained mechanical forces exerted across the shoulder or hip joint. Therefore, the aim of this systematic review was to identify and synthesise findings from studies which reported the incidence or prevalence of Superior Labrum Anterior to Posterior (SLAP) tears in physically demanding occupations, and the risk factors associated with their development. Methods: This review was conducted according to the PRIMSA-P guidelines and registered on the Open Science Framework. PubMed, EBSCO, Scopus, Web of Science, CINAHL and ProQuest databases were systematically searched using the following key terms: ‘labral tear’, ‘work’ and ‘risk’. Key findings from the included studies were extracted, including risk factors, prevalence or incidence and risk ratios (e.g., relative risk, hazard ratios, and incidence rate ratios). Each study included in the review was critically appraised to assess its methodological quality, using the Critical Appraisal Skills Programme (CASP) toolkit for cohort studies, and the Joanna Briggs Institute (JBI) case series critical appraisal tool for a case series study. Meta-analysis was conducted using the Cochrane Collaborations software package, Review Manager (RevMan, version 5.3). A random effects model was selected due to the variability in participant demographics and other characteristics across the included studies. OR and 95% CI were calculated. Results: Six articles met the eligibility criteria, and these included three studies on professional athlete populations, two on military populations, and one study reporting on SLAP tears arising from workplace accidents or as a condition arising from occupational tasks. The methodological quality scores of the included studies ranged from 50% to 92%, with an average score of 73%. SLAP tears comprised 3.1% of shoulder injuries recorded over a 15-year period in the NFL and reported incidence in military populations was 2.13 [95% CI 2.11 to 2.16] per 1,000 person-years. Identified risk factors include younger age, male sex, acute weight-bearing and overhead movements, gameplay (as opposed to training), Army or Marine Corps service and enlisted rank. Meta-analysed data comprised from the military and sporting population studies, indicated strong evidence (p < 0.001; OR 11.40 [95% CI 5.65 to 23.02]; I2 = 35%) for the role of direct contact or trauma in developing SLAP tears compared to indirect or non-contact tasks. Discussion: The findings showed individuals of male sex and of younger age, are at increased risk of sustaining SLAP tears. The results of the meta-analysis provided strong evidence that direct contact or trauma to the glenohumeral joint resulting from collisions or force directed to the shoulder from an abducted arm position was more likely to be associated with shoulder labrum tears (primarily SLAP, although inclusive of Bankart and other labral tears) than other forms of indirect force applied to the shoulder or non-contact mechanisms. Impact: Tackling, blocking, collisions, repeated overhead shoulder lifting, combat sports, and sporting tasks predispose physically demanding occupations to increases in SLAP injury risk. Conflict of interest statement: This research was funded by the Department of Veterans’ Affairs.

SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis.

The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Economic and decision analysis; Level of evidence, 4. A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.

Posterior polar cataract: Hydrodissection and nucleus rotation in manual small-incision cataract surgery not a taboo with proper fluidics.

A posterior polar cataract is a discoid posterior polar plaque-like cataract with a thin and fragile to absent posterior capsule with adherent acellular opacity to the capsule reported in the literature. It is a stationary or slowly progressive opacity. A higher risk of complications such as posterior capsular tear and nucleus drop makes this a challenging surgery. The techniques described in the literature include bimanual irrigation aspiration, leaving the plaque for later Yag, bimanual micro phaco, Lambda technique with dry aspiration, Phaco if opacity &lt;4 mm and soft nucleus, pars plana vitrectomy (PPV), pars plana lensectomy (PPL) if opacity &gt;4 mm and soft nucleus, intra-capsular cataract extraction (ICCE) and scleral fixated intraocular lens (IOL) if opacity &gt;4 mm with the hard nucleus, viscodissection, 3 ports PPL, PPV, low parameters phaco, modified epinucleus removal, inverse horse-shoe technique, standard phacoemulsification, chip and flip for soft cataracts, stop and chop for hard cataracts, layer-by-layer phacoemulsification, standard lens aspiration, pars plicata posterior vitrecto-rhexis, manual small-incision cataract surgery, and conventional extracapsular extraction. A posterior capsule rupture rate of 0 to 36% is reported in different series for cataract extraction. To prevent this dreaded complication, surgeons used many modifications. Minimal hydrodissection in posterior polar cataract extraction was described by Fine et al. The authors describe a technique of low flow manual small-incision cataract surgery with minimal hydrodissection and nucleus rotation with no associated posterior capsule rent. This demonstrates that if the fluidics is understood and corrected, then minimal hydrodissection and nucleus rotation is not taboo in posterior polar cataract extraction by manual small-incision cataract surgery.

Primary Biceps Tenodesis Is Superior to Revision Following Failed SLAP Repair

To compare satisfaction and return to play (RTP) rates between patients undergoing primary biceps tenodesis for a symptomatic SLAP tear and patients undergoing secondary biceps tenodesis following a failed SLAP repair. A retrospective review of patients who underwent subpectoral mini-open biceps tenodesis following failed SLAP repair between January 2011 and October 2019 was performed. Inclusion criteria included age older than 16 years, skeletal maturity, and a minimum follow-up of 12 months. Both athletes and nonathletes were included across all types of sport. Patients who had anterior or posterior instability or rotator cuff tears were excluded; in addition, those requiring concomitant procedures were excluded. Case-control matching was performed using age, sex, indication, follow-up, and type of sport, to generate a 3:1 control group for the primary biceps tenodesis cohort. Primary outcome measurements were collected via telephone in 2020 and included the American Shoulder and Elbow Surgeons score, visual analog scale score, Subjective Shoulder Value score, patient satisfaction, willingness to undergo surgery again, and revisions. RTP and timing of RTP were evaluated as secondary outcomes. A P value of <.05 was considered to be statistically significant. The current study included 76 patients in total; 57 patients with primary biceps tenodesis, and 19 patients with secondary biceps tenodesis. The mean age was 39 years (19-48 years), 100% were male, and the mean follow-up was 54 months (16-99 months). Patient reported outcomes were obtained postoperatively via telephone survey. Overall, we found that primary biceps tenodesis patients reported greater American Shoulder and Elbow Surgeons scores (89.9 vs 76.4, P= .0162), lower visual analog scale scores (1.0 vs 3.1, P= .0034), and greater Subjective Shoulder Value scores (86.7 vs 64.7, P= .0004). Overall, there was no significant difference in the total rate of RTP (84% vs 75%, P= .5025), or timing of RTP (8.2 months vs 8.1 months, P= .9529) between patient groups. Patients reported playing tennis, swimming, golf, rock climbing, and basketball. No patients required a further shoulder surgery after undergoing biceps tenodesis. In this study, patients undergoing primary biceps tenodesis had significantly better functional outcomes compared with secondary biceps tenodesis following a failed SLAP repair. III, retrospective comparative study.

SLAP Injury and the Superior Labrum.

Injuries around the superior labrum are a common cause of shoulder dysfunction and pain. The injuries sustained result mainly from repetitive microtrauma but can also occur following a fall on outstretched hand. Both athletic and general populations can be affected. Injuries to the superior labrum are called superior labrum anterior and posterior (SLAP) tears. Based on cross-sectional imaging findings, the literature defines four main SLAP tears (I-IV) and six extended types (V-X). An accurate description of imaging findings of the SLAP tear type, along with concomitant findings, aids clinicians in treatment planning. We also briefly discuss management options, postoperative appearance of superior labral repair, and the diagnosis of a retear.

Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis

ObjectivesThe comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus...

Postoperative complications of combined phacoemulsification and pars plana vitrectomy in diabetic retinopathy patients.

PurposeTo compare intra- and postoperative complications in combined phacoemulsification and pars plana vitrectomy surgeries performed in patients with non-proliferative diabetic retinopathy (NPDR) vs. proliferative diabetic retinopathy (PDR).MethodsRetrospective, case series of patients with diabetic retinopathy who underwent combined phacovitrectomy surgery between 2008 and 2017. We compared intraoperative complications including posterior capsular rupture and retinal tear, and postoperative complications including corneal edema, macular edema (ME), epiretinal membrane (ERM), neovascular glaucoma and persistent inflammation.ResultsA total of 104 eyes of 104 patients were included in this study. Twenty-four eyes (23.1%) were categorized as NPDR and 80 eyes (76.9%) as PDR. The most common indications for surgery in the NPDR group were ERM (67%) and rhegmatogenous retinal detachment (12.5%), while in the PDR group, indications were vitreous hemorrhage (56%) and tractional retinal detachment (19%). The most common intraoperative complication was retinal tear (8% in NPDR and 19% in PDR, p = 0.195) and postoperative complication was ME (29% in NPDR and 26% in PDR, p = 0.778). There were no statistically significant differences in intra- and postoperative complication rates between the NPDR and PDR groups, even after adjusting for confounders; patient age at surgery and indication for surgery.ConclusionAfter combined phacovitrectomy in NPDR and PDR patients, new-onset ME was found in about a quarter of eyes in both groups. Intraoperative anti-VEGF or steroid administration, and intense postoperative anti-inflammatory medication and follow-up should be regarded after phacovitrectomy regardless of the DR level.

Internal tibial torsion is associated with medial meniscus posterior horn tears.

Risk factors for meniscal tears play a decisive role in deciding on treatment and rehabilitation. The purpose of this study was to investigate the effect of tibial rotation on medial meniscus posterior horn tears (MMPHTs). This study is a retrospective case-control study. Fifty patients with meniscal tears and 57 knees with intact meniscus were compared. Tibial rotation, femoral version, tibial slope and knee varus were measured in each participant. Knee osteoarthritis was classified according to the Kellgren-Lawrence classification. Demographic characteristics were noted. There were significant differences in the mean tibial torsion angles and mean mechanical axes between the groups. The mean tibial rotation and mean mechanical axis were 26.3° ± 6.7 and 3.7° ± 2.7 in the MMPHT group and 30.3° ± 8.4 and 2.05° ± 2.7 in the control group, respectively (p = 0.008, p = 0.002). The current retrospective study has shown that tibial rotation is markedly reduced in patients with MMPHTs. Although the actual mechanism is not clear, the internal torsion of the tibia causes a decrease in the foot progression angle and increases the knee adduction moment, which in turn increases the medial tibial contact pressure. Internal torsion of the tibia, such as knee varus, may play a role in the aetiology of MMPHTs by this way. Whilst there was a significant difference in the mean varus and tibial torsion between the groups, there was no significant difference in the mean femoral version or tibial slope. III.

Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function.

Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.

Right Arm Pain—Football

HISTORY: A 16-year-old right-hand dominant male football lineman presents for acute on chronic R anterior shoulder pain. 7 days prior to presentation he hit a blocking dummy and felt his R shoulder “pop in and out” and subsequently had a “dead arm”. Today his R shoulder feels stiff and aches with overhead activities. He has rested since the injury. No neck pain or numbness/tingling. He previously had episodes of feeling his shoulder shift out of place, none of which required formal reduction. PHYSICAL EXAMINATION: Musculoskeletal: R shoulder.Inspection: R biceps appears smaller than L; no deformity. Palpation: nonspecific tenderness over anterior shoulder. ROM: full FLEX/EXT/ABD/ER/IR; slight pain with ER and ABD. Strength: 5-/5 biceps; 5-/5 shoulder FLEX; all rotator cuff muscles are strong. Special Tests: O’Brien’s test +; apprehension/relocation test +; posterior load and shift causes pain. Neurovascular: sensation intact in all UE dermatomes; radial artery pulses 2+. Neck exam: no midline tenderness; full ROM. DIFFERENTIAL DIAGNOSIS: glenoid labral tear; glenohumeral dislocation and subsequent instability; long head biceps tendon (LHBT) dislocation; congenital absence or anomalous origin of LHBT. TEST AND RESULTS: MR shoulder arthrogram: anterior and posterior humeral head impaction fractures consistent with recent anterior and posterior shoulder dislocation; anterior and posterior labral tears; absence of long head of biceps. Diagnostic US of the R shoulder was performed after MRI reported absent LHBT. US revealed medial dislocation of the long head of the biceps located directly lateral to the coracoid process and passing over the lesser tuberosity. The bicipital groove is shallow and without overlying tendon. FINAL WORKING DIAGNOSIS: dislocation of long head of biceps; anterior and posterior glenoid labrum tear; Hill-Sachs and reverse Hill-Sachs lesion. TREATMENT AND OUTCOMES: The patient was referred to orthopedic surgery and subsequently scheduled for R shoulder arthroscopy with labral repair/capsulorrhaphy. LHBT will be evaluated and tenotomy or tenodesis will be performed depending on operative findings. The planned surgery is scheduled for after the date of abstract submission, and final treatment and outcome will be updated.

Injury Prevention Effect of MRI Imaging Technology in Physical Education and Sports Training.

In order to solve the problem of observing and analyzing the clinical value of MRI diagnosis in patients with knee sports injury and guiding clinical targeted treatment, the author proposed a sports injury prevention method in sports training teaching based on MRI image observation. This method retrospectively analyzed the imaging data of 101 patients with knee joint MRI examination due to osteoarthritis, sports injury and synovitis in joint surgery, and arthroscopic exclusion of true meniscus tear, MR multisequence and multiplane scans were performed to observe the anatomical features of TGL and MFL images and the occurrence rate of the lateral meniscus “false tear sign,” and the χ2 test was used to compare the occurrence rate of “pseudo-tear sign” between genders and sides. Experimental results show that the incidence of TGL on MRI was about 67.3% (68/101), and the incidence of “pseudo-tear sign” in the anterior horn of the lateral meniscus caused by TGL was 2.9% (2/68). The overall appearance rate of MFL on MRI was 91.1% (92/101), the appearance rate of plate anterior ligament (HL) was 13.9% (14/101), and the occurrence rate of “pseudo-tear sign” in the posterior horn of the lateral meniscus caused by HL was 7.1% (1/14). The occurrence rate of the posterior ligament (WL) was 77.2% (78/101), and the incidence of “pseudo-tear sign” in the posterior horn was 20.5% (16/78). According to the shape and course of TGL and MFL on MRI, and the direction and position of the lateral meniscus pseudotear, combined with MRI sagittal plane and coronal plane observation, it can effectively identify the true and false attributes of lateral meniscus anterior and posterior horn tears, thereby reducing unnecessary surgical treatment.

Accuracy of MR arthrography in the detection of posterior glenoid labral injuries of the shoulder

ObjectiveThe purpose of this study is to evaluate the accuracy of MR arthrography in detecting isolated posterior glenoid labral injuries using arthroscopy as the reference standard.MethodsMR arthrograms of 97 patients with isolated posterior glenoid labral tears by arthroscopy and those of 96 age and gender-matched controls with intact posterior labra were reviewed by two blinded radiologists for the presence and location of posterior labral abnormalities. The sensitivity and specificity of detection of posterior labral tears were calculated as well as the prevalence of associated pathologies. Medical records were reviewed for demographics, history and direction of shoulder instability, and prior surgery.ResultsPosterior labral pathology was detected by MR arthrography with sensitivities of 76% and 84% for readers 1 and 2, and a specificity of 88% for both readers. Kappa value for interreader agreement was 0.91. Twenty-two of twenty-three (96%) tears isolated to the posteroinferior quadrant on arthroscopy were correctly identified on MRI. Commonly associated pathologies included paralabral cyst (38%), humeral fracture (7%), and glenoid fracture (2%). Fifteen of ninety-seven (16%) patients with posterior tears on both arthroscopy and MRI had glenoid rim deficiency on imaging versus no patients with intact posterior labra (p < 0.001). Forty of ninety-seven (41%) patients with posterior tears on arthroscopy had a history of posterior instability versus none without posterior tears. There was no significant difference in tear length on MRI between those with a history of instability and those without (p = 0.56).ConclusionMR arthrography is accurate in detecting posterior glenoid labroligamentous injuries.

The correlation between types of posterior upper rotator cuff tears and intramuscular fat infiltration based on magnetic resonance imaging: A retrospective observational study.

Objective: This study investigated the correlation between types of posterior upper rotator cuff tears (RCTs) and intramuscular fat infiltration (FI) in magnetic resonance imaging (MRI). Methods: The shoulder joints of 50 adults with a full-thickness posterior upper RCT diagnosed by MRI, from January 2019 to December 2021, were retrospectively analyzed. The patients were divided into three groups according to tear type: 1) an L-shaped tear group; 2) a crescent/U-shaped tear group; 3) a complete tear group. The correlation among age, gender, tear range, trauma history, and the duration of clinical symptoms was analyzed. The MRI images were used by two musculoskeletal imaging physicians to evaluate the type and range of tears, the Goutallier grade of the supraspinatus and infraspinatus, and the correlations and reliability were analyzed. Results: Differences in the tear range (p < 0.001) and the Goutallier grade of the infraspinatus muscle (p = 0.036) among the L-shaped, crescent/U-shaped, and complete tear groups were statistically significant; however, differences in the Goutallier grade of the supraspinatus muscle was not statistically significant (p = 0.356). In the crescent/U-shaped tear group, age was significantly correlated with the Goutallier grade of the supraspinatus muscle (RS = 0.720, p = 0.029) and the infraspinatus muscle (RS = 0.713, p = 0.032). In the complete tear group, tear range was significantly correlated with the Goutallier grade of the supraspinatus muscle (RS = 0.801, p = 0.001) and the infraspinatus muscle (RS = 0.802, p = 0.001). The Goutallier grades of the supraspinatus muscle (kappa, 0.489) and the infraspinatus muscle (kappa, 0.424) presented with interobserver consistency. Conclusion: The type of posterior upper RCT correlates with the degree of FI. There is a positive correlation between the FI of crescent/U-shaped full-thickness RCTs and age. Additionally, the range of complete tears in the posterior upper RC has a positive correlation with FI.

The Effect of Abnormal Tibial Slope on Medial Meniscus Tear

Objective: To study the relationship between tibial plateau retroversion and medial meniscus injury, and further discuss and explore the abnormal anatomical factors. Methods: 36 patients who underwent knee surgery in overseas Chinese hospital from 2011 to 2022 were randomly selected and divided into groups A and B. Group A (28 cases) had definite medial meniscus injury, while group B (8 cases) had no medial meniscus injury and underwent other operations. All medial meniscus injuries met the diagnostic criteria and could be observed under arthroscopy. The tibial plateau caster angle (PTS) was measured on MRI, and the statistical significance was determined by two independent sample t-test and chi square test. The variables with statistical significance were analyzed by binary logistic regression. Finally, the independent risk factors of medial meniscus injury were determined, and the 0r value was calculated. P value &lt;0.05 was considered statistically significant. Results: there were 28 knees in group A and 8 knees in group B. There was no significant difference in age, sex and BMI between the two groups (p&gt;0.05). The main tear sites of medial meniscus were posterior horn tear (57,14%) and body tear (14.28%), and the tear types were complex tear (32.1%) and horizontal tear (21.4%). The average PTS of group A (8.69 °) was significantly higher than that of group B (6.22 °) (p&lt;0.01). The results of binary logistic regression analysis showed that PTS was statistically significant (p&lt;0.005), so we believed that the increase of PTS (OR=1.62, 95%CI, 1.086～2.403) was an independent risk factor for medial meniscus injury. Conclusion: PTS is higher in patients with medial meniscus injury. The abnormal anatomical structure of increasing retroversion is a risk factor for medial meniscus injury.

Paper 29: Return to Sport Testing vs Time-Based Clearance in Posterior Shoulder Instability

Objectives:Recurrent pain, instability and loss of function are challenging complications that can occur after arthroscopic treatment of posterior shoulder instability and SLAP tears in athletes. Many surgeons allow return to sport after a designated arbitrary postoperative time point. Recent evidence has demonstrated that a majority of athletes have residual strength and functional limitations at 6 months postoperatively – the time at which most time-based protocols allow full return to sport. Recent data has also been presented that patients undergoing arthroscopic Bankart repair who are required to meet objective return to sport testing criteria have a 4x lower rate of recurrent anterior instability than those who return based on time elapsed since surgery. Considering these findings, the purpose of this study is to investigate the use of a similar objective return to sport testing protocol on recurrence rates following arthroscopic surgery for posterior shoulder instability and SLAP tears. We hypothesized that patients who meet objective return to sport criteria would have a lower rate of reoperation and recurrence of symptoms compared to those who did not undergo the testing and were cleared to return based on time from surgery.Methods:Consecutive patients (Group 1) who underwent arthroscopic posterior shoulder stabilization surgery with or without SLAP repair by a single surgeon from 2016 to 2019, had a minimum of 1 year follow up, and completed functional and strength testing to evaluate readiness for return to sport were included in this retrospective case-controlled study. These patients were compared to a control group of historical consecutive cases (Group 2) from 2012-2016 who did not undergo return to sports testing and were cleared for sports after a minimum of 6 months following surgery. Failure was defined as recurrent symptoms of pain or instability requiring reoperation. Exclusion criteria were: patients undergoing isolated anterior stabilization procedures with or without concomitant SLAP tears, multidirectional instability, and open procedures. Chi-square, Fisher exact tests and two-tailed Students T-test were performed. Statistical significance was set at p<0.05.Results:There were 33 patients in Group 1 who underwent return to sport testing, and 91 patients in Group 2, the historical control. There were no differences between groups regarding sex (p=0.46), hand dominance (p=0.16), side affected (p= 0.69). The average age of Group 1 (20.8 +/- 4 yrs) was significantly younger than Group 2 (31.5 +/- 9.1 yrs, p< 0.00001). Patients who underwent return to sport criteria-based testing protocol had a rate of recurrent symptoms of pain or instability of 12.1% compared to 18.6% for those who did not (p= 0.43). Similarly, there were no reoperations for in Group 1, while three patients in group 2 (3.3%) underwent revision surgery for recurrent symptoms. This difference, however, did not reach statistical significance (p= 0.5633).Conclusions:In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. This may be related to an overall lower rate of reoperation in patients undergoing arthroscopic posterior stabilization or SLAP repairs in general compared to those undergoing arthroscopic anterior stabilization and differences in tolerance and presentation of recurrent posterior instability/SLAP tears versus anterior instability. It is possible that criteria-based return to sport testing prior to clearance to return to sport may be less critical for improving failure rates following arthroscopic posterior stabilization and SLAP repair than for anterior stabilization. Alternatively, given low reoperation rates overall, future studies investigating the role of return to sport testing after arthroscopic surgery for posterior shoulder instability and SLAP repairs may need to include more patients in order to detect differences related to the testing protocol. This study provides a basis upon which further studies, involving larger patient populations, may be conducted to elucidate any impact on functional scores and recurrence rates that may be associated with return-to-sport protocols based on functional testing rather than time since surgery.

Evaluation of the Diagnostic Utility of Spinal Magnetic Resonance Imaging in Low Back Pain Patients

Introduction: Low back pain secondary to degenerative disc disease is a condition that affects young to middle-aged persons with peak incidence at approximately 30-39 years. Magnetic Resonance Imaging (MRI) is the standard modality for detecting disc pathology. This study is being conducted to review the pattern of spinal degenerative diseases in patients referred to our institution. Methods: A retrospective study was conducted at Gandaki Medical College Teaching Hospital &amp; Research Centre (GMCTHRC) from January 2018 to April 2018 with approval from the Institutional Review Committee of Gandaki Medical College Teaching Hospital and Research Centre. The MRI findings were noted i.e. disc desiccation, disc bulge (diffuse, symmetrical and asymmetrical), disc protrusion, neural foramen narrowing, traversing nerve root compression, exiting nerve root compression and posterior annular ligament tear. Results: Out of 98 patients enrolled in the study mean age being 41 years. Disc bulge as most common finding seen in 89 (90.8%) followed by protrusion 50 (51.1%) neural foraminal narrowing (NFN) 72 (73.4%) traversing nerve roots (TNR) compression 58 (59.1%) and exiting nerve root (ENR) compression 22 (22.4%). Conclusions: The study shows that degenerative disc diseases remain the cause of morbidity in the most productive years of life (30-40 years). Large volumes of MRIs performed for this condition represent a significant economic and healthcare burden in a developing country like Nepal.

The Impact of COVID-19 on the Timing of Rotator Cuff Repair and Method of Postoperative Follow-up.

Objective Rotator cuff repair (RCR) is one of the most common arthroscopic procedures. Our investigation aims to quantify the impact that the COVID-19 pandemic had on RCR, specifically on patients with acute, traumatic injuries. Methods Institutional records were queried to identify patients who underwent arthroscopic RCR between March 1 st to October 31 st of both 2019 and 2020. Patient demographic, preoperative, perioperative, and postoperative data were collected from electronic medical records. Inferential statistics were used to analyze data. Results Totals of 72 and of 60 patients were identified in 2019 and in 2020, respectively. Patients in 2019 experienced shorter lengths of time from MRI to surgery (62.7 ± 70.5 days versus 115.7 ± 151.0 days; p = 0.01). Magnetic resonance imaging (MRI) scans showed a smaller average degree of retraction in 2019 (2.1 ± 1.3 cm versus 2.6 ± 1.2 cm; p = 0.05) but no difference in anterior to posterior tear size between years (1.6 ± 1.0 cm versus 1.8 ± 1.0 cm; p = 0.17). Less patients in 2019 had a telehealth postoperative consultation with their operating surgeon compared with 2020 (0.0% versus 10.0%; p = 0.009). No significant changes in complications (0.0% versus 0.0%; p > 0.999), readmission (0.0% versus 0.0%; p > 0.999), or revision rates (5.6% versus 0.0%; p = 0.13) were observed. Conclusion From 2019 to 2020, there were no significant differences in patient demographics or major comorbidities. Our data suggests that even though the time from MRI to surgery was delayed in 2020 and telemedicine appointments were necessary, RCR was still performed in a timely manner and with no significant changes in early complications. Level of Evidence III.

Revisiting Kümmell's disease: MRI findings beyond the intraosseous cavity for improved diagnosis.

The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD. A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses. KDwas diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD(p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64days in the KD group and 14days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001). Prevertebral soft-tissue changes and intraosseous cavity areassociated with KD. Combinedfindings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.

Paper 11: Return to Sport Testing vs Time-Based Clearance in Posterior Shoulder Instability

Objectives:Recurrent pain, instability and loss of function is a challenging complication that can occur after arthroscopic treatment of posterior shoulder instability and SLAP tears in athletes. Many surgeons allow return to sport after a designated arbitrary postoperative time point. Recent evidence has demonstrated that a majority of athletes have residual strength and functional limitations at 6 months postoperatively – the time at which most time-based protocols allow full return to sport1. Recent data has also been presented that patients undergoing arthroscopic Bankart repair who are required to meet objective return to sport testing criteria have a 4x lower rate of recurrent anterior instability than those who return based on time elapsed since surgery2. Considering these findings, the purpose of this study is to investigate the use of a similar objective return to sport testing protocol on recurrence rates following arthroscopic surgery for posterior shoulder instability and SLAP tears. We hypothesized that patients who meet objective return to sport criteria would have a lower rate of reoperation and recurrence of symptoms compared to those who did not undergo the testing and were cleared to return based on time from surgery.Methods:Consecutive patients (Group 1) who underwent arthroscopic posterior shoulder stabilization surgery with or without SLAP repair by a single surgeon from 2016 to 2019, had a minimum of 1 year follow up, and completed functional and strength testing to evaluate readiness for return to sport were included in this retrospective case-controlled study. These patients were compared to a control group of historical consecutive cases (Group 2) from 2012-2016 who did not undergo return to sports testing and were cleared for sports after a minimum of 6 months following surgery. Failure was defined as recurrent symptoms of pain or instability requiring reoperation. Exclusion criteria were: patients undergoing isolated anterior stabilization procedures with or without concomitant SLAP tears, multidirectional instability, and open procedures. Chi-square, Fisher exact tests and two-tailed Students T-test were performed. Statistical significance was set at p<0.05.Results:There were 33 patients in Group 1 who underwent return to sport testing, and 90 patients in Group 2, the historical control. There were no differences between groups regarding sex (p=0.46), hand dominance (p=0.16), side affected (p= 0.69. The average age of Group 1 (20.8 +/- 4 yrs) was significantly younger than Group 2 (31.6 +/- 9.1 yrs, p< 0.00001). Patients who underwent return to sport criteria-based testing protocol had a rate of recurrent symptoms of pain or instability of 12.1% compared to 18.9% for those who did not (p= 0.43). Similarly, there were no reoperations for in Group 1, while three patients in group 2 (3.3%) underwent revision surgery for recurrent symptoms. This difference, however, did not reach statistical significance (p= 0.5633).Conclusions:In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. This may be related to an overall lower rate of reoperation in patients undergoing arthroscopic posterior stabilization or SLAP repairs in general compared to those undergoing arthroscopic anterior stabilization and differences in tolerance and presentation of recurrent posterior instability/SLAP tears versus anterior instability. It is possible that criteria-based return to sport testing prior to clearance to return to sport may be less critical for improving failure rates following arthroscopic posterior stabilization and SLAP repair than for anterior stabilization. Alternatively, given low reoperation rates overall, future studies investigating the role of return to sport testing after arthroscopic surgery for posterior shoulder instability and SLAP repairs may need to include more patients in order to detect differences related to the testing protocol. Objective functional testing may be a viable alternative to arbitrary, time-based criteria for returning to sport in patients who have undergone arthroscopic posterior shoulder stabilization and SLAP repairs.