Postoperative Magnetic Resonance Imaging Research Articles

Increased global posterior tibial slope is significantly associated with higher ACL graft signal intensity on 2-Year postoperative MRI after primary ACL reconstruction using hamstring tendon autografts.

The healing and remodeling process of tendon grafts after anterior cruciate ligament (ACL) reconstruction (ACLR) has received significant attention. This study aims to identify preoperative factors associated with postoperative signal intensity of the ACL graft after primary ACLR. A total of 90 patients underwent primary ACLR using hamstring tendon autografts by the same senior surgeon between January 2013 and December 2020 were included. Patients were followed up and scheduled for a 2-year postoperative magnetic resonance imaging (MRI) scan at our institute. Concomitant injuries were confirmed by arthroscopy. Posterior tibial slope (PTS) and anterior tibial subluxation (ATS) were measured on preoperative MRI, whereas the normalized signal intensity of the ACL graft was evaluated on postoperative MRI and calculated as the ratio of the graft signal intensity to that of the patellar tendon. Multivariable linear regression models were performed to identify preoperative factors associated with the postoperative signal intensity of the ACL graft. Multivariable analyses showed that increased global PTS (GPTS) (P = 0.008) and concomitant articular cartilage injuries (P = 0.005) were associated with higher average signal intensity of the ACL graft on two-year postoperative MRI, while preoperative internal rotational tibial subluxation (IRTS) calculated as the difference between lateral ATS and medial ATS did not show a significant association. Specifically, an increased GPTS was significantly associated with higher signal intensity in the proximal section of the ACL graft (P = 0.005), whereas no significant associations were observed in the middle and distal sections. Increased preoperative GPTS was significantly associated with higher signal intensity of the ACL graft on 2-year postoperative MRI after primary ACLR, suggesting that a steep preoperative tibial slope may contribute to a suboptimal ligamentization process in hamstring tendon autografts. Level III, retrospective cohort study.

SURG-42. THE T1/T2 RATIO IS ASSOCIATED WITH RESECTABILITY IN PATIENTS WITH IDH-MUTANT ASTROCYTOMAS CNS WHO GRADES 2 AND 3

Abstract PURPOSE IDH-mutant astrocytomas CNS WHO grade 2 and 3 show heterogenous appearance on magnetic resonance imaging (MRI). In the pre-molecular era, the discrepancy between T1 hypointense and T2 hyperintense tumor volume in absolute values has been proposed as a marker for diffuse tumor growth. We set out to investigate if a ratio of T1 to T2 tumor volume (T1/T2 ratio) is associated with resectability and overall survival in patients with IDH-mutant astrocytomas. METHODS Patient data from two centers (Center A: Sahlgrenska University Hospital, Gothenburg, Sweden; Center B: LMU University Hospital, Munich, Germany) were collected retrospectively. Inclusion criteria were as follows: pre- and postoperative MRI scans available for volumetric analysis (I), diagnosis of an IDH-mutant astrocytoma between 2003-2021 (II), and tumor resection at initial diagnosis (III). Tumor volumes were manually segmented. The T1/T2 ratio was calculated and correlated with extent of resection, residual T2 tumor volume, and overall survival. RESULTS The study comprised 134 patients with 65 patients included from Center A and 69 patients from Center B. The median overall survival was 134 months and did not differ between the cohorts (p=0.29). Overall, the median T1/T2 ratio was 0.79 (range 0.15-1.0). Tumors displaying a T1/T2 ratio of 0.33 or lower showed significantly larger residual tumor volumes postoperatively (median 17.9 cm3 versus 4.6 cm3, p=0.03). The median extent of resection in these patients was 65% versus 90% (p=0.03). The ratio itself did not correlate with overall survival. In multivariable analyses, larger postoperative tumor volumes were associated with shorter survival times (HR 1.02, 95% CI 1.01-1.03, p<0.01). CONCLUSION The T1/T2 ratio might be a good indicator for diffuse tumor growth on MRI and is associated with resectability in patients with IDH-mutant astrocytoma. This ratio might aid to identify patients in which an oncologically relevant tumor volume reduction cannot be safely achieved.

Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery

Abstract Background Nasoseptal flaps (NSF), perfused by the posterior septal artery (PSA), are heavily utilized in endonasal skull base surgery (ESBS). We use indocyanine green (ICG) fluorescence angiography to assess PSA perfusion. Methods A prospective study of adult ESBS patients assessed PSA perfusion using intraoperative ICG. PSA ICG fluorescence intensities (FIs) were quantified. Factors analyzed included demographics, comorbidities, prior sinonasal surgery, surgical approach, concurrent septoplasty, NSF harvest timing, and flap-related complications. t-Tests compared significant ICG baseline differences and changes from baseline. ICG enhancement was compared with postoperative magnetic resonance imaging (MRI). Results A total of 54 patients were studied. Of these, 35 NSFs were harvested, while the remaining 19 underwent cuts for rescue flaps. Mean PSA FI changed from baseline 118.1 ± 28.6 to 114.4 ± 32.3 following reconstruction. Tobacco users had lower baseline FI compared with non-tobacco users (78.3 ± 62.8 vs. 118.4 ± 29.1, p = 0.003). Transpterygoid approaches showed greater decrease from baseline (−25.8 ± 58.9 vs. −3.8 ± 32.1, p = 0.035) than transsphenoidal. No other studied factors, including revision case, timing of flap harvest, flap side, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. In total, 34 of 35 NSFs were viable. ICG fluorescence had a 100% sensitivity, 0% specificity, and 96.6% positive predictive value (PPV) for NSF viability, while MRI enhancement had a 100% sensitivity, 100% specificity, and 100% PPV for NSF viability. Conclusion ICG angiography may provide an intraoperative assessment of flap viability with comparable PPV as postoperative MRI. Tobacco use and transpterygoid approaches may be associated with decreased PSA perfusion.

Prospective evaluation of MRI artefacts following breast conserving surgery and sentinel lymph node dissection with the magnetic technique

IntroductionSuperparamagnetic Iron Oxide (SPIO) nanoparticles serve as a promising tracer for sentinel lymph node (SLN) detection in breast cancer. Concerns exist regarding artefacts on postoperative Magnetic Resonance Imaging (MRI), especially following breast conservation (BCS). Materials and methodsIn this prospective observational study, 97 women with DCIS or invasive breast cancer underwent BCS and SLN detection with peritumoral SPIO injection administered up to four weeks before surgery. Postoperatively, patients were followed with MRI and mammograms, and imaging outcomes were evaluated by four, independent breast radiologists, blinded to clinical data, using a predefined, standardized questionnaire. ResultsIn 97 patients included, there was inter-rater discordance in the prevalence of “any artefact” (range: 24.1–74.4 %; weighted average: 32.4 %) and “SPIO specific artefact” (range: 12.0–49.4 %; weighted average: 20.9 %). The median area of “any artefact” was 9.24 cm2 (iqr 4.72, 15.50) and SPIO specific artefact 9.88 (iqr 5.32, 15.5). Likert scores indicated higher difficulty interpreting MRI if artefacts were present (OR: 2.295, 95 % CI 1.028, 5.123; p = 0.043), but this was reduced if intravenous contrast was administered (OR: 0.177, 95 % CI 0.091, 0.342; p < 0.001). Multivariable analysis identified free-hand SPIO administration as a risk factor (OR 8.929, 95 % CI 2.849, 27.778; p < 0.001). All six patients with local recurrence were successfully diagnosed on MRI by all raters. ConclusionThis prospective cohort study suggests that a targeted peritumoral SPIO injection can result in the removal of SPIO during lumpectomy and address the concerns for artefacts on postoperative MRI follow-up, in the selected patients that MRI may be warranted.

Asymmetry of the Frontal Aslant Tract and Development of Supplementary Motor Area Syndrome

Background/Objectives: The purpose of this study was to investigate preoperative interhemispheric differences of the FAT in relation to the onset of postoperative SMA syndrome. Methods: This was a single-center retrospective analysis of patients who underwent surgical resection of diffuse gliomas involving the SMA between 2018 and 2022. Inclusion criteria were availability of preoperative and postoperative Magnetic Resonance Imaging, no previous surgery, and no neurological deficits at presentation. Diffusion-weighted data were processed by spherical deconvolution (SD) and diffusion tensor imaging tractography algorithms, and TrackVis was used to dissect the FAT of both hemispheres. The FAT data were analyzed for correlation with postoperative SMA syndrome onset. Results: N = 25 cases were included in the study, among which n = 23 had preoperative bilaterally identifiable FAT by SD. N = 12 developed an SMA syndrome, 6 demonstrated a motor-only syndrome, 4 had a verbal-only syndrome, and 2 had mixed verbal and motor features. The SMA syndrome incidence was significantly more frequent in lower-grade gliomas (p = 0.005). On the tumor side, the FAT identified by SD was smaller than the contralateral (mean volume 6.53 cm3 and 13.33 cm3, respectively, p &lt; 0.001). In the 6 cases that developed a verbal SMA syndrome, a normalized FAT volume asymmetry (FAT-VA) demonstrated an asymmetry shifted towards the non-dominant side (mean FAT-VA = −0.68), while the cases with no postoperative verbal impairment had opposite asymmetry towards the dominant side (mean FAT-VA = 0.42, p = 0.010). Conclusions: Preoperative interhemispheric FAT volume asymmetry estimated according to functional dominance can predict postoperative onset of verbal SMA syndrome, with proportionally smaller FAT on the affected dominant hemisphere.

Persistence of Labral Tears and Resolution of Paralabral Cysts with 2-year MRI analysis after Periacetabular Osteotomy (PAO) for Hip Dysplasia

To evaluate the labrum status and paralabral cysts on preoperative and postoperative magnetic resonance imaging (MRI) in patients with developmental dysplasia of the hip (DDH) who underwent periacetabular osteotomy (PAO). A retrospective review was conducted using prospectively collected data from patients who had undergone primary PAO between June 1, 2021 and May 30, 2022. Inclusion criteria were an age range of 16 to 55 years and a minimum follow-up of two years. MRI was utilized to evaluate the preoperative and postoperative conditions of the labrum and the presence of paralabral cysts. Furthermore, the correlations between the presence of paralabral cysts and demographic and radiographic variables were investigated. Additionally, patient-reported outcomes (PROs), minimal clinically important difference (MCID), and complications were reported during the final follow-up evaluation. A total of 23 patients were included in the final analysis, with an average follow-up of 26.6 ± 3.4 months (range, 24-32 months). All patients diagnosed with symptomatic DDH exhibited labrum tears. MRI scans revealed paralabral cysts in ten out of twenty-four (41.6%) patients, with a significant correlation noted between the presence of cysts and preoperative LCEA (ρ=-0.649; P=0.001), ACEA (ρ=-0.637; P=0.001), Tönnis angle (ρ=0.593; P=0.002) and age (ρ=-0.444; P=0.034). Postoperative MRI scans at one year showed resolution of all paralabral cysts, while labral tears were found to persist. At the end of the follow-up period, most patients improved considerably in PROs compared to preoperative values. The probabilities of achieving the MCID were 91.3% on the HOS-ADL, 78.2% on the HOS-SSS, 91.3% on the mHHS, 73.9% on the iHOT-12, and 69.6% on the VAS pain scale. All symptomatic patients with DDH had labral tears and a high prevalence of paralabral cysts, which were corrected with reduced acetabular coverage. After PAO surgery, patients experienced notable enhancements in PROs, with resolution of paralabral cysts but persistence of labral tears.

Postoperative Nodal Efficiency of the Lesional-Hemispheric Hand Motor Area Increasing Potentially Facilitated Motor Recovery for SMA Syndrome.

Supplementary motor area (SMA) syndrome commonly occurs after glioma resection and requires weeks to months of recovery. Thirty-four glioma patients with SMA syndrome were reviewed and assigned to recovered and non-recovered groups based on whether their motor function recovered on postoperative day 7. To validate the association between variations in nodal properties and recovery time, neuro-navigated repetitive transcranial magnetic stimulation (nrTMS) was applied to stimulate potential nodes. Nine other patients (five nrTMS therapy and four sham-nrTMS treatments) with SMA syndrome with unrecovered motor functions on postoperation day 7 were prospectively enrolled. The potential nodes of the sensorimotor network related to recovery time were investigated using preoperative and postoperative resting-state functional magnetic resonance imaging, graph theoretical analysis, and dynamic functional connectome analysis. Nodal efficiency of the lesional-hemispheric upper limb region of BA 4 (A4ul_L) increased in the recovered group (preoperative, 0.472 ± 0.027; postoperative, 0.535 ± 0.020; p = 0.0006). The patients in the nrTMS therapy group quickly recovered (12.0 ± 1.6 days) compared to the sham-nrTMS group (29.5 ± 3.8 days, p = 0.0024). Variations in A4ul_L nodal efficiency was negatively correlated with recovery time (r = -0.841; p = 0.0046). A4ul_L demonstrates enhanced postoperative nodal efficiency and shows therapeutic potential in SMA syndrome recovery, suggesting its viability as a therapeutic target.

Higher Posterior Tibial Slope and Lower Medial Proximal Tibial Angle of the Knee Are Associated with Delayed Graft Maturation after ACL Reconstruction Surgery with Hamstring Autograft

PurposeThis study aims to relate bone shape with anterior cruciate ligament (ACL) graft maturation, as evaluated by quantitative magnetic resonance imaging (MRI). MethodsWe retrospectively evaluated patients aged 18-60 years who underwent ACL reconstruction with a hamstring autograft with doubled semitendinosus and gracilis at our institution between 2018 and 2020 with isolated ACL injuries. All patients had a minimum follow-up period of 2 years. To evaluate alignment, radiographs of the knee were taken preoperatively. Postoperative 3T magnetic resonance imaging (MRI) and patient-reported outcomes (PRO) scores were acquired at 2 years after surgery. A combined T1ρ/T2 quantification sequence and a 3D multi-echo ultrashort echo-time (UTE) Cones sequence were obtained in a sagittal-oblique plane for better assessment of the ACL graft. After acquiring images, a manual segmentation for ACL graft was performed to assess T1ρ, T2 and UTE T2* relaxation times. Correlations between radiographic parameters or PRO scores and T1ρ, T2 and UTE T2* values were tested with Pearson correlation coefficients. Significance was defined as p<0.05. ResultsSubjects were 28 patients (12 males and 16 females) and had an average age of 34.3 years (SD=8.5 years) and a BMI of 24.4 kg/m2 (SD=4.5 kg/m2). A significant correlation was found between the preoperative PTS and the T1ρ, T2 and UTE T2* relaxation times (r=0.41; p=0.033, r =0.47; p=0.014 and r =0.41; p=0.030), indicating inferior graft maturation in patients with higher PTS. Furthermore, a negative correlation was identified between the preoperative MPTA and the T1ρ, T2 and UTE T2* relaxation times (r=-0.39; p=0.039, r =-0.46; p=0.018 and r =-0.43; p=0.024), indicating inferior graft maturation in patients with greater varus knee alignment. ConclusionThe study findings suggest that an increased PTS and lower MPTA are associated with inferior graft maturation as per T1ρ, T2 and UTE T2* imaging at 2 years post-ACL reconstruction. Level of EvidenceLevel IV retrospective case series

Reversal of Denervation Changes in Infraspinatus Muscle After Operative Management of Paralabral Cysts: An MRI-Based Study.

Paralabral cysts at the spinoglenoid notch are rare disorders that can potentially lead to compressive suprascapular neuropathy. Given their infrequency, a standard treatment protocol has not yet been established. This study aimed to assess changes in the infraspinatus muscle using magnetic resonance imaging (MRI) and to compare the outcomes of 2 different surgical methods. It was hypothesized that surgical intervention could alleviate compressive neuropathy, with comparable outcomes between the 2 surgical approaches. Cohort study; Level of evidence, 3. This retrospective review encompassed 43 patients undergoing arthroscopic labral repair for a paralabral cyst at the spinoglenoid notch, with cyst decompression (27 patients; labral repair with cyst decompression [LRCD] group) or without cyst decompression (16 patients; labral repair only [LRO] group). Preoperative MRI focused on evaluating the condition of the infraspinatus and teres minor muscles. Electromyography (EMG) was conducted on 36 patients (21 in LRCD and 15 in LRO) to assess suprascapular nerve function. Postoperative evaluations were performed in 35 patients at postoperative 1 year, excluding those lost to follow-up. Postoperative MRI findings (24 patients in LRCD and 11 patients in LRO) and functional outcome scores including recovery of external rotation power were compared with preoperative status in both groups. Preoperative MRI revealed denervation changes or atrophy of the infraspinatus in 26 of the 43 patients (60.4%). Among the 36 patients who underwent preoperative EMG, 21 patients (58.3%; 13 patients in LRCD and 8 patients in LRO) showed evidence of suprascapular neuropathy. A discrepancy between EMG and MRI findings was noted in 10 patients, with 5 patients showing suprascapular neuropathy according to EMG despite normal muscle status on MRI scans, and the remaining 5 vice versa. Notable atrophy of the infraspinatus was seen in 6 patients and teres minor hypertrophy in 5 patients, all of whom exhibited concurrent infraspinatus atrophy. Postoperatively, cyst disappearance was observed in all cases in both LRCD (24 patients) and LRO (11 patients) groups. Denervation changes in the infraspinatus were resolved in all patients. In patients with infraspinatus atrophy, some improvement was noted. Teres minor hypertrophy persisted in 2 of 4 patients. Improvements were similar in both groups (all P > .05). External rotation power improved postoperatively in both groups (from 39.1 ± 18.6 to 50.6 ± 17.7 N in LRCD, P < .001; from 45.1 ± 16.0 to 54.2 ± 10.7 N in LRO, P = .025). Both LRCD and LRO surgical approaches appear to be effective for paralabral cysts at the spinoglenoid notch. Suprascapular neuropathy can be successfully addressed by both methods. However, conditions with severe infraspinatus atrophy and teres minor hypertrophy warrant further investigation in larger series.

Intraneural and Extraneural Ganglion Cysts at the Greater Sciatic Notch Involving the Sciatic Nerve Causing Sciatica: Two Case Reports

Intraneural ganglion cysts (IGCs) are benign mucinous cysts within the epineurium of peripheral nerves. Hip joint-related IGCs are much rarer than those that arise from peripheral nerves around the joints of limbs. The unifying articular synovial theory has been accepted as explaining the pathogenesis of IGCs. Herein, we present two cases of hip joint-related ganglion cysts—one case of an IGC and one case of an extraneural ganglion cyst—that involved the sciatic nerve through the articular branch of the hip joint and caused sciatica. Preoperative and postoperative magnetic resonance imaging (MRI) findings of the articular branch derived from a paralabral cyst of the hip are presented, as well as photographic findings of a ganglion cyst with the articular branch addressed through a transgluteal approach. Despite improvement in postoperative sciatica due to cyst decompression and treatment aimed at addressing the articular branch, the articular branch remained present on postoperative MRI. Unlike IGCs arising from peripheral nerves associated with limb joints, involvement of the sciatic nerve might make it challenging to treat articular branches due to the location of the sciatic nerve over the greater sciatic notch of the deep gluteal region.

Comparison of Postoperative Epidural Hematoma Formation Between Biportal Endoscopic Spine Surgery and Conventional Microscopic Surgery: A Randomized Controlled Trial.

Biportal endoscopic spine surgery (BESS) has become widely recognized as a minimally invasive method for spinal decompression and discectomy. However, postoperative epidural hematoma (POEH) presents a significant risk in spinal surgery due to its potential to compress neural elements and lead to neurological deficits. This study compares the clinical and radiological outcomes of BESS with those of conventional microscopic surgery. In this single-center, single-blinded, actively controlled randomized clinical trial, 46 patients undergoing single-level posterior decompression or discectomy for spinal stenosis or herniated intervertebral discs were enrolled. Participants were randomly allocated to either the conventional microscopic surgery group or the BESS group. Experienced spine surgeons performed all procedures. Postoperative magnetic resonance imaging assessments were conducted following the removal of the drain system. Outcome measures included the cross-sectional area (CSA) of the dura sac and POEH, as well as the incidence of neurological deficits. The demographic and baseline characteristics of the patients were similar across the 2 groups, with 24 in the conventional group and 22 in the BESS group. There were no significant differences in the preoperative and postoperative CSA of the dura sac between the groups. However, the BESS group exhibited a significantly larger CSA of POEH (0.36 ± 0.34 cm²) compared with the conventional group (0.17 ± 0.15 cm², P = 0.033). Despite this higher incidence of POEH, there was no corresponding increase in neurological deficits or revision surgeries. The findings indicate that while BESS achieves decompression comparable to that of conventional microscopic surgery, it is associated with a higher incidence of epidural hematomas. Importantly, these hematomas did not result in an increased rate of neurological deterioration or the need for surgical interventions. Further studies with larger sample sizes and extended follow-up are required to confirm these results and further refine the BESS technique. Despite a higher incidence of epidural hematomas, BESS offers comparable decompression to microscopic surgery without increased neurological risks, making it a viable, less invasive option for patient care.

Increased Postoperative Deltoid Signal seen after Suprapectoral Biceps Tenodesis: Potential Risk to the Anterior Branch of the Axillary Nerve

BackgroundArthroscopic suprapectoral biceps tenodesis is a common procedure for lesions of the long head of the biceps in the setting of anterior shoulder pain. However, the distal portal poses a theoretical risk to the terminal branches of the axillary nerve as the nerve travels from posterior to anterior to innervate the anterior deltoid. The purpose of this retrospective cohort study was to assess for axillary nerve branch injury, identified by deltoid signal change in postoperative magnetic resonance imaging (MRI) in patients who underwent an arthroscopic suprapectoral biceps tenodesis. MethodsPatients who underwent rotator cuff repair with a concomitant arthroscopic suprapectoral biceps tenodesis, had a postoperative MRI, and at least 1 year of follow-up were included. The incidence of increased deltoid signal consistent with injury to an anterior branch of the axillary nerve on proton density fat saturated sequences was collected. Age, sex, body mass index (BMI), and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons Shoulder Score (ASES) score, Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function (PF), and upper extremity (UE) scores, and Single Assessment Numeric Evaluation (SANE) score were compared in patients with and without increased deltoid signal on postoperative MRI. P<0.05 was used for significance. ResultsTwenty-four patients were eligible for inclusion (9 female, average age 59.0±10.1, BMI 27.6±6.7). Edema-like signal within the anterior deltoid musculature was observed in 9 patients on postoperative MRI. Two patients had a second follow-up MRI performed which demonstrated resolution of signal, and one patient required a second surgery for release of adhesions. Patients with increased deltoid signal had higher BMI (p=0.03). There was no difference in any other demographic or postoperative PROM between patients with increased signal and those without at any follow-up time point. No patient demonstrated persistent weakness or numbness in the axillary nerve distribution at final follow-up. DiscussionOver one third of patients in our cohort had MRI evidence of axillary nerve branch injury as seen on proton density fat saturated MRI sequences postoperatively. The distal arthroscopic portal for a suprapectoral biceps tenodesis may place anterior terminal branches of the axillary nerve at risk for injury. Additional investigation and strategies for avoidance of nerve injury in this area should be pursued.

Evaluation of healing after arthroscopic repair of lateral meniscal tears around the popliteal hiatus

BackgroundThe popliteal hiatus stabilizes the lateral meniscus (LM). Variable failure rates for LM repairs have been reported in knees with lateral meniscal tears (LMTs), which may be attributable to low vascularity around the popliteal hiatus. An effective repair method is essential to enhance the biological healing and stability of LMTs around the popliteal hiatus. HypothesisArthroscopic repair of LMTs, including the popliteus tendon around the popliteal hiatus, is expected to produce a low reoperation rate and effective treatment, both clinically and radiographically. Material and methodsFrom June 2011 to August 2020, 93 patients (mean age 27.9 ± 13.5 years) who underwent arthroscopic repair of LMTs including the popliteus tendon around the popliteal hiatus were enrolled. Patients with LMTs were divided into three groups: isolated LMTs, discoid LMTs, and LMTs with ACL injury. Patients had a minimum clinical follow-up of 2 years (mean 37.9 ± 19.3 months) and Tegner activity, Lysholm knee, and Hospital for Special Surgery (HSS) scores were evaluated for all patients. The widths of the popliteal hiatus and LM extrusion were measured on the sagittal and coronal planes using preoperative and postoperative magnetic resonance imaging (MRI). ResultsThe Tegner activity (2.6 ± 1.2–4.5 ± 1.3), Lysholm (67.9 ± 14.2–88.1 ± 6.4), and HSS scores (79.8 ± 11.5–93.7 ± 5.1) were significantly improved in all knees (p < 0.001). The width of the popliteal hiatus measured on MRI was significantly decreased, when comparing the preoperative and postoperative MRI for all knees (sagittal plane, 2.9 ± 1.4–1.5 ± 0.5 mm; coronal plane, 3.8 ± 2.5 to 1.9 ± 1.0 mm) (p < 0.05). The LM extrusion measured on the sagittal plane of postoperative MRI was also significantly reduced after arthroscopic repair (24.8 ± 3.1–23.7 ± 2.8 mm) (p = 0.001). Five reoperations (5/93, 5.3%) were performed, suggesting a clinical failure. ConclusionArthroscopic repair of isolated, discoid and post-traumatic LMTs including the popliteus tendon around the popliteal hiatus, is an effective surgical treatment for LM stabilization. Level of evidenceLevel IV, retrospective series.

The incidence of meniscal cyst formation following meniscal repair using the all-inside suture anchor device is comparable to conventional techniques.

Post-operative meniscal cyst formation occurs following all-inside device meniscal repair. This study aimed to compare the incidence of cysts in patients who underwent meniscal repair with and without all-inside suture devices. This retrospective study included 227 knees that underwent meniscal repair between 2021 and 2022. The incidence of post-operative meniscal cysts was compared between patients who underwent repair using an all-inside suture anchor device (Group SA) and those who did not use an anchor (Group NA), based on post-operative magnetic resonance imaging (MRI) findings. Risk factors, such as the number of anchors used, were investigated. Using a subgroup analysis, the incidence of meniscal cysts based on the type of device used was investigated. Groups SA and NA comprised 125 and 102 knees, respectively. Group SA had 11 cases of cysts (9% incidence), whereas Group NA had 7 cases (7% incidence), and no statistically significant difference was observed (p = 0.63). Symptomatic cysts were observed in two patients (1.6%) in Group SA, whereas none was observed in Group NA (0%); the difference was not significant (p = 0.50). Factors such as the number of anchors and sutures used and MRI timing were not identified as risk factors. Cyst incidence varied according to anchor type: Stryker AIR+ (4 out of 55, 7%), Smith & Nephew Fast-Fix 360 (7 out of 56, 13%) and Arthrex Fiber Stitch (0 out of 26, 0%), with no significant difference found (p = 0.14). The incidence of cysts in patients undergoing meniscal repair with an all-inside suture anchor device was 9%, showing no significant difference compared with Group NA. Cyst incidence was not affected by device type. Level III, retrospective comparative study.

Comparison of Mediolateral (V-shaped) versus Anteroposterior Dominant Rotator Cuff Tears: The Anteroposterior Tear Width Contributes More to Postoperative Retears than Mediolateral Length when the Tear Size Area is Similar

Tear size is a significant prognostic factor following rotator cuff repair. However, no study has investigated which dimension of the tear, the mediolateral or anteroposterior, more significantly influences the outcome when the product of the two dimensions, the tear size area, is similar. A retrospective cohort study was conducted with patients who underwent arthroscopic FTRCT repair. Two contrasting groups were derived from preoperative tear dimensions. The mediolateral dominant (MLD) group consisted of 45 FTRCTs with the mediolateral tear dimension at least 1.5 times larger than the anteroposterior, and retraction exceeding the humeral head apex. The anteroposterior dominant (APD) group included 35 FTRCTs with an inverse proportion of the dimensions and retraction short of the humeral head apex. Demographic data, pre- and postoperative magnetic resonance imaging (MRI), clinical scores, and strength were compared between the groups. The mean follow-up was 26.7 and 32.2 months in the MLD and APD groups, respectively. The tear size in area (MLD vs. APD, 521.0 vs. 523.4 mm2, P=.960) and the discrepancy between ML and AP dimensions (2.0 vs. 1.9, P=.597) were similar. However, the MLD group demonstrated significant female predominance (P=.003), dominant arm involvement (P=.007), a higher incidence of pathologic subacromial spurs (P=.016), narrower acromiohumeral distance (P<.001), shorter residual tendon (P<.001), and advanced supraspinatus muscle atrophy (P=.005). Other baseline parameters were comparable between the groups. At the one-year postoperative MRI, the MLD group demonstrated a significantly lower retear rate (4.4% vs. 31.4%, P=.001). Nevertheless, clinical scores and strength at the last follow-up did not significantly differ. In a similar tear size area, the greater AP width contributes more than the ML length in causing a retear. Female predominance, dominant arm involvement, subacromial spurs, shorter residual tendon, and supraspinatus muscle atrophy were more demonstrated in MLD tears. Surgeons should be aware that healing may be poor in APD tears despite less retraction.

Autologous platelet-rich plasma and fibrin-augmented minced cartilage implantation in chondral lesions of the knee leads to good clinical and radiological outcomes after more than 12 months: A retrospective cohort study of 71 patients.

The treatment of cartilage lesions remains a challenge. Matrix-associated autologous chondrocyte implantation has evolved to become the gold standard procedure. However, this two-step procedure has crucial disadvantages, and the one-step minced cartilage procedure has gained attention. This retrospective study aimed to evaluate the clinical and radiological outcome of an all-autologous minced cartilage technique in cartilage lesions at the knee joint. In this retrospective cohort study, 71 patients (38.6 years ± 12.0, 39,4% female) with a magnetic resonance imaging (MRI) confirmed grade III-IV cartilage defect at the medial femur condyle (n = 20), lateral femur condyle (n = 2), lateral tibia plateau (n = 1), retropatellar (n = 28) and at the trochlea (n = 20) were included. All patients were treated with an all-autologous minced cartilage procedure (AutoCart™). Clinical knee function was evaluated by the Tegner score, visual analogue scale, the subjective and objective evaluation form of the International Knee Documentation Committee and the Knee Injury and Osteoarthritis Outcome Score (KOOS). MRI analyses were performed by magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 knee score. Follow-up examination was 13.7 ± 4.2 (12-24) months postoperative. All clinical scores significantly improved after surgical intervention (p < 0.0001), especially the subgroup sports and recreation of KOOS showed clear changes from baseline in the follow-up examination. In the postoperative MRI evaluation, 39 of 71 patients showed a complete fill of the cartilage defect without subchondral changes in 78% of the patients in the MOCART 2.0 score in the follow-up analysis. None of the patients showed adverse effects, which are linked to the minced cartilage procedure during the time of follow-up. An all-autologous minced cartilage technique for chondral lesions at the knee joint seems to be an effective and safe treatment method with good clinical and radiological short-term results. Level IV.

Study design and procedures in the incontinence post robot-assisted radical prostatectomy: anatomical and functional causes (IPA) - a prospective observational clinical trial.

To describe the study design and procedures of the incontinence post robot- assisted radical prostatectomy, anatomical and functional causes (IPA) trial. This trial aims to identify and study patient and procedure specific factors leading to urinary incontinence post robot-assisted laparoscopic radical prostatectomy (RALP). The IPA study is a prospective, multicentre, open non-randomised surgical trial, including patients prior to RALP and registered on-line (ISRCTN67297115). IPA is administered from the Department of Urology at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients undergo an anatomical and functional evaluation using magnetic resonance imaging (MRI), urodynamics including cystometry, pressure-flow and urethral pressure profile, and dynamic transrectal ultrasound prior to and 3 months after RALP. The incontinence data are gathered using patient reported outcome measure questionnaires. The primary endpoint is incontinence at 3 months after RALP, defined as need of any pad. The secondary endpoints are incontinence 12 months post RALP defined as need of any pad, and 3- and 12-months post RALP, defined as use of more than a safety pad. Until October 2023, 207 patients have been included of the stipulated 1,000, with an increasing rate of accrual. Out of these patients,187 have had a pre- and post-operative MRI and 177 have undergone pre- and post-operative urodynamics. The design of the IPA study, together with promising accrual and coming multicentre inclusion, will hopefully result in the identification, and deeper understanding, of the various risk-factors for post-RALP incontinence. This could improve information and decision making regarding adequate treatment for patients with prostate cancer.

Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection

Objective: Advanced imaging in the management of childhood bone and joint infection (BJI) has the potential to improve disease outcomes. Knowledge about the optimal timing for magnetic resonance imaging (MRI) in relation to both surgically and nonsurgically managed BJI is limited. This study examines the impact of MRI timing on number of surgeries, length of stay (LOS), hospitalization cost, and disease recurrence in childhood BJI. Methods: This is a retrospective review of patients younger than 16 years with acute hematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region from 2018 to 2023. Cases undergoing MRI as part of diagnostic workup were included. Treatment, hours between admission and MRI, LOS, hospitalization cost, and infection recurrence were assessed. Results: There were 563 cases of BJI, of which 390 met the inclusion criteria. Cases were primarily AHO (85%). The percentage of cases having MRI increased over time from 54% (2018) to 80% (2023). Locally disseminated infections such as subperiosteal abscess or adjacent septic arthritis occurred in 48%. Children with preoperative (n = 145) versus postoperative MRI (n = 60) had a lower reoperation rate (33% vs 77%, P = 0.001) and shorter LOS (14.1 vs 22.4 d, P = 0.002). Hospitalization costs appeared lower but did not differ statistically ($59,419 vs $159,353, P = 0.12). In nonoperative cases, LOS was shorter if an MRI occurred within 48 hours of admission (7.3 vs 10 d, P = 0.03). Disease recurrence was not associated with MRI timing. Conclusion: Overall, children with BJI who underwent MRI scans before surgery had lower reoperation rates. Children receiving MRIs within 48 hours of admission had shorter LOS.

Isolated in-situ mosaicplasty fixation of unstable knee osteochondritis dissecans in skeletally mature patients; a combined mechanical and biological solution with excellent outcomes and a low re-operation rate

ObjectivesUnstable Osteochondritis dissecans (OCD) of the knee can result in substantial morbidity; the aims of surgical management are to provide stability to the lesion and to stimulate biological healing. The aims of this paper were to review the outcomes of a previously described, but uncommonly used, technique involving isolated mosaicplasty fixation of unstable knee OCD. MethodsA retrospective review of skeletally mature patients treated with in-situ mosaicplasty fixation of unstable OCD of the knee was performed. Two out of thirteen knees also underwent concomitant realignment osteotomy. Post-operative Magnetic Resonance Imaging (MRI) and patient reported outcome measures were reviewed. ResultsTwelve patients (13 knees) were included; there were 5 females and 7 males. The mean age at time of surgery was 22 years (range 16-32). The lesion location was lateral femoral condyle in 7 cases and medial femoral condyle in 6 cases. Follow-up MRI scans confirmed fragment healing in 12 knees (92%). One patient required further surgical intervention for ongoing symptoms and radiological non-union: the patient underwent an off-loading distal femoral osteotomy to correct valgus mal-alignment. ConclusionThis series describes the outcomes following an uncommonly performed, yet reproducible and effective method of fixation of unstable knee OCDs. We believe in-situ mosaicplasty fixation represents an opportunity to provide both mechanical stability and biological augmentation of OCD healing and the series confirms that excellent results can be achieved, with a low re-operation rate. Level of EvidenceLevel IV

Percutaneous endoscopic transforaminal decompression surgery for symptomatic double-level lumbar spinal stenosis with ossification.

This study aimed to explore the short-term effects of percutaneous endoscopic transforaminal decompression (PETD) for the treatment of symptomatic double-level lumbar spinal stenosis (LSS) with ossification. Twenty-eight patients diagnosed with double-level lumbar spinal stenosis who underwent double-level PETD surgery between January 2021 and January 2023 at our institution. General information, such as age, sex, disease duration, hospitalization time, and operation time, was recorded. Magnetic resonance imaging (MRI) dural sac cross-sectional area (DSCA) was recorded to assess the degree of spinal canal decompression. The White-Panjabi scoring system (WP) was used to assess preoperative and postoperative lumbar spine stability. Pre- and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess symptom improvement, and surgical efficacy was evaluated using the modified Macnab evaluation criteria at the 1-year postoperative follow-up. The types and risks of complications were also recorded. The patient's 1-year postoperative follow-up MRI showed that both L3/4 and L4/5 DSCA were significantly enlarged compared with preoperative values (P < .001). There was no significant difference in the WP scores at 3 months postoperatively compared with those preoperatively (P > .05). The VAS scores for hip and lower extremity pain at 3 days, 3 months, and 1 year postoperatively were significantly lower than those preoperatively (P < .001), and the ODI scores at 3 months and 1 year postoperatively were significantly lower than those preoperatively (P < .001). There were no significant differences in hip pain, lower extremity pain VAS scores, or ODI scores between the postoperative follow-up time points (P > .05). There was 1 case of lower limb numbness and 1 case of neuroedematous pain in the postoperative period, and all patients had no complications, such as dural sac tear, infection, or recurrence. The 1-year postoperative follow-up was assessed as excellent in 17 cases, good in 9 cases, and possible in 2 cases using the modified Macnab criteria, with an excellent rate of 92.9%. The efficacy of double-level PETD for symptomatic double-level LSS is clear, the local stability of the lumbar spine is less affected, and the risk is low, which can reduce the chances of reoperation in patients. Thus, it is a recommended surgical procedure.