Type Of Tear Research Articles

Evaluation of the Early Functional Outcome Following Arthroscopic Partial Meniscectomy for Meniscal Tears

Meniscal tears are among the common knee pathologies which affect activities of daily living if not managed properly. Arthroscopic knee surgery is an evolving procedure in our environment and patient satisfaction with this procedure needs to be evaluated. This was a prospective study carried out between June 2017 and May 2018 with the aim to determine the effectiveness of Arthroscopic Partial Meniscectomy in the management of meniscal tears in our environment. The Western Ontario Meniscal Evaluation Tool (WOMET) Knee Score was used to assess patient satisfaction with this procedure. A total of thirty-one patients were recruited into the study consisting of eighteen males and thirteen females with an average age of thirteen years (17 - 48 years) who underwent arthroscopic partial meniscectomy. Preoperative and postoperative knee scores at 6 weeks and 12 weeks were compared using the Western Ontario Meniscal Evaluation Tool. At the end of the study period, data collated were analyzed using the specified tools. In terms of clinical outcomes, arthroscopic partial meniscectomy showed statistically significant improvement of symptoms as evidenced by a mean knee score of 75.6 (SD 9.3) at 6 weeks, 87.7 (SD 4.7) at 12 weeks compared with a preoperative knee score of 46.7. Medial meniscal tears were more common than lateral meniscal tears in all age groups and both sexes recruited into the study. The most common type of meniscal tear seen was the longitudinal type of tear while complex tear is the least type of tear seen. The surgery (arthroscopic partial meniscectomy) is an evolving area of sports medicine that requires sub-specialization, however solves the problem of increased mobility following open surgery. This study will tend to add to existing knowledge as patients who are mostly sports inclined can return to play very early with better outcome scores as regards pain and function.

Open Hip Abductor Tendon Repair into a Bone Trough: Improved Outcomes for Hip Abductor Tendon Avulsion.

Background:Hip abductor tendon tears are a well-recognized entity that results in progressive lateral hip pain, weakness, and limping. These can occur in patients with native hips or in patients following total hip arthroplasty. However, treatment of these 2 distinct groups does not differ. We describe a new repair technique utilizing a longitudinal bone trough in the greater trochanter. We compare our results (focusing on gluteus medius tendon avulsions) and traditional repair with suture anchors or transosseous bone tunnels. Additionally, we propose a classification system that attempts to describe the different types of tears to guide treatment, as the current classification system is not helpful in defining pathology or guiding treatment. Our proposed classification will help to better describe tear types anatomically and thereby guide appropriate surgical interventions based on these types.Description:Abductor tears were classified, according to our system, as Type I when there was no gluteus medius avulsion from bone (with subtype A indicating a partial tear of the gluteus minimus or gluteus medius; B, a complete tear of the gluteus minimus; and C, a longitudinal tear of the gluteus medius) or Type II when there was a gluteus medius avulsion (with subtype A indicating an avulsion of <50% of the insertion into the greater trochanter, and B, an avulsion of ≥50% of the insertion). Repair into a bone trough involves (1) freeing up and mobilizing the tendon from overlying fascia, (2) placing 2 evenly spaced Krackow stitches in the tendon, (3) creating a bone trough using a burr in the midline of the greater trochanter, (4) creating bone tunnels out the lateral wall of the trough to pass sutures, and (5) passing sutures through the bone tunnels to allow inset of the tendon into the trough, and later tying the sutures over the lateral osseous bridge.Alternatives:Alternative treatment options include nonoperative and operative management. Nonoperative treatment choices include physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification with assistive walking devices. Surgical alternatives include endoscopic or open direct soft-tissue repair, suture anchor repair, bone tunnel repair, graft jacket reconstruction, or gluteus maximus muscle transfer.Rationale:Because of discouraging outcomes experienced by us and others, a new technique (a greater trochanter longitudinal bone trough) was developed to improve surgical results. This technique, utilizing an abductor tendon repair into a bone trough, improved our surgical outcomes for abductor tendon avulsions. We found that outcomes after surgical treatment of abductor tendon tears without avulsion are superior to those after repairs of abductor tendon avulsions, which is an important distinction compared with previous literature on abductor tendon repairs.

Predictors of Successful Treatment 1 Year After Arthroscopic Partial Meniscectomy: Data from the OME Cohort.

Background:Arthroscopic partial meniscectomy (APM) is one of the most common orthopaedic procedures. Understanding factors that predict better patient-reported outcomes is important for guiding patient and clinician decision-making. The purpose of this study was to evaluate predictors of pain and function after APM in a large, multisite, academic health system cohort.Methods:We prospectively enrolled 665 patients who were ≥40 years of age and who had APM without any concomitant ligament or cartilage-resurfacing procedures. There were 486 subjects (73%) who completed baseline and follow-up questionnaires including demographic variables (age, sex, body mass index [BMI], education level), surgical findings (meniscal tear type, articular cartilage grade), and patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS] Pain, Physical Function Short Form [PS], and knee-related Quality of Life [QOL]; and Veterans RAND 12-Item [VR-12] Mental Component Score [MCS] and Physical Component Score [PCS]). We constructed multivariable statistical models to assess predictors of improvement in patient-reported outcomes, as well as a model to assess predictors of a successful improvement of at least 10 points in either KOOS Pain or KOOS-PS.Results:The mean age was 55 years, 46% of patients were female, and the mean BMI was 30 kg/m2. There were clinically important and significant improvements (p < 0.001) in all patient-reported outcomes from baseline to the 1-year follow-up. The following factors predicted less improvement in at least 1 patient-reported outcome: higher baseline score, higher BMI, older age, less education, current smoking, lower VR-12 MCS, prior ipsilateral surgical procedure, bipolar medial compartment cartilage lesions, and a lateral meniscal tear. Eighty-three percent of subjects had a successful improvement of 10 points in either KOOS Pain or KOOS-PS. The odds of successful improvement were lower in patients with a medial meniscal root tear, a lateral meniscal tear, or higher baseline KOOS Pain score.Conclusions:Eighty-three percent of patients improved by at least 10 points in pain and function after APM. Patients with a medial meniscal root tear or a lateral meniscal tear had decreased odds of a clinically important improvement in pain or function after APM. Increased BMI, smoking, and worse VR-12 MCS are potentially modifiable risk factors that predict less improvement after APM and warrant further study.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Fetal Instrumental Extractions at the Maternity Section of the Dakar Nabil Choucair Health Centre (Senegal) in 2017: Epidemio-Clinical Aspects, Indications and Prognosis

Introduction: An instrumental extraction is performed in order to shorten the phase of expulsion of the fetus outside the maternal pelvic pathway, when there is a suspected fetal state or a defect in progression of the fetal mobile. It can be responsible for immediate or late maternal complications, which are not specific because they can occur after a normal delivery. The objectives of this work are to describe the epidemiological-clinical and prognosis aspects of deliveries assisted by instrumental extractions in a reference maternity unit in Dakar. Materials and Methods: This was a retrospective, descriptive and analytical study between January 1, 2017 and December 31, 2017, a period of 12 months at the maternity ward of the Nabil Choucair Health Center. The collection was carried out using the survey form completed on the basis of the analysis of the files, the delivery register and the anaesthesia register of the operating room. The parameters studied were about socio-demographic characteristics, indications and prognosis. The data entry was carried out using the Sphinx version 5 software and the data analysis using the Epi info version 3.5 software. Results: During the period of our study, we collected 94 instrumental extractions. The frequency of instrumental extractions was 1.7%. The average age of the patients was 25 years with extremes of 16 to 43 years old. The average parity was 1 with extremes 1 to 6. Among parturient women, 12 patients (12.8%) had a history of suction cup, two (2.1%) had received forceps and three (3.2%) had a cesarean section. The average gestational age was 39 Weeks of Amenorrhea (WA), the average uterine height was 32 cm, fetal heart sounds were normal in 98% parturient’ cases. The vaginal touch had found a fully dilated cervix, a rupture of the amniotic sac with clear amniotic fluid in 98% of parturient women and a fetus with an anterior left iliac occipito topin 69.4% of cases. The pelvis was clinically normal in all parturient women. The indications were dominated by maternal fatigue (65.9%). The spatula was the most commonly used instrument (82.7%). Episiotomy was performed in 97.3% of cases. The average weight of the newborn was 3058 grams and an Apgar score of 8/10 was noted in 96% of newborns. We noted 3 cases of maternal complications with perineal tear type (3.2%) and 1 case of perineal tear associated with postpartum hemorrhage (1.06%). The neonatal prognosis was dominated by 2 caput succedaneum cases (2.1%). Newborns were alive and well in 97.8%. We noted 2 cases of death, i.e. 2.1% in unsolved circumstances. All the mothers were alive and well at (100%). Conclusion: Instrumental extractions must be integrated into our structures to significantly reduce the number of abusive cesarean sections. The perfect mastery of extraction techniques and indications makes it possible to reduce fetal suffering while avoiding the morbidity associated with instrumental extractions.

Identifikasi Cacat Prioritas pada Proses Shaving untuk Pengendalian Mutu Kualitas

PT XYZ is a company engaged in leather tanning since 1966. The skin used by PT XYZ is sheep skin and goat skin, each of which has a composition of 50%. This study aims to analyze product defects in the process of shaving (tanning) by using statistical quality control and knowing the factors that cause product defects using Ishikwa diagrams. The results showed that there were three types of disabilities, namely tear, lorek, and thinness. By using the control chart p (p-chart) there are 5 out of control data observations with prioritization of repairs that must be done first is the type of tear, thinness, and finally lorek which analyzed the causes of product defects using Ishikawa diagram.

Is Primary Arthroscopic Repair Using the Pulley Technique an Effective Treatment for Partial Proximal ACL Tears?

Attention has recently been paid to primary arthroscopic repair to treat ACL tears because of the disadvantages associated with reconstruction. However, there remain many unanswered questions and concerns about its application in the treatment of ACL tears. (1) Does primary arthroscopic repair using the pulley technique result in satisfactory ROM (a functional ROM with a flexion contracture of 30° or less), knee stability, and functional scores in patients with partial proximal ACL tears? (2) What complications are associated with primary arthroscopic repair using the pulley technique in patients with partial proximal ACL tears? Between January 2014 and March 2016, we treated 23 patients surgically who had partial proximal ACL tears and excellent tissue quality (defined as a remnant with mild interstitial tearing and the ability to hold sutures). All patients meeting those two criteria were treated using primary arthroscopic repair using the pulley technique. During that period, this represented 13% (23 of 183) of the patients we treated surgically for an ACL tear. Patients were excluded if they had other ACL tear types, insufficient tissue quality (defined as a severely torn remnant that was not strong enough to hold sutures), multi-ligamentous injuries, or substantial arthrosis (chondromalacia greater than Outerbridge grade 3, most of which underwent conversion to ACL reconstruction). Clinical outcomes were assessed using ROM, the anterior drawer test, the Lachman test, Lysholm score, Tegner activity score, IKDC subjective score, and radiographs. Twenty-one patients were observed for a mean (range) period of 36 months (25-49), and two were lost to follow-up. At the most-recent follow-up examination, all patients achieved full extension and only one patient lacked full flexion, with a flexion contracture of 10°. Twenty patients had no instability on the anterior drawer test and Lachman test findings, and one patient had a 1 + anterior drawer test. The mean Lysholm score improved from a mean ± SD of 71 ± 9 before surgery to 94 ± 6 (mean difference 23 points [95% CI 20 to 25]; p < 0.001) at latest follow-up. The IKDC subjective score improved from 64 ± 10 to 86 ± 11 points (mean difference 22 points; p < 0.001). We found no difference in the Tegner score from before surgery to latest follow-up (6.3 ± 1.2 versus 6.1 ± 1.2; mean difference 0.2; p = 0.056). One patient re-ruptured his ACL 2 months after surgery in military training during an obstacle race. No complications such as infection, thrombosis, stiffness, patellofemoral pain, or implant failure were observed. Primary arthroscopic repair using the pulley technique can achieve short-term clinical success in a carefully selected (the selection process includes first identifying the ACL injury pattern preoperatively with MRI, then confirming the diagnosis under arthroscopy, and deciding whether to perform a repair intraoperatively) subset of patients with partial proximal ACL tears and excellent tissue quality (defined as a remnant with mild interstitial tearing and the ability to hold sutures). Despite the promising clinical outcomes of our study, this technique should not be widely adopted unless it has been compared directly with ACL reconstruction, so future studies should be conducted to compare the clinical outcomes between this technique and ACL reconstruction, and longer-term follow-up is necessary to identify whether there is deterioration in the clinical outcomes over time. Level IV, therapeutic study.

Meniscus-Derived Matrix Bioscaffolds: Effects of Concentration and Cross-Linking on Meniscus Cellular Responses and Tissue Repair.

Meniscal injuries, particularly in the avascular zone, have a low propensity for healing and are associated with the development of osteoarthritis. Current meniscal repair techniques are limited to specific tear types and have significant risk for failure. In previous work, we demonstrated the ability of meniscus-derived matrix (MDM) scaffolds to augment the integration and repair of an in vitro meniscus defect. The objective of this study was to determine the effects of percent composition and dehydrothermal (DHT) or genipin cross-linking of MDM bioscaffolds on primary meniscus cellular responses and integrative meniscus repair. In all scaffolds, the porous microenvironment allowed for exogenous cell infiltration and proliferation, as well as endogenous meniscus cell migration. The genipin cross-linked scaffolds promoted extracellular matrix (ECM) deposition and/or retention. The shear strength of integrative meniscus repair was improved with increasing percentages of MDM and genipin cross-linking. Overall, the 16% genipin cross-linked scaffolds were most effective at enhancing integrative meniscus repair. The ability of the genipin cross-linked scaffolds to attract endogenous meniscus cells, promote glycosaminoglycan and collagen deposition, and enhance integrative meniscus repair reveals that these MDM scaffolds are promising tools to augment meniscus healing.

Epidemiology, Injury Patterns, and Treatment of Meniscal Tears in Pediatric Patients: A 16-Year Experience of a Single Center.

Background:Meniscal injuries in children continue to increase, which may be attributable to increasing levels of athletic participation and may be associated with additional injuries or need for additional surgeries.Purpose:To better understand the patterns of pediatric meniscal injuries by analyzing tear location, morphologic features, and associated injury patterns over a 16-year period.Study Design:Case series; Level of evidence, 4.Methods:Pediatric patients were identified and were included in the study if age at the time of initial surgery for meniscal tear was between 5 and 14 years for female patients and 5 and 16 years for male patients. Patients were observed until age 18, and any subsequent surgeries were noted. Demographic factors, tear type and location, associated injuries, and treatment type were analyzed.Results:Mean patient age at surgery was 13.3 years, and 37% of patients were female. A total of 1040 arthroscopic meniscal surgeries in 880 pediatric patients were evaluated. There were 160 reoperations in 138 patients, representing a reoperation rate of 15%. These included 98 reoperations on the ipsilateral knee in 88 patients and 62 operations for injuries to the contralateral knee in 50 patients; 53% of surgeries were meniscal repair, as opposed to partial meniscectomy, and the most common technique was an all-inside repair (91%). Significant differences were identified between male and female patients. Male patients were more likely to have lateral meniscus (74% vs 65%), posterior horn (71% vs 60%), peripheral (45% vs 30%), and vertical tears (31% vs 21%); concomitant ACL injury (50% vs 40%); and an associated osteochondritis dissecans lesion (7% vs 4%). Female patients were more likely to have medial meniscus (24% vs 17%), anterior horn (25% vs 15%), and degenerative tears (34% vs 26%); discoid meniscus (33% vs 24%); and isolated meniscal tears (47% vs 33%).Conclusion:This evaluation of a large series of patients has helped characterize injury patterns associated with pediatric meniscal surgeries. Most meniscal tears were repaired (53%) and were associated with additional injuries (62%), especially anterior cruciate ligament injuries (48%). More than 25% of patients had a discoid meniscus. Injury patterns differed significantly between male and female patients.

Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory PanelClassification System in 44 countries.

SummaryBackgroundSkin tears are acute wounds that are frequently misdiagnosed and under‐reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way.ObjectivesTo measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally.MethodsA multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two‐round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter‐rater reliability and intrarater reliability of the instrument.ResultsA definition for the concept of a ‘skin flap’ in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79–0·80] and sensitivity ranged from 0·74 (95% CI 0·73–0·75) to 0·88 (95% CI 0·87–0·88). The inter‐rater reliability was 0·57 (95% CI 0·57–0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73–0·75).ConclusionsThe ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under‐reported too often.A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries.Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking.

Anterior cruciate ligament injuries are commonly combined with meniscal tears. This study was performed to analyze the kinematics and kinetics of knees with anterior cruciate ligament deficiency with or without a combined medial or/and lateral meniscal injury during level walking. In all, 29 patients with unilateral anterior cruciate ligament deficiency and 15 healthy male volunteers were recruited. Among these patients, 12 had isolated unilateral anterior cruciate ligament injuries (ACLD group), 5 had combined anterior cruciate ligament and lateral meniscal injuries (ACLDL group), 5 had combined anterior cruciate ligament and medial meniscal injuries (ACLDM group), and 7 had combined anterior cruciate ligament and medial/lateral meniscal injuries (ACLDML group). A subject-specific musculoskeletal multibody dynamics model was utilized to estimate the tibiofemoral joint kinematic and kinetic behaviors based on the experimental data measured by using an optical tracking system. Regardless of the presence or absence of meniscal injury, the knees with anterior cruciate ligament deficiency exhibited significantly less extension than the control knees at the terminal stance (range of extension: ACLD, 4.84° ± 4.31°; ACLDL, 6.65° ± 5.73°; ACLDM, 5.21° ± 4.77°; ACLDML, 6.91° ± 4.30°; control, 12.35° ± 5.52°; P < 0.05). A lower extension moment and adduction moment in all anterior cruciate ligament deficiency affected knees were detected during the terminal stance when compared with control knees (P < 0.05). The ACLDML group showed significantly lower proximal-distal compressive forces and anterior-posterior shear forces (approximately 0.5-1.5 body weight; P < 0.05) compared to the other 4 groups, while the anterior-posterior and medial-lateral shear forces tended to increase in the ACLD, ACLDL, and ACLDM groups at the mid to terminal stance. Significant lower adduction-abduction and internal-external moment peaks were observed in ACLDML groups, but not in the ACLD, ACLDL and ACLDM groups. These results indicate that the combination of an anterior cruciate ligament injury and meniscal injury could alter the kinematics and kinetics of anterior cruciate ligament deficiency affected knees depending on the presence and type of the meniscal tear.

All-Inside Suture Repair for Isolated Radial Tears at the Midbody of the Lateral Meniscus

In young athletes, radial tear of the midbody on the semilunar lateral meniscus in stable knees is most common. Conventionally, for this type of tear, meniscectomy has been considered as a first-line treatment. However, meniscectomy does not prevent degenerative change. Therefore, repair is another treatment option for a full radial tear, though this type of tear can be difficult to repair because of the lack of a vascular supply. Compared with conventional transcapsular suture techniques (e.g., inside-out/outside-in techniques or all-inside techniques with implants), all-inside suture (AIS) repair techniques can avoid bunching of the meniscus to the capsule. AIS is considered suitable for restoration of normal structure and movement of the meniscus after repair, which can be advantageous for meniscal healing. However, AIS repair for an isolated radial tear at the midbody of the lateral meniscus has rarely been reported. Therefore, we applied the AIS repair technique for isolated radial tear at the midbody of the semilunar lateral meniscus using a QuickPass SutureLasso with 2-0 FiberWire. This procedure is easier and less invasive, shortening the gap by drawing each stump of the meniscus in the direction of the circumference.

Chemical composition and biological effects of three different types (tear, paste, and mass) of bitter Ferula assa-foetida Linn. gum

Ferula assa-foetida gum oleoresin (FAGO) is traditionally used for treatment of different ailments. The subject of this article was to evaluate the chemical composition and antibacterial effects of the different types of bitter FAGO essential oils in the natural habitat of Southwest Iran. α-pinene (38.2%), and (Z)-propenyl sec-butyl disulfide (12.4%) were the main components of F. assa-foetida tear type essential oil, with high antibacterial, anti-biofilm and cytotoxic activities, followed by paste and mass types, respectively. α-pinene (27.8%), and (Z)-propenyl-sec-butyl disulfide (24.2%) were identified as main components of paste type. α-pinene (33.4%), β-pinene (16.3%), and (Z)-propenyl sec-butyl disulfide (16.1%) were the main components of asafoetida mass type gum oleoresin essential oil. FAGO essential oil specially tear one could serve as suitable candidate for further studies.

Clinical Outcomes of Revision Meniscal Repair

Background:The failure rate after arthroscopic primary meniscal repair ranges from 5% to 43.5% (mean 15%). Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported.Objective:This was a retrospective study aim to evaluate the outcome of revision meniscal repair in patients with re-tears in Makassar’s hospitals from 2010 – 2017.Methods:A medical record review was performed to identify all patients undergoing revision meniscal repair between 2010 and 2017 in Makassar’s hospitals. Only patients with re-tears of the primary repaired meniscus were included. Surgical technique of primary and revision meniscus repair was detailed. The records of all patients were reviewed to collect patient demographics, affected side of the re-teared meniscus, reasons for failed primary repair, combined disorder, location of the tear, and duration between the primary and revision surgery. Follow-up evaluation included clinical outcome scores (Lysholm Score).Results:A total 9 of 15 patients (5 male and 4 female) with a mean age of 25.3 years (range, 19 to 44) and a mean BMI of 24.48 kg/m2 (range, 19.6 to 32.9) were included. Three lateral menisci and six medial meniscal repairs were revised at mean 23.3 months (range, 19 to 32) after primary repair. Reasons for failed primary repairs were traumatic re-tears in 4 patients (44%) and non-traumatic re-tears in 5 patients (56%). Patients undergoing isolated meniscal repair were found in 6 patients, 2 patients with ACL concomitant disorder, and 1 patient with osteoarthritis. Two tears occurred in the red-red zone and 7 in the red-white zone. At final follow-up, the mean Lysholm score significantly improved from 79.8 points (range, 75-84 points) at pre-revision to 88.1 (range, 80 to 97).Conclusion:Meniscal repair should always be considered when the anatomic conditions are favorable (location, type of tear, ACL status).

Factors associated with choice for surgery in newly symptomatic degenerative rotator cuff tears: a prospective cohort evaluation

The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient- and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P = .0004), pain development earlier in surveillance (P = .0002), a greater increase in pain (P = .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P = .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P = .13), tear enlargement (P = .67) nor tear size (P = .51) was associated with surgery. Neitherthe severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.

Confirming the Presence of Unrecognized Meniscal Injuries on Magnetic Resonance Imaging in Pediatric and Adolescent Patients With Anterior Cruciate Ligament Tears.

Prior research has shown decreased accuracy of meniscal injury detection using magnetic resonance imaging (MRI) for anterior cruciate ligament (ACL)-deficient adult patients as well as ACL-deficient pediatric and adolescent patients. The objectives of this study were the following: (1) assess the diagnostic ability of MRI in detecting meniscal injuries for pediatric and adolescent patients undergoing arthroscopic ACL reconstruction and (2) characterize the unrecognized meniscal injuries. The sensitivity, specificity, positive predictive value, and negative predictive value of meniscal tears (medial, lateral, or both) on MRI were calculated for the 107 patients in this cohort. Fisher exact tests were used to compare event frequencies between medial meniscal (MM) and lateral meniscal (LM) tears. One-way analysis of variance tests were performed to compare event rates between the location and type of unrecognized meniscal tears. The median age of the cohort was 15 (range: 7 to 18). The sensitivity, specificity, positive predictive value, and negative predictive value of MRI in detecting meniscal tears (medial, lateral, or both) in ACL-deficient pediatric and adolescent patients was 62.3%, 68.4%, 78.2%, and 50.0%, respectively. There were 26 (24.3%) cases in which a meniscal injury was not detected on MRI, but was discovered arthroscopically (MM: 5 knees, LM: 20 knees, both: 1 knee). These unrecognized meniscal injuries were more commonly the LM than the MM (77.8%, P-value=0.100), a vertical/longitudinal tear type (77.8%, P-value <0.001), and located in the posterior horn (74.1%, P-value <0.001). In this ACL-deficient pediatric and adolescent cohort, there were 26 (24.3%) patients with unrecognized meniscal injuries. A vertical tear in the posterior horn was the most commonly unrecognized meniscal injury, supporting the findings of prior research postulating that the location and configuration of a tear influence the accuracy of MRI in detecting these injuries. More research is needed to investigate strategies to improve the detection of meniscal tears in pediatric and adolescent patients preoperatively. These findings have implications with regard to patient counseling, operative planning, anticipatory guidance with regard to postoperative rehabilitation, recovery expectations, and surgical outcomes. Level IV.

Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair.

Background:The incidence of rotator cuff repairs has risen dramatically over the past 10 years, most notably in the working-class population. Return to work (RTW) is a valuable outcome measure to set patient expectations before surgery.Purpose:To establish the rate of RTW after rotator cuff repair with respect to stratified levels of occupational demand (sedentary, light, moderate, and heavy) and to identify clinical factors significantly associated with postoperative RTW.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who received rotator cuff repair between 2014 and 2017 were queried from a prospectively maintained institutional registry. Work status was evaluated from clinical and physical therapy notes, and RTW was stratified based on duty level. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) values were calculated for American Shoulder and Elbow Surgeons (ASES) score and subjective Constant score through use of an anchor-based approach. Patient demographic factors, preoperative ASES scores, Constant scores, and health-related quality of life scores, as well as change in postoperative scores exceeding the thresholds for MCID, SCB, and PASS, were analyzed to determine significant associations with RTW without restriction.Results:In total, 89 patients with documented pre- and postoperative work status underwent surgery. Rates of RTW for sedentary, light, moderate, and heavy duties were 100%, 84.0%, 77.4%, and 63.3%, respectively, within return at less than 7 postoperative months on average. RTW was associated with achieving PASS (P = .004) but not achieving MCID and SCB (P = .429 and .452, respectively). Injury to a patient’s dominant side had reduced odds (0.057; 95% CI, 0.004-0.763; P = .030) for RTW at full duty. Tear characteristics and type of insurance were not associated with RTW. Preoperative Veterans RAND Mental Component Score (>53.3; area under the curve, 70.4%) was predictive of returning to work.Conclusion:A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. Preoperative mental health scores can predict future return to work, which supports the concept that mental health status plays an important role in the outcomes after rotator cuff repair surgery.

Intra-articular and meniscal pathology according to anterior cruciate ligament injury pattern: both-bundle tear or selective bundle tear.

Background Articular cartilage injury and meniscal tear are usually combined with anterior cruciate ligament injury. Purpose We investigated the incidence of cartilage injury and traumatic meniscal tear according to the type of combined anterior cruciate ligament tear (both-bundle versus selective bundle tear). Material and Methods This retrospective study included 103 patients diagnosed with anterior cruciate ligament tear after knee joint magnetic resonance imaging and who underwent knee joint arthroscopy. Two radiologists evaluated articular cartilage injuries and meniscal tear independently. We used the chi-square test to analyze the association between type of anterior cruciate ligament bundle tear and presence of cartilage or meniscal injury in each reader. Results Cartilage injury presented a significantly higher prevalence in both-bundle tear than did selective bundle tear in reader 1 ( P = 0.004). In reader 2, both-bundle tear had a tendency for higher risk of cartilage injury, but this was not statistically significant ( P = 0.178). In meniscal injury, there was a statistically significant increase in the risk of associated meniscal injury in both-bundle tear versus selective bundle anterior cruciate ligament injury ( P = 0.019 and 0.021). The risk of accompanying traumatic meniscal lesion was significantly higher in both-bundle tear ( P = 0.036 and 0.018). Conclusion The incidence of accompanying meniscal injury, especially traumatic tears, is higher in both-bundle anterior cruciate ligament tear than in selective bundle tear. There was no significant difference in incidence of cartilage injury between both-bundle tear and selective bundle tear, although one of two readers showed a higher incidence in both-bundle tear.

Added value of thin axial MR cuts in the diagnosis of several meniscal tears: how far are they reliable?

BackgroundThe purpose of the study is to assess the added value of thin-cut (1 mm) axial magnetic resonance (MR) fat-saturated proton density (FS PD) weighted images (WIs) in the diagnosis of different types of meniscal tears. The study was conducted between January 2016 and August 2017 at a major private center group. This study included 28 patients with clinical suspicion of meniscal tear of age between 30 and 48 years including 19 males and 9 females. Axial 1-mm FS PD WIs were performed in addition to the conventional MR sequences. The type and classification of the meniscal tear were then diagnosed by a group of highly experienced musculoskeletal radiologists. The group assessed the morphology and classification of tears. The diagnosis was then confirmed by arthroscopy as a gold-standard reference.ResultsMeniscal tears were found in 23 out of 28 patients. Twenty-seven meniscal tears were found in the 23 patients: 2 root attachment radial tears (6.9%), 8 radial tears (27.6%), 7 longitudinal [vertical] tears (24%), 3 horizontal tears (10%), 5 displaced bucket handle tears (17%), 1 case of flab tear (3.4%), 1 case of meniscal fraying (3.4%), and 2 lesions which were diagnosed as artifacts and confirmed negative for tears by arthroscopy (6.8%). Diagnostic performance was as follows: sensitivity 96.3%, positive predictive value 100%, accuracy 96.6%, prevalence 93%, specificity 100%, and negative predictive value 66.67%.ConclusionThe study declared high diagnostic performance of thin-cut fat-saturated PD WIs in the diagnosis of different types of meniscal tears regarding their classifications and morphology which is crucial for further management.

Relationship of the Shape of Subacromial Spur and Rotator Cuff Partial Thickness Tear.

BackgroundThe present study was undertaken to evaluate the relationship between location of the rotator cuff tear and shape of the subacromial spur.MethodsTotally, 80 consecutive patients who underwent arthroscopic repair for partial thickness rotator cuff tear were enrolled for the study. Bigliani’s type of the acromion, type of subacromial spur, and location of partial thickness tear of the rotator cuff were evaluated using plain X-ray and magnetic resonance imaging. We then compared the groups of no spur with spur, and heel with traction spur.ResultsOf the 80 cases, 25 cases comprised the no spur group, and 55 cases comprised the spur group. There was a significant difference in type of tear (p=0.0004) between these two groups. Bursal side tears were significantly greater (odds ratio=6.000, p=0.0007) in the spur group. Subjects belonging to the spur group were further divided into heel (38 cases) and traction spur (17 cases). Comparing these two groups revealed significant differences only in the type of tear (p=0.0001). Furthermore, the heel spur had significantly greater bursal side tear (odds ratio=29.521, p=0.0005) as compared to traction spur.ConclusionsThe heel spur is more associated to bursal side tear than the traction spur, whereas the traction spur associates greater to the articular side tear.

Meniscus Tear Management: Indications, Technique, and Outcomes

Meniscus tears are commonly encountered in the clinical and operative setting and vary in presentation, including bucket-handle, radial, and horizontal cleavage tears. Historically, tears were treated with benign neglect or partial meniscectomy. However, a great deal of subsequent research has highlighted the biomechanical consequences of tears and meniscectomy, including increased peak local contact forces, progressive postmeniscectomy arthritis, and subsequent arthroplasty. With the advent and evolution of repair devices, increasing attention is being turned to the ideal restorative treatment of meniscus tears. Successful meniscus repair is centered about the ABCs of repair: Anatomic reduction, Biologic preparation and augmentation, and Circumferential compression. Recent advances in repair techniques have included microfracture of the intercondylar notch to provide healing factors and marrow cells for augmented healing, all-inside suture devices enabling the reduction and fixation tears without the need for additional assistants and the morbidity of inside-out exposure, and circumferential compression combined with clot augmentation to reduce and fix horizontal cleavage tears and recreate biomechanics to within 15% of baseline contact forces. Clinical outcomes of meniscus repair using modern techniques have been promising, with reapproximation of native joint biomechanics, substantial improvements in patient subjective outcome scores, and satisfactory reoperation rates. With implementation of the ABCs of meniscus repair as well as the continued expansion of the orthopedic surgeons' meniscus repair toolbox, restoration and preservation of the meniscus are increasingly possible across the spectrum of tear types.