Type Of Tear Research Articles

Ultrasound for Treating Meniscocapsular Separation Together With Arthroscopy

Magnetic resonance imaging (MRI) can be used to identify most types of meniscal tears; however, meniscocapsular separation of the medial meniscus can be difficult to identify with MRI. Here we present a technical note on the intrasurgical use of ultrasonography for the detection of meniscocapsular separation and confirmation of the beneficial effect of suturing on the stability of this lesion in a representative case of meniscocapsular separation that could be diagnosed with ultrasonography but not MRI preoperatively. Ultrasonography can detect meniscocapsular separation as a vertical low echoic area and be performed together with arthroscopy using the picture-in-picture function of the ultrasonography machine. Ultrasonography is an effective tool for diagnosing meniscocapsular separation and is helpful during arthroscopic surgery.

Meniscus morphology: Does tear type matter? A narrative review with focus on relevance for osteoarthritis research

To give a narrative overview of meniscal tears with a radiologic emphasis on the morphologic type, technical considerations, and on the relevance of the type of meniscal tear in the context of osteoarthritis (OA) research. Total 20 years of the PubMed database were searched for epidemiological, radiological, arthroscopic and biomechanical reports, and review articles focusing on meniscal tears in middle-aged and older individuals, in the setting of OA. Case reports, publications on meniscal tears in young active individuals, and publications not in English were excluded. Meniscal intra-substance signal abnormalities are associated with an increased risk of a degenerative meniscal tear in the same segment. Posterior radial tears of the medial meniscus appear to be a highly relevant event in OA of the knee, with associated cartilage loss and meniscal extrusion. Radial tears are more commonly missed on MRI than other types, and should be carefully looked for on coronal and axial images. While medial meniscus posterior root tears are of "radial" morphology, there is growing interest in looking at them as a separate entity, mainly because they require a different therapeutic approach. There is a lack of data on the relevance of different morphologic types of meniscal tears to the natural history of knee OA, both cross-sectionally and-especially-longitudinally. Further epidemiologic studies should focus on specific meniscal tears based on their morphology to better understand their relevance in the genesis and progression of knee OA.

A Comparison of Levels of Muscle Activity Based on Stabilization Exercise Methods Applied to Patients with Rotator Cuff Tendon Tears

For normal shoulder joint movements, sternoclavicular articulation, the acromio-clavicular joint, the glenohumeral joints, and the scapulothoracic joints should be coordinated. For remedial program after arthroscopic surgery for rotator damage, muscle exercise for the rotator should be regarded as an important factor, and clinical approaches should be adopted to promote muscle control and balance. This study was conducted on 30 patients in their 30s and 40s who underwent arthroscopic surgery for supraspinous muscle tendon rupture 4–6 weeks prior; such rupture represents one of the most common types of rotator cuff tear. Four types of remedial treatments—rowing in prone position, Superman ‘T’, prone supported on elbow and pushup with hands—were used to measure the muscle activity of the upper trapezius, lower trapezius, and serratus muscle. Considering all these factors, it was determined that each exercise method led to different muscle activities. No ideal exercise method was found to reduce the muscle activity of upper trapezius muscle and increase that of the lower trapezius and serratus muscle. Therefore, it is considered that each stabilization exercise should be applied in a selective manner based on the patient’s condition and a doctor’s diagnosis.

Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review

Background: Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. Purpose: To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores. Study Design: Systematic review. Methods: A search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted. The selection criteria for inclusion were English-language in vivo clinical studies reporting on isolated meniscal repairs utilizing an arthroscopically assisted technique that outlined the postoperative rehabilitation protocol and included at least a 2-year follow-up. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, tear type, repair technique, postoperative protocol details, clinical failures, and outcome scores were extracted from the eligible studies. Rehabilitation protocols were divided into “accelerated,” “motion restricted,” “weight restricted,” and “dual restricted” according to the limitations placed on the treatment groups. Results: Fifteen studies, containing 17 different treatment groups, met the inclusion criteria. The 2 accelerated groups, 2 motion-restricted groups, 4 weight-restricted groups, and 9 dual-restricted groups showed similar efficacy in terms of clinical success and postoperative outcome scores. Early range of motion and weightbearing status showed no influence over clinical outcomes. Of the 17 groups, 13 reported a greater than 70% clinical success rate with significant variation in the tear type, fixation technique, and postoperative restrictions. Conclusion: Early range of motion and immediate postoperative weightbearing appear to have no detrimental effect on the chances for clinical success after isolated meniscal repair. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Studies reporting outcomes regarding isolated meniscal repair are limited. Future research should include determining the ideal combination of weightbearing and range of motion for specific tear types.

Traumatic and Degenerative Meniscus Tears Have Different Gene Expression Signatures

Background: Meniscus tears are classified as traumatic or degenerative based on the tear pattern. There is little evidence demonstrating biological differences between the 2 tear types. Hypothesis: Gene expression signatures in the injured meniscus are different between traumatic (vertical) and degenerative (complex, horizontal, or flap) tears. Study Design: Controlled laboratory study. Methods: Samples of the torn meniscus from the white-white zone were removed at the time of clinically indicated partial meniscectomy from 48 patients (37 with degenerative tears and 11 with traumatic tears). mRNA expression in the injured menisci was measured by quantitative real-time polymerase chain reaction for selected molecular markers of osteoarthritis, inflammation, and cartilage homeostasis (eg, cytokines/chemokines, aggrecanases/metalloproteinases, transcription factors, cartilage matrix genes, and adipokines). The tear pattern (traumatic or degenerative) and location (medial or lateral) were recorded for each patient. Gene expression differences between degenerative and traumatic tears were computed after adjusting for patients’ age, sex, and body mass index and for location of the resected meniscus (medial/lateral). Results: Gene expression in meniscus tears varied by pattern. Chemokines (IL8 [P < .001] and CXCL6 [P < .001]) and matrix metalloproteinases (MMP1 [P = .011] and MMP3 [P = .016]) were expressed at a significantly higher level in traumatic tears compared with degenerative tears. In contrast, COL1A1 was expressed at a lower level in traumatic tears compared with degenerative tears (P = .058). None of the genes tested demonstrated significant differences between medial and lateral meniscus tears. Conclusion: Traumatic meniscus tears overall exhibited a higher inflammatory/catabolic response as evidenced by higher levels of chemokine and matrix metalloproteinase expression than degenerative tears. These findings suggest that there is a (molecular) biological distinction between traumatic and degenerative tears. Clinical Relevance: The catabolic/inflammatory differences between traumatic and degenerative tears may be relevant to treatment decisions regarding the meniscus as well as advance our understanding of how meniscus tears relate to the development of knee osteoarthritis.

Posterior Root Meniscal Tears: Preoperative, Intraoperative, and Postoperative Imaging for Transtibial Pullout Repair.

The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. ©RSNA, 2016.

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study.

BackgroundHorizontal instability impairs clinical outcome following acute acromioclavicular joint (ACJ) reconstruction and may be caused by insufficient healing of the superior acromioclavicular ligament complex (ACLC). However, characteristics of acute ACLC injuries are poorly understood so far. Purposes of this study were to identify different ACLC tear types, assess type-specific prevalence and determine influencing cofactors.MethodsThis prospective, cross-sectional study comprised 65 patients with acute-traumatic Rockwood-5 (n = 57) and Rockwood-4 (n = 8) injuries treated operatively by means of mini-open ACJ reduction and hook plate stabilization. Mean age at surgery was 38.2 years (range, 19–57 years). Standardized pre- and intraoperative evaluation included assessment of ACLC tear patterns and cofactors related to the articular disc, the deltoid-trapezoidal (DT) fascia and bony ACJ morphology. Articular disc size was quantified as 0 = absent, 1 = remnant, 2 = meniscoid and 3 = complete.ResultsAll patients showed complete ruptures of the superior ACLC, which could be assigned to four different tear patterns. Clavicular-sided (AC-1) tears were observed in 46/65 (70.8 %), oblique (AC-2) tears in 12/65 (18.5 %), midportion (AC-3) tears in 3/65 (4.6 %) and acromial-sided (AC-4) tears in 4/65 (6.1 %) of cases. Articular disc size manifestation was significantly (P < .001) more pronounced in patients with AC-1 tears (1.89 ± 0.57) compared to patients with AC-2 tears (0.67 ± 0.89). Other cofactors did not influence ACLC tear patterns. ACLC dislocation with incarceration caused mechanical impediment to anatomical ACJ reduction in 14/65 (21.5 %) of cases including all Rockwood-4 dislocations. Avulsion “in continuity” was a consistent mode of failure of the DT fascia. Type-specific operative strategies enabled anatomical ACLC repair of all observed tear types.ConclusionsAcute ACLC injuries follow distinct tear patterns. There exist clavicular-sided (AC-1), oblique (AC-2), midportion (AC-3) and acromial-sided (AC-4) tears. Articular disc size was a determinant factor of ACLC tear morphology. Mini-open surgery was required in Rockwood-4 and a relevant proportion of Rockwood-5 dislocations to achieve both anatomical ACLC and ACJ reduction. Type-specific operative repair of acute ACLC tears might promote biological healing and lower rates of horizontal ACJ instability following acute ACJ reconstruction.

Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears

Very little longitudinal information has been available regarding the relationship of cuff tears and arthritis. The purpose of this study was to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear. Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI). Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI. Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points.

Arthroscopic Meniscectomy for Medial Meniscus Horizontal Cleavage Tears in Patients under Age 45.

PurposeThe purpose of this study was to evaluate the demographics, clinical features, and outcomes of arthroscopic partial meniscectomy (APM) for isolated medial meniscus horizontal cleavage tears (MMHCTs) in patients under 45 years of age.Materials and MethodsWe retrospectively reviewed 98 patients (100 knees) under 45 years who underwent APM for MMHCTs. Clinical outcomes were assessed using International Knee Document Committee (IKDC) subjective core, Tegner activity scale, visual analog scale (VAS) pain score, and a question on the symptom relief.Results79% were male and 70% had no trauma. The mean symptom duration was 10 months. At arthroscopy, a flap tear was identified in 75%. At a mean of 19-month follow-up, the IKDC subjective score, Tegner activity scale, and VAS pain score were significantly improved compared to the preoperative values (p=0.025, p=0.043, and p=0.032, respectively). While 85% were free of symptoms, 15% had persistent pain. No significant differences in outcomes were observed based on the tear type and the presence of flap tears. No progression or development of radiographic degenerative changes was observed in all knees.ConclusionsDemographics of MMHCTs under age 45 showed a male dominance and higher frequency of non-traumatic tears. APM was beneficial to symptomatic HCTs in this cohort during the short-term follow-up. Type of HCTs and combined flap tears did not affect clinical outcomes.

Correlation Between Hip Arthroscopy Outcomes and Preoperative Anesthetic Hip Joint Injections, MR Arthrogram Imaging Findings, and Patient Demographic Characteristics

The purpose of this study is to determine whether the preoperative response to intraarticular hip anesthetic injection correlates with the outcome of hip arthroscopy. A secondary aim is to determine whether the outcome of arthroscopy correlates with intraarticular pathologic findings or patient demographic characteristics. Ninety-three patients who underwent MR arthrography (MRA), preoperative injections of anesthetic into the hip joint (with pain scores documented), and subsequent hip arthroscopy (with a modified Harris Hip Score [mHHS] determined at 1 year after arthroscopy) were included in the study. MRA images and surgery reports were retrospectively reviewed to identify information about labral tear type and size and cartilage damage grade. The correlation between the response to hip anesthetic injection (defined as poor [0-30% improvement], moderate [31-60% improvement], or good [61-100% improvement]) and the surgical outcome (poor, fair, or good, as determined on the basis of the mHHS or the need for repeat surgery) was evaluated using the Fisher exact test. Univariate analysis (performed using the Fisher exact test) and multivariate analysis (performed using ANOVA) of correlations with age, sex, body mass index (BMI [weight in kilograms divided by the square of height in meters]), the interval between injection and surgery, labral tear type and size, and cartilage damage grade were also performed. Comparison of the response to preoperative hip anesthetic injection with the outcome of arthroscopy at 1 year indicated no statistically significant association (p = 0.59). The BMI of the patient, however, was statistically significantly associated with surgical outcome (p = 0.03), with a BMI of less than 25 denoting a higher likelihood of a good surgical outcome. No statistically significant correlations were noted in analyses of surgical outcomes and patient age (p = 0.31) and sex (p = 0.83); the interval between injection and surgery (p = 0.28); labral tear type, as determined by MRA (p = 0.34) and arthroscopy (p = 0.47); labral tear size, as determined by MRA (p = 0.34); and cartilage grade, as determined by MRA (p = 0.58) and arthroscopy (p = 0.26). No positive or negative correlation was noted between the response to preoperative hip anesthetic injection and the outcome at 1 year after hip arthroscopy. Only BMI was shown to correlate with the surgical outcome.

Genotoxic potential of Fasciolagigantica infection in experimentally infected rabbits.

A number of parasitic platyhelminthes are known to cause genotoxicity in humans and animals. However no such information is available on tropical liver fluke, Fasciola gigantica, which incurs huge economic losses worldwide. In the present study the genotoxic potential of F. gigantica infection in rabbits, experimentally infected with the metacercarial cysts of this parasite, has been investigated using the standard comet assay and micronucleus (MNi) test on the isolated hepatocytes and the whole blood from the infected rabbits. The tail length of the comet in both hepatocytes and reticulocytes from the infected animals was significantly prominent (p<0.05) as compared to the controls. About 61.17% of the hepatocytes from the infected rabbits were positive for MNi formation. A number of blood cells also showed cellular deformities, which were recognised as spicule type, schistocytes, tear drop type, acanthocytes and dumbbell type. It is possible that during the establishment of host-parasite relationship the worms might have released some products which could have contributed to the induction of cellular and DNA damage. However, long term studies are required to understand the serious implications of such an effect caused by F. gigantica, though hepatic carcinoma has not been reported so far due to fasciolosis, however, considering the present results the possibility may not be rule out for the disease progression in this direction.

Incidence and risk factors associated with retinal redetachment after silicone oil removal in the African population.

The purpose of this study was to investigate the incidence and risk factors associated with retinal redetachment after silicone oil (SO) removal in the African population. A retrospective cohort study was performed on patients undergoing SO removal over a period of 4years. The risk factors assessed were (1) characteristics of the retinal detachments including type of retinal detachment, type, number and location of the retinal tears, and proliferative vitreoretinopathy (PVR) score, and (2) surgical factors including type of silicone oil used, use of laser prior to SO removal, and location of the laser (360° or around the tear only). SO was removed either through a pars plana approach or transpupillary approach and anterior limbal incision. Ninety-nine eyes met the inclusion criteria during the study period. Twelve patients (12%) had retinal redetachment after SO removal. Factors associated with redetachment were a preexisting macular hole, PVR grade B or worse, and no intraoperative endolaser photocoagulation. The incidence of redetachment in African population is similar to that reported from developed countries and other advanced vitreoretinal centers. Redetachment occurred at higher rates in patients with preexisting macular holes and tears who did not receive intraoperative endolaser photocoagulation and patients with a severe grade of PVR.

OmaniAdult Crying: Causes and Motivations

-Crying is physiological and psychological condition and it occurring with organism whether voluntary or involuntary. In current research, researchers shed light on the process of crying with humans and for both of them male and female. The sample have ranged and for both male and female between 15 years to 25 years. The sample consisted school and high education students in addition employees from public and private sector. The objectives of this research was to know the differences between maleand female in the number of times crying and its relationship to their age. Also this research aim to knowing the reasons of crying with humans either was male or female as well as to knowing types of tears. Finally, researchers highlighted the emotional crying with Omani adults and analyse reasons of it. The result shows that Omani females cry more than males crying between 15 to 17 years (binging of adolescent Stage) old but with the onset of adulthood, case is reflected, where males increases in the number of time crying than females, specifically from age 18 to age 22 or 23.This is due to the fact that males begin their university life and begin with the personal, emotional and social responsibility which push males to the difficulty encountered thus showing signs of sadness and oppression and begin shedding tears but in isolation from the social world around him. Then, after 23 years old and above, females start to increase comparing with malesand this is due to feminine nature that tend to the passion and the incapability to control their emotions compared to males which their nature tend to stay away from passion as much as they can and reliance on the mind and thinking in solving the problems they face it.

Arthroscopic meniscectomy of traumatic versus atraumatic tears in middle aged patients: is there a difference?

Meniscal tears can be classified in various ways, one of which is into traumatic or degenerative. It is not known whether partial meniscectomy of clinically defined traumatic compared to degenerative tears in middle age patients has favorable results. The purpose of this study was to compare the outcome after arthroscopic partial meniscectomy of clinically defined traumatic to degenerative meniscal tears in middle age patients. Eighty-six middle aged patients with stable knees and no radiographic signs of osteoarthritis who had arthroscopic partial meniscectomy were divided into a study group of 43 patients with a preceding knee injury related to their knee symptoms (traumatic group) and a control group of 43 uninjured patients (atraumatic group), matched by age, sex, body mass index and comorbidities. The surgical findings and postoperative clinical scores were compared between the two groups. There were no statistical differences in surgical findings of tear types and degree of chondral lesions. At the end of the follow-up 33 (77%) patients in each group were satisfied to have had the operation. The median Lysholm score improved from 65.9±17.4 to 77.4±21.2 points (P=0.001) in the traumatic group and from 65.3±17 to 82.4±17.7 in the atraumatic group (P<0.0001). Arthroscopic partial meniscectomy in middle aged patients with stable knees and no signs of radiographic osteoarthritis improve pain and function. There were no differences in surgical findings and short term clinical outcome between patients with and without preceding knee injury.

Biomarker Changes in ACL Deficient Knees Compared with Contralaterals

Objectives:Introduction: Though outcomes following ACL reconstruction are largely positive, patients’ post-operative recovery is highly variable, and is typically based off generalized timetables derived from population data. In an attempt to individualize prognostic estimates and establish how biomarker concentrations may change with injury, we sampled knee joint synovial fluid from patients with ACL tears with and without associated cartilage injuries and compared biomarker concentrations to samples obtained from the contralateral non-injured knee.Methods:480 patients indicated for knee arthroscopy had samples drawn to form a synovial fluid database. If no injury history or symptoms were present in the contralateral knee, samples were drawn as well. For the current study, only patients that had confirmed ACL injury at the time of arthroscopy were included. Associated cartilage injury location, size and depth was documented. Synovial fluid samples were centrifuged, and the concentrations of 20 biomarkers were determined using a multiplex magnetic bead immunoassay. Concentrations were then compared between the three study groups (ACL tear with cartilage injury, ACL tears without cartilage injury, and healthy contralateral knees) using a Welch ANOVA test with pairwise comparisons.Results:The study included samples from 132 knees: 34 ACL tears without cartilage injury (mean age 34.0 years); 28 ACL tears with cartilage injury (mean age 36.3 years), and 72 contralateral knees (41.1 years). ANOVA testing demonstrated significant differences among groups for: MMP-3 (p>001); TIMP-1 (p=.001); TIMP-2 (p=.015); FGF-2 (p=.011); IL-6 (p=.001); and MIP-1b (p=.001). Pairwise comparisons demonstrated no significant differences between ACL tears with, and without cartilage damage, but did show both types of ACL tears had significantly higher concentrations of MMP-3, TIMP-1, IL-6, and MIP-1b than contralaterals. ACL tears without cartilage damage had significantly lower concentrations of TIMP-2 and FGF-2 (13) than contralaterals (Table 1).Conclusion:The course from surgery to symptomatic relief and functional improvement following ACL reconstruction is highly variable. Data from the current study demonstrated that cytokine concentrations are significantly different between ACL tears (+/- cartilage damage) and healthy knees. These validated differences can help establish synovial fluid biomarker analysis as a method for injury stratification ultimately providing patient-specific prognostic data.

Correlation between Subscapularis Tears and the Outcomes of Physical Tests and Isokinetic Muscle Strength Tests

Background: The aim of this study was to investigate the correlation between the type of subscapularis tendon tears diagnosed during arthroscopy and the outcomes of physical tests and of isokinetic muscle strength tests. Methods: We preoperatively evaluated physical outcomes and isokinetic muscle strength of 60 consecutive patients who underwent an arthroscopic rotator cuff repair and/or subacromial decompression. We divided the patients into five groups according to the type of subscapularis tear, which we classified using Lafosse classification system during diagnostic arthroscopic surgery. Results: When we performed a trend analysis between the outcomes of the physical tests and the severity of subscapularis tendon tear, we found that both the incidence of positive sign of the collective physical tests and that of individual physical tests increased significantly as the severity of the subscapularis tear increased (p Conclusions: Although no single diagnostic test surpasses above others in predicting the severity of a subscapularis tear, our study implies that, as a collective unit of tests, the total incidence of the positive rate of the physical tests and the extent of isokinetic strength deficit may correlate with severity of subscapularis tears.

Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear

The purpose of this study was to investigate the role of coracoacromial ligament degeneration and specific anatomic parameters in the etiology of partial-thickness rotator cuff tears. This study retrospectively assessed 96 patients (mean age, 50.1 years [17-76]; 34 men, 62 women) diagnosed with bursal-side and articular-side rotator cuff tears with a history of failed conservative treatment and persistent shoulder pain who underwent arthroscopic surgery. Video records of the surgery were used to evaluate the type of cuff tear, grade of coracoacromial ligament degeneration, and associated pathologic changes; preoperative magnetic resonance images were used to measure acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. Most of the patients with articular-side tears demonstrated grade 0 and grade 1 coracoacromial ligament degeneration, whereas patients with bursal-side tears had grade 1 and grade 2. There was a significant positive correlation between the grade of coracoacromial ligament degeneration and bursal-side partial rotator cuff tears, whereas no correlation was observed with articular-side tears. There was no significant difference between bursal-side and articular-side partial cuff tears regarding acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance. Grade 1 and grade 2 coracoacromial ligament degeneration is a strong predictive factor for impingement syndrome in the etiology of bursal-side partial cuff tears and can guide the surgeon to consider ligament release and débridement or acromioplasty in these patients.

Meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures.

To prospectively evaluate the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures and to test for possible relationships between associated meniscal lesions and patient demographics or injury characteristics. A prospective multicenter study was conducted to arthroscopically assess the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures between 04/2014 and 10/2015. Patient demographics and injury characteristics were assessed preoperatively. The presence of a meniscal injury was evaluated arthroscopically and characterized according to tear type and location (Cooper classification). Patients with and without meniscal injuries were compared with regard to sex, age, height, weight, BMI, type of injury, mechanism of injury, time to surgery, Tanner stage, sexual maturity (prepubescent vs. pubescent), and modified Meyers and McKeever classification. A total of 54 consecutive patients (65% males, mean age: 12.5±3.2years) were enrolled. Meniscal injury were found in 20 patients (37%). The lateral meniscus was involved in 18 patients (90% of all meniscus injuries) and the medial meniscus in 2 patients (10% of all meniscus injuries). The most common tear pattern was a longitudinal tear of the posterior horn of the lateral meniscus (30% of all meniscus injuries) and the second most common tear was a root detachment of the anterior horn of the lateral meniscus (20% of all meniscus injuries). Higher age, advanced Tanner stage, and pubescence were significantly associated with an accompanying meniscal injury. Meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures must be expected in almost 40%, with a higher prevalence with increasing age and sexual maturity. With regard to the clinical relevance, the results of the present study argue in favor for magnetic resonance imaging prior to surgery in every patient with a suspected tibial eminence fracture and for an arthroscopic approach to adequately diagnose and treat meniscal injuries. II.

Threads for tear film collection and support in quantitative amino acid analysis.

The collection of tears for chemical composition analysis is complicated by both the difficulty in sampling the tear film and the relatively low microliter volumes available for analysis. The experiments in this study are focused on the demonstration of a method for determining amino acids from tear samples. Phenol red thread was used to absorptively collect tear fluid for qualitative and quantitative analyses of amino acids in basal, reflex, and emotional tears. The thread is also used as a support for sample preparation followed by elution with a buffer. The phenol red indicator on the thread turns from yellow to red with 15-s tear absorption and allows accurate volume measurement from 100nL to over 1μL. Derivatization of amino acids was performed directly on the thread with primary amine reactive fluorescamine for fluorescence detection. Analyte elution was performed via centrifugation with the thread in a pipet tip suspended in a centrifuge tube. Collected tear eluate was analyzed via capillary electrophoresis with LED-induced fluorescence. Glycine, glutamate, and aspartate were baseline resolved and used for method characterization. Recoveries were at 50% for a single derivation and elution step but average recoveries near 90% were found with two-step processing. Glutamate and aspartate are shown to be stable stored on thread for 3days. Basal, reflex, and emotional tears were analyzed from three subjects showing distinct amino acid profiles for each tear type. The demonstration of this method may facilitate the development of routine tear compositional analysis to assess ocular health. Graphical Abstract Schematic drawing of thread-based tear collection and quantitative analysis.

RETRACTED: Abduction external rotation position in magnetic resonance arthrography for the diagnosis of rotator cuff tears.

This article aims at evaluating the effectiveness of abduction and external rotation (ABER) position used in magnetic resonance (MR) arthrography for diagnosing rotator cuff tears. A retrospective analysis was performed using 183 MR arthrography images of shoulder joint. Each patient was either examined in a neutral position or ABER position. Then the imaging results were compared with those diagnostic results obtained from shoulder arthroscopy. Also the specificity, sensitivity, negative predictive value, positive predictive value, and accuracy of MR arthrography in the two positions described above were evaluated. A total of 64 patients were diagnosed with rotator cuff tears using arthroscopy and the diagnostic results include 16 complete rotator cuff tears and 48 partial tears; 47 supraspinatus tendon tears and 17 posterosuperior cuff tears; 22 delamination tears and 26 tears complicated with anteroinferior labrum-ligament complex injuries. The differences in specificity, sensitivity, negative predictive value, positive predictive value and accuracy between neutral position and ABER position using MR arthrography were not statistically significant (all P>0.05). For diagnosing posterosuperior cuff tears, the sensitivity of ABER position was significantly higher than that of the neutral position (94.12% vs. 64.71%, P=0.034). For diagnosing delamination tears, the sensitivity and negative predictive value of ABER position were significantly higher than those of the neutral position (P=0.009 and P=0.036 respectively). For diagnosing rotator cuff tears complicated with anteroinferior labrum-ligament complex injuries, the sensitivity of ABER position was statistically higher than that of the neutral position (96.15% vs. 73.08%, P=0.021). This study suggests that MR arthrography in ABER position is a superior tool for diagnosing certain types of rotator cuff tears. Apart from that, MR arthrography in ABER position improved the detection rate of posterosuperior cuff tears, delamination tears and rotator cuff tears complicated with anteroinferior labrum-ligament complex injuries.