Type Of Tear Research Articles

MRI Findings Associated With Anterior Cruciate Ligament Tears in National Football League Athletes.

Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes. To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL). Cross-sectional study; Level of evidence, 3. Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology. Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear. ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism.

Rotator Cuff Injuries in the Pediatric Population: A Retrospective Review of Patient Characteristics and Treatment at a Single Center.

As youth participation in contact and overhead sports has increased in recent decades, so has the occurrence of injuries of the shoulder. Rotator cuff injury (RCI) is an infrequent shoulder pathology in pediatric patients and its description in the literature has been scarce. A greater understanding of RCI characteristics and treatment outcomes in children and adolescents would improve our understanding of this pathology and help to better guide clinical decision-making. To identify pediatric patients with magnetic resonance imaging-confirmed RCI treated at a single center to summarize injury characteristics, treatment, and outcomes. It was hypothesized that injuries would occur predominantly in overhead throwing athletes and would demonstrate good outcomes among both operatively and nonoperatively treated patients. Cross-sectional study. Level 4. A retrospective review of pediatric patients (<18 years old) diagnosed with and treated for an RCI between January 1, 2011 and January 31, 2021. Patient demographics, injury mechanism and type, treatment, and outcomes were collected. Descriptive statistics were performed. Bivariate testing was used to compare operatively and nonoperatively treated cohorts. A total of 52 pediatric patients treated for a rotator cuff avulsion, partial tear, or complete tear were identified. Mean age was 15 years and 67% of patients were male. Injuries were related most commonly to participation in throwing sports. Operative management occurred in 23% of patients, while 77% were managed nonoperatively. Treatment cohorts differed based on tear type, with all complete tears being managed operatively (P < 0.01). Associated shoulder pathology was common, with the most frequent finding being anterior shoulder instability pathology. Return to play was longer for operatively managed patients (7.1 vs 4.5 months; P < 0.01). The present study expands the limited data available regarding RCIs in pediatric patients. Most injuries are associated with sports and involve the supraspinatus tendon. RCIs were associated with good outcomes and low rates of reinjury in patients managed both nonoperative and operatively. RCI should be considered in throwing athletes with shoulder pain, even in skeletally immature patients. This retrospective study fills the hole in the literature by detailing the patterns associated with RCI characteristics and treatment outcomes. In contrast to studies of adult RCIs, our results suggest that outcomes are good regardless of treatment type.

(214) Female bmg Urethroplasty and 2nd Degree Vaginal Tear Repair

Abstract Introduction Pregnancy and childbirth bring biological, psychological, and social changes which may influence women's health. Objective Second degree tears are the most common type of tear. A female urethral stricture is a less common condition. Buccal mucosa graft (BMG) is widely used tissue for urethral stricture repair. Methods We present a 38-year old female who suffered a 9-year long history of urethral stricture disease and dyspareunia after two vaginal child births. The patient (pt) had urethral injury and 2nd degree tear in vaginal wall and pelvic muscle. Despite repeated attempts of urethral dilations, the stricture and the obstructive complaints persisted. Additionally, lack of sexual arousal and painful intercourses, affected the patient’s quality of life. The pt was treated with a dorsal onlay urethroplasty using a buccal mucosa graft, excision of vaginal wall scar, pelvic floor muscle repair, and repair of vaginal opening The surgery was carried out with a suprameatal approach. A semicircular incision was performed and the urethra was dissected from the ventral aspect of the clitoris with a sharp and blunt dissection up to the proximal part of stricture. Then, a dorsal sagittal incision is performed over the stricture and the BMG is sutured dorsally for the edges and quilted with 4.0 polyglactin sutures. A 16Fr Foley catheter was left in place for two weeks. Then, we performed hydrodissection of posterior vaginal wall, scar excision from episiotomy and 2nd degree tear, approximation of levator ani muscle, vaginal wall and opening repair. Results Two weeks after surgery the patient urinates without strain and with no post voiding residual urine. Uroflow 6 weeks after surgery showed Qmax of 28ml/sec and urethra was easily passable for 20Fr Nelaton catheter. Eight weeks after surgery the patient reported having a normal sexual life without pain and lack of sexual satisfaction Conclusions Female dorsal onlay urethroplasty and vaginal wall tear repair are feasible and give great functional and aesthetical results Disclosure No

GNRB® laximeter with magnetic resonance imaging in clinical practice for complete and partial anterior cruciate ligament tears detection: A prospective diagnostic study with arthroscopic validation on 214 patients

BackgroundAccurate diagnosis of anterior cruciate ligament (ACL) injury is not always obtained with magnetic resonance imaging (MRI). Other tools, such as the GNRB® arthrometer, help to accurately identify the type of ACL tear. The aim of this study was to show that the GNRB® could be a relevant complementary solution to MRI in ACL injuries detection. MethodsA prospective study performed between 2016 and 2020 included 214 patients who had undergone knee surgery. The study compared sensitivity/specificity pairs of MRI and the GNRB® at 134 N to detect healthy ACL, partial and complete ACL tears. Arthroscopies were the ‘gold standard’. Forty-six patients had a healthy ACL with associated knee lesions, 168 patients had ACL tears where 107 were complete tears and 61 were partial tears. ResultsFor healthy ACL, MRI scored 100% for sensitivity (SE) and 95% for specificity (SP), and the GNRB® scored SE 95.65% and SP 97.5% at 134 N. For complete ACL tears, MRI scored 80.81% for sensitivity (SE) and 64.49% for specificity (SP), and the GNRB® scored SE 77.78% and SP 85.98% at 134 N. For partial tears, MRI scored SE 29.51% and SP 88.97%, and the GNRB® scored SE 73.77% and SP 85.52% at 134 N. ConclusionGNRB® sensitivity and specificity were equivalent to those of MRI for healthy ACL and complete ACL tear detection. However, MRI had some difficulty in detecting partial ACL tears compared with the GNRB® which showed better sensitivity.

Reliability of MRI Interpretation of Discoid Lateral Meniscus: A Multicenter Study.

Discoid lateral meniscus (DLM) has a varied and complex morphology that can be challenging to assess and treat. Preoperative magnetic resonance imaging (MRI) is frequently used for diagnosis and surgical planning; however, it is not known whether surgeons are reliable and accurate in their interpretation of MRI findings when defining the pathomorphology of DLM. Surgeons experienced in treating DLM are able to reliably interpret DLM pathology using MRI. Cohort study (diagnosis); Level of evidence, 3. Knee MRI scans from 44 patients (45 knees) were selected from a pool of surgically treated patients with DLM. Five reviewers (fellowship-trained pediatric sports medicine surgeons) performed independent review of each MRI scan using the PRiSM Discoid Meniscus Classification. Inter- and intraobserver reliability of the rating factors-primary (width, height, presence of peripheral instability or tear) and secondary (location of instability or tear, tear type)-was assessed using the Fleiss κ coefficient, designed for multiple readers with nominal variables (fair reliability, 0.21-0.40; moderate, 0.41-0.60; substantial, 0.61-0.80; excellent, 0.81-1.00). Reliability is reported as κ (95% CI). Interobserver reliability in assessing most primary and secondary characteristics ranged from substantial (meniscal width) to moderate (peripheral instability, anterior instability, posterior instability, and posterior tear). Intraobserver reliability for most characteristics ranged from substantial (peripheral instability, presence of tear, anterior instability, posterior instability, and posterior tear) to moderate (meniscal width, anterior tear, and tear type). Notable exceptions were presence of tear, anterior tear, and tear type-all with fair interobserver reliability. Height had poor interobserver reliability and fair intraobserver reliability. Orthopaedic surgeons reliably interpret MRI scans using the PRiSM Discoid Meniscus Classification for the majority of DLM characteristics but vary in their assessment of height and presence and type of tear. MRI evaluation may be helpful to diagnose discoid by width and identify the presence of instability: 2 major factors in the decision to proceed with surgery. Arthroscopic evaluation should be used in conjunction with MRI findings for complete DLM diagnosis.

The Lateral Meniscus Oblique Radial Tear (LMORT).

The lateral meniscus oblique radial tear (LMORT) of the posterior horn is a relatively new term for one of the more common types of lateral meniscal tears found in patients with acute anterior cruciate ligament (ACL) injuries. Given the importance of anatomical reduction and preservation of the lateral meniscus to maintain normal knee stability and slow the progression of early-onset osteoarthritis, LMORT classification and treatment guidelines have been formulated. This article provides a review of the prevalence, classification, biomechanics, surgical repair techniques, and outcomes related to LMORT injuries. Current research demonstrates favorable clinical results when LMORTs are surgically treated based on recent evidence. Biomechanically, repair of the higher grade 3 and 4 LMORT lesions have led to comparable results when compared to an intact lateral meniscus, and superior results when compared to partial meniscectomy and untreated tears. Ongoing research is aimed to determine the difference between LMORT repairs compared to intact lateral menisci at the time of ACL surgery regarding comparable patient outcomes. LMORT lesions are common tears of the lateral meniscus that should be treated surgically based on tear type at the time of ACL surgery. The benefit of doing so has already been demonstrated biomechanically.

The Incidence of Postoperative Shoulder Stiffness After Arthroscopic Rotator Cuff Repair: A Systematic Review.

Rotator cuff tear (RCT) is a common shoulder condition frequently treated with arthroscopic rotator cuff repair (ARCR) after conservative interventions have failed. Postoperative shoulder stiffness (POSS) is a common complication after ARCR. The purpose of this study is to determine the incidence of POSS after ARCR in total and based on tear extent prior to ARCR. A systematic review was performed using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and ScienceDirect databases. The search terms were "rotator cuff repair" AND "arthrofibrosis" OR "postoperative shoulder stiffness." Articles were selected based on ARCR and the presence of POSS documentation. Twenty-five articles out of 284 articles met the final selection criteria after reviewing for patients who received ARCR. Out of all patients (n=9,373), 597 had POSS (6.4%). Out of the 2,424 patients with a specified tear pattern, 96 out of 1,862 (5.2%) patients with full-thickness tearsand 58 out of 562 (10.3%) patients with partial-thickness tears had POSS after ARCR. Partial-thickness tears are associated with higher rates of POSS after ARCR as compared to full-thickness tears (p<0.001). Overall, POSS is a common complication after ARCR with an incidence of 6.4%, regardless of tear type. POSS is more common in patients who receive ARCR for partial-thickness RCT (10.3%) as compared to patients who receive ARCR for full-thickness RCT (5.2%). More research is needed to determine other factors impacting the incidence of POSS after ARCR.

Imaging and histological evaluation of the long head of the biceps tendon in the presence of different types of rotator cuff tears

BackgroundA comparison of changes in the long head of the biceps tendon for different types of rotator cuff tears has not been previously performed. Furthermore, the correlation between the thickening and degeneration of the long head of the biceps tendon and the cause of these changes have not been fully clarified. We evaluated the relationship between degenerative changes in the long head of the biceps tendon and rotator cuff tears in a rat model using imaging and histology.MethodsNinety-six 12-week-old Sprague–Dawley rats were divided into anterior (subscapularis tear), anterosuperior (subscapularis, supraspinatus, and infraspinatus tears), superior (supraspinatus and infraspinatus tears), and control groups. The long head of the biceps tendon was harvested at 4 or 12 weeks postoperatively. The cross-sectional areas of the intra- and extra-capsular components of the tendon were measured using micro-computed tomography, and the affected/normal ratio of the cross-sectional area was calculated. Masson’s trichrome staining and Alcian blue staining were performed for histologic analysis, with degenerative changes described using the modified Bonar scale. The correlation between the affected/normal ratio and Bonar scores was evaluated.ResultsThe affected/normal ratio was higher for the anterior and anterosuperior groups than for the control group at 4 and 12 weeks. The ratio increased for the intra-articular portion in the superior group and for both the intra- and extra-articular portions in the anterior and anterosuperior groups. Degeneration considerably progressed in the anterior and anterosuperior groups compared with the control group from weeks 4 to 12 and was greater in the intra- than in the extra-articular portion. The ratio correlated with extracellular matrix score.ConclusionsSubscapularis tears were associated with progressive thickening and degeneration of the long head of the biceps tendon at 4 and 12 weeks postoperatively, which was more significant in the intra- than in the extra-articular portion. Histologic evaluation indicated that the extracellular matrix likely caused these degenerative changes.

Degloving Injury of Rectus Femoris Presenting as Mass in the Anterior Thigh: A Case Report

Injuries to the rectus femoris muscle are common in athletes. The complex muscle-within-amuscle anatomic configuration of the rectus femoris muscle makes it susceptible to various types of injuries. The purpose of this study was to describe the MRI characteristics of injuries to the rectus femoris whereby the inner bipennate component of the indirect head is dissociated from its superficial unipennate component resembling a finger in a glove. Finally, treatment and functional outcome may vary depending on the type of tear. Knowing different imaging patterns of these tears is important to provide accurate diagnosis and treatment.

Medial Meniscal Extrusion in Patients With Medial Meniscus Root Tears: A Systematic Review and Meta-analysis.

Medial meniscal extrusion (MME) has received significant interest because of its correlation with medial meniscus root tears (MMRTs), its potential as a diagnostic tool, and its significance in the progression of knee osteoarthritis (OA). To (1) evaluate if MMRTs significantly increase MME compared with nonroot tears (NRTs) and no tears and (2) determine the clinical outcomes of increased MME. Systematic review; Level of evidence, 4. Electronic database searches of PubMed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were conducted on June 6, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist criteria. The searches were conducted using the keywords "meniscus tear" and "extrusion." No restrictions were placed on the date of publication. Quality and sensitivity assessments were conducted on included studies. Major MME was defined as an extrusion ≥3 mm. Twenty-two studies involving 7882 knees were included. Compared with patients with NRTs, those with MMRTs had a 1.12-mm greater mean absolute meniscal extrusion (AME) and were 3.45 times more likely to have major MME (P < .001 for both). Compared with patients with no tears, those with MMRTs had a 2.13-mm greater AME (P < .001). Within patients with MMRT, those with widely displaced MMRT had a 1.01-mm greater AME compared with nondisplaced MMRT (P < .001). Patients with OA had a 0.73-mm greater AME and were 3.86 times more likely to have major MME compared with patients without OA (P < .001 for both). Within patients who were not stratified according to MMRT, NRT, or no tears, those who eventually developed OA had a 0.79-mm greater AME than those who did not have OA (P = .02). Patients with MMRTs had higher MME values compared with those with other types of meniscal tears and those without any meniscal tears. Patients with knee OA were more likely to have higher MME compared with those without OA.

Meniscus repair via collagen matrix wrapping and bone marrow injection: clinical and biomolecular study

PurposeThe functional outcomes of arthroscopic matrix-based meniscus repair (AMMR) in patients two and five years after the treatment clearly show that the use of the collagen matrix and bone marrow aspirate creates favorable biological conditions for meniscus healing. This study not only provides ten follow-up results but also investigates biomolecular mechanisms governing the regenerative process.MethodsCase series was based on data collected from patients who underwent AMMR procedure, starting with preoperatively through two-year and five-year till ten-year follow-up. The outcomes are presented as IKDC and the Lysholm subjective scores as well as the imaging results. Biomolecular investigation of the membranes utilized in the AMMR procedure include DNA content analysis, cell viability and proliferation study of bone marrow and bone marrow concentrate-derived cells, and cytokine array performed on monocytes cultured on the membranes.ConclusionData collected from patients who underwent AMMR procedure, starting with pre-operatively through two year and five year till ten year follow-up, indicate the possibility for long-term, stable meniscus preservation. Outcomes are manifested with a visible improvement of the IKDC and the Lysholm subjective scores as well as in the imaging results. The type of the meniscal tear or complexity of the knee injury (isolated AMMR vs. AMMR + ACL) did not affect the clinical outcomes. The study highlighted the role of the membrane in facilitating cell adhesion and proliferation. Additionally, several cytokines were selected as potentially crucial products of the membrane vs. monocyte interactions, driving the tissue regeneration and remodeling. Interestingly, thresholds of what constitutes a safe and well-decellularized membrane according to relevant literature have been significantly breached, but ultimately did not elicit detrimental side effects.

Modified Dynamic CT Myelography for Type 1 and 2 CSF Leaks: A Procedural Approach.

Dynamic CT myelography can identify spinal CSF leaks secondary to dural tears (type 1) and ruptured meningeal diverticula (type 2), but the radiation can be high secondary to multiple successive acquisitions. The purpose of this article is to discuss the procedural approach of a modified dynamic CT myelography technique with single scan acquisitions, reduced contrast volume, and condensed scan coverage and compare its radiation dose with that in traditional dynamic CT myelography. Retrospective review was performed for patients with spontaneous CSF leaks showing extradural collections on spine MR imaging who underwent traditional and modified dynamic CT myelography. The radiation doses between the 2 cohorts were compared. Thirty-seven patients (25 women, 12 men) had a type 1 or 2 CSF leak on dynamic CT myelography. Thirty-one patients had a type 1 CSF leak, and 6 patients had type 2 leaks. The traditional dynamic CT myelography was performed in 25 patients, and the average number of acquisitions per dynamic CT myelography was 3.6. The mean total effective dose per dynamic CT myelography was 31.3 mSv (range, 11.3-68.4 mSv). The modified dynamic CT myelography was performed in 12 patients, and the average number of acquisitions was 2.8. The mean total effective dose per dynamic CT myelography was 15.1 mSv (range, 4.8-24.6 mSv). The effective dose and dose-length product between the cohorts were statistically significant (P < .0001 and .01, respectively). Modified dynamic CT myelography performed with single scan acquisitions, smaller volume of contrast, and reduced scan coverage can reduce the radiation dose for type 1 and 2 CSF leak detection.

Deep Learning Diagnosis and Classification of Rotator Cuff Tears on Shoulder MRI.

Detection of rotator cuff tears, a common cause of shoulder disability, can be time-consuming and subject to reader variability. Deep learning (DL) has the potential to increase radiologist accuracy and consistency. The aim of this study was to develop a prototype DL model for detection and classification of rotator cuff tears on shoulder magnetic resonance imaging into no tear, partial-thickness tear, or full-thickness tear. This Health Insurance Portability and Accountability Act-compliant, institutional review board-approved study included a total of 11,925 noncontrast shoulder magnetic resonance imaging scans from 2 institutions, with 11,405 for development and 520 dedicated for final testing. A DL ensemble algorithm was developed that used 4 series as input from each examination: fluid-sensitive sequences in 3 planes and a sagittal oblique T1-weighted sequence. Radiology reports served as ground truth for training with categories of no tear, partial tear, or full-thickness tear. A multireader study was conducted for the test set ground truth, which was determined by the majority vote of 3 readers per case. The ensemble comprised 4 parallel 3D ResNet50 convolutional neural network architectures trained via transfer learning and then adapted to the targeted domain. The final tear-type prediction was determined as the class with the highest probability, after averaging the class probabilities of the 4 individual models. The AUC overall for supraspinatus, infraspinatus, and subscapularis tendon tears was 0.93, 0.89, and 0.90, respectively. The model performed best for full-thickness supraspinatus, infraspinatus, and subscapularis tears with AUCs of 0.98, 0.99, and 0.95, respectively. Multisequence input demonstrated higher AUCs than single-sequence input for infraspinatus and subscapularis tendon tears, whereas coronal oblique fluid-sensitive and multisequence input showed similar AUCs for supraspinatus tendon tears. Model accuracy for tear types and overall accuracy were similar to that of the clinical readers. Deep learning diagnosis of rotator cuff tears is feasible with excellent diagnostic performance, particularly for full-thickness tears, with model accuracy similar to subspecialty-trained musculoskeletal radiologists.

Techniques to treat challenging meniscus tears

IntroductionMeniscus tears are one of the most common knee pathologies encountered. Although meniscus tears were initially treated with meniscectomy, numerous studies have described the effect of meniscectomy on accelerating degenerative changes of the knee. In addition, certain tear patterns that may have been traditionally underrecognized are now the subject of recent investigation on the merits of repair. ObjectivesWe review the existing literature on the biomechanical and clinical outcomes following treatment of radial, horizontal cleavage, and ramp meniscus tears. This article will also highlight meniscus repair strategies for these tear patterns. MethodsPubMed was searched. All levels of evidence (I-IV) pertaining to meniscus tears were analyzed and presented. ResultsFor radial tears, all-inside techniques are gaining popularity, with 2 emerging strategies: “tie-grip” sutures and transtibial approaches. For horizontal tears, circumferential sutures allow even compression of the superior and inferior leaflets of the tear. Multiple techniques have been described for repair of ramp lesions, which are best recognized with a systematic exploration of the posteromedial aspect of the knee. ConclusionsIncreased awareness of certain meniscus tear types and their effect on knee kinematics and stability has led to investigation and evolution of repair techniques, with an increased emphasis on all-inside repairs.

Superior Labrum Anterior – Posterior (SLAP) Lesion: Consideration and Controversies

SLAP tears are a common pathology, observed in 26% of patients undergoing shoulder arthroscopy. First described by Andrews et al, SLAP tears were then further subclassified by Snyder et al. The variable relationship between the anterosuperior labrum and the glenohumeral ligaments has important implications for the evaluation and treatment of SLAP lesions. These normal variants include a sublabral recess / foramen (3.3%), a sublabral foramen with a cord-like MGHL (8.6%) and an absent anterosuperior labrum with a cord-like MGHL (i.e. Buford complex, 1.5%). Frequently accepted mechanisms of injury include forceful traction loads to the arm, direct compression loads, and repetitive overhead throwing activities. SLAP lesions are difficult to examine accurately, because that most SLAP lesions occur concomitantly with other shoulder injuries (e.g. glenohumeral instability, rotator cuff tears, biceps tendon ruptures), and they typically have no specific associated pain pattern. Several provocative tests for SLAP tears have been described, however, none of these tests has been found to be highly accurate for diagnosis of SLAP tears. The definitive diagnosis of SLAP lesions is best made through diagnostic arthroscopy. Treatment of these lesions is directed according to its type. Treatment ranges from non-operative management to surgical management including SLAP repair, biceps tenotomy, and biceps tenodesis. The management of Type-II SLAP (most common) of the shoulder remains a controversial topic. Whether to repair a shoulder SLAP lesion or perform a biceps tenodesis depends on a multitude of factors: patient age, activity or work level, type of SLAP tear, location of SLAP tear, and quality of labral tissue. Determining which procedure to perform does not have such a simple, one-size-fits-all solution.

Multiomic Approaches for Cancer Biomarker Discovery in Liquid Biopsies: Advances and Challenges.

Cancer is a complex and heterogeneous disease that poses a significant threat to global health. Early diagnosis and treatment are critical for improving patient outcomes, and the use of liquid biopsies has emerged as a promising approach for cancer detection and monitoring. Traditionally, cancer diagnosis has relied on invasive tissue biopsies, the collection of which can prove challenging for patients and the results of which may not always provide accurate results due to tumor heterogeneity. Liquid biopsies have gained increasing attention as they provide a non-invasive and accessible source of cancer biomarkers, which can be used to diagnose cancer, monitor treatment response, and detect relapse. The integration of -omics technologies, such as proteomics, genomics, and metabolomics, has further enhanced the capabilities of liquid biopsies by introducing precision oncology and enabling the tailoring of treatment for individual patients based on their unique tumor biology. In this review, we will discuss the challenges and advances in the field of cancer liquid biopsies and the integration of -omics technologies for different types of liquid biopsies, including blood, tear, urine, sweat, saliva, and cerebrospinal fluid.

25, 50 and 75 years ago

25, 50 and 75 years ago

Tough gel adhesive is an effective method for meniscal repair in a bovine cadaveric study

PurposeTo test tough gel adhesives to repair meniscus tears under relevant loading conditions and determine if they have adequate biomechanical properties to repair meniscus tears in a bovine cadaveric study.MethodsCyclic compression tests on 24 dissected bovine knees were performed. The tough gel adhesive was used either as an adhesive patch or as a coating bonded onto commercially available surgical sutures. Forty-eight menisci were tested in this study; 24 complete radial tears and 24 bucket-handle tears. After preconditioning, the specimens underwent 100 cycles of compression, (800 N/0.5 Hz) on an Instron© machine and the size of the gaps measured. One third of the menisci were repaired with pristine sutures, one third with adhesive patches, and one third with sutures coated in adhesive gel. The size of the gaps was compared after 100 and 500 cycles of compression.ResultsThe mean gap measured at the tear site without treatment was 6.46 mm (± 1.41 mm) for radial tears and 1.92 mm (± 0.65 mm) for bucket-handle tears. After treatment and 500 cycles of compression, the mean gap was 1.63 mm (± 1.41 mm) for pristine sutures, 1.50 mm (± 1.16 mm) for adhesive sutures and 2.06 mm (± 1.53 mm) for adhesive gel patches. There was no significant difference between treatments regardless of the type of tear. Also, the gaps for radial tears increased significantly with the number of compression cycles applied (p > 0.001).ConclusionFrom a biomechanical standpoint, the tough adhesive gel patch is as effective as suturing. In addition, it would allow the repair of non-suturable tears and thus broaden the indications for meniscus repair.Level of evidenceControlled laboratory study.

The clinical and radiographic outcomes of type 2 medial meniscus posterior root tears following transtibial pullout repair.

The aim of this study was to compare the clinical outcomes of different subtypes of type 2 medial meniscus posterior root tears following transtibial pullout repair. In total, 147 patients (mean age: 66.2 ± 8.3years) who were diagnosed with type 2 medial meniscus posterior root tears and underwent transtibial pullout repair were included. Patients were divided into 2A (n = 31), 2B (n = 90), and 2C (n = 26) groups according to tear type. Clinical outcomes were assessed pre-operatively and at second-look arthroscopy using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status was evaluated at second-look arthroscopy. Medial meniscus extrusion was calculated using magnetic resonance imaging pre-operatively and at second-look arthroscopy. No significant differences in pre-operative or post-operative clinical scores were observed between each subtype, although clinical scores improved post-operatively for each subtype. Significant differences were noted in the anteroposterior width of the bridging tissues at second-look arthroscopy (2A, 7.1 ± 1.2; 2B, 6.2 ± 1.7; and 2C, 6.2 ± 1.7mm; p = 0.045); type 2A tears were the widest. There was a significant difference in post-operative medial meniscus extrusion (2A, 3.2 ± 0.9; 2B, 4.0 ± 1.2; and 2C, 4.0 ± 1.4mm; p = 0.004) and its progression (2A, 0.7 ± 0.6; 2B, 1.2 ± 0.8; and 2C, 1.2 ± 0.8mm; p = 0.008), and type 2A tears were the shortest. Although there was no significant difference in the post-operative clinical scores among different type 2 tears in the short term, type 2A tears showed better healing and medial meniscus extrusion progression prevention, thus indicating the usefulness of classifying tear type in estimating post-operative outcomes. III.

Factors that influence pregnant women’s decision on mode of delivery after previous obstetric anal sphincter injury

PurposeMaternal request for caesarean section (CS) is increasing. One common reason is following a previous obstetric anal sphincter injury (OASI). We aim to understand which factors bear the greatest influence in driving this women’s decision-making process once they are pregnant after having sustained an OASI. MethodsPregnant women with a previous OASIS who were attending their first antenatal appointment were deemed eligible and were asked to complete two questionnaires on their preferred mode of delivery (MoD) and ongoing pelvic floor symptomatology. Data were analysed with descriptive and inferential statistics using SPSS, and results were presented both quanti- and qualitatively. ResultsData from 63 participants was included in the final analysis. Most women had experienced 3A/3B OASIS (n = 49, 77.78 %), and they were more likely to report bladder pain and difficulties with voiding than those with major tears (p < 0.05). The type of tear did not impact directly on the preferred MoD. However, women still experiencing bladder pain were more likely to request a CS (p < 0.05). Even though all participants who attended a perineal trauma clinic postpartum found it helpful, they reported that ultimately the decision on how to deliver was theirs, and their ideas and concerns played the greatest influence. ConclusionPregnant women with ongoing urinary symptoms rather than sexual or bowel dysfunction seem to favour a planned CS, regardless of the severity of their previous tear. Postpartum follow-up in a perineal trauma clinic is extremely valuable but even more is the need to understand women’s motivations to support them make an informed decision.