Type Of Tear Research Articles

Ulnar Collateral Ligament Repair of the Elbow-Biomechanics, Indications, and Outcomes.

Traditionally medial elbow injuries in overhead athletes have been treated with ulnar collateral ligament (UCL) reconstruction as first described by Dr. Frank Jobe. Recent literature has shown favorable outcomes in select patients treated with UCL repair. Newer techniques utilizing suture augmentation demonstrate biomechanical profiles as good or better than the native state and/or reconstruction. This review aims to evaluate these biomechanical studies and the clinical outcomes of ulnar collateral ligament repair with suture augmentation. UCL repair has favorable outcomes in select patients with specific tear type patterns. Clinical outcomes have shown return to play rates of 92-97% with mean time of 2.5-6months post-operatively. Biomechanical data comparing UCL repair to reconstruction techniques have shown improved resistance to common forces applied to the elbow during overhead activities. Additionally, suture tape augmentation dramatically improves stability of ligament repair without over-constraining the elbow. Initial ulnar collateral ligament repair data was poor, and thus UCL reconstruction became the mainstay of treatment for overhead athletes. Recent studies evaluating the biomechanical properties as well as clinical outcomes have demonstrated favorable data when UCL repair is performed. When considering the drawbacks of a prolonged recovery associated with reconstruction, UCL repair is a viable option in select patients.

Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings.

Magnetic resonance imaging (MRI) has been widely used for the diagnosis of meniscal tears, but its diagnostic accuracy, depending on the type and location, has not been well investigated. We aimed to evaluate the diagnostic accuracy of MRI by comparing MRI and arthroscopic findings. Preoperative 3.0-T MRI and arthroscopic findings from 2005 to 2018 were reviewed to determine the presence, type, and location of meniscus tears. In addition, subgroup analysis was performed according to anterior cruciate ligament (ACL) injury. The exclusion criteria were as follows: (1) Inflammatory arthritis, (2) other ligament injuries, (3) inability to classify meniscal tears due to degenerative arthritis, (4) over 90 days from MRI to surgery, and (5) incomplete data. Of the 2998 eligible patients, 544 were finally included. The sensitivity and specificity of MRI in determining medial and lateral meniscus tears were 91.8% and 79.9%, and 80.8% and 85.4%, respectively. The accuracy of MRI in the ACL-injured group was lower than that in the ACL-intact group (medial meniscus: 81.7% vs. 88.1%, p = 0.041; 72.9% vs. lateral meniscus: 88.0%, p < 0.001). MRI accuracy was low for the longitudinal tears of the posterior horn of the medial meniscus in the ACL-injured group. MRI could be a diagnostic tool for meniscus tears, but has limited accuracy in their classification of the type and location. Hence, care should be taken during arthroscopic assessment of ACL-injured patients due to low diagnostic accuracy of preoperative MRI.

Meniscal tears are more common than previously identified, however, less than a quarter of people with a tear undergo arthroscopy

PurposeThe management of meniscal tears is a widely researched and evolving field. Previous studies reporting the incidence of meniscal tears are outdated and not representative of current practice. The aim of this study was to report the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee and the current intervention rate in a large NHS trust.MethodsRadiology reports from 13,358 consecutive magnetic resonance imaging scans between 2015 and 2017, performed at a large UK hospital serving a population of 470,000, were assessed to identify patients with meniscal tears. The hospital database was interrogated to explore the subsequent treatment undertaken by the patient. A linear regression model was used to identify if any factors predicted subsequent arthroscopy.Results1737 patients with isolated meniscal tears were identified in patients undergoing an MRI for knee pain, suggesting a rate of 222 MRI confirmed tears per 100,000 of the population aged 18 to 55 years old. 47% attended outpatient appointments and 22% underwent arthroscopy. Root tears [odds ratio (95% CI) 2.24 (1.0, 4.49); p = 0.049] and bucket handle tears were significantly associated with subsequent surgery, with no difference between the other types of tears. The presence of chondral changes did not significantly affect the rate of surgery [0.81 (0.60, 1.08); n.s].ConclusionMeniscal tears were found to be more common than previously described. However, less than half present to secondary care and only 22% undergo arthroscopy. These findings should inform future study design and recruitment strategies. In agreement with previous literature, bucket handle tears and root tears were significant predictors of subsequent surgery.Level of evidenceIII.

A Parametric Study on Factors Influencing the Onset and Propagation of Aortic Dissection Using the Extended Finite Element Method.

Aortic dissection is a life-threatening event which starts most of the time with an intimal tear propagating along the aortic wall, while blood enters the medial layer and delaminates the medial lamellar units. Studies investigating the mechanisms underlying the initiation sequence of aortic dissection are rare in the literature, the majority of studies being focused on the propagation event. Numerical models can provide a deeper understanding of the phenomena involved during the initiation and the propagation of the initial tear, and how geometrical and mechanical parameters affect this event. In the present paper, we investigated the primary factors contributing to aortic dissection. A two-layer arterial model with an initial tear was developed, representing three different possible configurations depending on the initial direction of the tear. Anisotropic damage initiation criteria were developed based on uniaxial and shear experiments from the literature to predict the onset and the direction of crack propagation. We used the XFEM-based cohesive segment method to model the initiation and the early propagation of the tear along the aorta. A design of experiment was used to quantify the influence of 7 parameters reflecting crack geometry and mechanics of the wall on the critical pressure triggering the dissection and the directions of propagation of the tear. The results showed that the obtained critical pressures (mean range from 206 to 251 mmHg) are in line with measurement from the literature. The medial tensile strength was found to be the most influential factor, suggesting that a medial degeneration is needed to reach a physiological critical pressure and to propagate a tear in an aortic dissection. The geometry of the tear and its location inside the aortic wall were also found to have an important role not only in the triggering of tear propagation, but also in the evolution of the tear into either aortic rupture or aortic dissection. A larger and deeper initial tear increases the risk of aortic dissection. The numerical model was able to reproduce the behaviour of the aorta during the initiation and propagation of an aortic dissection. In addition to confirm multiple results from the literature, different types of tears were compared and the influence of several geometrical and mechanical parameters on the critical pressure and direction of propagation was evaluated with a parametric study for each tear configuration. Although these results should be experimentally validated, they allow a better understanding of the phenomena behind aortic dissection and can help in improving the diagnosis and treatment of this disease.

Publicly Available Rehabilitation Protocols Designated for Meniscal Repairs Are Highly Variable

PurposeTo compare publicly available rehabilitation protocols designated for meniscal repairs published online to determine the variability in meniscus repair protocols including different types of tears (radial vs nonradial repairs).MethodsFrom the Fellowship and Residency Electronic Interactive Database Access System (FREIDA), a list of publicly available academic residency programs and orthopaedic sports medicine fellowships was obtained. With this list, an electronic search using Google was performed looking for meniscal repair rehabilitation protocols. In addition to academic institutions, private practice organizations with published meniscus repair rehabilitation protocols found during the search also were examined.ResultsOf 189 academic institutions, a total of 30 academic institutions had protocols that were included. Another 29 private practice programs were subsequently found and included. In total, 59 rehabilitation protocols fit the inclusion criteria. Six of the 59 specified radial repair and 53 did not. For return to full range of motion, nonradial protocols averaged 6.7 weeks and radial protocols averaged 7.3 weeks. For return to full weight-bearing, nonradial protocols averaged 6.2 weeks and radial protocols averaged 7.5 weeks. For return to sport, nonradial protocols averaged 17.8 weeks and radial protocols averaged 23.3 weeks. For time spent in a brace, nonradial protocols averaged 5.7 weeks and radial protocols averaged 6.7 weeks.ConclusionsOf publicly available meniscal repair rehabilitation protocols, a small percentage (10.2%) changed their protocol in relation to tear type and there was a wide range of timeframes for each rehabilitation component. Protocols for radial tears tended to brace patients longer, limit their range of motion longer, delay full weight-bearing, and delay return to sport. However, it is recognized that some surgeons could be modifying their protocols in relation to tear type without publishing that information online.Clinical RelevanceAs stated in the purpose, the point of this study was to access only the protocols that would be available to the public. If anything, awareness should be raised for surgeons to look at their existing protocols and update them if they are truly incomplete and outdated. More research needs to be done to structure a rehabilitation protocol that is specific to the meniscal tear type, as the current protocols have a wide range of variance.

Sonographic evaluation of the association between calcific tendinopathy and rotator cuff tear: a case-controlled comparison.

To compare the incidence of rotator cuff (RC) tears on shoulder ultrasounds of patients with RC calcific tendinopathy (CaT) to that of a control group without CaT. In this retrospective case-control study, 50 shoulder ultrasounds of patients with CaT were compared independently by 2 musculoskeletal radiologists to 50 patients from a control group without CaT to catalog the number and type of RC tears. RC tears in the CaT group were further characterized based on location, into tears in the specific tendon(s) containing calcium versus all tendon tears. RC tears were diagnosed in 38% (19/50) of the control group (16 full-thickness) as compared to 22% (11/50) with CaT (6 full-thickness). The fewer full-thickness tears in the CaT group (12%, 6 of 50) compared to that in the control group (32%, 16 of 50) was statistically significant (P = 0.016, odds ratio 0.29). Only 7 of the 11 tears in the CaT group were in a calcium-containing tendon (3 full-thickness). The fewer calcium-containing tendon tears compared to tears in the control group was also statistically significant (P = 0.006, odds ratio 0.27). Furthermore, the fewer full-thickness calcium-containing tendon tears (6%, 3/50) compared to full-thickness tears in the control group (32%, 16/50) were yet more statistically significant (P = 0.001, odds ratio 0.14). In patients with shoulder pain and CaT, we observed a decreased number of RC tears and especially calcium-containing tendon tears, as compared to similar demographic patients with shoulder pain but without CaT. Key Points • Patients with rotator cuff calcific tendinopathy have few rotator cuff tears, especially full-thickness tears, compared to a control group without calcific tendinopathy. • The tendons containing the calcium hydroxyapatite deposition were the least likely to have a rotator cuff tear. • Future studies could evaluate if calcium hydroxyapatite deposition provides a protective mechanism against rotator cuff tears. • Musculoskeletal ultrasound is more sensitive than MRI in the evaluation of rotator cuff calcific tendinopathy.

Delayed anterior cruciate ligament reconstruction increases the incidence of medial meniscal bucket handle tears and medial compartment chondral injuries in patients aged40years and older.

No widely accepted evidence-based indications exist for the initial surgical management of patients with anterior cruciate ligament (ACL) injuries ≥ 40years old, and treatment for these patients remains controversial. This study aimed to evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injury in patients aged ≥ 40years. The patients who underwent primary ACL reconstruction were divided into two groups based on elapsed time from injury to surgery: early group, < 12months; and delayed group, ≥ 12months. Patient records were reviewed for incidence and types of meniscal tears and chondral injuries in each group. Chondral injury grades were evaluated with International Cartilage Regeneration and Joint Preservation Society (ICRS) Criteria. This study evaluated 67 knees in the early group and 33 knees in the delayed group. Mean ages in each group were 46.9 ± 6.5 and 46.9 ± 6.0. The delayed group showed significantly higher rates of medial meniscal tear [31 of 33, 93.9% vs 29 of 67, 43.3%; P < 0.0001; odds ratio (OR), 20.31; 95% confidence interval (CI), 4.49-91.9], medial femoral condyle chondral injuries ≥ ICRS grade II (15 of 33, 45.5% vs 8 of 67, 11.9%; P < 0.001; OR, 6.15; 95% CI 2.24-16.83), and medial tibial chondral injuries ≥ ICRS grade II (7 of 33, 21.2% vs 3 of 67, 4.5%; P < 0.05; OR, 5.74; 95% CI 1.38-23.9) compared with the early group. With respect to types of medial meniscal tear, the delayed group showed a significantly higher frequency of bucket handle tears (11 of 33, 33.3%) compared with the early group (2 of 67, 3.0%; P < 0.0001; OR, 16.25; 95% CI 3.34-79.1). Delayed ACL reconstruction was associated with increased incidence of chondral injuries and medial meniscal tears, particularly bucket handle tears in this cohort. Level III.

Anterior cruciate ligament injury patterns and their relationship to fatigue and physical fitness levels - a cross-sectional study.

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that leads to many consequences such as early osteoarthritis and knee joint instability.To explore the association of the types of ACL tear (complete and partial) and side of injury (dominant vs nondominate) with types of playing surfaces, sports, shoes, and mechanism of injuries as well as to determine whether higher levels of fatigue and physical fitness are risk factors for complete ACL tear.This cross-sectional study used a questionnaire to collect information from young male adults with a confirmed ACL injury who were attending rehabilitation programs. The outcomes of interest were patterns of ACL injury, levels of fatigue before the injury on a 0 to 10 scale, and levels of physical fitness (hours per week). Mann–Whitney U and Kruskal Wallis tests were used to assess the differences between groups, while the odds ratios were calculated to evaluate risk factors for complete ACL tear.One hundred thirteen young male adults with a confirmed ACL injury were enrolled. Most of the reported ACL injuries in this study were complete tear (80.5%) and occurred more frequently in the dominant leg (74.6%) due to noncontact mechanism (63.6%). More ACL injuries happened while playing soccer (97.2%) on artificial turf (53.3%). The level of fatigue before ACL injury was significantly higher in partial ACL tear injuries compared to complete ACL tear injuries (P = .014). For every 1-point increase in the level of fatigue on a 0–10 scale, there was a 25% reduction in complete ACL injury risk (P = .023).The pattern of ACL types of tear and side of injury varies in different playing surfaces and mechanisms of injuries. Higher levels of fatigue seem to be associated with a partial tear of the ACL and reduction of a complete ACL tear risk factor.

A Comparative Study on the Effect of Using Three Maternal Positions on Postpartum Bleeding, Perineum Status and Some of the Birth Outcomes During Lathent and Active phase of the Second Stage of Labor

BACKGROUND/AIMS This study aimed to determine the effect of three different positions of delivery on the postpartum bleeding, perineum status, and some birth outcomes. MATERIALS and METHODS This clinical trial study was performed on 96 primiparous pregnant women who had voluntarily entered the trial and were randomly assigned to one of the following three groups: lithotomy, sitting, and squatting group in the second stage of labor. Bleeding during the first hour after delivery, postpartum status of the perineum, as well as type and degree of tear were measured. The data were analyzed using Statistical Package for the Social Sciences 17 (SPSS Inc.; Chicago, IL, USA). RESULTS and CONCLUSION The mean volume of bleeding in the lithotomy group was significantly lower than those in the other two groups (p=0.016), and there was no significant difference between the sitting and squatting groups. There was no significant difference among the three groups in terms of the perineal status (tear and episiotomy), the height of the uterus, and the neonatal mean Apgar mean scores at 1 and 5 minutes (p>0.05). The use of different delivery positions based on the status of the mother can have different effects on the mother and infant outcomes; further studies are warranted on this subject. Keywords: Childbirth position, episiotomy and laceration, post partum position

Protocol for a multi-site pilot and feasibility randomised controlled trial: Surgery versus PhysiothErapist-leD exercise for traumatic tears of the rotator cuff (the SPeEDy study)

BackgroundClinically, a distinction is made between types of rotator cuff tear, traumatic and non-traumatic, and this sub-classification currently informs the treatment pathway. It is currently recommended that patients with traumatic rotator cuff tears are fast tracked for surgical opinion. However, there is uncertainty about the most clinically and cost-effective intervention for patients with traumatic rotator cuff tears and further research is required.SPeEDy will assess the feasibility of a fully powered, multi-centre randomised controlled trial (RCT) to test the hypothesis that, compared to surgical repair (and usual post-operative rehabilitation), a programme of physiotherapist-led exercise is not clinically inferior, but is more cost-effective for patients with traumatic rotator cuff tears.MethodsSPeEDy is a two-arm, multi-centre pilot and feasibility RCT with integrated Quintet Recruitment Intervention (QRI) and further qualitative investigation of patient experience. A total of 76 patients with traumatic rotator cuff tears will be recruited from approximately eight UK NHS hospitals and randomly allocated to either surgical repair and usual post-operative rehabilitation or a programme of physiotherapist-led exercise. The QRI is a mixed-methods approach that includes data collection and analysis of screening logs, audio recordings of recruitment consultations, interviews with patients and clinicians involved in recruitment, and review of study documentation as a basis for developing action plans to address identified difficulties whilst recruitment to the RCT is underway. A further sample of patient participants will be purposively sampled from both intervention groups and interviewed to explore reasons for initial participation, treatment acceptability, reasons for non-completion of treatment, where relevant, and any reasons for treatment crossover.DiscussionResearch to date suggests that there is uncertainty regarding the most clinically and cost-effective interventions for patients with traumatic rotator cuff tears. There is a clear need for a high-quality, fully powered, RCT to better inform clinical practice. Prior to this, we first need to undertake a pilot and feasibility RCT to address current uncertainties about recruitment, retention and number of and reasons for treatment crossover.Trial registrationClinicalTrials.gov (NCT04027205) – Registered on 19 July 2019. Available via

Anterior cruciate ligament tear patterns in young patients: An arthroscopic multicenter study

IntroductionIn the last decade, there has been a renewed interest in anterior cruciate ligament (ACL) preservation surgeries in the younger patients. Several ACL preservation techniques such as primary repair, augmented repair, and scaffold repair have been described based on the particular tear type and pattern. The purpose of this study was to determine the distribution of tear patterns in young patients presenting with an acute ACL injury. MethodsA prospective observational study was performed at two tertiary children’s hospitals. Patients under 18 years undergoing ACL reconstruction within 8 weeks of initial injury were included from 2017 to 2019. Tear patterns were classified by two orthopedic surgeons from each of the two centers during arthroscopic ACL reconstruction into 4 types: I. Avulsion off the femur, II. <10% of total ACL length tear from femoral end, III. Mid-substance tear and IV. Single bundle tear. For reliability, the four surgeons classified ACL injury (2 rounds each) based on de-identified intraoperative videos of 33 randomly selected surgical ACL cases. Inter and intra-rater reliability studies were calculated using Kappa statistics. Results224 patients (123 males, 101 females) with mean age of 16 (range: 9–18) years were enrolled in this study. Fifty-seven (25%) patients reported contact injury while 167 (75%) reported non-contact. Isolated ACL injury was recorded in 70 (31%) patients, while concomitant injuries were recorded in 154 patients (69%). The most common associated injury was lateral meniscus tear (35%), followed by lateral and medial meniscus tears (20%). According to our classification, 31 (14%) patients were Type I, 30 (13%) were Type II, 139 (62%) were Type III, 18 (8%) were Type IV. The intra-rater reliability was excellent for 2 reviewers, good for 1 and marginal for another. The overall inter-rater reliability for all 4 reviewers was marginal for both readings. There was no statistical difference in the occurrence of type of tear based on the mechanism of injury (contact vs non-contact) or age of the patients. ConclusionsThis is the first multicenter study using an arthroscopic assessment to classify the location of ACL tear in the young population. It gives us further insight on the possible application for surgeries to preserve the ACL in this group. Larger studies incorporating these findings with MRI evaluation and ACL repair techniques are needed to confirm the utility of this information to decide the eligibility for repair in pediatric patients.

Impact of Socioeconomic Status on Concomitant Injuries and Access to Care Following ACL Injury

Time to ACL reconstruction has been shown to vary greatly in diverse patient populations, and delay has been associated with additional knee pathology. However, there is a paucity of literature examining the correlation between lower socioeconomic status, delay in treatment and increased concomitant pathologies following ACL injury. The purpose of this study was to identify socioeconomic factors in patients sustaining an ACL tear that may influence a delay in seeking treatment or lead to concomitant pathology at the time of surgery. All patients undergoing ACL reconstruction at our institution between November 2015 and August 2018 were identified. Patients were emailed a survey asking about income, highest level of education, primary language spoken at home and the number of re-injuries prior to surgery. Insurance status, date of injury, number of weeks from the initial injury to the first visit with orthopaedic surgery, and date of surgery were recorded from the patient’s medical record. Multiple linear regression with backwards elimination was used to determine statistically significant independent predictors for each outcome. A standard least squares model was used for continuous variables and a nominal regression model for nominal variables. Standard summary statistics are reported for demographic information. The predictive value of the time between the injury and seeing an orthopaedic surgeon on meniscus tears was assessed by establishing a cutoff value that maximized sensitivity and specificity. Then, the group that saw a surgeon faster was compared to the slower group by Chi-Square analysis or Fisher’s Exact Test, depending on the number of patients in each cell. P < .05 was considered significant. Of the 241 patients who met the inclusion criteria, 126 responded to the survey, with an average age of 26.5 ± 9.88 years. Insurance information from all 241 patients was used. Patients with commercial insurance visited an orthopaedic surgeon 39.4 weeks earlier (P=.012) and underwent surgery after being seen by an orthopaedic surgeon 5 weeks sooner (P=.016) as compared to patients with government insurance. English speaking patients independently predicted an earlier visit with an orthopaedic surgeon by 55.86 weeks compared to non-English-speaking patients (P=.027). Speaking English predicted earlier surgery after seeing an orthopaedic surgeon by 21 weeks compared to non-English speakers (P=.019). Additionally, non-English speakers had an odds ratio of 4.62 for having a bucket handle medial meniscus tear at the time of ACL reconstruction (P=.01; CI=1.67-21.3) compared to English speakers. With respect to education, having a college degree predicted earlier initial visit to an orthopaedic surgeon by 36 weeks (P=.023) and predicted earlier surgery by 32 weeks (P=.036) compared to those without a college degree. The level of education completed was not an independent predictor of a bucket handle meniscus tear at the time of surgery. Income level was not a significant independent predictor of number of weeks from initial injury to seeing an orthopaedic surgeon, or time between the initial visit with orthopaedics and surgery. However, having a household income less than $100,000/year independently predicted 0.25 more episodes of instability (P=.039), and an odds ratio of 7.37 (CI=1.20-53.39) for having a bucket handle medial meniscus tears at the time of surgery. Time from injury to seeing an orthopaedic surgeon longer than 13 weeks significantly increased the chance of any type of meniscus tear (P=.007) and specifically non-bucket tears (P=.022). Times longer than 30 weeks, 4 days significantly increased the chance of a bucket handle meniscus tear at the time of surgery compared to both no meniscus tear (P < .001) and a non-bucket type meniscus tear (P < .001). Patients with government insurance and who were non-English-speaking experienced later access to care and later surgery after orthopaedic surgery evaluation. Non-English-speaking patients also experienced higher rates of re-injury, instability, and bucket handle medial meniscus tears. Patients without a college degree also experienced later access to care. Patients with a household income less than $100,000/year experienced higher rates of instability and bucket handle medial meniscus tears. Delayed access to orthopaedic care longer than 13 weeks was associated with higher rates of meniscus tears, and after 30 weeks bucket handle meniscus tears were significantly increased. These data may inform the orthopaedic and broader medical communities of the impact of lower socioeconomic status on patients' access to care and higher rates of concomitant injuries.

Public Insurance Status Negatively Affects Access to Care in Pediatric Patients With Meniscal Injury.

Background:Non- and underinsured individuals experience poor access to care and treatment delays. Meniscal injury is a common reason for surgical intervention in the pediatric population, and delays in care can lead to progression of the tear and other associated problems.Purpose:To investigate the impact of insurance status on access to care and severity of meniscal injury in the pediatric population.Study Design:Cohort study; Level of evidence, 3.Methods:Enrolled in this study were 49 patients receiving care for a meniscal injury between 2016 and 2018 from a safety-net medical system that does not prioritize patients based on insurance status. The patients were stratified into those publicly insured and those privately insured. Access to care was measured as wait time to various points of care: initial injury to clinic, injury to magnetic resonance imaging (MRI), injury to surgery, clinic to MRI, clinic to surgery, and MRI to surgery. The severity of the meniscal tear was measured by findings at the time of arthroscopy, including the type of tear identified, surgery performed, and cartilage injury.Results:Publicly insured patients waited a mean 230 days longer (347 vs 117 days; P < .01) to undergo surgery after injury compared with privately insured patients. The mean wait times in all categories except time from MRI to surgery were significantly longer for publicly insured patients, including injury to clinic (212 vs 73 days; P < .01), injury to MRI (260 vs 28 days; P < .001), injury to surgery (347 vs 117 days; P < .01), clinic to MRI (36 vs 3.9 days; P < .001), and clinic to surgery (136 vs 44 days; P < .01). Neither increased wait times nor insurance status were associated with greater surgical repair rate, severe tear type, or cartilage injury.Conclusion:Publicly insured pediatric patients waited significantly longer for a diagnosis of meniscal tear compared with privately insured patients, even in a safety-net setting. These delays were not associated with greater tear severity or cartilage changes. Providers in all models of care should recognize that insurance status and the socioeconomic factors it represents prevent publicly insured patients from timely diagnostic points of care and strive to minimize the resulting delayed return to normal activity as well as the potential long-term clinical effects thereof.

A study on spectrum of MRI findings in traumatic knee

MRI has emerged as an excellent modality for imaging of ligaments, cartilage, menisci and other structures around the knee joint. This is due to the combination of multiplanar capability and superior soft tissue characterization. This modality has superseded already available modalities like radiograph and CT, over last two decades. A prospective study consisting of 50 patients with traumatic knee joint was undertaken to study the spectrum of MRI findings in all consecutive cases of knee trauma referred from orthopedic OPD. Out of 20 patients with isolated medial meniscus tear, the posterior horn was commonest site of involvement occurring in 11 patients (55%) and the predominant type of tear was horizontal and oblique that occurred in 7 patients each (35%). Grade III tear were the commonest seen in 12 patient (60%) followed by grade II in 8 patients (40%).

Mode III fracture toughness testing and numerical modeling for aerated autoclaved concrete using notch cylinder specimen subjected to torsion

The aerated autoclaved concrete [AAC] is a widely used material in civil engineering for constructing masonry elements. It has excellent insulation and strength properties. The soft porous building materials during exploitation of engineering structures are subjected to various types of loading. The stress state in masonry elements are generated by thermal conditions, shrinkage, weight of other structural elements and service loads. In specific cases, the failure of these materials can be occurred due to out-of-plane sliding or mode III deformation. However, the mode III fracture toughness (KIIIc) of such materials has rarely investigated. In this research using a circumferentially notched cylinder sample subjected to torsion moment, the mode III fracture behavior of AAC (as a model brittle and soft building-material) is investigated experimentally. The KIIIc value was obtained equal to 8.201 ± 0.549 kPa m0.5 for the AAC with a nominal density of 700 kg/m3 that is significantly smaller than the mode I fracture toughness (KIc) of this material demonstrating the high risk of fracture under tear type loads. The laboratory tests were re-analyzed numerically. The results of the conducted analyses indicate that the numerical predictions of AAC under torsional loading conditions and based on the fracture properties assessed in the bending test allows predicting the mode III fracture toughness of AAC with an acceptable agreement.

Evaluation of Traumatic Knee and Shoulder Joint Ligaments with MRI among Adult Sudanese Patients

Background: Magnetic resonance imaging (MRI) is currently regarded as the reference standard for the diagnosis and evaluation of internal derangements of the knee and shoulder girdle. This study aimed to evaluate traumatic injuries of the knee and shoulder joint ligaments by MRI and classify the most common ligament injuries. Methods and Results: This study included 50 patients, who were presented in the Radiology Department of Modern Medical Center in Khartoum, in the period from October 2019 to January 2020. The sample was divided into two groups: shoulder joint group (Group 1, n=30) with an age range between 16 and 74 years and knee joint group (Group 2, n=20) with an age range between 16 and 77 years. The age group most affected with shoulder (46.7%) and knee joint (25%) injuries was 46-65 years. The injuries of the shoulder (40%) and knee joints (55%) were common in patients with body weight ranging from 71-80kg and &gt;81kg, respectively. Different grades of partial meniscus tear of both shoulder and knee joints were noted as Grades 1 and 2 in 8.7% of cases, Grade 2 - 13%, Grades 2 and 3 - 34.8%, and Grade 3 - 30.4%. There were incidences of 27.3%, 0%, 54.5%, 15.20, 0%, and 3% for anterior cruciate ligament, posterior cruciate ligament, medial meniscus C-shape (M Me C), lateral meniscus C-shape (L Me C), MCL, and LCL tears in the knee joints of the affected patients. Conclusion: MRI revealed that injuries to the shoulder and knee joints were common in patients with body weight ranging from 71-80kg and &gt;81kg, respectively. Different grades of partial meniscus tear of the shoulder and knee joints were noted though Grades 2 and 3 partial tears were the most common finding. Finally, it was noted that in the knee joints of the affected patients, the M Me C shaped tear was the major type of tear.

Effects of peripheral tears of the triangular fibrocartilage complex on distal radioulnar joint stability: A biomechanical study

BackgroundPeripheral triangular fibrocartilage complex (TFCC) tears may induce instability of the distal radioulnar joint (DRUJ). In this biomechanical study, simulated peripheral tears of the TFCC were examined on the stability of the DRUJ. Restabilization effect of the DRUJ by ulnar shortening and direct repair of those injuries were sequentially examined. MethodThe DRUJ stiffness was measured in intact, simulated two types of peripheral tears (ulnar and extended ulnodorsal) at three forearm positions: neutral, 60° pronation and 60° supination in 8 fresh frozen cadaver specimens. After the tears were sutured with stitches or after simulated ulnar shortening of 3 mm, the DRUJ stiffness was again measured. ResultsThe ulnar and ulnodorsal TFCC tears decreased the DRUJ stiffness significantly compared with the intact in all forearm positions. When ulnar shortening was done for the ulnar tear, the DRUJ stiffness increased significantly in the neutral and 60° pronated positions. When the ulnar TFCC tear was repaired, the DRUJ stiffness increased significantly in all forearm positions. DRUJ stiffness did not increase either with ulnar shortening or repair in ulnodorsal tear of the TFCC, however. ConclusionThe simulated TFCC tears indicated significant loss of DRUJ stiffness. Direct repair or ulnar shortening was effective only on treatment of the ulnar tear of the TFCC in this study.

Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction

BackgroundThis study examines the relationship between meniscus tear presentations and failure rates following all-inside repair in isolation and in conjunction with an anterior cruciate ligament (ACL) reconstruction. MethodsEighty seven consecutive patients undergoing all-inside meniscal repair at a single institution from July 2016 to June 2018 were retrospectively reviewed. Details of patient presentation, tear type and location, the presence or absence of simultaneous ACL reconstruction, and surgical repair details were recorded to evaluate the relationship between patient characteristics and the primary endpoint of repair failure. ResultsPatients were followed for an average of 2.7 ± 0.8 years. Three patients (3.4%) experienced 30-day complications including 1 deep vein thrombosis and 2 joint aspirations. Within the study time frame, 15 repairs (17.2%) failed, with 10 (11.5%) failing within one year of the initial procedure; the average time to failure was 12.3 ± 9.0 months. Patients undergoing concurrent ACL reconstruction were less likely to experience repair failure (9.7% vs. 36.0%, p = .009), while bucket-handle repairs were more likely to fail during the study period (45.0% vs. 9.0%, p = .001). These trends remained after controlling for tear location, body mass index, and number of sutures (ACL reconstruction Odds Ratio [OR]: 0.229, p = .029; Bucket-handle OR: 9.400, p = .003). ConclusionOur findings suggest concurrent ACL reconstruction at the time of meniscal repair is associated with increased repair survival. The all-inside technique may be successfully used across a variety of tear types and locations, although further study of its efficacy in repairing bucket-handle tears is warranted.

Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis

PurposeTo define the time required to achieve the minimally clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) for isolated arthroscopic partial meniscectomy (APM), and define preoperative and intraoperative factors that predict both early and late achievement of the stated metrics.MethodsPatients who underwent isolated APM between 2014 and 2017 were retrospectively included. Patients without preoperative and 6-month patient-reported outcome measure scores, revision procedures, and significant concomitant procedures were excluded. The MCID, SCB, and PASS were calculated for knee-based patient-reported outcome measure scores using receiver operating curve analysis. Kaplan-Meier survival analysis established the time required to achieve MCID, SCB and PASS. Hazard ratios from multivariate Cox regression allowed for the isolation of demographic and intraoperative factors predictive of the delayed time required to achieve MCID, SCB and PASS.ResultsA total of 126 patients (42.86% female, age: 48.9 ± 12.4 years) were included. Overall achievement rates ranged between 73.0% and 89.7% for MCID, 43.7% and 68.2% for SCB, and 50.8% and 68.3% for PASS. Median achievement time for MCID was 5.68-5.78 months, 5.73-6.05 months for SCB and 6.54-7.72 months for PASS. Multivariate Cox regression identified older age, workers’ compensation status, diabetes, and various tear types (i.e., longitudinal, transverse, bucket handle, complex) as predictors of early clinically significant outcome achievement (hazard ratio: 1.02-24.72), whereas subsequent steroid injection, higher preoperative scores and root and flap tears predicted delays in clinically significant outcome achievement (hazard ratio: 0.12-0.99).ConclusionsThe majority of patients undergoing APM achieve benefit within 6 months of surgery, with diminishing proportions at later timepoints. Important factors for consideration of the the timeline of achieving clinically significant outcome include age, diabetes, workers’ compensation, preoperative score, and tear type. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving APM.Study designLevel IV, Therapeutic Case Series.

Современные подходы к лечению повреждений ладьевидно-полулунной связки кистевого сустава (обзор литературы)

Introduction The scapholunate interosseous ligament binds the scaphoid and lunate together, and is the primary stabilising ligament between these two bones. Scapholunate injuries lead to chronic instability and degenerative arthritis of the wrist. Scapholunate injuries are graded based on the acuity and the severity of the injury. Purpose The paper is a review of various techniques used to repair or reconstruct the scapholunate ligament according to the clinical manifestations, anatomic and pathologic findings. Methods A review of the literature covering this topic is presented. Results Conservative treatment is primarily indicated in stable and partial ligament tears. Arthroscopic treatment is used when immobilization is unsuccessful. Arthroscopically assisted scapholunate reduction and K-wire fixation is commonly used for acute injuries. Primary repair of scapholunate injuries are performed in all tear types using an open approach. Surgical indications depend on the severity of the instability, time after trauma and the presence of degenerative changes. Acute repair of scapholunate ligament injuries remains the gold standard as an earlier intervention provides better results. Acute injuries to the scapholunate ligament require two-four weeks before surgery. Within this period the ligament is often still repairable itself both with or without supplementary capsulodesis procedures; ligament reconstruction is generally preferable in patients with chronic injures. There are many arthroscopic techniques to treat chronic scapholunate injures such as scapholunate ligament primary repair using various types of capsulodesis, tendon graft reconstruction, bone-ligament-bone procedure, various intercarpal fusions and proximal row carpectomy, total wrist fusion and arthroplasty. Conclusion Early diagnosis and management of scapholunate ligament tears are necessary to preserve wrist functions.