Type Of Tear Research Articles

Evolution of knowledge on meniscal biomechanics: a 40\xa0year perspective

BackgroundKnowledge regarding the biomechanics of the meniscus has grown exponentially throughout the last four decades. Numerous studies have helped develop this knowledge, but these studies have varied widely in their approach to analyzing the meniscus. As one of the subcategories of mechanical phenomena Medical Subject Headings (MeSH) terms, mechanical stress was introduced in 1973. This study aims to provide an up-to-date chronological overview and highlights the evolutionary comprehension and understanding of meniscus biomechanics over the past forty years.MethodsA literature review was conducted in April 2021 through PubMed. As a result, fifty-seven papers were chosen for this narrative review and divided into categories; Cadaveric, Finite element (FE) modeling, and Kinematic studies.ResultsInvestigations in the 1970s and 1980s focused primarily on cadaveric biomechanics. These studies have generated the fundamental knowledge basis for the emergence of FE model studies in the 1990s. As FE model studies started to show comparable results to the gold standard cadaveric models in the 2000s, the need for understanding changes in tissue stress during various movements triggered the start of cadaveric and FE model studies on kinematics.ConclusionThis study focuses on a chronological examination of studies on meniscus biomechanics in order to introduce concepts, theories, methods, and developments achieved over the past 40 years and also to identify the likely direction for future research. The biomechanics of intact meniscus and various types of meniscal tears has been broadly studied. Nevertheless, the biomechanics of meniscal tears, meniscectomy, or repairs in the knee with other concurrent problems such as torn cruciate ligaments or genu-valgum or genu-varum have not been extensively studied.

Medial meniscus extrusion as a predictor for a poor prognosis in patients with spontaneous osteonecrosis of the knee

BackgroundRisk factors for the progression of spontaneous osteonecrosis of the knee (SONK) remain unclear. The purpose of this study was to investigate the association between magnetic resonance imaging (MRI) findings of the meniscus and the prognosis of SONK. MethodsA total of 78 consecutive patients (female 85%; mean age 75.6 ± 7.2 years old) diagnosed with SONK were included. Of these, 30 patients did not receive surgery within 1 year from the onset of SONK (conservative group), while the remaining 48 patients underwent unicompartmental knee arthroplasty due to worsening of symptoms (UKA group). Using MRI findings obtained within 3 months of the onset, we compared the types of meniscus tear and medial meniscus extrusion between the conservative group and UKA group. We performed a receiver operating characteristics (ROC) analysis to estimate the cut-off value. ResultsPatients in the UKA group showed greater medial meniscus extrusion (absolute value, 4.2 mm ± 1.9 vs. 2.8 mm ± 1.2, P = 0.001; relative percentage of extrusion (RPE), 45.7% ± 21.5 vs. 30.7% ± 12.9, P = 0.001) and a higher prevalence of radial tear (P = 0.021) than those in the conservative group. In the multivariate analysis, RPE remained a relevant independent factor (P = 0.035) for future UKA. An ROC analysis found that the cut-off point of RPE was 33% (sensitivity, 81.2%; specificity, 63.3%). ConclusionRPE was a predictor of the prognosis of patients who underwent UKA within 1 year after the onset of SONK. Our results suggest that patients with RPE ≥ 33% are at high risk for progression.

Functional outcome of arthroscopic meniscal repair in meniscal tears: a prospective study in tertiary care hospital in North India

<p><strong>Background:</strong> A Meniscal injury can result in intra articular damage and which can eventually result in osteoarthritis if not treated on time and the objective should be to save the meniscus wherever possible. This study was done to analyse the functional outcome of arthroscopic meniscal repair done in different types of Meniscal tears.</p><p><strong>Methods:</strong> The study was conducted on a group of 28 patients with meniscal injury admitted in government medical college Jammu from November 2018 to October 2020. All the tears were located in the red-red and red-white zones. The functional outcome was assessed on the basis of Lysholm Tegner scoring. A standard rehabilitation protocol was followed post repair.<strong></strong></p><p><strong>Results:</strong> Twenty-eight patients were included in the study. Male patients outnumbered the females and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by road traffic accidents and falls. Bucket handle tears were most commonly seen in the group of patients. ACL injury was the major associated injury to be noted. The functional outcome between pre and post operation was statistically significant (p<0.05). In one of the patient failures was seen. Two patients were lost to follow up and were not included in the study.</p><p><strong>Conclusions:</strong> Arthroscopic meniscal repair is a has a very good functional outcome according to our study and should be preferred over meniscectomy (subtotal or total), as meniscus being a very important shock absorber present between the knee joint can lead to delay in osteoarthritis of knee joint. Therefore, our priority should be to save the meniscus and restore the normal anatomy of the knee joint for its biomechanical stability and normal function.<strong></strong></p>

Rotator Cuff Tears: An Everlasting Enigma

Rotator Cuff (RC) tear is a common cause of disability and pain for which middle aged and elderly individuals seek orthopaedic consultation. A unique feature of RC tear treatment is that it encompasses an entire spectrum, which ranges from humble conservative methods to complicated tendon transfers. There is a now a fair amount of agreement about which treatment modality must be offered to whom, based on tear type, tendon retraction, tissue quality and patient profile. What must be borne in mind however, is that no bridges be burnt when choosing a treatment method. This would keep the door open for a salvage or revision procedure to help the patient. This issue of the Asian Journal of Arthroscopy is a symposium dedicated to management strategies for Rotator cuff tears. The importance of clinical examination in a patient with shoulder pain and weakness cannot be overemphasized. It is the cornerstone of formulating an individualized treatment plan. Vivek Pandey has discussed the methodology for all the relevant tests to accurately diagnose a rotator cuff tear, along with their pearls and pitfalls. One of the most important reasons why arthroscopic shoulder surgery in general and rotator cuff surgery is particular has evolved, is the remarkable progress in imaging, especially Magnetic Resonance scans. Anupama Patil has written a detailed descriptive review in this subject. An understanding of the nuances of imaging will help the clinician to clinically co-relate her findings. A sound clinician is one has a grasp of theoretical concepts developed and validated over the years. The ability to a classify rotator cuff tear based on imaging findings and co-relating clinically in the foundation on which every treatment decision is made. Ram Chidambaram has written an exhaustive review detailing all classification systems for rotator cuff tear. Jaap Willems has presented an algorithm for such decision making based primarily on age and tear morphology. The non-operativ

Comparison of tear characteristics, outcome parameters and healing in traumatic and non-traumatic rotator cuff tear: a prospective cohort study.

Acute traumatic and chronic non-traumatic rotator cuff tears are etiologically distinguishable entities. However, prospective studies comparing tear characteristics and outcomes between these two types of tears are lacking. The purpose of this study was to compare the tear characteristics, clinical and functional outcomes, and tendon healing as assessed on magnetic resonance imaging (MRI), between traumatic and non-traumatic rotator cuff tears. MRI proven rotator cuff tears were allocated into two groups according to the history of injury: Group 1 included 28 patients with traumatic tears and group 2 included 33 patients of non-traumatic cuff tears. Both the groups were compared for preoperative tear characteristics (tear size, muscle atrophy, fatty degeneration), range of motion, strength of shoulder abduction and external rotation, functional outcomes, and tendon integrity on MRI, 2years after the surgery. Postoperative mean active range of abduction (p = 0.005), abduction strength (p = 0.013), external rotation strength (p = 0.027), University of California at Los Angeles score (p < 0.001), Constant score (p = 0.002), American Shoulder and Elbow Surgeons scores (p = 0.028) and visual analog scale for pain (p = 0.02) were significantly better in group 1 as compared to group 2. The postoperative structural integrity of the cuff on MRI was better in group 1 as compared to group 2, but the values did not reach statistical significance (p = 0.13). Findings from this study suggest that traumatic tears affect younger patients and while having a larger tear size, they have lesser muscle atrophy, fatty degeneration, and tendon retraction. Functional outcomes are better after treatment of traumatic tears as compared to non-traumatic tears. Chronicity of the tear and tendon retraction negatively affected healing in traumatic cuff tears. Muscle atrophy was found to be associated with poorer healing in non-traumatic tears. However, tear size was not associated with healing. II, Prospective cohort study.

Variability of glenoid labral tear patterns: a study of 280 sequential surgical cases.

Glenoid labrum tears are a common cause of shoulder pain and instability and tear patterns have historically been ascribed into categorical descriptions such as anterior, posterior, and superior labral tears (SLAP [superior labrum anterior and posterior]) with multiple subtypes. Although often quoted as representing no more than 10% of instabilities, posterior shoulder instability may be more common than previously recognized. The purpose of this study was to review observed labral tear patterns and compare incidence and morphologies to historical descriptions. All patients undergoing arthroscopic or open labral repair (Current Procedural Terminology codes 29806, 29807, 23455, 23460, 23462, 23465) by 2 fellowship-trained shoulder surgeons from July 2012 to May 2019 were retrospectively reviewed. Labral tears were categorized into 3 groups: exclusively anterior to the midline of the glenoid, exclusively posterior, and those crossing the midline of the glenoid. Chief complaint, mechanism of injury, hand dominance, preoperative MRI interpretation by surgeon, and independent radiologist were analyzed for each tear type. During the 7-year period, 280 patients underwent arthroscopic or open labral repair. Sixty percent of tears were traumatic, with dislocation being the most common traumatic mechanism at 31.4%. Ten distinct tear patterns were identified: 3 types of 90° tears (anteroinferior, posteroinferior, and posterosuperior), 4 types of 180° tears (anterior, posterior, inferior, and SLAP), 2 types of 270° tears (anteroinferior and anterosuperior), and 360° labral tears. A total of 134 tears (47.9%) were classified as posterior, and 72 tears (25.7%) were anterior. Seventy-four tears (26.4%) were combined anterior-posterior tears. Labral tears involving some portion of the posterior labrum constituted 74% of tears. A significant association between tear location and primary complaint (P < .001) was noted. Patients with anterior tears complained of only instability in 62.5% of cases, and only pain in 22%. Patients with posterior labral tears complained primarily of pain in 68% of cases, and instability in 21%. There was an accurate preoperative diagnosis given by both radiologists and surgeons on 30% (n = 63) of the tears. There is a wide variety of labral tear patterns identified at the time of surgery, and the incidence of posterior labral tears is higher than previously described. Isolated Bankart lesions are relatively rare and are often associated with more extensive labral lesions. Patients with posterior labral pathology more often complain of pain rather than instability, whereas patients with anterior labral tears more often complain of instability.

Maternal and Neonatal Outcomes of Operative Vaginal Deliveries at a Single Tertiary Center.

ObjectivesOur study sought to assess the maternal and neonatal outcomes of operative vaginal deliveries (OVDs) at Sultan Qaboos University Hospital (SQUH). We assessed the proportion of OVDs along with the proportion of maternal and neonatal outcomes of kiwi OmniCup vacuum, metal cup vacuum, and forceps deliveries.MethodsWe conducted a retrospective cohort study in the Obstetrics and Gynecology Department at SQUH from June 2015 to March 2018. The hospital information system was utilized to obtain records of all women who delivered at SQUH by vacuum or forceps during the study period. We collected data on maternal demographics, maternal and neonatal outcomes, and total number of deliveries.ResultsDuring the study period, 3.8% of deliveries were OVDs. The most common instrument used was the Kiwi OmniCup vacuum device. No significant difference was found between the type of tears and instrument used except perineal tears (p = 0.003), which was seen more in the vacuum group, particularly Kiwi OmniCup. Neonatal birth weight (p = 0.046) was significantly higher in the metallic vacuum cup group. Thirty-one neonates (6.6%) were admitted to the neonatal intensive care unit, and most were born using Kiwi OmniCup vacuum (67.7%).ConclusionsOVD is an ideal alternative to cesarean section with fewer maternal and neonatal complications in women who cannot deliver spontaneously if performed by a well-trained obstetrician.

Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Tendon Injuries

Background: Pertrochanteric calcifications can be found in patients with greater trochanteric pain syndrome (GTPS). A systematic description of the types and prevalence of these calcifications has not been undertaken. Furthermore, there is conflicting evidence regarding their association with abductor tendon injuries. Purpose: (1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS. (2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Of these, 85 procedures were isolated treatment of GTPS and the remaining 628 were ancillary to hip arthroscopy. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR). Results: Surgery was performed on 713 hips with recalcitrant GTPS. No tear was found in 340 hips (47.7%), 289 hips (40.5%) had a partial-thickness tear, and 84 hips (11.8%) had a full-thickness tear. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; P = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47]; P < .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; P < .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; P < .001) were the findings with the highest OR for the presence of any type of tear. Distally directed enthesophytes were the findings with the highest OR for a full-thickness tear (OR, 15.79 [95% CI, 7.55-33.06]; P < .001). Isolated ossicles were the findings with the highest OR for a partial-thickness tear (OR, 1.73 [95% CI, 0.96-3.13]; P = .070). Conclusion: Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.

Primary Repair of Anterior Cruciate Ligament Injuries: Current Level of Evidence of Available Techniques.

Recently, there has been a resurgence of interest in primary anterior cruciate ligament (ACL) repair that has the potential to preserve native tissue using a more minimally invasive approach. Multiple repair techniques for different tear types have been reported over the last decade. From a healing perspective, proximal tears can be reapproximated directly to the femoral wall because they have better intrinsic healing capacity than midsubstance tears. These procedures can be classified further as direct suture repair with or without static or dynamic augmentation. Current evidence does not support direct repair of midsubstance tears because of their limited healing capacity. In many instances, biological augmentation is needed to enhance the healing potential of the ACL. While ACL repair is certainly not an effective surgical approach for all tears or in all patients, this procedure can be an effective and less morbid alternative to ACL reconstruction in carefully selected patients. The overall current reported level of evidence of published studies has ranged from low to moderate, and thus there is a need for higher-quality, comparative studies in which outcomes of larger patient groups are compared with the current gold standard of ACL reconstruction.

Double bucket handle tear of the superior labrum in a young patient presented with shoulder instability treated with arthroscopic debridement: A case report.

Introduction and importanceThe two major etiologies of shoulder superior labral tears anterior to posterior (SLAP) are traumatic and degenerative processes. Bucket handle tears of the superior labrum represent one-third of labral lesions. However, in this article, we present a double bucket handle tear which has been reported once in the literature.Presentation of caseA 25-year-old male presented with complaint of chronic pain in his right shoulder with a remote history of traumatic dislocation. Physical examination revealed a positive apprehension test. Shoulder magnetic resonance imaging (MRI) showed a superior labral tear with a Hill-Sach lesion. Arthroscopy showed a double bucket handle tear of superior labrum and mild biceps tendonitis along with Bankart lesion. The tear was resected and the Bankart lesion was repaired followed by supervised physical therapy. Good clinical outcomes in form of resolution of pain and shoulder instability at six months were obtained.DiscussionSLAP tears are common shoulder lesion that is reported differently in the literature. Arthroscopic studies had reported the incidence between 3.9%-11.8. The diagnosis of such lesion relies on the clinical presentation and imaging. Knesek et al. classified SLAP lesions based on the integrity of the biceps anchor and the type of labral tear (Knesek et al., 2013). The standard treatment of symptomatic SLAP lesions is Arthroscopic debridement. However, non-operative management was described in the literature.ConclusionDouble bucket handle injuries of the superior labrum are reported in literature once. These lesions can be treated with arthroscopic debridement and Bankart repair and followed by supervised physical therapy.

Ramp Lesion Subtypes: Prevalence, Imaging, and Arthroscopic Findings in 2156 Anterior Cruciate Ligament Reconstructions

Background: Ramp lesions are defined as a particular type of injury within the posterior horn of the medial meniscus and its meniscocapsular attachments. Five subtypes have been described: type 1, meniscocapsular lesion; type 2, partial superior lesion; type 3, partial inferior lesion or hidden type; type 4, complete tear in the red zone; and type 5, complete double tear. Purpose: (1) To determine the prevalence of different subtypes of ramp lesions in patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR). (2) To describe the characteristics of ramp lesions based on imaging and diagnostic arthroscopy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: All patients who underwent arthroscopic ACLRs between November 2015 and November 2018 by 2 senior surgeons at 1 institution were evaluated retrospectively (1) to describe the subtypes of ramp lesions diagnosed intraoperatively using transnotch arthroscopic exploration of the posteromedial compartment and (2) to look for any factors significantly associated with these subtypes. The following parameters were studied: demographics; history and clinical findings including time between injury and surgery, side-to-side laxity, and pivot shift; lesions missed on magnetic resonance imaging (MRI) scans and medial proximal tibial bone contusion visible on MRI scans; and arthroscopic confirmation of ramp lesion (ie, prevalence), associated lateral meniscal tear, or medial chondral tear. Results: Out of 2156 primary or revision arthroscopic reconstructions, 334 ramp lesions were confirmed, giving a prevalence of 15.5%. The subtype distribution was as follows: type 1, 47.9%; type 2, 4.8%; type 3, 11.4%; type 4, 28.7%; type 5, 7.2%. Multivariate analysis showed that gross pivot shift was significantly associated with complete ramp tears (odds ratio, 4.8; 95% CI, 1.7-17.2). Hidden lesions (type 3, inferior partial tear in the red zone) were the most likely to be missed on preoperative MRI (45.9%). Conclusion: In a population undergoing ACLR, the prevalence of ramp lesions was 15.5%. Among the subtypes of ramp lesion, the most common was a meniscocapsular junction tear (type 1). Partial inferior tears (type 3) were the most likely to be missed on preoperative MRI scans. Gross pivot shift was significantly associated with complete ramp tears (types 1, 4, and 5).

Histologic and molecular features in pathologic human menisci from knees with and without osteoarthritis.

The objective of this study was to evaluate histologic and molecular features of meniscus degeneration in cohorts of patients with and without osteoarthritis (OA) of the knee. Menisci were obtained from patients undergoing total knee arthroplasty for OA (TKA) or arthroscopic partial meniscectomy (APM) for a torn knee meniscus. Degenerative meniscal tears were among the most common tear type in the APM group based on the pattern. Using an integrative workflow for molecular evaluation of formalin-fixed and paraffin-embedded tissues, human menisci underwent blinded histologic evaluation and NanoString gene expression analyses. Histology revealed increased proteoglycan content in TKA menisci compared to APM menisci, but otherwise no significant differences in the total pathology score or sub-scores between patients based on age or cohort. NanoString analyses revealed differential expression of genes primarily associated with the PI3K-AKT signaling pathway, cell cycle, and apoptosis. These data provide new insights into histological and molecular features of meniscus degeneration in patients with and without knee OA. Histologic assessment of menisci showed similar severity of overall degeneration between cohorts, but there were differences at the molecular level. The dysregulated pathways identified in this study could contribute to early-onset meniscus degeneration, or to a predisposition to meniscus tears and subsequent knee OA. Further studies that validate genes and pathways uncovered in this study will allow us to evaluate novel approaches to assess and treat meniscal degeneration.

Portable Electromagnetic Knee Imaging System

The high rate of knee injuries among athletes and other people and the need for early onsite detection to avoid severe ligament tear highlight the necessity of a portable knee imaging tool. Thus, an electromagnetic system based on a multistatic radar to image knee injuries is introduced. The system includes an antenna array of eight printed biconical elements, which have wide operational bandwidth of 103.4%, covering the band 0.7–2.2 GHz, and unidirectional radiation with a high front-to-back ratio for improved imaging. The antenna array is placed on movable holders around the knee to ensure equal distances from its boundaries. The antenna is assessed in terms of simulated and measured near- and far-fields, along with electromagnetic wave penetration into the knee. The complete system is built and experimentally validated on in-house built durable, realistic knee phantoms, which emulate normal and injured cases. To reconstruct knee images, a modified multistatic confocal algorithm is used. Since the left and right knees of humans are mirror-symmetrical, the modified algorithm uses a differential approach to remove signal clutters, multistatic coherence factor to improve the quality of channels, and applies dielectric mapping to reduce detection error. The images indicate the ability of the system to detect different types of ligament tears with an accurate localization.

Meniscal Root Repair Along with Auxiliary Procedures for Joint Preservation: Current Concepts.

Meniscal root repair and joint preservation surgeries have gained increased interest in the last decade, from a better interpretation of the role of meniscal functions, from the biomechanical studies. Several published results from both biomechanical and clinical studies has proven the effectiveness of meniscal root repairs and has led to a unanimous international consensus for the need for root repair surgery. Meniscal repair by suture pull-out technique is widely followed around the world and leads to adequate healing and good clinical outcome. There are auxiliary procedures like centralization sutures (to reduce the meniscal extrusion), high tibial osteotomy, cartilage repair procedures,meniscal root reconstruction and ligament reconstructions areperformed along with meniscalroot repair, especially in the younger patients and recently sub-chondroplasty for the bone marrow lesions (BMLs)are also executed. This review article discusses the anatomy, types of root tears,evaluation, treatment, outcomes of root repair, and theneed for additional procedures, which areimperative for joint preservation and restoration of the biomechanics of the knee.

Factors aff5cting outcomes of conservative management for pseudoparalysis of the shoulder

This study aimed to analyze factors aff5cting the outcome of conservative management of pseudoparalysis of the shoulder. This study included 27 patients with pseudoparalysis of the shoulder, including 18 women and 9 men, with a mean age of 80.1 years. The type of cuff tear was massive tear in all the patients. All patients were treated conservatively for a mean duration of 3.9 months. Satisfactory results were achieved in 19 patients. Eight patients with unsatisfactory results eventually required surgery. The factors that caused nonresponse to treatment in 8 patients were compared with the contributing factors to treatment response in 19 patients. The factors were as follows: patient characteristics, degree of osteoarthritis change, and associated tear of the subscapularis tendon. All data were statistically analyzed. The identified factors that had a significant difference between the 2 groups were as follows: degree of osteoarthritis change and associated tear of the subscapularis tendon. Tear of the subscapularis tendon and changes in osteoarthritis were suggested to be factors that aff5cted the outcomes of conservative management. In the patients with osteoarthritis, satisfactory pain relief was difficult to attain. In patients with tears of the subscapularis tendon, decreased centripetal force due to collapse of the force couple was considered the cause of the poor outcomes. Surgical treatment should be considered positively for patients with factors that cause poor outcomes of conservative management of pseudoparalysis of the shoulder.

Perineal tears sustained during vaginal birth: a cross-sectional study

Aim: To analyse the type, location, degree, shape and size of perineal tears sustained during normal birth. Design: Cross-sectional study. Methods: The sample was composed of 100 women with perineal tears whose length and depth were measured using the tool Peri-Rule&#8482;. Bivariate and multivariate analyses were carried out using a significance level of 5% (p = 0.05). Results: Similar numbers of women sustained single or multiple tears (51% vs 49%). Perineal tears occurred more frequently in the posterior than anterior region of the perineum (80% vs 58%). In 77.5%, 20.0% and 2.5% of the women, first-, second- and third-degree tears, respectively, occurred in the posterior region of the perineum, with over half of them having straight-line tears (62.5%), approximately one third having U-shaped tears (35.0%) and a minority having star-shaped tears (2.5%). Perineal oedema during labour (OR = 5.31) remained an independent predictor of second-degree tears. Infant birth weight (RCÂ = -1.32), perineal body length (RC = 0.41) and oxytocin use (RC = -6.44) were statistically significantly associated with the size of perineal tears sustained. Conclusion: Perineal tears following normal birth were most likely of the first degree, straight-line and occurred mainly in the posterior region of the perineum. The degree, length and depth of the tears varied according to the location.

Combined clinical test and magnetic resonance imaging have similar diagnostic values in the diagnosis of subscapularis tear

The aim of the present study was to compare the diagnostic values of clinical tests and magnetic resonance imaging (MRI) which used for the diagnosis of subscapularis (SSc) tears in the patients who underwent arthroscopic rotator cuff surgery. Two-hundred and nine consecutive patients who underwent arthroscopic rotator cuff surgery between 2015 and 2019 were analyzed. The lift-off test, belly-press test and bear-hug test were performed preoperatively. 1.5T MRI scans of all patients were evaluated for SSc integrity. The diagnostic values of both clinical tests and MRI were calculated. SSc tears were graded according to Fox and Romeo. Arthroscopic findings were used as the gold standard for diagnosis of SSc tears. There were 54 SSc tears accounting for an prevalence of 29%. The BHT showed the greatest sensitivity for both type II-II-IV (73.3%) and all types of (68.5%) SSc tears. The sensitivity and specificity of the combined test and MRI were 91.1-87.2% and 93.3-90.8% in Type II-III-IV SSc tears, respectively, and 81.5-88.6% and 88.9-94.7% in all SSc tears, respectively. There were no statistically significant difference between combined test and MRI in terms of sensitivity and specificity (n.s.). The present study is the first that compared both clinical tests and MRI with arthroscopic findings in terms of sensitivity and specificity in the same patient group. A combination of clinical tests increases their diagnostic values and shows similar sensitivity and specificity as MRI. I.

Return to Play After Platelet-Rich Plasma Injection for Elbow UCL Injury: Outcomes Based on Injury Severity.

Background:Ulnar collateral ligament (UCL) injuries of the elbow are uncommon in the general population but prevalent in the athletic community, particularly among baseball players. Platelet-rich plasma (PRP) injection therapy has become a popular nonoperative adjuvant treatment for such injuries to help reduce recovery time and avoid surgery.Purpose/Hypothesis:To analyze patient outcomes by injury severity and identify injury types that responded most favorably and unfavorably to PRP treatment. It was hypothesized that PRP therapy would prove to be most beneficial in the treatment of lower-grade, partial UCL tears and less effective in the treatment of more severe, complete UCL tears.Study Design:Cohort study; Level of evidence, 3.Methods:A cohort of 50 patients with UCL injuries in their dominant elbow, diagnosed by MRI (magnetic resonance imaging) arthrogram, underwent PRP therapy in conjunction with an established rehabilitation program. UCL injuries were classified by MRI as low-grade partial tear (Type I), high-grade partial tear (Type II), complete tear (Type III), or tear in more than 1 location (Type IV).Results:In total, 24 of 39 (61.5%) Type I and II tears, 3 of 3 (100%) Type III tears, and 1 of 8 (12.5%) patients with Type IV tears responded to UCL PRP injection therapy and were able to return to play without surgery. Ten patients required subsequent UCL PRP injections, of which 3 (30%) were able to return to sport without surgery.Conclusion:PRP treatment for Types I and II UCL tears shows great promise when combined with physical therapy and a rehabilitation program. Type III UCL tears demonstrated a high rate of success, although with low cohort numbers. Type IV UCL tears did not appear to respond well to PRP injection therapy and often required surgical intervention or cessation of sport. Therefore, PRP treatment does not appear to be appropriate for patients with complete Type IV UCL tears but may enhance recovery and improve outcomes in throwing athletes with Types I, II, and III UCL injuries.

Research on TBM Cutterhead Crack Damage and Fatigue Reliability

The cutterhead of a tunnel-boring machine (TBM) is the main weighted part in the process of tunneling and bears loadings in different directions. A fatigue failure of a cutterhead would severely affect the construction progress and safety. Therefore, it is of great importance to study the fatigue reliability of its cracks. In this study, the area of the cutterhead with a higher stress was found using static strength analysis and we analyzed the dynamic stress characteristics. In addition, the stress intensity factor of a cutterhead crack was calculated using the submodeling technique, and the crack propagation mechanism and damage characteristics of a cutterhead crack were also analyzed. Then, combined with crack fatigue theory, we proposed a fatigue reliability evaluation method based on the Joint Committee on Structure Safety method (known as the JC method), and the effects of different factors on the reliability were discussed for different geological conditions. The results show that the crack propagation was of the open and tear types in the deepest part of the crack tip, but there are three kinds of propagation modes at both ends. As the initial crack depth increased, the fatigue reliability of the cutterhead decreased significantly. The reliability was positively correlated with the crack shape ratio. However, there were no significant relationships between the reliability and the depth of the critical crack.

How does rerupture affect sleep and quality of life in patients undergoing arthroscopic rotator cuff repair?

Background/aimSleep disturbance and related improvement in quality of life as a result of arthroscopic repair in rotator cuff tear (RCT) patients can be considered as an important parameter. The aim of our study is to evaluate the rotator cuff by ultrasonography (USG) in the first postoperative year and to examine whether there is a difference between sleep disturbance and quality of life between cases of rupture and healthy patients. In addition, we aim to compare the preoperative and at least the first postoperative year’s sleep disturbances and quality of life among patients who underwent arthroscopic RCT repair and to examine the effects of factors affecting this situation.Materials and methodsWe retrospectively reviewed the records of patients who were operated on for RCT. In this process, 257 patients were examined and 76 patients who met the inclusion criteria were included in the study. The Pittsburgh sleep quality index (PSQI), Constant–Murley shoulder score (CSS), and Oxford shoulder score (OSS) were used to evaluate the results preoperatively and at the last control visit of each patient. In the USG performed in the postoperative first year, the rotor cuff was evaluated in terms of rerupture.ResultsIt was observed that 14 (18.4%) patients’ rotor cuffs were reruptured and those of 62 (81.6%) patients were intact. The preoperative PSQI, CSS, and OSS values of the patients were calculated as an average of 10.79 ± 3.58, 35.61 ± 8.88, and 17.61 ± 4.20 and the mean postoperative values were calculated as 5.45 ± 1.68, 81.55 ± 5.27, and 38.05 ± 3.06, respectively. The postoperative PSQI value was statistically significantly lower in patients with tears of <1 cm (PSQI: 4.29 ± 0.73) than in those with tears of 1–3 cm (PSQI: 5.50 ± 2.17) and 3–5 cm (PSQI: 5.88 ± 1.25) (P < 0.001). The mean CSS and OSS values were significantly higher in postoperative measurements for all tear types. According to the size of the tear, postoperative CSS and OSS values were statistically significantly lower in patients with tears of 3–5 cm (CSS: 78.59 ± 4.50 and OSS: 36.18 ± 2.47) than those with <1 cm (CSS: 85.43 ± 2.14 and OSS: 40.57 ± 1.55) and 1–3 cm (CSS: 83.21 ± 5.35 and OSS: 39.07 ± 2.94) tears (P < 0.001).ConclusionIn the USG performed in the postoperative first year, it was determined that the patients with healthy rotator cuffs recovered better than those with rerupture.