Type Of Tear Research Articles

Medial meniscus tears are most prevalent in type I ACL tears, while type I ACL tears only account for 8% of all ACL tears.

This study aimed to assess the distribution of different anterior cruciate ligament (ACL) tear locations in different magnetic resonance imaging (MRI) planes, and to explore the relationships of ACL tear types with both meniscus injuries and bone bruising. A retrospective study was performed in patients under 60years old who underwent MRI scans in the sagittal and coronal oblique planes of the knee for ACL tears between 2014 and 2020. Patients with reports of chronic tears, partial tears, or prior surgeries were excluded. Tear locations were classified into five types, and the meniscus tear measurement variables included the presence of ramp, root, bucket-handle, and other types of tears. All injuries were confirmed by arthroscopy. Meanwhile, the presence and location of bone bruising were analysed and scored with the Whole-Organ Magnetic Resonance Imaging Score (WORMS) bone bruising subscale. A total of 291 patients were included. The prevalence rates of type I and type III injuries were 23/291 (7.9%) and 145/291 (49.8%) in the sagittal plane and 22/291 (7.6%) and 179/291 (61.5%) in the oblique coronal plane, respectively. The prevalence of medial meniscus tears with ACL tears was 126/291 (43.3%), while that of lateral meniscus tears with ACL tears was 77/291 (26.5%). The highest prevalence of medial meniscus injury with ACL tears was 15/22 (68.2%) for type I injuries. Bone bruises were located on the lateral femoral center in 125 patients (46%) and on the lateral tibia posterior in 132 patients (48%); the common areas of bone bruising were slightly correlated with type III ACL tears but not correlated with type I ACL tears. The plane in which an MRI scan is performed affects the classification of ACL tears. The tear type is associated with the prevalence of medial meniscus injuries, and medial meniscus tears are most prevalent in type I ACL tears. IV.

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three-Year MRI Follow-Up.

ObjectiveTo describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations.MethodsA total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing.ResultsPreoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus.ConclusionsArthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.

Poster 240: Pediatric Meniscal Repair Patients are Ready to Return to Sport Six Months after Surgery According to Isokinetic Dynamometry Testing: A Retrospective Review

Objectives:The incidence of meniscal injures in the pediatric population has been increasing over the past decade. This is likely due to more rigorous athletic activity, earlier sports specialization, year-round competition, and increasing awareness of and screening for these injuries. Many meniscal tears occur during sporting activity, and the goal of surgery is to return an athlete to play (RTP). Strength symmetry is a RTP criteria when considering return to cutting and pivoting sports. Isokinetic dynamometry testing is often done for ACL reconstruction recovery but there is currently little literature on its use in meniscal repair protocols for RTP. The purpose of this study was to establish appropriate knowledge and expectations for RTP following meniscal repair in patients ages 18 and under. It was hypothesized that patients would not meet RTP criteria based on dynamometry testing at four months post-op, but would at six months post-op.Methods:Electronic medical records were reviewed to identify patients who underwent meniscus repair at a single academic institution between 2009 and 2018. Patients were included if 18 years of age or under at the time of surgery and had concurrently undergone dynamometry testing at 4 and 6 months post-operatively. Records were reviewed for demographic data including age, sex, body mass index (BMI), and sports played. Isokinetic dynamometry testing measured quadriceps and hamstring strength at 60°/sec and 300°/sec (ft/lbs). Limb symmetry index (LSI (%)) was calculated [(involved/uninvolved) x 100%] and eligibility for RTP was deemed an LSI >85%.Results:A total of 473 patients were identified who underwent meniscus repair and dynamometry testing. Twenty-three patients met all inclusion criteria for analysis. The mean age was 16±1.24 years, with sex distribution being 52% male and 48% female. The mean BMI of 24.3±4.47. Athletes participated in the following sports (Tegner Activity Scale: 7 or higher): basketball, football, soccer, lacrosse, wrestling, volleyball, softball, track and field; including three multi-sport athletes. 83% of patients had concurrent ligamentous reconstruction at the time of meniscus surgery.Conclusions:Only 50% of patients with isolated meniscus repair met RTP criteria at 4 months. However, 75% or greater met criteria at 6 months (Table 1). Additionally, patients with a concurrent ligamentous repair were challenged to meet RTP criteria at both time points. These data suggest that formal physical therapy for greater than 6 months is beneficial to achieve suggested RTP strength criteria for those with isolated meniscus repair; furthermore, those with meniscal repair and concurrent ligamentous reconstruction will require longer episodes of care to meet RTP criteria. Future studies are needed to examine factors that lead to earlier RTP, such as; type of tear, type of sport, level of competition, and quadriceps/hamstring strength prior to surgery.Table 1.Isolated MeniscusTable 2.Concurrent Ligament Reconstruction

Clinical Outcomes for Open Hip Abductor Repair Using Tenodesis and Bone Trough Repair Techniques.

Hip abductor complex tears remain an injury without a clear consensus on management. Surgical treatment has been recommended after unsuccessful nonoperative management. This study evaluates both tenodesis and bone trough techniques, with treatment choices guided by previously described tear classification. This is a retrospective cohort study of 45 hips in 44 patients who underwent surgical treatment for symptomatic, chronic hip abductor tear unresponsive to nonoperative treatment. Demographics and preoperative and postoperative values (including visual analog scale pain scores, gait assessment, and muscle strength) were evaluated. Type I tears were treated using tendon tenodesis. Type II tears were treated through a bone trough repair. Forty-five hips (44 patients) were operated on with a minimum of 6-month follow-up. There were 27 type I and 18 type II tears. Eighty-seven percent of patients were female. Twenty-eight percent of type II patients (5/18) had a preexisting arthroplasty in place. Significant improvements in pain (P < .001), gait (P < .001), and muscle strength (P < .001) were achieved in both the tear types. Type I repairs showed superior results to type II repairs. However, both showed significant improvements. Postoperative magnetic resonance imaging at 6 months showed healed tenodesis in 81% (17/21) of type I tears and 50% (5/10) of type II tears. Our study shows improvement in pain and function after surgical repair of hip abductor tendon injuries in both simple and complex tears. This improvement is seen even during ongoing surgical site healing. Magnetic resonance imaging findings may remain abnormal for more than 1 year after surgery and do not clearly denote repair failure.

A ResNet50-Based Approach to Detect Multiple Types of Knee Tears Using MRIs

The recommended tool for assessing knee injury is magnetic resonance imaging (MRI). However, knee MRI interpretation takes time and is vulnerable to clinical errors and inconsistency. A deep learning automated technique for reading knee MRI might help physicians identify high-risk patients and make diagnosis easier. In this study, we have proposed a deep learning-based model to detect ACL and meniscus tears and other knee abnormalities. At its core, this model is based on the ResNet50 transfer learning technique. In this paper, we have focused to present a ResNet50-based model for detecting different knee problems using MRIs. The best models for every option achieved the objectives that were probably similar. The models were developed using 18, 3, and 1 slice. These models’ outcomes were rather startling. The AUC findings obtained with 1 slice per MRI exam were equivalent to those obtained with 18 and 3 slices and, in some cases, were significantly better. The dataset used in this model is from Stanford University. We trained this model in three different settings of MRI slices (18, 3, and 1). The best results that our models were able to achieve were when trained using 3 slices of each MRI sample. The area under the receiver operating characteristic curve, or AUC curve, values that our best models were able to achieve for detecting ACL, meniscus, and other knee abnormalities are 0.87, 0.82, and 0.90, respectively. The results of our models are comparable to some state-of-the-art models. These models are very fast and efficient to train and hence will be helpful to doctors for making an effective and fast diagnosis based on knee MRIs.

Clinical and Functional Outcome of Meniscal Injuries Treated with Platelet-Rich Plasma: A Single-Center Case Series.

Meniscal injuries are among the most frequently encountered conditions in the knee joint. Therapeutic approaches are diverse and are largely dependent on the extent and location of the injury. The purpose of this study was to describe the clinical and functional outcomes of an intraarticular and percutaneous platelet-rich plasma (PRP) injection regime in patients with stable meniscal injuries. Demographics, the type of tear, affected knee, surgical procedure, type of intervention, follow-up period, and outcomes were recorded in all cases. Patient-reported outcome measures included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity level scale. Overall patient satisfaction, quality of life, and pain intensity were also assessed. A total of 38 cases (8 females) had sustained a stable meniscal lesion (32 medial, 6 lateral) and met the inclusion criteria. All of them received three intraarticular and percutaneous PRP injections. Patients receiving the PRP injection regime reported clinically (p = 0.000) and functionally (p = 0.000 and p = 0.001) significant improvement in all outcome measures during this interval. All patients reported they were very satisfied or satisfied with the outcome. The results of this study suggest that the treatment of stable meniscal injuries with percutaneous–intraarticular PRP injections can achieve a significant clinical and functional improvement.

Surgical Management of Discoid Lateral Meniscus With Anterior Peripheral Instability: Retaining an Adequate Residual Meniscus Volume

Discoid lateral meniscus (DLM) presents with differing pathoanatomy and may exhibit various types of tears. The treatment strategy is based on the presence and location of instability as a result of deficient capsular attachment. Recently, meniscal stabilization after saucerization has been recommended for DLM to preserve the meniscus shape, prevent extrusion, and mitigate against the progression of osteoarthritis. In addition to stabilization, the resection volume is important to prevent osteoarthritic changes. Although there was no tear and no displacement of the lateral meniscus on magnetic resonance imaging, some DLMs were found to have tears and peripheral instability during arthroscopy. Therefore, the assessment of peripheral instability during surgery is very important to achieve a desirable clinical outcome. This Technical Note describes an arthroscopic technique for anterior peripheral stabilization of the DLM, in which we highlight the surgical procedure for repair of the anterior horn, reassess the instability around the popliteal hiatus after the anterior horn is repaired, and the stabilization of the posterior horn, if necessary.

Outcomes analysis of anterior and lateral approach for open repair of hip abductor tendons.

Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome. Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed. 90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found (n = 5 IR, n = 8 THA+repair), including 9 re-operations (n = 4 IR, n = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores (p = 0.0175), and there was trend (p > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA). Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.

Evaluation of anatomical variations with morphological measurements and their relationship with rotator cuff tear and acromion types

Introduction: There many more anatomical measurements such as the acromiohumeral distance and lateral acromion angle and acromial configuration was reported as might be associated with rotator cuff tear. In our study, we aimed to reveal the effect of acromion index, acromiohumeral distance, lateral acromion angle, critical shoulder angle values and the acromion type in the development of rotator cuff tear. &#x0D; Material and Method: In our retrospective study, 58 patients and 29 asymptomatic volunteers who underwent shoulder magnetic resonance imaging examinations were examined. acromion index, acromion humaral distance, lateral acromion angle and critical shoulder angle were measured and their relationship with rotator cuff tear and acromion types were evaluated. &#x0D; Results: Type III (hooked) of acromial shapes, higher acromion index and critical shoulder angle values, lower acromiohumeral distance and lateral acromion angle values are more frequently seen in rotator cuff tear patients, in our study. &#x0D; Conclusion: Thus, we revealed anatomical malformations that predispose to rotator cuff tear concerning the shoulder joint.

Development of convolutional neural network model for diagnosing meniscus tear using magnetic resonance image

BackgroundDeep learning (DL) is an advanced machine learning approach used in diverse areas, such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is advantageous for image recognition and classification. In this study, we aimed to develop a CNN to detect meniscal tears and classify tear types using coronal and sagittal magnetic resonance (MR) images of each patient.MethodsWe retrospectively collected 599 cases (medial meniscus tear = 384, lateral meniscus tear = 167, and medial and lateral meniscus tear = 48) of knee MR images from patients with meniscal tears and 449 cases of knee MR images from patients without meniscal tears. To develop the DL model for evaluating the presence of meniscal tears, all the collected knee MR images of 1048 cases were used. To develop the DL model for evaluating the type of meniscal tear, 538 cases with meniscal tears (horizontal tear = 268, complex tear = 147, radial tear = 48, and longitudinal tear = 75) and 449 cases without meniscal tears were used. Additionally, a CNN algorithm was used. To measure the model’s performance, 70% of the included data were randomly assigned to the training set, and the remaining 30% were assigned to the test set.ResultsThe area under the curves (AUCs) of our model were 0.889, 0.817, and 0.924 for medial meniscal tears, lateral meniscal tears, and medial and lateral meniscal tears, respectively. The AUCs of the horizontal, complex, radial, and longitudinal tears were 0.761, 0.850, 0.601, and 0.858, respectively.ConclusionOur study showed that the CNN model has the potential to be used in diagnosing the presence of meniscal tears and differentiating the types of meniscal tears.

Adolescent Baseball Pitchers With Ulnar Collateral Ligament Tears Exhibit a High Proportion of Partial Tears

Background: Ulnar collateral ligament (UCL) tears in the throwing elbow are classified according to grade and location using magnetic resonance arthrography (MRA). However, the frequency of each tear type and the association to age, competition level, and radiographic findings in adolescent baseball pitchers are unknown. Purposes: The primary purpose of this study was to use MRA to characterize the severity, location, and UCL tear type in adolescent pitchers. The second aim was to describe the relationship between the UCL tear type and age, competition level, and plain radiographic findings. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Records of adolescent pitchers with a UCL tear treated by the senior author between 2007 and 2016 were retrospectively reviewed. MRA scans were reviewed and tears were classified according to the Joyner-Andrews classification. Low-grade partial tears are classified as type I, high-grade partial tears as type II, complete full-thickness tears as type III, and tear pathology in >1 region in the UCL as type IV. Each type of tear also has a location designated at the midsubstance, ulna (U), or humerus (H). Patient characteristics, competition level, and associated plain radiographic abnormalities were recorded. Univariate analyses were performed to examine the relationships between tear types and age, competition level, and plain radiographic findings. Results: A total of 200 adolescent pitchers (mean ± SD age, 17.2 ± 1.5 years) with MRA scans were reviewed. Type II-H (n = 62), type II-U (n = 51), and type III-U (n = 28) were the most common tear types observed. Type II tears comprised 64.5% of adolescent UCL tears, with type II-H being the most common. Plain radiographs were abnormal in 32% of patients, with calcifications (10.5%) and olecranon osteophytes (12.5%) being the most common findings. There were no significant relationships between tear type and age (P = .25), competition level (P = .23), or radiographic abnormalities (P = .75). Conclusion: Humeral-sided high-grade partial tears were the most common tear type in adolescent pitchers. There was no relationship between UCL tear type and age competition level, and plain radiographic abnormalities.

Research on Influencing Factors of Clinical Efficacy of Meniscus Resection Based on Logistic Regression Analysis.

In order to solve the factors affecting the clinical efficacy of meniscus resection, a method based on logistic regression analysis is proposed. From May 2019 to May 2020, 60 patients with discoid meniscus who underwent arthroscopic surgery in the Joint Department of the Second Hospital of a certain city were selected as the research objects; the surgical methods are divided into partial meniscus excision and plasty and total meniscus resection. The Lysholm function score was used to evaluate the clinical efficacy of arthroscopic surgery for discoid meniscus injuries before and 3, 6, and 12 months after surgery and postoperative application of Ikeuchi score and Tegner exercise ability score to assess age, gender, body mass index (BMI), duration of symptoms, and the influence of meniscus injury types and surgical methods on the efficacy of arthroscopic surgery for discoid meniscus injuries. Experimental results show that Ikeuchi's assessment of the excellent and good rate of arthroscopic knee joints was significantly higher than that of the control group, the incidence of postoperative pain was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05). Postoperative pain and premature weight-bearing of discoid meniscus injury of knee joint, factors such as noncold compress after operation, articular cartilage damage, age, and time from onset to operation are closely related; the difference was statistically significant (P < 0.05). Postoperative evaluation according to Ikeuchi score: excellent in 38 cases, good in 14 cases, 8 cases were poor, and the excellent and good rate was 86.7%. The patient's age, type of meniscus tear, and duration of symptoms have a certain impact on the postoperative clinical efficacy of discoid meniscus injury; BMI and surgical methods have no significant impact. Logistic regression analysis results show that postoperative pain and premature weight-bearing of discoid meniscus injury of the knee joint, no cold compress after operation, accompanied by articular cartilage damage, age, and factors such as onset to operation time are closely related; the difference was statistically significant (P < 0.05). It proves that arthroscopic surgery for discoid meniscus injury has the advantages of less damage and faster recovery, it is the first choice for the treatment of discoid meniscus injury, and the postoperative effect is significant in young patients and those with short duration of symptoms; mixed tears have a greater impact on the postoperative recovery of patients with discoid meniscus injury; therefore, patients with discoid meniscus injury should undergo surgery as soon as possible and perform active rehabilitation exercises after the operation.

Medial meniscus extrusion and stage are related to the size of spontaneous osteonecrosis of the knee in patients who underwent high tibial osteotomy

PurposeSpontaneous osteonecrosis of the knee (SONK) causes acute atraumatic knee pain, and meniscus tears may be associated with the pathogenesis of SONK. The purpose of this study was to investigate the relationship of the type of meniscus tear and medial meniscus extrusion with SONK on the medial femoral condyle in patients who underwent surgical treatment with high tibial osteotomy due to severe knee pain. MethodsWe enrolled 98 patients with 102 knees who underwent medial opening wedge high tibial osteotomy (OWHTO) under the diagnosis of medial femoral condyle osteonecrosis at our hospital from December 2003 to January 2020. Based on the Koshino classification, cases of SONK were classified as stage 1–4. The relationships of demographic data, X-rays and MRI images, including femorotibial angle (FTA), meniscus tear type, and medial meniscus extrusion (MME), with the stage and volume of SONK were investigated. ResultsNinety-eight patients (29 males and 69 females), with an average age at surgery of 69.2 ± 9.6 years and Body mass index(BMI) of 61.0 ± 17.6 kg/m2. In 102 cases of SONK, 11 knees, 18 knees, 46 knees, and 27 knees were classified as stage 1–4, respectively. The mean SONK volume was 2161.61 µm (range 95.67–7484.68 µm) on preoperative MRI. The preoperative FTA (mean 180.86°, range 172–187°) was not associated with the stage or volume of SONK. Meniscus tears were found in all cases of SONK and consisted of 2 degenerations, 2 horizontal tears, 0 vertical tears, 40 radial tears, 4 complex tears, and 54 medial meniscus posterior root tears (MMPRTs). In addition, 99% (101/102) of knees showed more than 3 mm of meniscus extrusion. Although the meniscus tear type was not associated with SONK stage, there was a high rate of tears that caused disruption of the hoop strain, such as MMPRTs (52.9%) or radial tears (39.2%). MME was significantly related to SONK volume (r = 0.387, p < 0.001). ConclusionAll patients with SONK had coexisting meniscus tears, most menisci had medial extrusion, and a positive correlation was observed between MME and SONK volume.

Meniscus Tear Types and Early Failures in Pediaric Patients: Descriptive EPIDemiologic Analysis from the Score Multi-Center Quality Imrovment Project.

Background:Meniscal tears have been reported at higher rates in the pediatric patient in recent years. Meniscus repair to restore meniscus function may be invaluable to the long-term health of the knee.Hypothesis/Purpose:To describe demographic characteristics, tear types, and surgical techniques for meniscus repair in pediatric patients, including risk factors for early repair failure.Methods:A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of meniscus repairs was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Each meniscus repair case with a complication form was secondarily reviewed to ensure consistency of identification and grading. Demographics, tear type, repair technique, and implant type, when applicable, were included, and a common cause analysis was performed to evaluate risk factors for early repair failures.Results:1230 meniscus repair cases (mean age 15.2, 5-19; Female 43.8%) were identified, consisting of 49.0% lateral meniscus repair (LMR), 36.0% medial meniscus repair (MMR), and 15.0% LMR+MMR. The majority (69.7%) were performed in conjunction with either ACL reconstruction (ACLr) or tibial spine repair (TSr). In both LMR and MMR, the most common tear type, technique, and implant were longitudinal/vertical tear (50.3%, 80.0%, respectively), all-inside repair (69.3%, 68.9%, respectively), and Smith & Nephew Fast-Fix 360 (37.8%, 36.8%, respectively). An inside-out repair was performed twice as often in both LMR and MMR when performed in isolation without an ACLr or TSr. For both LMR and MMR, surgeons used an average of 2 sutures/devices (38.0%) with 6.5% involving 10+ sutures/implants. Variation in meniscus repair techniques was seen between tear types, displacement, and location (Tables 1, 2). Radial tears were uncommon in the MM (2.7%), but were commonly treated in the LM (12.32%) using all-inside (42.1%), inside-out (30.2%), and outside-in (19.7%) techniques. Meniscus tears with displacement were seen in 35.2% of MM tears and 25.3% of LM tears, with anterior displacement being the most common direction. For both LMR and MMR, the most common technique for tears with displacement was all-inside (58.4%). There were 15 early (<8 months) repair failures (1.2%), most common type and technique of which were MMR (73.3%) and all-inside (73.3%).Conclusion:The techniques utilized for pediatric meniscus tears depend upon tear type, displacement, and whether performed in conjunction with an ACLr or TSr. MMR performed with all-inside technique may be at risk for early failure.Table 1: Pediatric Lateral Meniscus tear and repair types from SCORE (a multi-center quality improvement registry)Table 2:Pediatric Medial Meniscus tear and repair types from SCORE (a multi-center quality improvement registry)

PROFILE OF SEXUAL VIOLENCE CASE AGAINST CHILDREN EXAMINED IN LANGSA GENERAL HOSPITAL IN 2019 – 2020

Background: News regarding violence against children spread in the mass media is enough to make people surprised. Cases of violence against children are still an iceberg phenomenon. This is because most children who are victims of sexual violence are reluctant to report it. In 2016, KPAI recorded 120 cases of violence against children. Then in 2017, there were 116 cases. Children are very vulnerable to threats of sexual violence due to their need of protection from adults. Almost all perpetrators of sexual violence against children are carried out by those closest to them and are usually favored, such as family members, relatives, neighbors, friends of fathers or mothers or peers. Methods: This research is descriptive with a cross sectional approach which aims to determine the profile of cases of sexual violence against children examined in Langsa General Hospital in 2019 - 2020 which was carried out in Langsa Hospital, Langsa City from August 2021 to October 2021. The population of this study was all data of cases of violence against children examined at the Forensic and Medicolegal Installation of Langsa Hospital in Langsa City in 2019 to 2020 with a sample of all data on cases of sexual violence against children examined at the Forensic and Medicolegal Installation of Langsa General Hospital in 2019 to 2021 using the method of total sampling. The inclusion criteria were data examined at the Forensic and Medicolegal Installation of Langsa General Hospital in Cases of Sexual Violence against Children in Langsa City in 2019 to 2020 which includes gender, education, type of tear, relationship between victim and perpetrator. The exclusion criteria were the Examined Data In the Forensic and Medicolegal Installation of Langsa Hospital in cases of violence against children in Langsa City, in 2019 to 2020 victims of abuse, victims of traffic accidents, victims of death. In this study, the variables studied were: (1). Gender (2). Education (3). Type of tear (4). Relationship between the victim and the perpetrator. Conclusion: Most victims of sexual violence were 88.5% female (23 cases), 65.38% (17 cases) in school category with the type of tear that was 34.8% old tear (8 cases), and the relationship between the victim and the perpetrators in the known category was 88.5% (23 cases).

Higher Rates of Mensical Repair and Rim Preservation in Younger Patients with Discoid Lateral Menisci

Background:Management of discoid meniscus in pediatric patients requires understanding of the presentation, associated risks, and appropriate techniques. Surgical treatment consists of saucerization, meniscus repair, meniscocapular stabilization, and, periodically, subtotal meniscectomy. The type of meniscal treatment is commonly determined during arthroscopy. Thus, surgeons, patients, and their parents/guardians must be prepared for a variety of surgical options.Hypothesis/Purpose:To compare intraoperative arthroscopic findings and treatment of discoid meniscus across pediatric age groups in a large multicenter quality improvement registry.Methods:A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of discoid meniscus surgery was reviewed. Audit processes using CPT codes were designed to ensure that all consecutive cases from 2018-2020 were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Patients were grouped into five groups based on age at time of surgery (<7, 7-10, 11-13, 14-16, >16). Demographic characteristics, discoid type, presence and type of tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Chi-Square or Fisher’s exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons.Results:274 patients were identified (mean age 12.4 years, range 3-18; 47.3% females). Complete discoid meniscus and peripheral rim instability were found to be more prevalent in younger age groups (Table 1). Peripheral rim instability was noted in 55.5% of cases, most commonly in the posterior horn (24.8%). While a focal region of instability was most common, the youngest age group was more likely to have either multifocal instability or no instability. Repair was conducted more commonly in the younger cohorts, with a significant decrease in repair percentage (p=0.008) per age group. All-inside was the most common repair technique in all age groups. Partial meniscectomy/debridement beyond saucerization occurred more frequently in older age groups than younger age groups (p=.0002), including 38.4% of cases in the oldest age group (Table 2).Conclusion:Younger patients experienced a greater incidence of complete discoid menisci and meniscus repair in this age group and was more likely to have more than one area of rim instability. However, when meniscal resection beyond a saucerization was required, this was more likely to occur in older patients.Table 1.Age-Related Comparison of Discoid Meniscal Presentation and TreatmentTable 2.Incidence of Additional Meniscal Resection Beyond Saucerization

Reliability of Magnetic Resonance Imaging Interpretation of Lateral Discoid Meniscus: A Multicenter Study

Background:Lateral discoid meniscus (LDM) often present with complex morphology that can be challenging to assess and treat arthroscopically. Preoperative magnetic resonance imaging (MRI) is frequently used for diagnosis and surgical planning, however it is not known whether surgeons are reliable and consistent in their interpretation of MRI findings.Hypothesis/Purpose:We hypothesize that surgeons experienced in treating LDM are able to reliably interpret discoid pathology using MRI, with the exception of evaluating dynamic factors (i.e. instability).Methods:Forty five discoid meniscus MRI selected from a pool of surgical discoid meniscus cases were included in this review. Five reviewers (experienced pediatric sports medicine surgeons) who were not involved in the MRI selection process performed independent review of each MRI to determine discoid meniscus classification. More than 4 weeks later, a second reading was performed by 3 of the 5 reviewers. Interobserver and intraobserver reliability of the primary (width, presence of instability or tear) and secondary (location of instability or tear, tear type) rating factors was assessed using the Fleiss κ coefficient, designed for multiple readers with nominal variables (reliability: fair, 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).Results:Interobserver reliability of assessment of meniscal width was substantial 0.67 (0.58-0.76), and intraobserver was moderate 0.52 (0.35-0.69). Assessment of presence of peripheral instability had moderate interobserver reliability 0.54 (0.45-0.63) and substantial intraobserver 0.61 (0.44-0.78). Presence of tear had fair interobserver reliability 0.39 (0.29–0.48) and substantial intraobserver 0.68 (0.51-0.85). When identifying location of instability or tear, interobserver reliability was moderate while intraobserver agreement was substantial for assessment of anterior instability (0.47 (0.37-0.56) and 0.68 (0.51-0.85), respectively); posterior instability (0.56 (0.47-0.65) and 0.62 (0.45-0.79), respectively); and posterior tear (0.41 (0.32-0.50) and 0.69 (0.52-0.86), respectively). The exception was identifying anterior tear, with fair interobserver reliability 0.33 (0.23-0.42) and moderate intraobserver 0.56 (0.39-0.73); Interobserver reliability was fair for tear type 0.34 (0.28-0.41) and intraobserver reliability moderate 0.55 (0.43-0.67).Conclusion:Orthopaedic surgeons experienced in the treatment of LDM vary from each other in their classification using MRI, especially with regard to assessment of meniscus tears. MRI evaluation may be helpful to diagnose discoid by width and identify presence of instability, two major factors in the decision to proceed with surgery. However, definitive treatment should be guided by a comprehensive arthroscopic evaluation.

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

Background:As youth participation in contact and overhead sports has increased in recent decades, so has the occurrence of traumatic and overuse 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 leading to management derived largely from adult-based evidence. Greater understanding of RCI characteristics and treatment outcomes in children and adolescents would improve our understanding of this pathology and help to guide clinical decision-making.Purpose:To identify pediatric patients with MRI-confirmed RCI treated at a single center in order to summarize injury characteristics, treatment and outcomes.Methods:A retrospective review of pediatric patients (<18yo) diagnosed with and treated for a RCI between 1/1/2011 and 1/31/2021. Patient demographics, injury mechanism and type, treatment, and outcomes were collected. Descriptive statistics were performed. Bivariate testing was also used to compare operatively and nonoperatively treated cohorts.Results:Fifty-two pediatric patients treated for a rotator cuff avulsion, partial tear, or complete tear were identified. Table 1.1 details injury characteristics, treatment modalities, and patient outcomes overall and each treatment cohort. Mean age was 14.9yo (10-17) and 67% of patients were male. Injuries were most commonly related to participation in the throwing sports (baseball, football, and softball). Operative management was employed 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. One operative patient experienced a retear. Return to play was longer for operatively managed patients (7.1 vs. 4.5 months, p<0.01).Conclusion:The present study expands the limited data available regarding RCIs in pediatric patients. Most injuries are associated sports and typically involve the supraspinatus tendon. RCIs are not restricted to skeletally mature patients and are frequently associated with other shoulder pathology. RCIs were associated with good outcomes and low rates of reinjury in patients managed both non-operative and operatively. RCI should be considered in throwing athletes with shoulder pain, even in skeletally immature patients. The optimal treatment strategy for each tear type remains uncertain, but outcomes appear favorable for patients overall.Table 1.1Rotator Cuff Injury Characteristics, Treatment Modalities, and Patient Outcomes

Older Age and Surgical Delay May Affect Medial Meniscus Repairability During Anterior Cruciate Ligament Reconstruction in Adolescents and Young Adults

Background:In the setting of meniscus pathology, earlier treatment of meniscus tears may increase the likelihood of repair in young patients. Moreover, delayed anterior cruciate ligament reconstruction (ACLR) has been associated with an increased risk of meniscus injury. There is, however, limited data on the relationship between surgical delay and meniscus repairability in the setting of an ACLR in young patients.Purpose:The purpose of this study was to examine meniscus tear patterns and the likelihood of repair at the time of ACLR in young athletes, and specifically, to determine whether age and time from injury to surgery are correlated with tear patterns or meniscus repairability.Methods:Records were retrospectively reviewed on patients aged 13-25 years who underwent primary ACLR from January 2017 through December 2017. Patients with multi-ligament knee injuries were excluded. Demographic data were collected including age, sex, BMI, race/ethnicity, insurance status, primary sport, mechanism of injury, and time from injury to surgery. Operative reports were reviewed to document meniscus tear type/pattern and all concomitant pathology/procedures. Univariate and logistic regression analyses were used to determine factors associated with meniscus repair.Results:89 eligible patients underwent ACLR during the study period. 59 (51% females) with mean age 19.3 ± 3.4 years had concomitant meniscus pathology and were included for analysis. The mean time to surgery was 5.2 ± 7.4 months. Combined medial and lateral meniscus tears accounted for 37% of tears, followed by lateral (32%) and medial (31%) tears. For tear type, medial and lateral tears were most commonly vertical (57.5%) and complex (34%), respectively. Surgical repair was performed in 67.5% of medial tears but only 34% of lateral tears. Univariate analyses demonstrated a statistically significant correlation between medial meniscus repair and time to surgery (p=0.01) and age (p=0.01), with repair less likely with a surgical delay >3 months and age >18 years. However, time to surgery was not significant after adjusting for age. There was a statistically significant difference in age between those with a surgical delay > 3 months (20.6 ± 3.4 vs.18.3 ± 3.0; p=0.01). Age and time to surgery did not affect the location or type of meniscus tear. There was no correlation between other demographic or surgical variables and time to surgery.Conclusion:In the setting of concomitant ACL and medial meniscus injury, age >18 years and surgical delay >3 months may decrease the likelihood of medial meniscus repair in young athletes.

Les déchirures radiales du tiers antérieur du ménisque latéral sont fréquemment associées à des déchirures horizontales

IntroductionRadial tears of the lateral meniscus are often located in the junction of the middle and posterior third or posterior tibial attachment. However, we observed that a few cases of radial tears occurred in the anterior third of the lateral meniscus, and in many cases, they were accompanied by horizontal tears. HypothesisRadial tears are more frequently accompanied by horizontal tears in the anterior third of the lateral meniscus than in other regions. Material and methodsFrom July 2006 to May 2019, patients who underwent arthroscopic surgery for radial tears of the lateral meniscus were included. Patients with radial tears in the anterior third of the lateral meniscus were classified into the anterior group and those with radial tears in the middle and posterior third were classified into the comparison group. Magnetic resonance imaging and arthroscopic findings were reviewed to evaluate whether radial tears were accompanied by other types of tears, especially horizontal tears. The incidence of complex tears between the two groups was compared. ResultsEighty knees in 79 patients were included. The mean age at the time of surgery was 44.1±16.9 years. The anterior group included 30 knees, and 19 (63.3%) of those also had horizontal tears. In the anterior group, all complex tears were accompanied by horizontal tears, and no other types of accompanying tears were observed. The comparison group included 50 knees, and 16 (32%) of those also had other types of tears. Of the 16 complex tears, 14 had horizontal tears and 2 had longitudinal tears. The incidence of complex tear was significantly higher in the anterior group than in the comparison group (p<0.001). ConclusionRadial tears occurring at the anterior third of the lateral meniscus are frequently accompanied by a horizontal tear. It is important to be aware and predict the occurrence of such characteristic tears and to do proper surgical procedures. Level of proofIV; Cross-sectional study.