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PubMed1978

Further pitfalls in knee arthrography.

Peripheral separations of the posterior medial meniscus, diagnosed at arthrography, may not be recognized at arthroscopy, arthrotomy or even upon examination of the resected specimen. Arthrographic recognition of an oblique buckethandle meniscal tear may be difficult when the visualized outer fragment maintains a triangular appearance. Articular cartilage defects, out of profile to the x-ray beam, may be suspected at fluoroscopy and confirmed by additional views. There is an icreased incidence of chondromalacia in symptomatic postmeniscectomy knees. Degenerative meniscal changes without arthrographically recognized discrete tears are common, particularly in older individuals. Localized lack of definition of meniscal surfaces may be the only arthrographic finding. Resected specimens invariably show surface irregularities to be more extensive than suggested radiologivally, and frequently there are unsuspected associated horizontal cleavage tears. The clinical implications of degenerated menisci are controversial. A variety of normal synovial folds can simulate the anterior cruciate ligament.

Fluoroscopy↗

PubMed1987

The articular disc of the wrist. Limits and relations.

The relationship between the discus articularis and its contiguous structures has been analyzed in 18 serially sectioned fetal hands. From this study, it can be concluded that these elements do not seem to be an extensive fibrous system emerging from the radius and reaching the metacarpal V, as it has been said, but a complex of clearly differentiated structures, of which further morphological details are given.

Fetus↗

PubMed1988

MR imaging of the knee: preliminary results with a 3DFT GRASS pulse sequence.

The knees of 17 patients (18 extremities) with possible meniscal, cruciate ligament, and articular cartilage abnormalities were examined with a three-dimensional Fourier transform (3DFT), gradient-refocused acquisition in a steady state (GRASS) pulse sequence. Arthroscopic confirmation was available in all cases and was the standard for comparison. Thirteen of these extremities were also examined by using a two-dimensional Fourier transform spin-echo pulse sequence with a 2000-msec repetition time and 20- and 80-msec echo time. In these 13 cases, both pulse sequences correctly identified seven of eight meniscal abnormalities. However, interpretation of the 3DFT GRASS images resulted in fewer false-positive meniscal tears (three vs six). Cruciate ligament tears were detected more readily on the 3DFT GRASS images (six vs three with two possible tears on the spin-echo images). These preliminary findings suggest that the overall accuracy of MR imaging of the knee could be improved by including 3DFT gradient-refocused pulse sequences.

Adolescent↗

PubMed1990

[Knee joint hemarthrosis--differential diagnostic considerations for planning an operation].

From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopy↗

PubMedDate not supplied

Intra-articular transfer of the iliotibial muscle-tendon unit.

The intra-articular transfer of the iliotibial muscle tendon unit is reproducible, does not require revascularization, and permits early rehabilitation. Of 62 patients followed Up from 24 to 55 months, excellent or good functional results occurred in 58 (93.6%). In vitro biomechanical analysis does not accurately assess this reconstruction, which appears to be a dynamic muscle tendon transfer.

Adult↗

PubMed2006

Arthroscopic management of distal radius fractures.

Arthroscopy has the advantage of providing a direct and accurate assessment of the articular surfaces and detecting the presence of injuries associated with distal radius fractures. Current indications, although numerous and potentially expanding, also are controversial. This report presents a global view of the current status of arthroscopy in the management of distal radius fractures. The rationale of arthroscopic treatment, the available evidence, and finally the diagnosis and treatment are discussed.

Arthroscopy↗

PubMed1986

Disk lesion of the wrist joint.

Thirty-three patients with lesions of the articular disk of the wrist joint were treated. Predictability of results is best when there is an isolated lesion without osteoarthritis or severe dislocation of the distal radioulnar joint. However, good results can be obtained in combined injuries (for example, after a Colles' fracture). Thirty of the thirty-three patients were satisfied with the results of their operation.

Adolescent↗

PubMed1997

The ligamentum teres of the hip: an arthroscopic classification of its pathology.

Pathology of the ligamentum teres is rarely diagnosed. We describe the classification of the lesions seen at hip arthroscopy based on a group of 20 patients. Three groups are noted: complete rupture, partial rupture, and the degenerate ligamentum. The complete ligamentum teres rupture group had a history of either major trauma or surgery and had a high incidence of other hip pathology such as labral tears and articular damage. The partial ligamentum rupture group presented with a long history of ill-defined hip pain. Minor associated hip abnormalities were seen at arthroscopy. Degenerate ligamentum teres rupture presented with symptoms of the underlying osteoarthritis. Debridement or washout was performed but, at 2 years, patients had severe persistent symptoms or had had a joint replacement.

Adult↗

PubMed1994

The function of discomuscular relationships in the human temporomandibular joint.

The aim of this morphological study was to investigate whether muscle tissue attaches directly to the discus articularis of the human temporomandibular joint (TMJ) and to indicate the probable significance of such attachments for the function of this articulation. The macroscopic and microscopic findings were derived from fixed and unfixed human TMJ of varying ages and genders, whereby the functional maturity of the masticatory apparatus was taken into consideration. To date, the results of this study show that aside from fibers originating from the superior venter of the m. pterygoideus lateralis, additional muscle or connective tissue fibers from the perimysium of the m. masseter insert to varying extent in the disc. The same is true for the m. temporalis, which is also directly connected to the disc via muscular or fibrous elements, or indirectly via fibers from the m. masseter. The insertion of the m. pterygoideus lateralis is always in the medial portion of the discus articularis and those of the mm. temporalis and masseter, respectively, in the middle and lateral portions of the disc. It is highly probable that a direct force transfer through the mm. temporalis and masseter to the articular disc takes place, and that these muscles contribute to the movement of the disc during jaw movement, whereas the size and form of the muscle insertions are subject to a great deal of individual variation. Differences were observed between immature and mature TMJ as well as between partly and fully toothed masticatory apparatuses.

Age Factors↗

PubMed1987

Osteochondral disruption of the second metatarsal: a variant of Freiberg's infraction?

A case of Freiberg's Infraction of the second metatarsal is presented. The metatarsal head was resected and its pathology proved very informative. Necrotic bone was not found, but a shearing type of separation was identified at the level of "tidewater mark" in the articular cartilage and was the major observation. This suggested the possibility that in adults Freiberg's Infraction rather than true avascular necrosis may be in fact the result of a shearing-compression type of injury occurring at the interface between mineralized and nonmineralized articular cartilage (tidewater mark). An anatomical examination of metatarsophalangeal joints in cadavers showed that during walking at the "toe off" position, the toes dorsiflex to force the metatarsal head into plantar flexion. The proximal phalanges ride dorsally over the metatarsal heads producing a shearing force that would support our interpretation of the observations made in the case presented.

Ankle Injuries↗

PubMed1992

Craniovertebral junction: normal anatomy with MR correlation.

The anatomy of the craniovertebral junction, although complex, may be well visualized by routine MR imaging. This essay discusses the anatomy of the complex articulations of the craniovertebral junction. Representative MR images and gross anatomic photographs are presented to illustrate the intricate ligamentous and articular anatomy. Knowledge of the normal anatomy of the occipitoatlantoaxial region is necessary in order to understand the common disorders that affect this area. The most common disorders are trauma and arthropathies, but also include congenital abnormalities and neoplasm. The resultant abnormal mechanics may lead to neurologic sequelae or pain.

Atlanto-Axial Joint↗

PubMed2000

Arthrography of the foot and ankle. Ankle and subtalar joint.

Arthrography is the intra-articular injection of contrast media. This article reviews the normal and pathologic findings of standard arthrography and MR imaging arthrography of the ankle and subtalar joint. Standard arthrography is used primarily after acute ankle sprains, whereas MR imaging arthrography is used for staging and detecting osteochondritis dissecans of the talus, anterolateral soft tissue impingement, and chronic lateral ankle instability.

Ankle Injuries↗

PubMed2002

Approach alternatives for treatment of osteochondral lesions of the talus.

Osteochondral lesions of the talus are common injuries, especially in the athletic population. Although multiple etiologies exist, lateral lesions have a higher incidence of association with a specific traumatic event. It has been postulated that lateral lesions are produced when the anterolateral aspect of the talar dome impacts the fibula on application of an inversion or dorsiflexion stress to the ankle [2]. There is general agreement that surgery should be performed only in symptomatic cases, as osteochondral lesions of the talar dome show little tendency to progression and do not seem to lead to osteoarthritis [10,42]. Appropriate preoperative imaging is extremely important. Standard radiographs of the ankle supplemented with lateral plantar flexion and dorsiflexion views and CT or Mr imaging can be helpful in evaluating the size, depth, and exact location of the lesion. This information is essential in planning the appropriate surgical procedure. Although many stage I and II lesions respond well to conservative therapy and a period of immobilization, some higher-grade lesions (stage III and IV) eventually require surgical intervention. Most lesions can be approached arthroscopically. Many arthroscopic procedures have been shown to be successful, including debridement with abrasion chondroplasty, subchondral drilling, and microfracture [18-20]. But certain larger or refractory lesions may require an open approach to the ankle joint to restore the articular cartilage. Most lateral lesions have an anterior location and are easily accessible through a standard anterolateral approach. Most medial lesions are located on the posterior talar dome, and a medial malleolar osteotomy is usually required. Osteotomies, in particular of the medial malleolus, should be approached carefully. The possible complications of nonunion and malunion can lead to progressive arthritis of the ankle joint.

Ankle Joint↗

PubMedDate not supplied

[Ultrasound of acute disorders of the shoulder].

Acute pain of the shoulder, with or without associated injury shows specific features that enable differentiation from chronic lesions. Osteo-articular injuries, tendinous lesions, bursitis and moving calcification may produce acute pain. Examination of the acromio-clavicular joint is also essential as acromial lesions are often overlooked in emergency radiology. Along with X-ray radiography, sonography, if adequately performed, is able to determine the etiology of acute pain and to establish lesion staging.

Acromioclavicular Joint↗

PubMed1996

Medial dislocation of the long head of the biceps tendon. Magnetic resonance imaging evaluation.

Medial dislocation of the long head of the biceps branchii tendon is a rare occurrence and is often associated with degenerative or traumatic tears of the rotator cuff, specifically tears of the subscapularis tendon. Following a dislocation, the biceps tendon will assume either an intra- or extra-articular position depending on whether or not the subscapularis tendon detaches from its humoral insertion. Magnetic resonance imaging (MRI) has been found to provide valuable information concerning the location of the biceps tendon and the integrity of the rotator cuff. In this report, three patients with suspected dislocations of the biceps tendon are evaluated using MRI.

Adult↗

PubMed1984

[Systematic research on enthesopathies in chronic rheumatism. Results and pathological significance. Relation to erosive spondylitis and other tendinous or synovial lesions].

A routine investigation for rheumatic tendon lesions was conducted in 47 patients with an inflammatory spondylo-arthropathy and in 30 patients with rheumatoid arthritis. The incidence of tendon lesions (calcaneal and extra-calcaneal) differed very significantly (p less than 0.001) between the two groups (58.3% of patients with inflammatory spondylo-arthropathy had at least one tendon lesion, 6.6% of patients with rheumatoid arthritis). These results and data from the literature suggest that rheumatic tendon lesions are a characteristic feature of spondylo-arthropathy in the same way as sacro-iliitis, the absence of subcutaneous nodules, the absence of rheumatoid factor and the high incidence of histocompatibility antigen HLA B27. Together with this diagnostic value, there is also a histopathological value: inflammatory and ossifying tendinitis contrasts with the destructive synovitis of rheumatoid arthritis and can be considered to be a "sign" of inflammatory spondylo-arthropathy. Tendinitis and juxta-articular bone lesions in the limbs, so-called "peripheral" lesions, are similar to the vertebral lesions around the intervertebral disk and the posterior interapophyseal joints found in inflammatory spondylo-arthropathy. These lesions seem to be a common pathological feature, at least in part, with the polyarthropathies of childhood.

Adolescent↗

PubMed1990

Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury.

Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Over 50% of the patients suffered concomitant ipsilateral knee injuries. Associated injuries required 37 nonorthopaedic procedures; 30 orthopaedic procedures were required to stabilize the axial skeleton and the other three extremities. Five patients ultimately required amputation, reflecting the magnitude of the initial high-energy trauma. Superior results were achieved when early rigid intramedullary fixation of the femur and rigid stabilization of the tibia with either an intramedullary nail or an external fixator was undertaken. Patients that underwent initial rigid intramedullary fixation of both the femur and tibia required fewer secondary operative procedures than those treated with primary external fixation. Rigid internal fixation allowed for thorough evaluation and treatment of the ligamentous structures of the knee and facilitated management of the soft tissue trauma.

Adolescent↗

PubMed2005

Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain.

BACKGROUND: After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. HYPOTHESIS: Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. RESULTS: In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. CONCLUSION: The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.

Adolescent↗