Based on a statistically significant mean difference (4.11 mm) and only a fair ICC (0.54 and 0.48) for raters comparing the 2 modalities, the measurements for the TT-TG cannot be used interchangeably between CT and MRI. Therefore, currently accepted values for TT-TG based on CT scans should not be applied to an MRI scan. The TT-PCL measurement is a measure of true lateralization of the tibial tubercle, while the TT-TG is an amalgamated measure of true lateralization and knee joint rotation.

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients.

Background:There is an increasing incidence of Human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. This has led to an increasing number of atypical features on magnetic resonance imaging (MRI). We postulated that the type 4 hypersensitivity response causing granulomatous inflammation may be disrupted by the HIV resulting in less vertebral body destruction. This study compares the MRI features of spinal tuberculosis in HIV positive and negative patients.Materials and Methods:Fifty patients with confirmed spinal tuberculosis, HIV status and available MRI scans at a single institution from 2003-2009 were identified. HIV status was positive in 20 and negative in 30. Females were predominant (34:16). The HIV positive group was younger at 32.4 versus 46 years (P=0.008). Blood parameters (WCC, ESR, Hb, Lymphocyte count) were not significantly different between the HIV groups. MRI scans were reviewed by a radiologist who was blinded to the HIV status. Site, extent of disease, body collapse, abscess location and volume, kyphotic deformity and cord signal were reported.Results:There was no difference between the number of vertebral bodies affection with TB involvement, presence of cord signal or incidence of non-contiguous lesions. The HIV negative group had significantly more total vertebral collapse (P=0.036) and greater kyphosis (P=0.002). The HIV positive group had a trend to larger anterior epidural pus collection (P=0.2).Conclusion:HIV negative patients demonstrate greater tuberculous destruction in terms of total percentage body collapse and resultant kyphosis. There is no difference in the incidence of cord signal or presence of non-contiguous lesions. HIV positive patients show a trend to a greater epidural abscess volume. This difference may be explained by the reduced autoimmune response of the type 4 hypersensitivity reaction caused by the HIV infection.

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Objective To investigate which of two commonly used treatment protocols for exercise-associated postural hypotension (EAPH) resulted in earlier discharge from the medical facility. Methods This randomised clinical fi eld trial was undertaken at two Ironman Triathlon competitions and one ultra-distance footrace. All collapsed athletes admitted to the medical facilities were considered for the trial. Following clinical assessment and special investigations to confi rm the diagnosis of EAPH, 28 athletes were randomly assigned to an oral fl uid and Trendelenburg position (OT=14) or an intravenous fl uid (IV=14) treatment group. Following admission fl uid intake was recorded, and all athletes were assessed clinically (blood pressure, heart rate, level of consciousness) every 15 min until discharge criteria were met. The main measure of outcome was the time to discharge (min). Results On admission, subjects in the OT and IV groups were similar with respect to age, systolic blood pressure, heart rate and serum sodium concentration. There were no signifi cant differences in heart rate, systolic and diastolic blood pressure between groups and over time until discharge. The fl uid intake during the treatment period was signifi cantly greater in the IV group (IV 1045±185 ml, OT 204±149 ml; p<0.001). The average time to discharge for the OT group (58±23 min) was similar to that of the IV group (52.5±18 min; p=0.47). Conclusion Endurance athletes with EAPH can be treated effectively using the Trendelenburg position and oral fl uids and the administration of intravenous fl uids does not reduce the time to discharge. The fi ndings of this study support the hypothesis that EAPH is a result of venous pooling due to peripheral vasodilatation, rather than dehydration.Due to the strenuous nature of ultra-endurance events, participants in these events are at risk of developing various medical conditions. 1-7 One of the most common clinical presentations during and following an endurance event is that of the 'collapsed' athlete. Various medical conditions may lead to collapse in athletes, including cardiovascular, metabolic, neurological, musculoskeletal and respiratory causes. [1][2][3][4][5][6][7] The most common cause for collapse is a condition referred to as exercise-associated postural hypotension (EAPH). 3 8-10 The exact pathophysiology of EAPH is still widely debated in the literature, and currently two hypotheses have been proposed. The fi rst hypothesis is that a combination of dehydration and hyperthermia causes circulatory failure, resulting in the collapse of the athlete. 3 5 11-14The second hypothesis is that pooling of blood occurs in the dilated venous system resulting in postural hypotension and thus collapse if generalised arterial vasoconstriction fails to occur immediately exercise terminates. 2 9 10 15-17As a result of this ongoing debate, there is no clarity on how best to treat athletes with EAPH. Instead two protocols are used to manage athletes with EAPH in race medical facilities. These are (1) intra...

Abstract:Re-injury to a recently rehabilitated or operated knee is a common occurrence that can result in significant loss of function. Knee stability measures have been used to diagnose and assess knee stability before and after rehabilitation interventions. Here, we systematically review the literature and evaluate the different anterior-posterior and rotational knee stability measures currently in use. A computer-assisted literature search of the Medline, CINAHL, EMBASE, PubMed and Cochrane databases was conducted using keywords related to knee stability measures. In a second step, we conducted a manual search of the references cited in these articles to capture any studies that may have been missed in the searched databases. The literature search strategy identified a total of 574 potential studies. After revisiting the titles and abstracts, 34 full-text articles met the inclusion criteria and were included in this review. Most articles compared knee stability measures, whilst other studies assessed their sensitivity and specificity. Several techniques and devices used to measure knee stability are reported in the literature. However, there are only a limited number of quality studies where these techniques and/or devices have been evaluated. Further development and investigation with high quality study designs is necessary to robustly evaluate the existing devices/techniques.

Extradigital glomus tumours are relatively uncommon. We present a case report of a glomus tumour of the elbow and review of the literature with regards to the clinical features, work-up and management of these tumours, to highlight the importance of considering a glomus tumour as part of the differential diagnosis in patient with atypical pain around the elbow.

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