The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 244 patients. A dedicated system for MRI of limbs and peripheral joints--the 0.2-T Artoscan (Esaote, Italy)--was used for imaging knee joint lesions. T1-weighted spin-echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of the femoropatellar joint were acquired. Paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments and medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 h after imaging, the sensitivity, specificity, and accuracy were respectively 93%, 97%, and 95% for tears of the medial meniscus; 82%, 96%, and 93% for tears of the lateral meniscus; 100%, 100%, and 100% for tears of the posterior cruciate ligament; 98%, 98%, and 97% for tears of the anterior cruciate ligament; and 72%, 100%, and 92% for full-thickness articular cartilage lesions. The examination can be performed within 30-45 min at lower cost than diagnostic arthroscopy. MRI with a 0.2-T magnet is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.
The results of magnetic resonance imaging (MRI) were compared with those of arthroscopy in a prospective series of 276 patients. A "dedicated system" for MRI of limbs and peripheral joints--the 0,2 Tesla ARTOSCAN (ESAOTE, Italy)--was used for imaging knee joint lesions. T1-weighted spin echo sagittal images, T2-weighted gradient-echo coronal images, and axial views for lesions of bone and the femoropatellar joint were acquired. If necessary paraxial sagittal and oblique coronal views were obtained for imaging of the cruciate ligaments. This protocol allowed excellent visualization of the cruciate ligaments, medial and lateral meniscus in almost all patients. Compared with arthroscopy performed within 48 hours after imaging, the sensitivity, specificity, and accuracy were respectively, 91, 92 and 91 per cent for tears of the medial meniscus; 80, 96, and 92 per cent for tears of the posterior meniscus; 100, 100, and 100 per cent for tears of the posterior cruciate ligament; 93, 98, and 99 per cent for tears of the anterior cruciate ligament; and 73, 100, and 92 per cent for full-thickness articular cartilage lesions. The examination can be performed within 30 to 45 minutes at a cost that is lower than that of diagnostic arthroscopy. ARTOSCAN imaging is a safe and valuable adjunct to the clinical examination of the knee and an aid to efficient preoperative planning.
Pain in the hindfoot due to overuse has many causes. One uncommon cause is the entrapment of the posterior tibial nerve: the tarsal tunnel syndrome. Pain when palpating posterior the medial malleolus and pain in the abductor hallucis muscle are typical symptoms. Application of a local anaesthetic leads to immediate pain relief. The distal motoric latency is prolonged, but not in all cases. First of all, treatment consists of local and oral antiphlogistics, orthopaedic arch-support and physiotherapy. In case of therapy-resistant pain over more than three months period, surgical decompression of the tibial nerve should be performed. In the last three years we treated 18 patients with a tarsal tunnel syndrome: 6 of 8 patients were symptom-free after surgical intervention, whereas only 3 of 10 were symptom-free after conservative treatment.
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