Twenty consecutive, chronic and isolated anterior cruciate ligament (ACL) lesions that underwent reconstruction with quadrupled semitendinosus (ST) and gracilis (G) were prospectively examined to compare tendon regeneration and muscle strength recovery. Twenty consecutive axial nuclear magnetic resonance (NMR) scans were done after 1 month, 6 months and 2 years from surgery. A CybexII was used to evaluate concentric strength deficits both in flexion and in internal tibia rotation at 6 months and 2 years. At 2 years, an NMR signal comparable to the contralateral was present in 14 (70%) cases and absent in 6 (30%). Semitendinosus tendon exceeded the meniscal plateau since the first month, while the G tendon crossed the joint line only after 6 months. However, the distal-end insertions of both tendons were always significantly more proximal than the contralateral normal side (ST: P = .002; G: P = .003). In case of tendon regeneration, flexion deficit was not significant after 6 months, while internal tibia rotation deficit became not significant only after 2 years. In case of non-regeneration, a flexion deficit was present after 6 months [15.5% (P = .05)] but not after 2 years, while internal tibial rotation deficit was significant both after 6 months [30.3% (P < .001)] and 2 years [24.3% (P = .03)]. In case of tendon regeneration, isokinetic evaluation showed a non-significant deficit in both flexion and internal rotation strength after ACL reconstruction with ST and G. At the 2-year follow-up, none of the 6 patients without tendon regeneration found any impairment in their sport activities despite the loss of internal rotation strength.
MRI is a potentially useful tool for evaluating the bone changes of renal osteodystrophy.
Parole chiave: ernia del disco lombare, risonanza magnetica RIASSUNTO -La risonanza magnetica (RM) e attualmente il modo non invasivo piu efficace nella rappresentazione del disco intervertebrale e nello studio delle sue alterazioni.Infatti il carattere multiparametrico dell'indagine (dipendente dal Tl, T2 e dalla densita protonica) e la visione secondo i vari piani dello spazio, associata all'ampio campo di vista, consentono il riconoscimento delle normali componenti del disco ed i rapporti che questo contrae con le strutture adiacenti quali i corpi vertebrali, il sacco durale, le radici nervose e le strutture ligamentose.Nella patologia degenerativa, accanto alia alterazione del disco, la RM e in grado di cogliere le variazioni di segnale in corrispondenza dei corpi vertebrali interessati dal fenomeno osteocondrosico.Lo studio eseguito secondo piani sagittali e coronali permette un'ottima visualizzazione del disco ed una facile identificazione di eventuali modificazioni del suo spessore. La patologia discale (protrusione, o «bulging», ed ernia nei suoi vari aspetti) comporta naturalmente variazioni morfologiche a carico del disco intersomatico: la RM ha la possibilita di documentare secondo vari piani questo tipo di patologia e le sue ripercussioni a carico degli involucri e delle strutture nervose contenute ne! canale vertebrale. SUMMARY -Magnetic Resonance ( MR) is at present the most effective noninvasive method in the imaging of the intervertebral disc and in the study of its alterations.The multiparametric character of the investigation (depending on T I, T2 and pro tonic density ) and the multiplanar imaging associated with the large focal area, allow the recognition of the normal components of the disc and its relationships with the surroundind structures such as vertebral bodies, dural sac, nervous roots and ligaments. In degenerative pathology, besides disc alterations, MR can record signal variations in the vertebral bodies involved by osteochondrosis.The study carried out according to sagittal and coronal plans allows a very good imaging of the disc and an easy identification of possible thickness alterations. Discal pathology (bulging and hernia in its various aspects) obviously implies morphological variations of the intersomatic disc: MR allows to evidence in several plans these alterations and their effects on the nervous structures of the vertebral canal and their sheaths. IntroduzioneLa risonanza magnetica (RM) e attualmente il metodo non invasivo piu efficace nella rappresentazione del disco intervertebrale e nello studio delle sue alterazioni. Infatti il carattere multiparametrico dell'indagine (dipendente dal Tl, T2 e dalla densita protonica) e la visione secondo i vari piani dello spazio, associata all'ampio campo di vista, consentono il riconoscimento delle normali componenti del disco ed i rapporti che questo contrae con le strutture adiacenti quali i corpi vertebrali, il sacco durale, le radici nervose e le strutture ligamentose 1 • 2 • 10 • 21 • 22 • L'efficacia diagnostica della RM in ...
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