PurposeGraft diameter ≥ 8 mm reduces the risk of failure after anterior cruciate ligament reconstruction (ALCR) with hamstring tendon autograft. Pre‐operative measurement of gracilis (GT) and semitendinosus (ST) cross‐sectional area using MRI has been utilized but the optimal location for measurement is unknown. The main purpose of this study was to examine the cross‐sectional areas of GT + ST at different locations and develop a model to predict whether a doubled hamstring graft of GT + ST will be of sufficient cross‐sectional area for ACLR.
MethodsA retrospective review was performed of 154 patients who underwent primary ACLR using doubled hamstring autograft. Cross‐sectional area measurements of GT + ST on pre‐operative MRI axial images were made at three locations: medial epicondyle (ME), tibiofemoral joint line (TJL), and tibial physeal scar (TPS) and calculated the correlation of intra‐operative graft size for each location using the Pearson’s correlation coefficient. A receiver operating characteristic (ROC) established a threshold that would predict graft diameter ≥ 8 mm.
ResultsMeasurement of GT + ST at the ME had a stronger correlation (r = 0.389) to intra‐operative graft diameter than measurements at the TJL (r = 0.256) or TPS (r = 0.240). The ROC indicated good predictive value for hamstring graft diameter ≥ 8 mm based on MRI measurement at the ME with the optimal threshold with the highest sensitivity and specificity as 18 mm2.
ConclusionCross‐sectional area measurement of GT + ST at the ME correlated most closely to intra‐operative diameter of a doubled hamstring autograft compared to measurements at the TJL or the TPS. As graft diameter < 8 mm is correlated with higher failure rates of ACL surgery, the ability to pre‐operatively predict graft diameter is clinically useful.
Level of evidenceLevel III, prognostic study.
OBJECTIVE-To describe the normal motion pattern at the midcarpal compartment during active radial-ulnar deviation of the wrist using dynamic MRI and to determine the observer performance for measurements obtained in asymptomatic volunteers.METHODS-Dynamic MRI of 35 wrists in 19 asymptomatic volunteers (age mean 30.4 yrs, sd 8.6) was performed during active radial-ulnar deviation using a fast gradient-echo pulse sequence with 315 ms temporal resolution (acquisition time, 19 sec). Two independent readers measured the transverse translation of the trapezium at the scaphotrapezium joint (STJ) and the capitate-to-Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. http://www.springer.com/gb/openaccess/authors-rights/aam-terms-v1
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We reviewed the spectrum of stomal incontinence following Malone antegrade continence enema in 75 patients and developed a new grading scale to help standardize this complication. Imbrication provided stomal continence in all patients. Without imbrication almost 90% had no stomal incontinence or grade 1 leakage after long-term followup.
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