Background Delay of as much as 5 months between ACL injury and surgery is known to be associated with increased risk of a medial meniscal tear, but the risk of additional meniscal tear progression with a longer delay to surgery is unclear. Questions/purposes We determined the (1) times of injury, MRI, and surgery in adolescents with ACL tears, and whether (2) timing of surgery, or (3) initial integrity of the meniscus seen on MR images predicted development of meniscal tears. Methods We reviewed 112 adolescents who were 15 ± 1 years old (mean ± SD) (range, 11-16 years) with a torn ACL. These patients underwent surgical repair from 2005 to 2011 in a Canadian city. We compared dates of injury, MRI, and surgery. A pediatric and musculoskeletal fellowship-trained radiologist reread the MR images, and meniscal injuries were graded according to severity. This was compared with surgical findings described in the operative report. Results Time after injury to MRI and surgery averaged 77 days (range, 1-377 days) and 342 days (range, 42-1637 days), respectively. Patients with new or worsened medial meniscal tears had waited longer for surgery (445 versus 290 days; p = 0.002). Bucket handle medial meniscal tears were more common in patients with surgery more than 1 year after injury than others (15 of 34 versus 14 of 75; p = 0.013). A medial meniscal tear observed on MR images was a significant covariate for a torn meniscus at surgery (relative risk, 5.7; 95% CI, 2.8-11.6). Medial meniscal survival continued to decline sharply greater than 1 year after injury. Conclusions Medial meniscal tears, especially bucket handle tears, increased steadily in frequency more than 1 year after ACL injury. Timely ACL reconstruction may be warranted to reduce the risk of further medial meniscal damage even in patients whose original injury occurred more than 1 year before. Level of Evidence Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
Use of 3D three-dimensional US showed that alpha angles measured at routine 2D two-dimensional US of the hip can vary substantially between 2D two-dimensional scans solely because of changes in probe positioning. Not only could normal hips appear dysplastic, but dysplastic hips also could have normal alpha angles. Three-dimensional US can display the full acetabular shape, which might improve DDH developmental dysplasia of the hip assessment accuracy.
Purpose
Clinical assessment of the Sacroiliac Joint (SIJ) has limitations due to the location and anatomy of the joint. Magnetic Resonance Imaging is a sensitive, non‐invasive tool in detecting early SIJ inflammatory changes and structural damage in Juvenile Idiopathic Arthritis (JIA). The quantification of interval change of pediatric SIJs using an MRI based scoring methods will serve as an important objective outcome measure for the assessment disease severity and treatment effectiveness in JIA.
Methods
The OMERACT consensus‐driven methodology consisting of iterative surveys and focus group meetings within an international group of pediatric rheumatologists and radiologist was utilized to decide the measurement construct, items, and definitions. Consensus was deemed to have been achieved if greater than 70% agreement was reached among voting attendees at the session in the absence of greater than 15% present or more in strong disagreement.
Results
Twenty‐eight international multidisciplinary experts from North America, Europe, South Asia, and South America participated in the study. Two domains, inflammation and structural, were identified. Definitions for bone marrow edema, joint space inflammation, capsulitis, and enthesitis were derived for joint inflammation; sclerosis, erosion, fatty lesion and ankylosis were defined for assessing structural joint changes.
Conclusion
Preliminary consensus‐driven definitions for inflammation and structural elements have been derived, underpinning the ongoing development of the Juvenile arthritis SIJ MRI scoring system (JAMRIS‐SIJ).
Support or Funding Information
Hospital for SickKids Research Trainee Fund (RESTRACOMP)
This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
The center of the ACL tibial attachment was consistently near 51% of the anteroposterior diameter, regardless of age or sex. The vertical depth of the tibial epiphysis was ~16 mm in adolescents. Maximum oblique depth from ACL attachment was ~30 mm, occurring at a mean angle ~50° regardless of age or sex. The normative values for tibial ACL attachment and epiphyseal anatomy presented here may be helpful in selecting candidates for surgery and in planning surgical approaches for pediatric ACL reconstruction.
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