Partial rotator cuff tears are the most common pathology of the shoulder joint. Diagnostic of such conditions is a challenging problem for trauma surgeon.Purpose of the study is to analyze the diagnostic significance of manual tests and the standard MRI of the shoulder joint.Materials and Methods. The study is a retrospective analysis of disease history data of 25 patients (15 males, 10 females) treated at the authors’ hospital during the period from 2014 to 2017. Examination was performed according to a standard protocol: assessment of shoulder range of motion, palpation, manual examination, including “full/empty can” test, a painful arc symptom and the Hawkins – Kennedy test. All patients underwent MRI of the shoulder joint. The mean age of patients was 50.8 years. Shoulder joint arthroscopic inspection was considered the gold standard for diagnostics.Results. After data analysis, the following results were obtained: sensitivity of the “full can” test was 68%, the accuracy was 68%; “empty can” test sensitivity and accuracy were 76%, respectively. MRI sensitivity for diagnostics of supraspinatus tendon ruptures was 84% with the accuracy of 84%. The combination of the Hawkins – Kennedy test with the symptom of painful arch demonstrated accuracy and sensitivity of 64%. The study evaluated the effectiveness of MRI for diagnostic of the rupture type: sensitivity for injury from the joint surface — 80%, from the subacromial space — 70%; specificity for ruptures from the articular surface — 90% and from the subacromial space — 93%. The accuracy was 84% for both types of ruptures.Conclusions. Combined application of manual tests and MRI of the shoulder joint allows to diagnose partial rotator cuff tears in the majority of cases.
Purpose of the study— to evaluate surgical treatment outcomes of the patients with chronical patella instabilitywho underwent double bundle transpatellar reconstruction of medial patella-femoral ligament (MPFL) by a semitendinous tendon autograft. Material and methods.26 patients with minimal 12 months follow up were included into the study. In all casessemitendinous tendon autograft was inserted through a vertical tunnel in the patella, formed in a loop, and fixed in femoral tunnel by a biodegradable screw. Preoperative MRIs were used to evaluate trochlear dysplasia type by D. Dejour classification, tibial tubercle to trochlear groove distance (TT-TG) and Insall-Salvati ratio. Postoperative x-rays were used to measure femoral tunnel angle (FTA), postoperative MRIs — to measure diameter of patella tunnel (d_Pat), distance from tunnel to medial border of patella (MPM) and diameter of tunnel in medial femoral condyle (d_Fem). Functional outcomes were evaluated by Kujala Score, Lysholm and IKDC, also the authors assessed the level of sports activity prior to and after the surgery. Results.Age median of the patients at the moment of procedure was 22 years. MRI data prior to surgery reportedthat the majority of patients suffered from B type of trochlear dysplasia, median TT-TG distance was 14.6 mm, median Insall-Salvati ratio was 1.1 mm. Postoperative x-rays and MRIs demonstrated median FTA of 18°, d_Pat median — 5.4 mm, MPM median — 7.0 mm, d_Fem median — 8.2 mm, no implant migrations were observed. Subjective assessment scores demonstrated excellent outcomes: Kujala Score — 96, IKDC — 87.4, Lysholm — 91. No secondary dislocations during follow up were reported, 48% of patients returned to sports on the pre-surgery or higher level, 52% of patients returned to sports with decreased activity. Conclusion.Transpatellar reconstruction of MPFL by semitendinous tendon autograft proved to be the efficienttreatment method of chronical patella instability.
Purpose – to assess the influence of combined femoral fixation technique during arthroscopic ACL reconstruction on the femoral tunnel widening at long term follow-up.Material and methods. 99 patients with primary hamstring tendon (HT) ACL reconstruction performed in 2007-2008 were analyzed. In the study group (42 patients) on the femoral side a combined cortical suspension (Endobutton CL, Smith Nephew) and transverse (Rigid Fix, Depuy Mitek) fixation of graft was used. In control group, isolated cortical suspension fixation (Endobutton CL, Smith Nephew) was used. On the tibial side for graft fixation a biodegradable screw (Biointrafix, DePuy Mitek) was used in all cases. Tunnel widening was calculated in percentage against primary tunnel diameter created during the surgery. MRI data were exported to eFilm (Merge Healthcare software), measurement of femoral tunnel diameters was performed on T1 sequences in coronal and sagittal planes on three different levels.Results. The mean age at the last follow up in the study group was 38.9±1.4, in control group – 38,6±1,08. The median time from surgery to follow up was 9 years and 4 months in the study group and 8 years 7 months in the controls. The incidence of graft failure in the study group was reported as 14.3%, while in the control group as 17,5%. The median femoral tunnel widening was larger in the control group at the joint aperture and midsection levels both in coronal and sagittal plane, although there was no statistically significant differences (p0,05).Conclusion. The combination of cortical suspension and transverse HT femoral graft fixation technique is likely to reduce tunnel enlargement at the long term follow-up. However further research and larger sample groups are required.
реферат Гетеротопическая оссификация -это состояние, характеризующееся формированием костной ткани в мягких тканях, которые не имеют остеогенных свойств. В статье представлен клинический случай лечения пациентки с массивной гетеротопической оссификацией в передне-медиальных отделах правого коленно-го сустава, которая возникла за 10 лет до обращения. пусковым механизмом стало резкое переразгибание коленного сустава. на МРТ коленного сустава было выявлено образование, оттесняющее здоровые ткани по переднемедиальной поверхности правого коленного сустава. на кТ коленного сустава визуализирована массивная кальцинация мягких тканей. Во время артроскопической операции было обнаружено новообра-зование плотной консистенции, с округлыми краями, незначительно спаянное с окружающими тканями. Выполнено его удаление. Диагноз был подтвержден результатами гистологического исследования. на конт-рольных рентгенограммах через 6 мес. после операции новых очагов гетеротопической оссификации не вы-явлено. удаление гетеротопического оссификата позволило получить хороший клинический результат. Heterotopic ossification is characterized by bone tissue formation in soft tissues that possess no osteogenic properties. The authors present a clinical case of a female patient with massive heterotopic ossification in anteromedial aspect of the right knee joint with 10 years history before admission for treatment. an abrupt knee Рязанцев М.с., Магнитская н.е., афанасьев а.п., Ильин Д.о., логвинов а.н., Фролов а.В., королев а.В. Массивная посттравматическая гетеротопическая оссификация коленного сустава (случай из клинической практики).
Европейская клиника сп ортивной травматологии и ортопедии (ECSTO), г. Москва, Россия Radiographic characteristics of the acromion process as a predictive factor of partial rotator cuff tears
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