Imaging of Abductor Tears: Stepwise Technique for Accurate Diagnosis.
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ABSTRACT:
SUBMITTER: Hartigan DE
PROVIDER: S-EPMC5709972 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Endoscopic repair of hip abductor tendons has been shown to have equivalent outcomes and lower complication rates compared with open repair. First reported in 2007, endoscopic repair has become more frequent, with multiple techniques previously described. Frequently, hip abductor tears involve a partial-thickness undersurface component that has been previously addressed endoscopically by making a longitudinal split in the tendon to access the diseased tissue. However, we present a technique for addressing these undersurface tears in situ, accessing the undersurface of the tear by coming under the distal anterior edge of the gluteus medius tendon.
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Project description:PurposeTo evaluate the 1-year outcomes of a small patient series following open gluteus medius/minimus repair with human dermal allograft incorporated into the repair construct using a double-row repair.MethodsData from consecutive patients undergoing a superior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy by a single fellowship trained surgeon from January 2018 to May 2019 were collected and analyzed. Baseline demographic data and magnetic resonance imaging were collected preoperatively. Clinical outcomes including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris hip score (mHHS), international Hip Outcome Score-12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were recorded at 1-year postoperatively.ResultsA total of 8 patients underwent open superior gluteal reconstruction for severe hip abductor deficiency. The mean age and body mass index were 62.6 ± 7.3 years and 29.6 ± 5.3 kg/m2, respectively. The majority of patients were female (N = 7, 87.5%). Three (37.5%) patients had undergone previous endoscopic gluteus medius repair and presented for revision surgery. All patients had full-thickness tears with gluteus medius and gluteus minimus involvement. Patients were evaluated at an average of 11.5 ± 1.7 months from the initial surgical intervention and reported a mean HOS-ADL of 82.9 ± 24.3, HOS-SS of 73.2 ± 37.3, mHHS of 83.6 ± 17.1, iHOT-12 of 63.9 ± 27.4, VAS Pain of 30.0 ± 23.1, and VAS Satisfaction of 87.1 ± 17.0. There was no evidence of retears in this patient cohort as defined by physical examination findings and/or corroborating magnetic resonance imaging.ConclusionsSuperior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy is a technique that demonstrates promising 1-year postoperative outcomes in both primary and revision patients.Level of evidenceLevel IV, therapeutic case series.
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Project description:Proximal hamstring tears are among the most common sports-related injuries. These injuries often occur as strains or partial tears at the proximal muscle belly or the musculotendinous junction, with avulsion injuries of the proximal attachment occurring less frequently. Regardless of the mechanism, they produce functional impairment and negatively affect an athlete's performance. Various classifications for these injuries are reported in the literature. Early surgical treatment is recommended for patients with either a 2-tendon tear/avulsion with more than 2 cm retraction or those with complete 3-tendon tears. Surgery can be performed in the chronic phase but it is technically demanding because of scar formation and tendon retraction. This Technical Note describes a biomechanically validated surgical technique for repair of the proximal hamstring tears.
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Project description:Background: Pathologically, Meniere's disease symptoms are considered to be associated with endolymphatic hydrops. Examinations revealing endolymphatic hydrops can be useful for accurate Meniere's disease diagnosis. We previously reported a quantitative method for evaluating endolymphatic hydrops, i.e., by measuring the volume of the endolymphatic space using three-dimensional magnetic resonance imaging (MRI) of the inner ear. This study aimed to confirm the usefulness of our methods for diagnosing Meniere's disease. Here, we extracted new explanatory factors for diagnosing Meniere's disease by comparing the volume of the endolymphatic space between healthy volunteers and patients with Meniere's disease. Additionally, we validated our method by comparing its diagnostic accuracy with that of the conventional method. Methods and Findings: This is a prospective diagnostic accuracy study performed at vertigo/dizziness centre of our university hospital, a tertiary hospital. Eighty-six patients with definite unilateral Meniere's disease and 47 healthy volunteers (25 and 33 males, and 22 and 53 females in the control and patient groups, respectively) were enrolled. All participants underwent 3-Tesla MRI 4 h after intravenous injection of gadolinium to reveal the endolymphatic space. The volume of the endolymphatic space was measured and a model for Meniere's disease diagnosis was constructed and compared with models using conventional criteria to confirm the effectiveness of the methods used. The area under the receiver operating characteristic curve of the method proposed in this study was excellent (0.924), and significantly higher than that derived using the conventional criteria (0.877). The four indices, sensitivity, specificity, positive predictive value, and negative predictive value, were given at the threshold; all of these indices achieved higher scores for the 3D model compared to the 2D model. Cross-validation of the models revealed that the improvement was due to the incorporation of the semi-circular canals. Conclusions: Our method showed high diagnostic accuracy for Meniere's disease. Additionally, we revealed the importance of observing the semi-circular canals for Meniere's disease diagnosis. The proposed method can contribute toward providing effective symptomatic relief in Meniere's disease.
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Project description:Transtendinous abductor tendon repair is a technique the authors described previously to diagnose and treat undersurface tears of the abductor tendons. In this surgical technique article, the authors describe a technique for knotless repair of undersurface tears of the abductor tendons that does not require a transtendinous split or suture passage through the abductor tendon. Because there is no suture passage through the abductor tendon or knot tying, the potential advantages include expeditious technique, compression of tendon against bony footprint, anatomic repair, and avoidance of knots facing the undersurface of the iliotibial band, which may lead to bursal irritation.
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Project description:This retrospective study was conducted to analyse the reliability of clinical diagnosis in meniscal tear injuries. All patients attending our clinic with knee pain from January 2003 to December 2004 underwent systematic and thorough clinical assessment. One hundred and fifty patients were clinically diagnosed to have meniscal tears. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. The accuracy of clinical diagnosis in our study was 88% for medial meniscal tears and 92% for lateral meniscal tears. The results of this study demonstrate that clinical diagnosis of meniscal tears is as reliable as the results published by other authors for magnetic resonance imaging (MRI) scan. We recommend the use of MRI for more doubtful, difficult and complex knee injuries.
| S-EPMC2267536 | biostudies-other
Project description:Purpose To assess the feasibility of luminal water imaging, a quantitative T2-based magnetic resonance (MR) imaging technique, for the detection and grading of prostate cancer (PCa). Materials and Methods Eighteen patients with biopsy-proven PCa provided informed consent to be included in this institutional human ethics board-approved prospective study between January 2015 and January 2016. Patients underwent 3.0-T MR imaging shortly before radical prostatectomy. T2 distributions were generated with a regularized non-negative least squares algorithm from multiecho spin-echo MR imaging data. From T2 distributions, maps of seven MR parameters, Ncomp, T2short, T2long, geometric mean T2 (gmT2), luminal water fraction (LWF), Ashort, and Along, were generated and compared with digitized images of hematoxylin-eosin-stained whole-mount histologic slices. A paired t test was used to determine significant differences between MR parameters in malignant and nonmalignant tissue. Correlation with Gleason score (GS) was evaluated with the Spearman rank correlation test. Diagnostic accuracy was evaluated by using logistic generalized linear mixed-effect models and receiver operating characteristic (ROC) analysis. Results The average values of four MR parameters (gmT2, Ashort, Along, and LWF) were significantly different between malignant and nonmalignant tissue. All MR parameters except for T2long showed significant correlation (P < .05) with GS in the peripheral zone. The highest correlation with GS was obtained for LWF (-0.78 ± 0.11, P < .001). ROC analysis demonstrated high accuracy for tumor detection, with the highest area under the ROC curve obtained for LWF (0.97 in the peripheral zone and 0.98 in the transition zone). Conclusion Results of this pilot study demonstrated the feasibility of luminal water imaging in the detection and grading of PCa. A study with a larger cohort of patients and a broader range of GS is required to further evaluate this new technique in clinical settings. © RSNA, 2017.
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Project description:Bucket-handle meniscal tears (BHMT) remain a challenge to treat due to their complex pathology and technical difficulty. Subtotal meniscectomy has shown to improve symptoms early but leads to accelerated osteoarthritis in the affected compartment and poor long-term outcomes. BHMT repair and meniscal preservation is the preferred option. This can be performed with inside-out, all-inside, or hybrid meniscus repair techniques. All-inside meniscus repair avoids the need for additional safety incisions, trained assistants for suture passing, and reduce concerns of soft-tissue and neurovascular complications. In this Technical Note, we detail our all-inside technique for BHMT technique and share tips for a successful repair.
| S-EPMC7953237 | biostudies-literature
Project description:Attempts to restore the anatomical footprint during rotator cuff repair for retracted, relatively immobile tears can be difficult. In some cases, it can lead to excessive tension of the repair. Previous studies have noted improved clinical outcomes when repair tension is not excessive, and medialization of the anatomical footprint has been suggested as a technique that can help surgeons repair large, retracted tears without excessive tension and achieve improved clinical outcomes. Of note, excessive tension when restoring the rotator cuff tendon to the anatomical footprint is not limited to large, retracted tears. In some cases, restoring small- and medium-sized tears to the anatomical footprint also can lead to excessive tension. Therefore, it is not uncommon for the authors to employ some degree of footprint medialization even for repair of small- or medium-sized tears if repair to the anatomical footprint will lead to excess tension. The purpose of this article and video demonstration is to provide instruction for a reproducible rotator cuff technique using a medialized single-row rip-stop construct combined with convergence. Technique Video Video 1 An arthroscopic rotator cuff repair with a medialized rip-stop convergence technique is shown for a left shoulder in the beach-chair position, as viewed through a posterior portal and lateral portal with lateral subacromial viewing perspective. Techniques and advantages of medialization are demonstrated with emphasis on creating an opportunity to perform a double-row repair when one otherwise would not be feasible due to the entire footprint’s medial shift.
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Project description:BackgroundWe previously reported a hybrid suture technique, wherein mattress and simple suturing are used to create Mason-Allen configuration, with low recurrence rates. This comparative study looking at the two years' clinical outcomes of arthroscopic anterior labral repair using the hybrid suture technique versus simple suture technique.MethodsWe identified 103 patients who underwent arthroscopic anterior labral repair from 2010 to 2015 with 2-year follow-up. The patients were categorized into two groups: hybrid suture technique (65 patients) and simple suture technique (38 patients). Clinical outcomes measures included UCLA shoulder score, Constant Shoulder Score, Numerical Pain Rating Scale, and Oxford Instability score.ResultsMean age of the patients was 27.02 ± 9.76 years (17-63), with 91 males and 12 females. At 24 months, both groups showed significant improvement in post-operative clinical scores compared to pre-operation. The patients in hybrid sutures technique demonstrated significant improvement in Constant Shoulder Score, UCLA shoulder score and Oxford Instability score compared to simple suture group at 3 months follow up. (121.98 ± 21.05 vs 109.32 ± 21.15, p < 0.05; 65.5 ± 19 vs 57.4 ± 17.6, p < 0.05; 27.3 ± 5.7 vs 23.7 ± 5.0, p < 0.05; 29.3 ± 8.9 vs 33.4 ± 8.2, p < 0.05). The postoperative recurrence rate was comparable between both groups (hybrid suture group 7.81% vs simple suture group 7.84%).ConclusionsArthroscopic anterior labral repair with hybrid suture technique offers significant early improvements in clinical scores and low recurrence rate compared to simple suture technique at 2-year follow-up.Level of evidenceLevel III; Retrospective Cohort Design; Treatment study.
| S-EPMC6734034 | biostudies-literature