Comparative Study between Multi-slice Computed Tomographic Arthrography and Arthroscopy in the Evaluation of Rotator Cuff Tears / Estudo comparativo entre artrotomografia computadorizada multi-slice e artroscopia na avaliação das lesões do manguito rotador

Abstract Objective To compare the imaging findings of anatomical alterations using multi-slice computed tomographic arthrography in the evaluation of rotator cuff tears in the shoulder, correlating them with the arthroscopy (the gold standard diagnostic test) findings. Materials and Methods A longitudinal, prospective, comparative study of diagnostic accuracy performed in the period between June 2016 and June 2017 in patients of both sexes, aged between 40 and 70 years, with shoulder rotator cuff tendon tears and therapeutic need to undergo shoulder arthroscopy. Patients with contraindication to magnetic resonance imaging were included. After multi-slice computed tomographic arthrography, all patients underwent arthroscopy. Results To obtain the results, the following parameters were determined: sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa coefficient, and contrast between the imaging method and arthroscopy. Conclusion In the impossibility of performing magnetic resonance imaging (the gold standard imaging technique), multi-slice computed tomographic arthrography is an imaging examination capable of evaluating/diagnosing rotator cuff tears.

Resumo Objetivo Comparar os achados por imagem das alterações anatômicas da artrotomografia computadorizada multi-slice na avaliação das lesões do manguito rotador do ombro e correlacioná-los com os achados da artroscopia (exame diagnóstico padrão-ouro). Materiais e Métodos Estudo longitudinal, prospectivo, comparativo de acurácia diagnóstica, feito de junho de 2016 a junho de 2017, em pacientes de ambos os sexos, com idades entre 40 e 70 anos, com lesão dos tendões do manguito rotador do ombro, e que tinham necessidade terapêutica de fazer artroscopia do ombro. Foram incluídos pacientes com contraindicação à realização de ressonância magnética. Após a artrotomografia computadorizada multi-slice, todos os pacientes foram submetidos a artroscopia. Resultados Para a obtenção dos resultados, os seguintes parâmetros foram considerados: sensibilidade, especificidade, acurácia, valor preditivo positivo, valor preditivo negativo, coeficiente Kappa, e contraposição do método de imagem com a artroscopia. Conclusão Na impossibilidade da realização da ressonância magnética (exame de imagem padrão-ouro), a artrotomografia computadorizada multi-slice se mostra um exame de imagem capaz de avaliar/diagnosticar as lesões do manguito rotador.

Accuracy of Magnetic Resonance Arthrography in Detecting Rotator Cuff Tears / Precisión de la artrografía por resonancia magnética en la detección de desgarros del manguito rotador

ABSTRACT Objective: Shoulder pain, a common cause of productivity loss and health-related expense, is commonly due to rotator cuff tears. Magnetic resonance (MR) imaging with intra-articular gadolinium, MR arthrography, is accepted internationally as an excellent modality for evaluating the rotator cuff. Ultrasound is cheaper and only slightly less sensitive in detecting rotator cuff tears, but MR is superior in detecting ancillary lesions. Magnetic resonance arthrography was introduced at the University Hospital of the West Indies (UHWI), Jamaica, in July 2003. This study aimed to evaluate our experience with MR arthrography and assess its accuracy. Methods: A retrospective study was carried out. All MR arthrography cases performed at UHWI between July 2003 and July 2006 were reviewed. Medical records were reviewed to determine surgical correlation. Results: A total of 140 MR arthrograms were performed; 55% of the patients were female. Ages ranged from the second to the ninth decade, having a distribution approaching but not attaining a normal distribution (p = 0.03) with clustering in the middle years. Magnetic resonance arthrography demonstrated torn rotator cuffs in 40 patients, none of whom was under the age of 40 years (p < 0.001). Fifteen patients had surgery which confirmed torn rotator cuffs in all 15. Conclusion: Magnetic resonance arthrography was found to be accurate in detecting rotator cuff tears. It should be considered in the evaluation of patients with suspected rotator cuff tears. For patients under the age of 40 years, sonography could be used as an alternative.

RESUMEN Objetivo: El dolor en el hombro, el cual es causa común de pérdida de productividad y gastos relacionados con la salud, se debe comúnmente a desgarros del manguito rotador. La imagen por resonancia magnética (IRM) con gadolinio intra-articular - conocida como artrografía RM - se acepta internacionalmente como una excelente modalidad para evaluar el manguito rotador. El ultrasonido es más barato y sólo ligeramente menos sensible a la hora de detectar desgarros del manguito rotador, pero la RM es superior en la detección de lesiones secundarias. La artrografía por resonancia magnética se introdujo en el Hospital Universitario de West Indies (HUWI), Jamaica, en julio de 2003. Este estudio tuvo como objetivo evaluar nuestra experiencia con la artrografía RM y evaluar su precisión. Métodos: Se realizó un estudio retrospectivo. Se revisaron todos los casos de artrografías RM realizadas en HUWI entre julio de 2003 y julio de 2006. Se revisaron las historias clínicas a fin de determinar la correlación quirúrgica. Resultados: Un total de 140 artogramas RM fueron realizados. El 55% de los pacientes eran mujeres. Las edades variaron del segundo al noveno decenio, con una distribución que se acercaba pero no llevaba a alcanzar una distribución normal (p = 0.03), concentrándose en los años intermedios. La artrografía de resonancia magnética mostró desgarros de los manguitos rotadores en 40 pacientes, ninguno de los cuales tenía menos de 40 años (p < 0.001). Quince pacientes tuvieron cirugía que confirmaba desgarros de los manguitos rotadores en los 15. Conclusión: Se halló que la artrografía por resonancia magnética era exacta a la hora de detectar los desagarros del manguito rotador. Debe considerarse en la evaluación de pacientes con sospecha de desgarros del manguito rotador. Para los pacientes menores de 40 años de edad, la sonografía podría ser utilizada como alternativa.

Utilidad de la artrografía intraoperatoria para el tratamiento de fracturas en niños / Usefulness of intraoperative arthrogram in the treatment of pediatric fractures

Introducción: El objetivo de este estudio fue evaluar las indicaciones y las complicaciones de una serie consecutiva de niños con fracturas a quienes se les realizó artrografía intraoperatoria. Materiales y Métodos: Se evaluó retrospectivamente a pacientes pediátricos con fracturas de codo o tobillo sometidos a una artrografía intraoperatoria, entre enero de 2009 y julio de 2014. Se analizaron los datos demográficos, la evolución clínica posoperatoria (criterios de la Clínica Mayo y puntaje de la AOFAS), la evolución radiográfica y las complicaciones derivadas del uso de material de contraste intrarticular. Resultados: Se evaluaron 25 pacientes (16 niños, 9 niñas) con una edad promedio de 7.6 años (rango 4-15). El seguimiento promedio fue de 30.1 meses. Quince tenían fracturas de codo y 10, de tobillo. Según el puntaje de la Clínica Mayo, 14 pacientes tuvieron resultados excelentes y uno fue bueno (promedio 99; rango 85-100). Los 10 pacientes con fracturas de tobillo obtuvieron resultados excelentes según el puntaje de la AOFAS (promedio 98,5; rango 95-100). No ocurrieron infecciones ni reacciones adversas relacionadas con el uso del medio de contraste. Tres pacientes tuvieron complicaciones no relacionadas con el uso del medio de contraste. Conclusión: La artrografía es un procedimiento simple, de bajo costo, que agrega poco tiempo quirúrgico y permite una mejor evaluación de estructuras intrarticulares para la toma de decisiones intraoperatorias. Es una herramienta útil que debe ser tenida en cuenta en el tratamiento de algunas fracturas en pediatría. Nivel de Evidencia: IV

Introduction: The objective of this study is to assess the indications and complications of a consecutive series of children with fractures where intraoperative arthrogram was performed. Methods: We retrospectively evaluated children with elbow or ankle fractures who underwent intraoperative arthrogram between January 2009 and July 2014. We assessed demographic data, postoperative clinical outcomes (Mayo Clinic and AOFAS scores), radiographic outcome and complications arising from the use of intra-articular contrast material. Results: Twenty-five patients (16 boys, 9 girls) with an average age of 7.6 years (range 4-15) were evaluated. The average follow-up was 30.1 months. There were 15 patients with elbow fractures and 10 with ankle fractures. According to Mayo Clinic score, results were excellent in 14 patients and good in one patient (average 99; range 85-100). Ten patients with ankle fractures presented excellent results according to AOFAS score (average 98.5; range 95-100). There were no in fections or adverse reactions related to the use of contrast. Three patients presented complications unrelated to the use of contrast. Conclusion: Arthrogram is a simple, low-cost procedure, adds short surgical time and allows better assessment of intraarticular structures for intraoperative decision-making. It is a useful tool that should be taken into account in the treatment of some pediatric fractures. Level of Evidence: IV

Do real ao ideal - o (des)cuidar da saúde dos idosos longevos / El real a lo ideal - el (des)cuidado de la salud de los más ancianos / From real to ideal - the health (un)care of long-lived elders

RESUMOObjetivo:analisar semelhanças e dessemelhanças nos significados do cuidado à saúde de idosos longevos atribuídos por eles e pelos profi ssionais de enfermagem no cenário de uma unidade básica de saúde.Método:pesquisa qualitativa etnográfica, alicerçada no método de Spradley e McCurdy e na antropologia interpretativa de Geertz e Kleinman. Participaram 20 informantes-chaves, as informações foram coletadas por meio da observação participante e entrevista etnográfica no período de março a outubro de 2013 e analisadas em domínios, taxonomias e tema cultural.Resultados:emergiram seis domínios e taxonomias culturais que mostraram razões, atributos e recursos para cuidar, na perspectiva dos idosos e dos profissionais de enfermagem e, por fim, o tema cultural: do real ao ideal - o (des)cuidar da saúde dos idosos longevos.Conclusão:o estudo mostrou o distanciamento entre o cuidado almejado e o realizado à saúde das pessoas com idade mais avançada no cenário estudado.

RESUMENObjetivo:analizar las similitudes y diferencias en los signifi cados del cuidado de salud para los más ancianos asignado por ellos y los profesionales de enfermería en un unidad básica de salud.Método:investigación cualitativa etnográfi ca, basado en método de Spradley y McCurdy y la antropología interpretativa de Geertz y Kleinman. Participaron 20 informantes clave y los datos fueron recolectados a través de la observación participante y entrevistas etnográfi cas en período de marzo a octubre de 2013 y analizados en dominios, taxonomías y tema cultural.Resultados:surgieron seis dominios y taxonomías culturales que mostraron las razones, atributos y recursos para cuidar, en perspectiva de los más ancianos y profesionales de enfermería; fi nalmente, el tema cultural: el real a lo ideal - el (des)cuidado de la salud de los más ancianos.Conclusión:el estudio demostró la distancia entre el cuidado de la salud deseado y real de las personas con edad avanzada en el escenario estudiado.

ABSTRACTObjective:to analyze similarities and dissimilarities in the meanings assigned to health care by long-lived elders and nursing professionals in a healthcare setting.Method:ethnographic qualitative research, based on the Spradley-McCurdy method and the interpretive anthropology of Geertz and Kleinman. The sample consisted of 20 key informants. Data were collected through participatory observation and ethnographic interviews from March to October 2013 and analyzed in domains, taxonomies and cultural themes.Results:Six domains and cultural taxonomies emerged and revealed reasons, attributes, and resources in providing care in relationship to long-lived elders and nursing professionals; fi nally, the following cultural theme emerged: the real to the ideal - the health (un)care of long-lived elders.Conclusion:The study showed the distance between the desired and actual health care provided to aged people in the scenario studied.

Variantes anatómicas del hombro: parte I: eficacia de la artro-resonancia para el diagnóstico de las variantes anatómicas del labrum glenoideo / Anatomic variants of the shoulder: MR arthrography efficacy in the diagnosis

Introducción: Actualmente no está clara la importancia clínica de las variantes anatómicas del hombro. La artro-resonancia (artroIRM) es un método que permite identificarlas en algunos casos. Nuestro objetivo es determinar el valor diagnóstico y la variabilidad interobservador de la artrolRM para variantes anatómicas. Materiales y métodos: Se evaluaron 53 artrolRM. El grupo de estudio fueron 27 pacientes con variantes anatómicas identificadas en la artroscopía, y el grupo control 26 pacientes sin variantes. Las variantes analizadas fueron el cord-like middle glenohumeral ligament, (MCLL), ya sea en forma aislada o formando parte de un complejo Buford, y el agujero sublabral. Un radiólogo experimentado (01), un especialista en artroscopía de hombro (02) y un residente del último año de traumatología (03), analizaron las artrolRM en forma aleatoria. Se calculó la concordancia entre las imágenes de artrolRM y la artroscopía con el índice kappa. Resultados: Para el diagnóstico de las variantes anatómicas obtuvieron una concordancia moderada tanto 01 (k: 0,4679) como 02 (k: 0,4093). El MCLL fue mejor diagnosticado por 01 con una sensibilidad de 66,7 por ciento, especificidad de 92,1 por ciento y un índice kappa bueno (0,7226). El agujero sublabral fue mejor diagnosticado por O2 con una sensibilidad de 40 por ciento, especificidad de 95,3 por ciento y un índice kappa moderado (0,434). 03 obtuvo una débil concordancia (k 0,2-0,4) para el diagnóstico de las variantes anatómicas. Conclusión: La artrolRM tiene una baja sensibilidad para el diagnóstico de las variantes anatómicas, aún siendo evaluada por especialistas experimentados. Su rol para el diagnóstico de las mismas continúa siendo incierto. Diseño del estudio: Estudio diagnóstico de casos y controles. Nivel de evidencia: III.

Artroresonancia de hombro: Lesiones de polea bicipital e intervalo de los rotadores / Arthro magnetic resonance imaging: Biceps pulley lesion and rotator interval

La porción larga del tendón bíceps y el intervalo rotador son estructuras anatómicas estrechamente asociadas que confieren estabilidad a la articulación del hombro. Las anormalidades del intervalo rotador pueden ser adquiridas o congénitas y se asocian a patrones de inestabilidad de la porción larga del tendón bíceps y a la producción de dolor. El diagnóstico clínico y artroscópico de las anormalidades del intervalo rotador y patrones sutiles de inestabilidad bicipital resultan de difícil detección. La artroresonancia presenta mayor resolución que la resonancia magnetica nuclear convencional para evaluar la anatomía del intervalo rotador debido a su capacidad para distender dicho espacio anatómico y visualizar los ligamentos de la polea bicipital (ligamento coracohumeral en sus dos porciones y ligamento glenohumeral superior) y las sutiles alteraciones que permite detectar a nivel de las fibras profundas del tendón subescapular y desgarro parcial anterior de la cara articular del tendón supraespinoso. Asimismo lesiones crónicas de sinovitis o tejido de granulación productoras de dolor pueden ser mejor detectadas. El objetivo del estudio es identificar las estructuras anatómicas por artroresonancia y las principales anomalías que pueden afectar la polea bicipital y por consiguiente el intervalo rotador.

Proyección de Rosenberg en la evaluación radiológica de la osteoartrosis de rodilla / Rosenberg projection for the radiological diagnosis of knee osteoarthritis

Background: Knee osteoarthritis is highly prevalent in our country. An early diagnosis is very important to provide an accurate and early treatment, and eventually delay its progression. Aim: To compare the diagnostic yield for osteoarthritis of two projections in knee Xray examination. Material and Methods: We evaluated 44 knees with conventional (AP weight-bearing, in full extension) and Rosenberg (PA weight-bearing in 45 degrees of flexion) X ray projections in 32 patients (24 women and 8 men), aged 26 to 78 years. All patients were symptomatic at the time of evaluation, with a suspicion of knee osteoarthritis. Both projections were analyzed and compared. Results: Joint space in the lateral compartment with conventional AP weight-bearing and Rosenberg projections were 8.6±11.5 mm and 7.8±10.9 mm, respectively (NS). The joint space for the medial compartment were 8.2±10.9 mm and 6.7±8.6 mm, respectively (p <0.05). Conclusions: Rosenberg projection is more sensitive to detect knee joint space narrowing as compared with conventional AP weight-bearing prqjection, at least in the medial compartment ofthe knee. Therefore, Rosenberg prqjection should be included in the initial study of any patient with suspicion ofknee osteoarthritis.

Shoulder instability: the role of MR arthrography in diagnosing anteroinferior labroligamentous lesions: Our experience at King Hussein Medical Center

To determine the reliability and accuracy of magnetic resonance arthrography of the shoulder for the diagnosis of anteroinferior labroligamentous lesions in patients with gleno-humeral joint instability. This retrospective study was performed at King Hussein Medical Center in Jordan. Twenty eight patients who underwent shoulder MR arthrogram and arthroscopy during a 22-month period were reviewed. All the twenty eight patients had history of previous shoulder dislocation and clinical suspicion of anteroinferior labroligamentous lesions and glenohumeral joint instability. The series included 24 males and 4 females. The mean average age of the patients was 29 years. All patients underwent shoulder MR arthrogram and the results of MR arthrogram were compared with the arthroscopic findings which were used as the reference standard. MR arthrograms were analyzed for the presence and type of labroligamentous injuries which include [Bankart, anterior labral periosteal sleeve avulsion [ALPSA], Perthes, glenolabral articular disruption [GLAD], or nonclassifiable lesion]. Sensitivity, specificity and accuracy for the detection and classification of anteroinferior labroligamentous lesions with MR arthrography were calculated. At arthroscopy, 21 anteroinferior labroligamentous lesions were diagnosed, including 15 Bankart lesions, three ALPSA lesions, two Perthes lesions and one GLAD lesion. Seven labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. When compared with arthroscopic findings, Shoulder MR Arthrography had two false-negative results [sensitivity, 92.8%] and no false-positive results. The sensitivity of shoulder MR Arthrography in detecting anteroinferior labroligamentous lesions was 92.8% [26/28] and specificity was [100%]. The overall accuracy of Shoulder MR Arthrography in detecting labroligamentous lesions in this study was 90.5% [19/21]. MR arthrography of the shoulder is reliable and accurate in classification of acute and chronic anteroinferior labroligamentous injuries

Evaluation of partial cranial cruciate ligament rupture with positive contrast computed tomographic arthrography in dogs

Computed tomographic arthrography (CTA) of four cadaveric canine stifles was performed before and after partial cranial cruciate ligament rupture in order to verify the usefulness of CTA examination for the diagnosis of partial cranial cruciate ligament rupture. To obtain the sequential true transverse image of a cranial cruciate ligament, the computed tomography gantry was angled such that the scanning plane was parallel to the fibula. True transverse images of cranial cruciate ligaments were identified on every sequential image, beginning just proximal to the origin of the cranial cruciate ligament distal to the tibial attachment, after the administration of iodinated contrast medium. A significant decrease in the area of the cranial cruciate ligament was identified on CTA imaging after partial surgical rupture of the cranial cruciate ligament. This finding implies that CTA can be used for assessing partial cranial cruciate ligament ruptures in dogs.

Artroresonancia: conceptos generales, indicaciones y rendimiento / MR arthrography: general concepts, indications and perfomance

La artroresonancia es un método de diagnóstico por imagen que ha mostrado ser de utilidad en la evaluación de algunas condiciones intraarticulares, considerándose el estándar de referencia en algunas de ellas. Este artículo revisa los aspectos técnicos, en relación al procedimiento propiamente tal, así como sus principales indicaciones, haciendo referencia a su rendimiento en las diferentes patologías.

CT Arthrography and Virtual Arthroscopy in the Diagnosis of the Anterior Cruciate Ligament and Meniscal Abnormalities of the Knee Joint

OBJECTIVE: To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. MATERIALS AND METHODS: Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. RESULTS: The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. CONCLUSION: CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.

Magnetic resonance arthrography in recurrent anterior shoulder instability as compared to arthroscopy: a prospective comparative study.

AIM: To evaluate the accuracy of magnetic resonance (MR) arthrographic imaging in the diagnosis of glenoid labral and ligament tears in recurrent shoulder instability. SETTINGS AND DESIGN: Prospective, comparative study at a tertiary care centre. MATERIAL AND METHODS: Patients with three or more episodes of anterior shoulder dislocation were enrolled in the study. They were subjected to magnetic resonance arthrography (MRA) for delineation of abnormalities. The findings obtained at MRA were compared with those found at arthroscopy and surgical exploration. RESULTS: MRA detected glenoid tears in all 22 patients with 20 (90%) patients having antero-inferior tears, 3 (14%) patients had superior labral involvement and 2 (10%) patients had posterior labral abnormality. On arthroscopy, antero-inferior, superior and posterior labral tear were found in 21 (95%), 5 (22%) and 7 (32%) patients respectively. MRA showed a sensitivity of 95%, and a specificity of 100% for the detection of the antero-inferior labral tears. The sensitivity of MRA for the detection of superior, middle and inferior glenohumeral ligament tear was 83%, 80% and 86% with a specificity of 100%, 71% and 93% respectively. MRA was 100% sensitive for the detection of rotator cuff injuries and detection of bony lesions like Hill-Sach's and bony Bankart's lesion. CONCLUSIONS: MRA is a sensitive and specific modality for evaluation of anterior shoulder instability.

[ role of arthrography inthe management of congenital dislocation of the hip]

Arthrography has a well established role in the management of congenital dislocation [dysplasia] of the hip [CDH]. This paper includes a brief historical review of the uses of arthrography and the opinions of experienced clinicians. Arthrography plays an important role in confirming concentricity of closed reduction in the management of CDH and reduces the incidence of avascular necrosis [AVN]. Arthrography is used in 2-3 cases of CDH every week at the King Khalid University Hospital [KKUH]. The methods of arthrography and possible complications are discussed according to the experience of the authors at the KKUH

Anthrographie opaque dans les derangements internes du genou (a propos de 200 cas)

A partir d'une etude prospective portant sur 7 ans; 2000 cas de derangements internes du genou ont ete analyses. Les lesions sont frequentes chez les sujets jeunes de sexe masculin (87 pour cent) avec pour cause essentielle les traumatismes surtout lors de la pratique du football. Les resultats arthrographiques revelent l'atteinte frequente des menisques surtout avec une predominance des fissurations