Predictive factors of effective tibial nerve release in tarsal tunnel syndrome.

BACKGROUND: Factors that may affect surgical decompression results in tarsal tunnel syndrome are not known. METHODS: A retrospective single-center study included patients who had undergone surgical tibial nerve release. The effectiveness of decompression was evaluated according to whether the patient would or would not be willing to undergo another surgical procedure in similar preoperative circumstances. RESULTS: The patients stated for 43 feet (51%) that they would agree to a further procedure in similar circumstances. Six feet with space-occupying lesions on imaging had improved results, but neurolysis failed in 9 feet with bone-nerve contact. Neurolysis was significantly less effective when marked hindfoot valgus (p = 0.034), varus (p = 0.014), or fasciitis (p = 0.019) were present. CONCLUSIONS: If imaging reveals a compressive space-occupying lesion, surgery has a good prognosis. In feet with static hindfoot disorders or plantar fasciitis, conservative treatment must be optimized. Bone-nerve contact should systematically be sought.

Comparison of resorption and remodeling of bioabsorbable interference screws in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of the study was to evaluate the influence of ß-tricalcium phosphate (ß-TCP) content on absorption rate and osteoconductive behavior of ß-TCP/poly-L-lactic acid (PLLA) interference screws for anterior cruciate ligament (ACL) reconstruction. The authors compared two biocomposite ß-TCP/PLLA screws containing 30 % (30TCP) and 60 % (60TCP) ß-TCP (Ligafix®, SBM), respectively, used in ACL reconstruction with patellar tendon (BPTB) and hamstrings (HS) autografts. METHODS: Twenty-eight knees with a 30TCP screw and 25 knees with a 60TCP screw were retrospectively included. Mean follow-up period was 37.5 months (range, 29-45 months). Post-operatively, all patients were examined clinically, had stress X-rays to measure anterior tibial translation and computed tomography (CT) to determine screw tract density, osteoconductivity and completed functional scores. RESULTS: Clinical evaluation and functional scores were similar for both groups. There was no case of tunnel widening, cyst formation, increased inflammatory process or osteolysis. Both types of screws evidenced a decrease of Hounsfield units (HU) density over time (p < 0.001). The 60TCP screw resorbed more rapidly than the 30TCP (-62 vs -52 % of initial HU density respectively, p < 0.01) at latest follow-up. At three years, 97 % of the 30TCP and 96 % of the 60TCP screws showed osteoconductivity according to the Barber-Dockery's architectural score. CONCLUSIONS: Both types of screws showed considerable osteoconductivity at the site of the screw tract. The majority of the 30 % ß-TCP screws were fully resorbed and osteointegrated during the fourth postoperative year. The clinical results are good-to-excellent for both groups. The addition of 30 % or 60 % ß-TCP in the biocomposite screw did not adversely affect clinical outcome and it minimized the inflammatory process. The material with the highest ß-TCP content was absorbed more rapidly, supporting the hypothesis that increased ß-TCP content in ß-TCP/PLLA biocomposite material resulted in enhanced absorption rate of interference screws used in ACL reconstruction without affecting fixation strength. LEVEL OF EVIDENCE: Level IV, Therapeutic case series.

Unknown Tendons, Muscles and Nerves of the Shoulder: Proposal for a Standardized Ultrasound-guided Examination, a "mini GEL" Experience.

Thanks to its excellent spatial resolution and dynamic aspect, ultrasound of the shoulder allows an optimal evaluation of tendon, muscle and nerve' structures in shoulder pain. Through this article and owing to inter-observer reproducibility, we will describe an ultrasound standardized protocol (posterior, anterior, global plane) in basic first ultrasounds (ie without tendon abnormality of the supra/infra spinatus, the biceps and subscapularis).

A novel lesion of the infraspinatus characterized by musculotendinous disruption, edema, and late fatty infiltration.

Isolated, atraumatic rupture of the infraspinatus (IS) with associated edema of its muscle is a previously undescribed lesion. We retrospectively identified 19 patients with MRI detected, isolated lesions of the IS tendon or musculotendinous junction with associated muscle edema. The average age at the time of presentation was 47.7 years (range, 30-66). There were 15 females and 4 males. Fourteen patients were treated nonoperatively; 5 underwent an open repair. All patients underwent clinical and MRI follow-up at an average of 50.3 months (range, 24-79) after the initial MRI. Constant scores were recorded as was a detailed physical examination. Two patients had a clear history of trauma with no preceeding shoulder problems; 17 had a history of chronic shoulder pain. We identified disruption occurring within the IS tendon in 9 patients and at the level of the musculotendinous junction in 8, while the level of disruption was inconclusive in 2. No patient had other full thickness tears. Electromyographic studies were normal, as were nerve conduction velocities in the suprascapular nerve in the 15 patients tested. There was a significant improvement in the Constant score comparing the score at presentation (53 points; range, 24-69) with the score at final follow-up (67.2 points; range, 28-95; P = .009). There was no significant benefit seen comparing the gain in the Constant score between those treated operatively and nonoperatively (P = .61). All 19 patients had progressed to stage 4 fatty infiltration of the IS muscle at latest follow-up.

High- versus low-field MR imaging.

The role of MR imaging as a noninvasive technique in the detection and evaluation of musculoskeletal diseases is unquestionable. Most of the studies reported in the literature are based on high-field MR imaging. Initial studies performed with low-field-strength have reported unsatisfactory results in the assessment of the musculoskeletal system. Recent improvements, however, have generated a renewed interest in low-field-strength MR imaging. This article presents the principal applications and results published in the literature.

End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes.

PURPOSE: To investigate the frequency and distribution of end plate marrow signal intensity changes in an asymptomatic population and to correlate these findings with patient age and degenerative findings in the spine. MATERIALS AND METHODS: MR imaging studies of the lumbosacral (LS) spine in 59 asymptomatic subjects were retrospectively reviewed by 2 musculoskeletal radiologists to determine the presence and location of fat-like and edema-like marrow signal changes about the end plates of the L1-2 through L5-S1 levels. The presence of degenerative changes in the spine was recorded as was patient age. Descriptive statistics were utilized to determine the frequency and associations of end plate findings and degenerative changes in the spine. Interobserver variability was determined by a kappa score. Binomial probability was used to predict the prevalence of the end plate changes in a similar subject population. The Fisher exact test was performed to determine statistical significance of the relationship of end plate changes with degenerative changes in the spine, superior versus inferior location about the disc and age of the patient population. RESULTS: Focal fat-like signal intensity adjacent to the vertebral end-plate was noted in 15 out of 59 subjects by both readers, and involved 38 and 36 out of 590 end plates by readers 1 and 2, respectively. Focal edema-like signal intensity adjacent to the vertebral end plate was noted in 8 out of 59 subjects by both readers and involved 11 and 10 out of 590 end plates by readers 1 and 2, respectively. Either fat or edema signal intensity occurred most often at the anterior ( p<.05) aspects of the mid-lumbar spine and was seen in an older sub-population of the study ( p<.05). CONCLUSION: End plate marrow signal intensity changes are present in the lumbar spine of some asymptomatic subjects with a characteristic location along the spine and in vertebral end plates.

Posterior tibial tendon and subtalar joint complex in rheumatoid arthritis: magnetic resonance imaging study.

OBJECTIVE: To observe by magnetic resonance imaging (MRI) the pathologic changes in the posterior tibial tendon (PTT), subtalar joint complex (STJC), and sinus tarsi in patients with rheumatoid arthritis (RA), and if possible to determine their involvement in the course of the disease. METHODS: Sixty-seven rheumatoid feet with mid and hindfoot pain underwent MRI with gadolinium injection. Localized enhancement and anatomic lesions were assessed in the 3 sites. RESULTS: On MRI, PTT involvement was seen to be more frequent than STJC or sinus tarsi. When there was gadolinium enhancement of the PTT there was no sinus tarsi enhancement (p = 0.014). Interosseous talocalcaneal ligament rupture was correlated with disability (p = 0.031). CONCLUSION: In RA patients with hindfoot pain, PTT synovitis is observed when there is no sinus tarsi synovitis.

Rheumatoid flat foot and deformity of the first ray.

OBJECTIVE: To study the relationship between flat foot and forefoot deformities in rheumatoid arthritis (RA) in order to improve understanding of the progression of deformity and thus provide more appropriate treatment. METHODS: Anteroposterior and lateral weight-bearing radiographs were obtained of 308 feet of patients with RA and 202 feet of patients with neck pain (control feet). RESULTS: In women with RA, we observed with disease duration an increased frequency of flat foot that was correlated with first ray deformity (chiefly metatarsus primus adductus) and severe stages of disability. Flat foot increased very markedly after 3-4 years of disease duration. In control women, flat feet were more frequent after the age of 50 years. CONCLUSION: In RA the inflammatory and mechanical factors leading to foot deformity must receive early medical treatment to avoid progressive hindfoot deformities that lead to disability.