RESUMEN
BACKGROUND: Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited. PURPOSE: To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan. RESULTS: A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with P < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with P > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS (P = .045) and iHOT-12 (P = .037) scores but a comparable survival (P > .05) at long-term follow-up compared with those who did not have loose bodies. CONCLUSION: Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.
Asunto(s)
Artroscopía , Condromatosis Sinovial , Articulación de la Cadera , Medición de Resultados Informados por el Paciente , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/diagnóstico por imagen , Estudios de Seguimiento , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Estudios Longitudinales , Resultado del Tratamiento , Anciano , Imagen por Resonancia Magnética , Dimensión del DolorRESUMEN
PURPOSE: To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ). METHODS: An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. RESULTS: Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons. CONCLUSION: OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.
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Cuerpos Libres Articulares , Osteocondritis Disecante , Trastornos de la Articulación Temporomandibular , Humanos , Osteocondritis Disecante/diagnóstico por imagen , Osteocondritis Disecante/terapia , Estudios Retrospectivos , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Radiografía , Imagen por Resonancia Magnética/métodos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/patología , Cuerpos Libres Articulares/cirugíaRESUMEN
BACKGROUND: The synovial chondromatosis is an uncommon proliferative metaplastic process of the synovial cells that can develop in any synovial joint. An isolated primary chondromatosis of the posterior compartment of the knee is uncommon and few cases are reported in literature. Our purpose is to describe a rare case of primary chondromatosis of the knee posterior compartment and report the arthroscopic loose bodies excision through a difficult posteromedial portal, avoiding the use of the accessory posterior portal, most commonly reported for approaching this disease. CASE PRESENTATION: We report a rare case of a 35-year-old Caucasian male patient with diagnosis of chondromatosis of the posterior knee compartment. The radiographs showed multiple loose bodies of the posterior compartment. The MRI revealed minimal synovial hypertrophy areas, multiple osteophytes in the intercondylar notch, and loose bodies in the posteromedial compartment. The CT allowed us to assess the bony structures, the morphology of the intercondylar notch, and the presence osteophytes of the medial and lateral femoral condyles. The CT images were crucial to plan how to reach the posterior compartments of the knee through a trans-notch passage. The patient underwent arthroscopic surgery using anteromedial, anterolateral, and posteromedial portals. The tunneling through the intercondylar osteophytes was performed to allow the arthroscope to pass trans-notch. To avoid additional accessory posterior portals, we used a 70° arthroscope to better explore the posterior knee compartment. The cartilage-like bodies were removed and synovectomy of the inflamed areas was performed. The clinical and radiological follow-up was 12 months and the patient showed excellent clinical outcomes, returning to his activities of daily living and sport activity. CONCLUSION: Our case report highlights the importance of the arthroscopic approach to treat synovial chondromatosis, despite the involvement of the posterior compartment of the knee. An optimal preoperative imaging allows to plan for the proper surgical procedure even in patients with severe osteoarthritis. Moreover, the adoption of an intercondylar notch tunneling and a 70° arthroscope can help surgeons to better explore the posterior knee compartment, avoiding an accessory posterior trans-septal portal. Therefore, a synovectomy of the inflamed foci may be useful to prevent recurrence.
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Condromatosis Sinovial , Cuerpos Libres Articulares , Humanos , Masculino , Adulto , Actividades Cotidianas , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Sinovectomía , Artroscopía/métodosRESUMEN
Primary synovial chondromatosis is a rare, benign proliferative disease of the joint synovium, tenosynovium, or bursal lining, in which cartilage metaplasia leads to the development of multiple intra-articular and periarticular loose osteocartilaginous bodies. This disease usually involves larger joints (knee, hip, elbow, and shoulder), but it has also rarely been reported in the hand. Patients with this disease complain of pain, swelling, nodules, and decreased range of motion of the affected joint. Due to its nonspecific symptoms and low prevalence, this disease often goes misdiagnosed, leading to delays in patient treatment. In the literature to date, there are only a few reports of primary synovial chondromatosis. In this case report, we present a patient with a rare case of primary synovial chondromatosis localized to right small finger distal interphalangeal joint.
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Condromatosis Sinovial , Condromatosis , Cuerpos Libres Articulares , Humanos , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Codo , DedosRESUMEN
The aim of this paper was to investigate the clinical and magnetic resonance imaging (MRI) features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Fourteen patients with SC of the TMJ were included in the study. Clinical and MRI features were analysed and divided into three types based on MRI classification: type I with loose bodies, type II with homogeneous masses, and type III with a mixture of loose bodies and homogeneous masses. All SCs occurred in the superior compartment of the TMJ. There were two patients (14%) categorised as type I, five (36%) as type II and seven (50%) as type III. Four patients (29%) had disc perforation, and nine had bone erosion; among those nine, seven (78%) had type III and two (22%) type II. Histological examination showed inflammation and calcification in the synovial membrane and, and cartilage of the hyaline type in all cases. MRI has advantages in the diagnosis of SC.
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Condromatosis Sinovial , Cuerpos Libres Articulares , Trastornos de la Articulación Temporomandibular , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/patología , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/patología , Imagen por Resonancia Magnética/métodos , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/diagnósticoAsunto(s)
Condromatosis Sinovial , Cuerpos Libres Articulares , Artroscopía , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugíaRESUMEN
No abstract available.
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Cuerpos Libres Articulares , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , RadiografíaRESUMEN
Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.
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Condromatosis Sinovial , Cuerpos Libres Articulares , Trastornos de la Articulación Temporomandibular , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Femenino , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Persona de Mediana Edad , Membrana Sinovial , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugíaRESUMEN
OBJECTIVES: The present study aimed to clarify the characteristic computed tomography (CT) features that indicate synovial chondromatosis (SC) with a few small calcified bodies or without calcification on panoramic images, and to discuss their differences from the features of temporomandibular disorder (TMD). METHODS: Panoramic and CT images from 11 patients with histologically verified SC of the temporomandibular joint were investigated. Based on the panoramic images, the patients were classified into a distinct group (5 patients) with typical features of calcified loose bodies and an indistinct group (6 patients) without such bodies. On the CT images, findings for high-density structures suggesting calcified loose bodies, joint space widening, and bony changes in the articular eminence and glenoid fossa (eminence/fossa) and condyle were analyzed. RESULTS: All 5 distinct group patients showed high-density structures on CT images, while 2 of 6 indistinct group patients showed no high-density structures even on soft-tissue window CT images. A significant difference was found for the joint space distance between the affected and unaffected sides. A low-density area relative to the surrounding muscles, suggesting joint space widening, was observed on the affected side in 2 indistinct group patients. All 11 patients regardless of distinct or indistinct classification showed bony changes in the eminence/fossa with predominant findings of extended sclerosis and erosion. CONCLUSION: Eminence/fossa osseous changes including extended sclerosis and erosion may be effective CT features for differentiating SC from TMD even when calcified loose bodies cannot be identified.
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Condromatosis Sinovial , Cuerpos Libres Articulares , Trastornos de la Articulación Temporomandibular , Condromatosis Sinovial/diagnóstico por imagen , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: This retrospective study summarized the clinical, radiographic, and arthroscopic manifestation of synovial chondromatosis (SC) of the hip, along with the post-operative effect to discuss the curative effect of arthroscopic management of hip SC. METHODS: Twenty-one patients who underwent arthroscopic surgery from the same surgeon for hip SC were followed up for an average of 45 months. T-shaped capsulotomy was routinely performed in each case. Visual analog scale, range of motion, modified Harris Hip Score, and International Hip Outcome Tool score were collected preoperatively and at the time of the latest follow-up. All patients' demographics, radiographs, and arthroscopic images were collected to summarize and conclude the similarities and differences of their manifestation. RESULTS: Large wedged clumps of loose bodies demonstrated distinguishable radiographic, arthroscopic appearance and demanded a different surgical strategy. Postoperative scores were all significantly improved. One case of residual pain and two cases of residual loose bodies with no symptom related were reported at the final follow-up. All but one patient were satisfied with the outcome. CONCLUSION: Arthroscopy treatment of hip SC with T-shaped capsulotomy has demonstrated a good result in terms of clinical outcome score, recurrence rate, and complication rate. On the basis of this study, we concluded the clinical performance of large wedged clumps of loose bodies of hip SC.
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Artroscopía/métodos , Condromatosis Sinovial/cirugía , Articulación de la Cadera/cirugía , Cuerpos Libres Articulares/cirugía , Capsulotomía Posterior/métodos , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/patología , Condromatosis Sinovial/fisiopatología , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/patología , Cuerpos Libres Articulares/fisiopatología , Masculino , Satisfacción del Paciente , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Primary synovial chondromatosis is a rare benign disease that occurs in the joint mucosa. CASE PRESENTATION: In this case report, a 14-year-old gymnast sustained pain in both elbows for 2 months with limited elbow joint activity. The initial diagnosis of bilateral elbow synovial chondromatosis was performed by physical examination and imaging report. Later, the patient was treated with open surgery on both sides of the elbow, including all loose bodies were removed out and the proliferative synovia were cut off. Histopathology reports confirmed synovial chondromatosis. CONCLUSIONS: The report introduced a case about synovial chondromatosis in bilateral elbow found in a 14-year-old girl, which is rarely involved in bilateral elbow and rarely found in adolescents. This case report aims to provide a treatment option for surgeons in similar situations.
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Condromatosis Sinovial/patología , Articulación del Codo/patología , Cuerpos Libres Articulares/patología , Rango del Movimiento Articular/fisiología , Adolescente , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Femenino , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Examen Físico , RadiografíaRESUMEN
BACKGROUND: Osteochondritis dissecans (OCD) is estimated to occur in 2% to 7% of patients with Legg-Calvé-Perthes disease (LCPD). Unstable osteochondral fragments secondary to LCPD may produce mechanical symptoms requiring surgical intervention. Reattachment of the fragment with open reduction and internal fixation (ORIF) may provide good clinical outcomes. The purpose of this study is to report short-term clinical and radiographic results of ORIF for the treatment of symptomatic osteochondral lesions resulting from LCPD. METHODS: Clinical data including patient demographics and patient-reported outcome scores were collected prospectively. All patients underwent preoperative radiographs and magnetic resonance imaging confirming an unstable OCD fragment as well as postoperative radiographs at regular intervals. Indications for ORIF of the OCD fragment were hip pain and mechanical symptoms with radiographic evidence of LCPD and a magnetic resonance imaging demonstrating an OCD fragment of the femoral head. Osteochondral fragment instability was confirmed intraoperatively. Preoperative and postoperative physical examination findings were documented. All patients failed a course of nonsurgical treatment (activity modification, anti-inflammatories, and physical therapy). RESULTS: From a total of 64 consecutive patients treated with hip preservation surgery for LCPD, 7 patients with symptomatic OCD secondary to LCPD were treated with surgical hip dislocation and ORIF of the femoral head osteochondral fragment. OCD size lesion ranged from 200 to 625 mm. All patients reported marked clinical improvement, with resolution of both pain and mechanical symptoms. Radiographs at final follow-up demonstrated complete osteochondral fragment healing without implant failure. Mean follow-up was 4.6 years (range, 1.1 to 7.4 y). There was a significant postoperative improvement in measured internal rotation in flexion (5.0±5.0 to 16.4±9.8; P=0.02). Modified Harris Hip Score markedly improved from baseline to final follow-up (47.8 to 82.7; [INCREMENT]34.9; minimal clinically important difference, 11; P=0.002), with all patients meeting minimal clinically important difference for modified Harris Hip Score. There were no complications and no progression of osteoarthritis in all patients at final follow-up. CONCLUSIONS: We have demonstrated both predictable radiographic healing and marked clinical improvement following ORIF of symptomatic post-Perthes OCD lesions. We advocate ORIF for symptomatic osteochondral lesions as a first-line surgical treatment for these patients due to the advantages of native osteochondral tissue preservation, predictable healing, and marked clinical improvement. LEVEL OF EVIDENCE: Level IV-case series.
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Cabeza Femoral , Cuerpos Libres Articulares , Enfermedad de Legg-Calve-Perthes/complicaciones , Procedimientos Ortopédicos/métodos , Osteocondritis Disecante , Adolescente , Niño , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Osteocondritis Disecante/diagnóstico , Osteocondritis Disecante/etiología , Osteocondritis Disecante/fisiopatología , Osteocondritis Disecante/cirugía , Radiografía/métodos , Resultado del TratamientoRESUMEN
PURPOSE: To investigate (1) the prevalence, size, and location of acetabular ossicles in general population; (2) differentiation between the characteristic types of acetabular ossicles: unfused ossification centers (true os acetabuli), rim fractures, labral calcifications and loose bodies; and (3) correlation between acetabular ossicles, and femoroacetabular impingement (FAI) with symptoms. METHODS: Patients aged 16 to 60 years who underwent abdominal and pelvic computed tomography (CT) with non-orthopaedic indications in 2016 and patients who underwent hip arthroscopy surgery from 2010 to 2016 in our institution were included for asymptomatic and symptomatic groups, respectively. Two investigators evaluated CT images to find the prevalence, size, location of acetabular ossicles, and relationship with symptoms and FAI. We correlated them with types of ossicles. RESULTS: This study included 5684 patients with 11368 hips (2790 male and 2894 female; mean age, 44.3 years) for asymptomatic group, and 264 patients with 289 hips (171 male and 93 female; mean age, 34.4 years) for symptomatic group. The prevalence of ossicles in symptomatic and asymptomatic groups was 8.65% (25/289) and 3.33% (378/11,368), respectively. The distribution of ossicles types in general population were labral calcifications (55.09%), rim fractures (35.73%), unfused ossification center (1.24%), and loose bodies (7.94%). Labral calcification had the smallest size and mostly was asymptomatic. Rim fracture was correlated with FAI in general (83.33%; P < .001) but not with any types of FAI. Size of ossicles was related with symptom (895.28 vs 103.64 mm3; P < .001). CONCLUSIONS: The prevalence of acetabular ossicles in general population are 3.46%, with significantly higher prevalence of acetabular ossicles were found in symptomatic group (8.65% vs 3.33%). Size of acetabular ossicles was significantly associated with hip pain. Labral calcification was the most common type of acetabular ossicles. Significant relationship was found between rim fracture and FAI but not with any specific types of FAI. LEVEL OF EVIDENCE: Level III, Retrospective comparative study.
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Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Pinzamiento Femoroacetabular/epidemiología , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroscopía , Enfermedades Asintomáticas , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/cirugía , Estudios de Casos y Controles , Femenino , Pinzamiento Femoroacetabular/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/patología , Fracturas Óseas/cirugía , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/patología , Cuerpos Libres Articulares/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector , Osificación Heterotópica/cirugía , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: The primary symptoms of elbow osteoarthritis are the progressive development of stiffness along with pain at the end range of motion due to osteophyte impingement. Surgical treatment involves resecting these "bone stops". In the literature, these osteophytic lesions are more common than cartilage lesions, which suggests they may occur beforehand. The aim of our study was to confirm osteophytes are more common than cartilage lesions, and also to establish a link between these lesions and the functional outcomes. METHODS: This was a prospective multicenter (8 hospitals) study conducted in the context of a symposium of the Francophone Arthroscopy Society (SFA). Eighty-seven patients with elbow osteoarthritis treated by arthroscopic release were included. The clinical outcomes (range of motion in flexion, extension and pronation-supination; strength; pain at rest and during activity; satisfaction; Andrews and Carson score; QuickDASH, Patient-Rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Self-Evaluation Elbow (SEE) were determined before the procedure and at the 6-month follow-up visit. A standard radiographic assessment was done before the surgery and at the last follow-up visit. A CT arthrogram was done before the procedure. The presence of joint narrowing, osteophytes, filling of fossa along with secondary osteochondroma was evaluated in terms of their location, severity, size and/or number. The presence of radial head subluxation was recorded. The Bröberg & Morrey and Rettig & Hastings classification systems were applied. All the postoperative clinical data along with their change (difference between preoperative and postoperative values) were compared to the imaging findings. RESULTS: Osteophytes were found in 95% of our patients. They were located at the olecranon in 85% of cases and at the coronoid process in 81%. Filled fossae found in 94% of cases. The olecranon, coronoid and radial fossa were filled in 83%, 80% and 60% of elbows, respectively. On the initial X-rays, joint narrowing was found in 68% of elbows. CT arthrogram identified narrowing in 70% of cases. Narrowing was present in the humeroradial joint in 60% of cases and in the humeroulnar joint in 23% of cases. The presence of joint narrowing on CT arthrogram was a negative prognostic factor for pain during activity (p<0.05) along with the Quick DASH (p<0.01) and PREE (p<0.05). Involvement of the humeroradial joint impacted pain at rest (p<0.01). Narrowing of the humeroulnar joint was associated with worse outcomes in terms of pain at rest (p<0.05) and during activity (p<0.05), QuickDASH (p<0.005), MEPS (p<0.05), PREE (p<0.05) and the SEE (p<0.05). The presence of loose bodies before the procedure was associated with better outcomes in terms of pain at rest (p<0.05), QuickDASH (p<0.001), MEPS (p<0.001), Andrews & Carson score (p<0.05) and PREE (p<0.005). The osteoarthritis stage in the Bröberg & Morrey or the Rettig & Hastings classification systems did not impact the various clinical parameters or functional outcome scores. DISCUSSION/CONCLUSION: In the imaging work-up, signs of impingement (osteophytes and filling of fossa) are more common than signs of joint narrowing. The presence of humeroulnar and/or humeroradial impingement when there are no cartilage lesions visible may correspond to a pre-arthritic stage. The outcomes of arthroscopic release are better in elbows with isolated impingement than in those with cartilage lesions, especially at the humeroulnar joint. Excision of secondary osteochondromas is also an excellent surgical indication. Current classification systems cannot be used to determine the prognosis before arthroscopic release of elbow osteoarthritis cases. LEVEL OF EVIDENCE: III, Prospective multicenter observational cohort study.
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Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Artrografía , Artroscopía , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Articulación del Codo/fisiopatología , Humanos , Luxaciones Articulares/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Fuerza Muscular , Olécranon/diagnóstico por imagen , Osteoartritis/complicaciones , Osteoartritis/fisiopatología , Osteofito/diagnóstico por imagen , Dolor/etiología , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Pronación , Estudios Prospectivos , Rango del Movimiento Articular , Índice de Severidad de la Enfermedad , Supinación , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Articulación Atlantoaxoidea/patología , Cuerpos Libres Articulares/patología , Articulación Atlantoaxoidea/diagnóstico por imagen , Femenino , Humanos , Cuerpos Libres Articulares/diagnóstico , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Persona de Mediana EdadAsunto(s)
Bolsa Sinovial/diagnóstico por imagen , Cuerpos Libres Articulares/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Artroscopía , Bolsa Sinovial/patología , Femenino , Humanos , Cuerpos Libres Articulares/patología , Articulación de la Rodilla/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: The discoid lateral meniscus (DLM) in children often presents peripheral rim instability (PRI) and is susceptible to tear or subluxation, which manifests symptoms and leads to a poor prognosis. We aimed to investigate the association between preoperative clinical and MRI findings and the intraoperative findings of PRI. METHODS: Children and adolescents aged younger than 16 years who underwent surgical treatment for DLM were retrospectively reviewed. Cases of bucket-handle tear were not included because they would confound the stability of the peripheral rim. Total 60 knees from 47 children were included. PRI was additionally subdivided based on the location, such as anterior, middle, and posterior, during the investigation. RESULTS: In multivariate analyses, both central (inward) (P=0.004) and external (outward) (P=0.029) displacement of lateral meniscal margin, and peripheral tear of the anterior body (P=0.022) were significant predictors of PRI, regardless of the location. The predictive factors for PRI based on each location were female gender (P=0.004), subjective symptom of clicking sound (P=0.023), and central displacement of the anterior meniscal margin (P=0.034) for anterior PRI; flexion contracture >10 degrees (P=0.017) and peripheral tear of the middle body (P<0.001) for middle PRI; and central displacement of the posterior meniscal margin (P=0.036) and peripheral tears of the anterior (P=0.029) and middle bodies (P=0.047) for posterior PRI. CONCLUSIONS: We evaluated the preoperative clinical and MRI findings that predict PRI of pediatric DLM. Displacements of the DLM, not only centrally (inward) but also externally (outward), seem to be significant predictive factors for PRI. Furthermore, some clinical findings were associated with PRI, even predicting the locations. Although the actual surgical procedure should be determined by meticulous probing during arthroscopy, preoperative prediction of the presence and location of PRI would help decrease the risk of oversight during surgery. LEVEL OF EVIDENCE: Level III-Diagnostic Study.
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Artropatías/diagnóstico por imagen , Imagen por Resonancia Magnética , Meniscos Tibiales/diagnóstico por imagen , Lesiones de Menisco Tibial/diagnóstico por imagen , Adolescente , Niño , Preescolar , Contractura/etiología , Femenino , Humanos , Artropatías/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Meniscos Tibiales/anomalías , Meniscos Tibiales/cirugía , Periodo Preoperatorio , Estudios Retrospectivos , Rotura/diagnóstico por imagen , Factores Sexuales , Lesiones de Menisco Tibial/cirugíaRESUMEN
PURPOSE: We aimed to determine the factors that influence the symptoms of naviculo-cuneiform (NC) coalition using radiography and computed tomography (CT). METHODS: We retrospectively reviewed the radiographic and CT findings of 37 NC coalition cases. The existence of a large pit (depth >3 mm), irregular articular surface, joint space narrowing, dorsal bony spur, subchondral sclerosis, multiple subchondral bony cysts, and intra-articular loose body were evaluated on radiographs or CT. The size of the largest subchondral bony cyst was also measured using CT. All cases were divided into two subgroups according to the symptoms. Fisher's exact test was used to distinguish the factors influencing the symptoms. RESULTS: Twenty-three and fourteen feet were enrolled into the symptomatic and asymptomatic groups, respectively. The rates of the large pit on either radiograph (47.83 vs. 21.43%) or CT (65.22 vs. 28.57%) were significantly different between both groups ( p = 0.001). The mean size of the largest subchondral bony cyst on CT was also significantly greater in the symptomatic group (4.25 vs. 1.53 mm, p = 0.005). CONCLUSION: A large deep pit and huge subchondral bony cyst on the radiograph or CT can be related to symptoms for the patient with NC coalition. A CT is highly recommended for a more accurate evaluation in patients with NC coalition.
Asunto(s)
Artropatías/etiología , Cuerpos Libres Articulares/etiología , Osteofito/etiología , Huesos Tarsianos/anomalías , Huesos Tarsianos/diagnóstico por imagen , Adulto , Femenino , Humanos , Artropatías/diagnóstico por imagen , Cuerpos Libres Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteofito/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Evaluación de Síntomas , Tomografía Computarizada por Rayos XRESUMEN
An 18-year-old military cadet presented to a direct-access physical therapy clinic 3 days after sustaining a lateral patellar dislocation that self-reduced with extension of the knee. Suspecting a loose body, the physical therapist ordered radiographs, which did not demonstrate any associated fractures. Rapid disposition was required to determine her potential to participate in mandatory Army field training, so the patient was referred to an orthopaedic surgeon, who ordered magnetic resonance imaging to assess for intra-articular pathology. Magnetic resonance imaging demonstrated a full-thickness defect in the patellar cartilage at the medial facet, with a loose fragment in the suprapatellar pouch. J Orthop Sports Phys Ther 2019;49(1):36. doi:10.2519/jospt.2019.7599.