Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum.

OBJECTIVE: The purpose of this study was to compare oblique axial MR arthrograms obtained with the patient's shoulder in abduction and external rotation (ABER) position with conventional axial MR arthrograms obtained with the patient's arm in neutral position and the shoulder not rotated in revealing tears of the anterior glenoid labrum (AGL). SUBJECTS AND METHODS: MR arthrography of the shoulder that included an additional oblique axial imaging sequence with the patient in the ABER position was performed in 256 patients. Assessment of AGL integrity with patients in both conventional axial and ABER positions was made before surgery. These assessments were compared with the surgical findings. RESULTS: Of the 92 patients who underwent surgery, AGL tears were found in 27. Conventional axial MR arthrograms revealed 13 tears (sensitivity, 48%; specificity, 91%). A separate review of MR arthrograms obtained with patients in the ABER position revealed 24 tears (sensitivity, 89%; specificity, 95%). Reviewed together, axial MR arthrograms and MR arthrograms obtained with patients in the ABER position revealed 26 tears (sensitivity, 96%; specificity, 97%). CONCLUSION: Oblique axial MR arthrograms obtained with the patient's shoulder in the ABER position were significantly more sensitive in revealing AGL tears (p = .005) than were conventional axial MR arthrograms obtained with the patient's aim in a neutral position and the shoulder not rotated.

Indications for bilateral total knee replacement.

A total of 64 patients with clinical and radiographic signs of bilateral knee arthritis were evaluated based on multiple associated variables including complications, community ambulatory levels, and timing of staged knee replacement. A pain/dysfunction categorization based on initial presentation was established so that temporal progression of symptoms could be documented. Two surgical groups were represented: simultaneous bilateral total knee replacement and staged bilateral knee replacement. The findings in this study indicate that a patient with equally painful knees should undergo simultaneous bilateral total knee arthroplasty. If a patient has bilateral disease but only one knee is symptomatic, surgery should be performed on only the painful knee. If both knees are symptomatic, but one knee is much more painful than the other, the choice of treatment must be individualized based on the patient's medical health, symptoms, type of fixation used, and Charnley activity classification.

Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: use of a cannulated reduction system.

A prospective study was performed on 16 patients with lateral tibial plateau fractures. All injuries were associated with alpine or cross-country skiing. Included in the study were those patients with an articular surface depression of > or = 2 mm with radiographic findings consistent with the AO/ASIF classification of tibial plateau fractures (41 B2.2/B3.1). A combined procedure was performed with arthroscopic visualization of the knee joint and utilization of a cannulated plateau elevator. All fractures were reduced with this device with subsequent autogenous bone graft and, when indicated, transverse cancellous lag screw fixation. Follow-up was 1-6.5 years for the 16 patients, with all but two reporting resumption of activity to preinjury levels.