Reproducibility of MRI in the diagnosis of meniscal ramp lesions: an inter-observer study.

BACKGROUND: Meniscal ramp lesions have gained much prominence in recent years due to a significant increase in their diagnosis and their important biomechanical involvement in the knee. A new proposed classification of these lesions has recently been published. PURPOSE: To evaluate the reproducibility of the new classification of meniscal ramp lesions recently published using magnetic resonance imaging (MRI). MATERIAL AND METHODS: A total of 249 post-traumatic knee MRI studies were evaluated by three musculoskeletal radiologists independently. Patients with an anterior cruciate ligament (ACL) tear on MRI in addition to a recent history of trauma to the knee for <12 months were included in the study, for a total of 95. We carried out an inter-observer concordance study to analyze whether the new classification is reproducible to detect meniscal ramp lesions and to classify them into their different types. RESULTS: Among our study cohort of 95 patients, we found 47 (49.5%) ramp lesions. In the inter-observer study, we obtained a good concordance (k = 0.733) in the detection of these lesions and an excellent one (k = 0.843) when the type of lesion is described. CONCLUSION: This study demonstrates that the new classification of meniscal ramp lesions has good reproducibility on MRI.

Spanish Consensus Statement: The Treatment of Muscle Tears in Sport.

On the 21st of March, 2015, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair. The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms-without inhibiting these from the early stages of the recovery period-all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain.

Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 1: clinical efficacy and safety.

OBJECTIVES: For trigger digits, intrasheath sonographically guided first annular (A1) pulley release has shown safety and effectiveness in cadavers. This clinical study describes sonographically guided A1 pulley release results in terms of resolution of symptoms, safety, and functional recovery. METHODS: Sonographically guided A1 pulley release (11-MHz probe) was used in 48 digits of 48 patients prospectively followed for 11.3 months and examined 1, 3, and 6 weeks, 3 and 6 months, and 1 year later. Resolution of triggering (primary variable of interest) was expressed as the "success rate" per digit. The time for taking postoperative pain killers, range of motion recovery, grip strength, QuickDASH test scores, return to normal activities (including work), cosmetic results, satisfaction, and complications were assessed. RESULTS: The success rate was 100%, and no cases recurred. Mean times were 1.9 days for taking pain killers, 6.6 days for returning to normal activities, and 9.9 and 3.8 days for complete extension and flexion recovery, respectively. Mean QuickDASH scores were 39.8 preoperatively and 7.8, 1.7, and 0 after 6 weeks, 6 months, and 1 year postoperatively. Grip strength reached greater than 90% of the individual's normal strength by the sixth week in men and by the third month in women (P < .001). Radial digital nerve numbness developed in 1 finger, which disappeared by the third week. No other complications were noted. All wounds were cosmetically excellent, and final satisfaction was excellent or good in 98%. CONCLUSIONS: With adequate anatomic knowledge, technical training, and a basic ultrasound machine, sonographically guided A1 pulley release can be performed safely and successfully, offering an alternative to classic open surgery in the ambulatory setting.

Physiological response of beach lifeguards in a rescue simulation with surf.

The objective of this study was to examine the physiological response of 14 lifeguards in a swimming pool simulation with 1.7 m waves and to study the efficiency of the torpedo buoy. The rescue time was determined with and without material, as were lactate levels, heart rate and VO(2max). The results obtained showed a VO(2 max) rate of 3.4 +/- 0.8 l/min without equipment and 3.3 +/- 0.8 l/min with equipment. Moreover, the time taken to swim towards the victim without equipment decreased by 7.7 s, while towing time was reduced by 10.8 s if said equipment was used. These results show that aquatic rescue makes considerable physiological demands on the swimmer and they also provide important data on the type of training and aptitude levels required by individuals wishing to join these rescue groups. The equipment currently used has a negative affect on the swim. STATEMENT OF RELEVANCE: The study shows that beach rescues make very high physiological demands on rescuers, thus underlining the need to perform entry tests for these highly demanding rescue teams. The auxiliary equipment is a help in the return time of rescue. However, it causes delays in the approach to the victim.