RESUMEN
Background: Four-dimensional computerized tomographies (4D-CTs) or motion CTs in elbow disorders have several potential advantages over conventional static imaging such as a reduction of misdiagnoses, a more targeted surgical approach, better patient understanding of their condition and potentially faster operative times. However, the radiation dose is higher than conventional static CT scans so this should be used judiciously. Our study reviews the current literature for 4D-CTs in dynamic elbow disorders and provides a technical note describing radiation-reduced targeted elbow 4D-CTs (te4D-CT) with two exemplar cases alongside our recommendations for when te4D-CTs are indicated. Methods: te4D-CTs are performed in a lateral decubitus elbow above head position. Preliminary static source axial cut CT obtained with subsequent sagittal and axial planes reconstruction and 3D reconstruction obtained, followed by scan performed in motion and reconstructed to 4D Component. te4D-CTs are taken for either flexion and extension (FE) or pronation and supination (PS) motions depending on the clinical pathology suspected following thorough clinical examination. Results: te4D-CT for PS and FE protocol scans had an effective radiation exposure dose of 0.53 and 0.95mSv, respectively, compared to 1.13-1.83 mSv in conventional elbow 4D-CTs. In addition, te4D-CTs have good diagnostic accuracy provided that the FE or PS pathology is identified carefully by the ordering physician. Conclusion: te4D-CT using isolated pronation and supination, or flexion and extension protocols does come with a significantly reduced radiation dose and can be of equal clinical yield compared with 4D-CTs.
RESUMEN
BACKGROUND: Cartilage defects are debilitating injuries that can reduce quality of life in patients. However, the poor regenerative properties of cartilage mean that cartilage repair remains challenging, and many methods have arisen to address that. Autologous matrix-induced chondrogenesis (AMIC®) is a popular technique to manage cartilage defects. Recent advances have allowed AMIC® to be done arthroscopically, instead of a mini-open arthrotomy approach. This systematic review and meta-analysis aims to investigate whether the arthroscopic approach to AMIC® provides better clinical outcomes than does the mini-open approach, in hopes of delineating a gold standard in cartilage repair. METHODS: With reference to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search of the following databases (PubMed, Embase, Scopus, and Cochrane Library) was performed on 26th October 2022 using a combination of the following search terms: "autologous matrix induced", "chondrogenesis", and "knee". A total of 390 studies were identified, of which, 24 studies were included in our final analysis. RESULTS: The arthroscopic approach achieves lower Visual Analogue Scale for pain scores. The International Knee documentation Committee) score and Knee Injury and Osteoarthritis Outcome Score were comparable between arthroscopic and open approaches. The open approach achieves a higher Magnetic Resonance Observation of Cartilage Repair Tissue score. Incidence of reported postoperative complications of revision surgery and knee stiffness was higher for the open approach than for the arthroscopic approach, whereas deep vein thrombosis was higher in the arthroscopic approach. CONCLUSION: The AMIC® repair outcomes indicate that the arthroscopic approach does not hold a distinct advantage over the open approach. The choice of approach should consider surgeon expertise, location of lesion, and patient-specific factors. LEVEL OF EVIDENCE: Systematic review and meta-analysis; Level III.
