Middle patellar tendon to posterior cruciate ligament (PT-PCL) and normalized PT-PCL: New magnetic resonance indices for tibial tubercle position in patients with patellar instability.

BACKGROUND: To demonstrate whether the distance between the middle point of the patellar tendon and posterior cruciate ligament (PT-PCL) calculated on a single axial MR image could be an alternative measure to tibial tubercle-PCL (TT-PCL) distance for TT lateralization without the need of imaging processing. To show that normalization of PT-PCL (nPT-PCL) against the maximum diameter of the tibial plateau may help to identify patients with patellar instability (PI). METHODS: MR scans of 30 patients (13 females, age 32 ±â€¯13 years) with known PI and 60 patients (31 females, age 39 ±â€¯19 years) with no history of PI were reviewed. Two operators calculated TT-PCL, and PT-PCL nPT-PCL. Intraclass correlation coefficient, Student's t-test, Receiver Operator Characteristic curves, Spearman's Rho and McNemar's test were used. RESULTS: Interobserver reproducibility was 0.894 for PT-PCL for TT-PCL (95% CI = 0.839-0.930) and 0.866 for TT-PCL (95% CI = 0.796-0.912). The PT-PCL was 23.5 ±â€¯3.8 mm in patients and 20.0 ±â€¯2.7 mm in controls (P < 0.001). The TT-PCL was 22.9 ±â€¯3.9 mm in patients and 20.5 ±â€¯2.7 mm in controls (P = 0.002). Correlation between the PT-PCL and TT-PCL was R = 0.838, P < 0.001. The PT-PCL had 66.6% (95% CI = 0.542-0.790) diagnostic yield. The nPT-PCL was significantly higher in patients (0.302 ±â€¯0.03) than controls (0.271 ±â€¯0.03; P < 0.001) with 73.9% (95% CI = 0.628-0.851) diagnostic yield. CONCLUSION: The PT-PCL correlated with TT-PCL, with 66.6% diagnostic yield. The nPT-PCL may represent an additional index, with 73.9% diagnostic yield.

Autologous platelet gel for tissue regeneration in degenerative disorders of the knee.

BACKGROUND: The refinement of the use of platelet-derived growth factors that has occurred over the last decade has led to a broadening of the fields of use, in particular for new treatments in orthopaedics aimed at improving tissue regeneration. MATERIALS AND METHODS: Twenty-seven patients, aged between 18 and 81 years, with a diagnosis of degenerative joint disease lasting for more than 1 year were treated. The patients were divided into two groups, one with arthritis of the knee, the other with degenerative cartilage disease of the knee. Both groups were treated with a therapeutic protocol consisting of a cycle of three infiltrations of platelet-rich plasma at weekly intervals.The extemporaneous preparation was made from a sample of about 8 mL of venous whole blood collected into a specific Fibrin Polymer 2 test-tube from RegenLab(®) and centrifuged before addition of calcium gluconate.During the initial pre-treatment evaluation, specific questionnaires were administered, the Numerical Rating Scale (NRS) for subjective measurement of pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); these assessments were repeated 7 days after the end of the treatment and at 6 months during the follow-up. RESULTS: The parameters evaluated improved in both groups after treatment and there was a further improvement after 6 months of follow-up; furthermore, there was a substantial decrease in pain right after the first infiltration. DISCUSSION: The patients were treated on an out-patient basis by a specifically created multidisciplinary team comprising a transfusion specialist, an orthopaedist and a radiologist, who collaborate in a symbiotic manner. The out-patient protocol exploits the regenerative properties of platelet-rich plasma, which is a low cost treatment; in practice, a diagnostic-therapeutic programme of lower intensity, but of high technical and professional quality is created. The strategy also reduces both the number of hospital services and the pharmacological support required, thereby optimising the use of health care resources.

Real-time tissue elastography for testicular lesion assessment.

OBJECTIVES: To assess the ability of Real-time Elastography (RTE) to differentiate malignant from benign testicular lesions. METHODS: In 88 testicles ultrasound identified 144 lesions, which were examined by RTE. Elasticity images of the lesions were assigned the colour-coded score of Itoh (Radiology 2006), according to the distribution of strain induced by light compression. RTE findings were analysed considering shape (nodular/pseudo-nodular), size (<5 mm, 6-10 mm, >11 mm) and score (SC1-5) of the lesions. RESULTS: 93.7% of all benign lesions showed a complete elastic pattern (SC1). 92.9% of benign nodules <5 mm and 100% of the pseudonodules showed a nearly complete elastic pattern (mainly SC1). 87.5% of malignant nodules showed a stiff pattern (SC4-5). RTE gave 87.5% sensitivity, 98.2% specificity, 93.3% positive predictive value, 96.4% negative predictive value and 95.8% accuracy in differentiating malignant from benign lesions. CONCLUSIONS: RTE is a useful technique in assessing small testicular nodules and pseudo-nodules. This is relevant in clinical practice allowing expectant management in RTE selected cases. The role of RTE seems less relevant for larger lesions because most of them are malignant at clinical and ultrasound assessment, limiting RTE to simply confirmation role. KEY POINTS: An emerging role for Elastography in allowing surveillance for small testicular lesions. Elastography can better differentiate benign from malignant testicular lesions. Follow up can be reduced for elastic testicular lesions at Elastography.