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1.
Sensors (Basel) ; 21(18)2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34577474

RESUMO

BACKGROUND: The preparation of bone for the insertion of an osseointegrated transfemoral implant and the insertion process are performed at very low speeds in order to avoid thermal damages to bone tissue which may potentially jeopardize implant stability. The aim of this study was to quantify the temperature increase in the femur at different sites and insertion depths, relative to the final implant position during the stepwise implantation procedure. METHODS: The procedure for installation of the osseointegrated implant was performed on 24 femoral specimens. In one specimen of each pair, the surgery was performed at the clinically practiced speed, while the speed was doubled in the contralateral specimen. Six 0.075 mm K fine gauge thermocouples (RS Components, Sorby, UK) were inserted into the specimen at a distance of 0.5 mm from the final implant surface, and six were inserted at a distance of 1.0 mm. RESULTS: Drilling caused a temperature increase of <2.5 °C and was not statistically significantly different for most drill sizes (0.002 < p < 0.845). The mean increase in temperature during thread tapping and implant insertion was <5.0 °C, whereas the speed had an effect on the temperature increase during thread tapping. CONCLUSIONS: Drilling is the most time-consuming part of the surgery. Doubling the clinically practiced speed did not generate more heat during this step, suggesting the speed and thus the time- and cost-effectiveness of the procedure could be increased. The frequent withdrawal of the instruments and removal of the bone chips is beneficial to prevent temperature peaks, especially during thread tapping.


Assuntos
Prótese Ancorada no Osso , Implantes Dentários , Temperatura Corporal , Osso e Ossos , Temperatura Alta , Temperatura , Termômetros
2.
Clin Anat ; 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34374453

RESUMO

The intercondylar fossa ("intercondylar notch," IN) is a groove at the distal end of the femur, housing important stabilizing structures: cruciate ligaments and meniscofemoral ligaments. As the risk for injury to these structures correlates with changes to the IN, exact knowledge of its morphology, possible physiological and pathological changes and different approaches for evaluating it are important. The divergent ways of assessing the IN and the corresponding measurement methods have led to various descriptions of its possible shapes. Ridges at the medial and lateral wall are considered clinically important because they can help with orientation during arthroscopy, whereas ridges at the osteochondral border could affect the risk of ligament injury. Changes related to aging and sex differences have been documented, further emphasizing the importance of individual assessment of the knee joint. Overall, it is of the utmost importance to remember the interactions between the osseous housing and the structures within.

3.
Semin Musculoskelet Radiol ; 25(2): 274-276, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34082453

RESUMO

Robert Kienböck (1871-1953) may be regarded as one of the first musculoskeletal radiologists who began his clinical and scientific work 2 years after the discovery of X-rays. He lent his name to Kienböck's disease, a traumatic malacia and osteonecrosis of the lunate, and to several other eponyms of diseases, devices, and parameters in radiology and radiation oncology. With his meticulous analysis of radiographic images of the highest quality, he anticipated many theories that were proposed in later decades.


Assuntos
Osso Semilunar , Osteonecrose , Radiologia , Humanos , Masculino , Osteonecrose/diagnóstico por imagem , Radiografia , Radiologistas
4.
Children (Basel) ; 8(4)2021 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-33920492

RESUMO

(1) Background: The determination of body composition is an important method to investigate patients with obesity and to evaluate the efficacy of individualized medical interventions. Bioelectrical impedance-based methods are non-invasive and widely applied but need to be validated for their use in young patients with obesity. (2) Methods: We compiled data from three independent studies on children and adolescents with obesity, measuring body composition with two bioelectrical impedance-based devices (TANITA and BIACORPUS). For a small patient group, additional data were collected with air displacement plethysmography (BOD POD) and dual-energy X-ray absorptiometry (DXA). (3) Results: Our combined data on 123 patients (age: 6-18 years, body mass index (BMI): 21-59 kg/m²) and the individual studies showed that TANITA and BIACORPUS yield significantly different results on body composition, TANITA overestimating body fat percentage and fat mass relative to BIACORPUS and underestimating fat-free mass (p < 0.001 for all three parameters). A Bland-Altman plot indicated little agreement between methods, which produce clinically relevant differences for all three parameters. We detected gender-specific differences with both methods, with body fat percentage being lower (p < 0.01) and fat-free mass higher (p < 0.001) in males than females. (4) Conclusions: Both bioelectrical impedance-based methods provide significantly different results on body composition in young patients with obesity and thus cannot be used interchangeably, requiring adherence to a specific device for repetitive measurements to ascertain comparability of data.

5.
Semin Musculoskelet Radiol ; 24(4): 337-354, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32992363

RESUMO

Radiologic imaging is crucial for diagnosing and monitoring rheumatic inflammatory diseases. Particularly the emerging approach of precision medicine has increased the interest in quantitative imaging. Extensive research has shown that ultrasound allows a quantification of direct signs such as bone erosions and synovial thickness. Dual-energy X-ray absorptiometry and high-resolution peripheral quantitative computed tomography (CT) contribute to the quantitative assessment of secondary signs such as osteoporosis or lean mass loss. Magnetic resonance imaging (MRI), using different techniques and sequences, permits in-depth evaluations. For instance, the perfusion of the inflamed synovium can be quantified by dynamic contrast-enhanced imaging or diffusion-weighted imaging, and cartilage injury can be assessed by mapping (T1ρ, T2). Furthermore, the increased metabolic activity characterizing the inflammatory response can be reliably assessed by hybrid imaging (positron emission tomography [PET]/CT, PET/MRI). Finally, advances in intelligent systems are pushing forward quantitative imaging. Complex mathematical algorithms of lesions' segmentation and advanced pattern recognition are showing promising results.


Assuntos
Diagnóstico por Imagem/métodos , Febre Reumática/diagnóstico por imagem , Algoritmos , Meios de Contraste , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos
7.
J Bone Miner Res ; 35(10): 1893-1903, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32543706

RESUMO

Bone morphogenetic proteins (BMPs) are potent osteogenic proteins that induce new bone formation in vivo. However, their effect on bone healing in the trabecular bone surfaces remains challenging. We evaluated the safety and efficacy of recombinant human BMP6 (rhBMP6) applied within an autologous blood coagulum (ABC) in a surgically created wedge defect of the proximal tibia in patients undergoing high tibial osteotomy (HTO) for varus deformity and medial osteoarthritis of the knee. We enrolled 20 HTO patients in a randomized, placebo-controlled, double-blinded phase I/II clinical trial. RhBMP6/ABC (1.0 mg/10 mL ABC prepared from peripheral blood) or placebo (10 mL ABC containing excipients) was administered into the tibial wedge defects. Patients were followed for 0 to 24 months by clinical examination (safety) and computed tomography (CT) and serial radiographic analyses (efficacy). The results show that there were no detectable anti-rhBMP6 antibodies in the blood of any of the 20 patients at 14 weeks after implantation. During the 24 months of follow-up, there were no serious adverse reactions recorded. The CT scans from defects of patients treated with rhBMP6/ABC showed an accelerated bone healing compared with placebo at 9 weeks (47.8 ± 24.1 versus 22.2 ± 12.3 mg/cm3 ; p = 0.008) and at 14 weeks (89.7 ± 29.1 versus 53.6 ± 21.9 mg/cm3 ; p = 0.006) follow-up. Radiographic analyses at weeks 6 and 24 and months 12 and 24 suggested the advanced bone formation and remodeling in rhBMP6/ABC-treated patients. In conclusion, we show that rhBMP6/ABC at a dose of 100 µg/mL accelerated bone healing in patients undergoing HTO without serious adverse events and with a good tolerability compared with placebo alone. Overall, for the first time, a BMP-based osteogenic implant was examined against a placebo for bone healing efficacy in the trabecular bone surface, using an objective bone mineral density measurement system. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.


Assuntos
Proteína Morfogenética Óssea 6/uso terapêutico , Osteoartrite do Joelho , Osteotomia , Adulto , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/cirurgia , Proteínas Recombinantes/uso terapêutico , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
8.
Eur Radiol ; 30(10): 5684-5689, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32435929

RESUMO

OBJECTIVES: To evaluate ESR eGUIDE-the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities-for learning purposes in different clinical scenarios. METHODS: This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups. RESULTS: Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2, p = 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5, p = 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7, p = 0.66). CONCLUSION: The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended. KEY POINTS: • ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students. • This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE. • In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Diagnóstico por Imagem , Educação de Graduação em Medicina/métodos , Avaliação Educacional/métodos , Radiologia/educação , Estudantes de Medicina , Estudos Cross-Over , Europa (Continente) , Humanos , Aprendizagem , Radiografia , Ensino , Interface Usuário-Computador
9.
Disabil Rehabil ; 42(1): 2-7, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30328719

RESUMO

Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.


Assuntos
Estado Funcional , Neoplasias , Qualidade de Vida , Reabilitação , Áustria/epidemiologia , Humanos , Neoplasias/epidemiologia , Neoplasias/psicologia , Neoplasias/reabilitação , Melhoria de Qualidade , Reabilitação/métodos , Reabilitação/organização & administração , Reabilitação/tendências , Centros de Reabilitação/normas , Participação Social
10.
J Clin Med ; 8(12)2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31835340

RESUMO

Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities-then often called "pseudoerosions"-is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term "pseudoerosion", to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: "rheumatoid arthritis", "bone erosion", "ultrasonography", "radiography", "computed tomography" and "magnetic resonance imaging". Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. "Calcified zone" is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.

11.
Wien Klin Wochenschr ; 131(23-24): 585-586, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31832815

Assuntos
Medicina , Áustria
13.
Wien Klin Wochenschr ; 131(23-24): 587-598, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31502065

RESUMO

BACKGROUND: The aim of this study was to analyze radiographic imaging techniques and to quantify bone ossification in the osteotomy gap after high tibial osteotomy. MATERIAL AND METHODS: Study phase 1: high tibial osteotomy was performed on six lower extremities of human body donors and experimental X­rays and computed tomography (CT) scans were applied. Different techniques were evaluated by three specialists for best representation of the osteotomy gap. Study phase 2: optimized radiological techniques were used for follow-up on 12 patients. The radiographs were examined by 3 specialists measuring 10 different parameters. The CT scans were analyzed with semiautomatic computer software for quantification of bone ossification. RESULTS: The osteotomy gap was best represented in 30° of flexion in the knee and 20° internal rotation of the leg. There were significant changes of the medial width over time (p < 0.019) as well as of the length of fused osteotomy, the Schröter score, sclerosis, trabecular structure and zone area measurements. Sclerosis, medial width of the osteotomy and area measurements were detected as reproducible parameters. Bone mineral density was calculated using CT scans, showing a significantly higher value 12 weeks postoperatively (112.5 mg/cm3) than at baseline (54.6 mg/cm3). The ossification of the gap was visualized by color coding. CONCLUSION: Sclerosis and medial width of the osteotomy gap as well as area measurements were determined as reproducible parameters for evaluation of bone healing. Quantification of bone ossification can be calculated with CT scans using a semiautomatic computer program and should be used for research in bone healing.


Assuntos
Consolidação da Fratura , Osteotomia/métodos , Tíbia , Fraturas Ósseas , Humanos , Articulação do Joelho , Tíbia/cirurgia
14.
Wien Klin Wochenschr ; 131(21-22): 567-575, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31267163

RESUMO

BACKGROUND: The aim of this study was to present a practical concept focusing on typical aspects of regular physical activity, exercise and physical modalities for patients suffering from metastatic bone disease or multiple myeloma. METHODS: A narrative review of the relevant scientific literature and presentation of clinical experiences. RESULTS: In cancer patients with metastatic bone disease or multiple myeloma, pain is treated in an interdisciplinary and multimodal setting by using medication, radiotherapy and physical medical modalities (e.g. transcutaneous electrical nerve stimulation); however, modalities increasing local blood flow, such as ultrasound therapy, thermotherapy, massage, various electrotherapy options, are not performed at the site of the tumor. For physical activity and exercise, a suitable indication of the static and dynamic capacity of the affected skeletal structures is essential. This process includes strategies to maintain and improve mobility and independence. Individually tailored and adapted physical activity and exercise concepts (programs) within a multidisciplinary and interdisciplinary setting (tumor board) are used to manage the condition and bone load-bearing capacity of the patient. Typical clinical features and complications, such as pathological fractures in patients suffering from metastatic bone disease and additionally hypercalcemia, monoclonal gammopathy with bone marrow aplasia and risk of renal failure in patients with multiple myeloma have to be considered when planning supportive strategies and rehabilitation. CONCLUSION: In order to ensure the safety and effectiveness of regular physical activity, exercise, and physical modalities in patients with metastatic bone disease or multiple myeloma, typical contraindications and considerations should be noted.


Assuntos
Neoplasias Ósseas , Mieloma Múltiplo , Doenças Ósseas , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Terapia por Estimulação Elétrica , Humanos , Mieloma Múltiplo/patologia , Mieloma Múltiplo/terapia , Segunda Neoplasia Primária , Estimulação Elétrica Nervosa Transcutânea
15.
Sci Rep ; 9(1): 10305, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311994

RESUMO

Predicting pathologic fractures in femora with metastatic lesions remains a clinical challenge. Currently used guidelines are inaccurate, especially to predict non-impeding fractures. This study evaluated the ability of a nonlinear quantitative computed tomography (QCT)-based homogenized voxel finite element (hvFE) model to predict patient-specific pathologic fractures. The hvFE model was generated highly automated from QCT images of human femora. The femora were previously loaded in a one-legged stance setup in order to assess stiffness, failure load, and fracture location. One femur of each pair was tested in its intact state, while the contralateral femur included a simulated lesion on either the superolateral- or the inferomedial femoral neck. The hvFE model predictions of the stiffness (0.47 < R2 < 0.94), failure load (0.77 < R2 < 0.98), and exact fracture location (68%) were in good agreement with the experimental data. However, the model underestimated the failure load by a factor of two. The hvFE models predicted significant differences in stiffness and failure load for femora with superolateral- and inferomedial lesions. In contrast, standard clinical guidelines predicted identical fracture risk for both lesion sites. This study showed that the subject-specific QCT-based hvFE model could predict the effect of metastatic lesions on the biomechanical behaviour of the proximal femur with moderate computational time and high level of automation and could support treatment strategy in patients with metastatic bone disease.


Assuntos
Neoplasias Ósseas/secundário , Fraturas do Fêmur/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Fraturas do Fêmur/etiologia , Análise de Elementos Finitos , Fraturas Espontâneas/etiologia , Humanos , Masculino , Modelagem Computacional Específica para o Paciente , Tomografia Computadorizada por Raios X
17.
Obes Surg ; 28(11): 3454-3465, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29968187

RESUMO

BACKGROUND: Little is known about changes in bone mineral density (BMD) following weight loss after one-anastomosis gastric bypass (OAGB) and the role of serum vitamin D and its supplementation on bone metabolism. We evaluated BMD after OAGB as a function of vitamin D supplementation with respect to a minimum threshold of 25-hydroxy-vitamin-D [25(OH)D] concentration, which could prevent or decelerate an eventual bone loss. METHODS: Fifty bariatric patients who participated in the randomized controlled trial were included in this analysis. BMD and anthropometric measurements by DXA and laboratory parameters were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. RESULTS: OAGB resulted in a 36% total body weight loss with a decrease in body fat and an increase in lean body mass. A significant decrease in BMD was seen in lumbar spine by 7%, left hip 13%, and total body 1%, but not in forearm. Bone turnover markers increased significantly but with normal parathyroid hormone concentrations. Weight loss was not associated with changes in BMD. A serum 25(OH)D concentration > 50 nmol/l at T6 and T12 (adequate-vitamin-D-group; AVD) showed a significant lower bone loss, compared to the inadequate-vitamin-D-group (IVD; < 50 nmol/l). Lower bone loss in the left hip showed a strong correlation with higher 25(OH)D concentrations (r = 0.635, p = 0.003). CONCLUSION: These findings support a dose effect of vitamin D supplementation on bone health and suggest that 25(OH)D concentrations need to be above 50 nmol/l at least during the first postoperative year to decelerate bone loss in patients undergoing OAGB. CLINICAL TRIAL REGISTRY NUMBER AND WEBSITE: Clinicaltrials.gov (NCT02092376) at https://clinicaltrials.gov /. EudraCT (2013-003546-16) at https://eudract.ema.europa.eu /.


Assuntos
Densidade Óssea , Derivação Gástrica/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Vitamina D , Perda de Peso/fisiologia , Densidade Óssea/efeitos dos fármacos , Densidade Óssea/fisiologia , Suplementos Nutricionais , Humanos , Vitamina D/farmacologia , Vitamina D/uso terapêutico
18.
Am J Phys Med Rehabil ; 97(9): 651-658, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29613883

RESUMO

OBJECTIVE: The aim of the study was to follow both the structure- and function-related long-term course of shoulders that had been treated with therapeutic ultrasound for symptomatic calcific tendinitis. DESIGN: This is a long-term follow-up of 45 shoulders (37 patients) that had been treated for symptomatic calcific tendinitis with either a series of ultrasound or sham ultrasound 10 yrs ago. The main outcome variables were presence of calcium deposits and subacromial impingement on standardized x-ray imaging, shoulder symptoms (Binder score), and function (Constant score). RESULTS: At 10 yrs, a similar proportion of calcium deposits had resolved in 78% of the originally ultrasound treated compared with 83% of sham-treated shoulders, whereas at 9 mos, significantly more calcium deposits had been resolved in the ultrasound group (P = 0.045). Relative to baseline, shoulder symptoms and function had significantly improved at both the 10-yr and 9-mo follow-up examinations with no significant differences between groups. Regular sports performance at baseline predicted a favorable long-term outcome. CONCLUSIONS: Symptomatic calcific tendinitis of the shoulder has a good likelihood to completely resolve in the long term. Treating the calcium deposit effectively, however, may not be causal to the recovery from symptoms and function in calcific tendinitis.


Assuntos
Calcinose/terapia , Síndrome de Colisão do Ombro/terapia , Articulação do Ombro/fisiopatologia , Tendinopatia/terapia , Terapia por Ultrassom , Adulto , Idoso , Índice de Massa Corporal , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Recidiva , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/diagnóstico por imagem , Dor de Ombro/fisiopatologia , Dor de Ombro/terapia , Esportes , Tendinopatia/fisiopatologia
19.
Eur Radiol ; 28(6): 2369-2379, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29322332

RESUMO

OBJECTIVES: To quantify the morphological correlation between the posterior cruciate ligament (PCL) and the meniscofemoral ligaments (MFLs), to propose normal ranges for different age populations, and to define guidelines for correct identification and differentiation of MFLs in routine MRI. METHODS: Three hundred forty-two subjects were included retrospectively and subdivided into five age groups. Morphometrics of the PCL and the MFLs were measured on standard MRI in the sagittal, coronal, and axial planes. Student's t test, Mann-Whitney U test, and ANOVA and Kruskal-Wallis tests with Bonferroni correction were used for comparison. RESULTS: The MFLs did not vary significantly between sexes (p > 0.05) or in those older than 10 years (p > 0.05). Longitudinal MFL growth is completed before age 11 years, with cross-sectional area (CSA) increasing until age 20. The CSA of the PCL was significantly (p = 0.028) larger in knees without a pMFL (Mdn = 39.7 mm2) than with a pMFL (Mdn = 35.4 mm2). MFLs were more often detected on sagittal than coronal images. CONCLUSIONS: This study describes the morphometric relation between the PCL and the MFLs on routine MRI. When reporting imaging findings in preparation for arthroscopic knee surgery, evaluation of MFLs, first in the sagittal and then the coronal plane, will achieve the best results. KEY POINTS: • The MFLs and the PCL have distinct morphological patterns throughout life. • These patterns show intimate anatomical relationships and a potential biomechanical impact. • Those patterns and relationships can be quantified with MRI. • A correlation exists between age and morphometrics of the MFLs. • Recommendations for correct identification of the MFLs are provided.


Assuntos
Articulação do Joelho/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Ligamento Cruzado Posterior/anatomia & histologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Estudos de Viabilidade , Feminino , Humanos , Lactente , Ligamentos Articulares/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
20.
Arch Orthop Trauma Surg ; 137(12): 1699-1705, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28918517

RESUMO

PURPOSE: Radial magnetic resonance imaging (MRI) is the most accurate diagnostic tool in assessing cam-type femoroacetabular impingement. Plain radiographs, however, are useful for the initial diagnosis in the daily practice and there is still debate regarding the optimal lateral view. The purpose of this study was to investigate the reliability of detecting cam deformities using the frog-leg view or the 45° Dunn view by comparison with radial MRI. MATERIAL: 66 consecutive hips with plain radiographs (36 with AP and frog-leg views, 30 with AP and 45° Dunn views) and radial MRI were assessed. Alpha angle measurements were obtained both for radiographs and for radial MRI reformats by two investigators. Statistics included frequency analysis, bivariate linear correlation analyses, and cross-table analyses testing the sensitivity and specificity of the radiographic projections for detecting an alpha angle larger than 55°. RESULTS: The intra-class correlation revealed excellent agreement between the two raters [ICC = 0.959, CI (0.943; 0.972)]. 50% (33/66) had the maximum alpha angle in the superior-anterior aspect of the femoral head-neck junction. Cam deformity was found in 40/66 cases (61%) in radial MRI. Pearson correlation demonstrated that the 45° Dunn view was most accurate for the superior-anterior aspect (0.730, p < 0.05). The frog-leg view was best suited for the anterior aspect (0.703, p < 0.05). The sensitivity for detecting cam deformities in the 45° Dunn view was 84 vs 62% in the frog-leg view. CONCLUSION: The frog-leg lateral radiograph does not provide reliable measurements of the alpha angle. This study highlights the importance of the 45° Dunn view for early detection of femoroacetabular cam-type impingement.


Assuntos
Impacto Femoroacetabular/diagnóstico por imagem , Adulto , Idoso , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
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