Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee: correlation between time from injury and knee scores.

PURPOSE: Anterior cruciate ligament (ACL) rupture is associated with meniscal tears and/or articular cartilage damage. The aim of this study was twofold: (a) to report and correlate the incidence of meniscal and cartilage lesions in ACL-deficient knees with time from injury and (b) to correlate lesions of menisci and cartilage with widely used knee scores. METHODS: Data were analysed from 109 consecutive patients with ACL rupture. Meniscal and articular cartilage lesions were documented during the arthroscopic reconstruction of the ACL. Patients were distributed into 3 groups according to time from injury; group A: 0-3 months (35 patients), group B: 3-12 months (39 patients) and group C: more than 12 months (35 patients). Lysholm, KOOS and IKDC rating scales were recorded preoperatively. Logistic regression analyses were applied to correlate the concomitant intra-articular pathologies with the time from injury and knee-rating scales. RESULTS: Of 109 patients, 32 (29%) had a medial meniscus tear, 20 (19%) had a lateral meniscus tear, 17 (15%) had both menisci torn and 40 (37%) had no meniscal tear. Analysis revealed that time from injury was not a significant factor for the presence of a meniscal lesion. The odds of development of a high-grade cartilage lesion in an ACL-deficient knee reconstructed more than 12 months from time from injury are 5.5 and 12.5 times higher when compared with knees that underwent ACL reconstruction less than 3 months and between 3 and 12 months after knee injury, respectively. No association was found between intra-articular pathology and the KOOS and Lysholm scores. A positive correlation between the IKDC score and patients without any intra-articular pathology was found. CONCLUSIONS: The presence of high-grade cartilage lesions is significantly increased in an ACL-deficient knee when reconstruction is performed more than 12 months after injury. However, the incidence of meniscal tears is not increased significantly. Correlation of intra-articular pathology in ACL-deficient knees with knee-rating scales is weak. LEVEL OF EVIDENCE: Diagnostic study, Level II.

Incidental Petrous Apex Cephalocele Presenting With Transient Global Amnesia: A Case Report and Rapid Literature Review.

Transient global amnesia (TGA) constitutes a rare clinical entity that manifests with temporary memory without any other neurological manifestation. Several pathogenetic mechanisms have been implicated, including temporal hypoperfusion, venous congestion, and cortical spreading potentials. Accordingly, the only relevant imaging findings are hippocampal CA1 areas of restricted diffusion on diffusion-weighted images. In the current case report, we present the rare case of a patient with TGA associated with bilateral petrous apex cephalocele (PAC). A 63-year-old female presented with a single episode of transient memory. The brain MRI showed a bilateral PAC and an empty sella. The patient was neurologically intact upon examination and was conservatively managed. There was no symptom recurrence during the six months of follow-up. We hypothesize that the presence of the meningocele could be associated with the pathogenesis of TGA. To the best of our knowledge, this is the first case of a petrous apex meningocele presenting with TGA. Most previously reported patients were females in their fourth decade of life, usually presenting with headaches or incidentally. Almost half of the cases were bilateral, with an empty sella. Surgical treatment was reserved for symptomatic patients with cerebrospinal fluid leaks and excruciating trigeminal neuralgia. Patients with TGA may be associated with temporal lesions, including PAC. Likewise, PAC is an extremely rare clinical entity that could occasionally present with TGA.

A comparison of early versus delayed repair of traumatic rotator cuff tears.

PURPOSE: The purpose of this study was to compare the clinical and magnetic resonance imaging (MRI) results between early and delayed operative treatment in patients with traumatic rotator cuff tears (RCT). METHODS: Thirty-five patients with a traumatic RCT who have been treated surgically during a 4-year period were included in the study. The results of early versus delayed repair of traumatic rotator RCT were assessed using the Constant and UCLA scores. In addition, all patients underwent a postoperative MRI to evaluate repair integrity. Early repair (within 3 weeks) was performed in 15 patients (group I) and delayed repair (after 3 weeks) in the rest 20 patients (group II). The time interval between injury and operation was 12 and 131 days on average for group I and II, respectively. RESULTS: Follow-up time was 34 and 38 months for group I and II, respectively. Postoperatively, the UCLA score was 31 and 26 (P < 0.05) for group I and II, respectively. The Constant score was 82 and 70 (P < 0.05) for group I and II, respectively. Range of motion was significantly better in group I. According to MRI, 5 patients (33%) in the group I and 7 patients (35%) in the group II had a retear. CONCLUSIONS: Early repair of a traumatic RCT provides better results in terms of shoulder function in comparison with a delayed repair. A delayed diagnosis of a traumatic RCT leads to difficulties in surgery and less good results. LEVEL OF EVIDENCE: Level III, therapeutic, retrospective, comparative study.