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BioMed Research International 2018To quantitatively assess changes in cartilage matrix after acute anterior cruciate ligament (ACL) rupture using T2- and T2-mapping and analyze the correlation between... (Clinical Trial)
Clinical Trial
Quantitative T2-Mapping and T2-Mapping Evaluation of Changes in Cartilage Matrix after Acute Anterior Cruciate Ligament Rupture and the Correlation between the Results of Both Methods.
OBJECTIVES
To quantitatively assess changes in cartilage matrix after acute anterior cruciate ligament (ACL) rupture using T2- and T2-mapping and analyze the correlation between the results of both methods.
METHODS
Twenty-three patients and 23 healthy controls were enrolled and underwent quantitative MRI examination. The knee cartilage was segmented into six compartments, including lateral femur (LF), lateral tibia (LT), medial femur (MF), medial tibia (MT), trochlea (Tr), and patella (Pa). T2 and T2 values were measured in full-thickness as well as superficial and deep layers of each cartilage compartment. Differences of T2 and T2 values between patients and controls were compared using unpaired Student's -test, and the correlation between their reciprocals was analyzed using Pearson's correlation coefficient.
RESULTS
ACL-ruptured patients showed higher T2 and T2 values in full-thickness and superficial layers of medial and lateral tibiofemoral joint. Meanwhile, patients exhibited higher T2 values in deep layers of lateral tibiofemoral joint. The elevated percentages of T2 and T2 value in superficial LT were most significant (20.738%, 17.525%). The reciprocal of T2 value was correlated with that of T2 value ( = 0.886, < 0.001).
CONCLUSION
The early degeneration could occur in various knee cartilage compartments after acute ACL rupture, especially in the superficial layer of LT. T2-mapping might be more sensitive in detecting deep layer of cartilage than T2-mapping.
Topics: Adult; Cartilage; Extracellular Matrix; Female; Humans; Longitudinal Ligaments; Magnetic Resonance Imaging; Male; Rupture
PubMed: 29888279
DOI: 10.1155/2018/7985672 -
Orthopaedic Surgery Nov 2023Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and...
BACKGROUND
Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and open surgery, and there is no consensus about which method is superior. It is important to clarify the presence of Achilles tendon (AT) degeneration, the rupture site, and the rupture shape before surgery to determine whether minimally invasive or open surgery should be selected, thereby reducing the re-rupture rate following acute ATR. The aim of this study was to investigate the diagnostic value of MRI in identifying the presence of AT degeneration, the rupture site, and the rupture shape for acute closed ATR.
METHODS
From January 2016 to December 2019, patients with acute closed ATR who had undergone repair surgery were retrospectively enrolled. All patients received MRI examination, and the distance between the insertion site and broken end and the rupture shape (types I, II, and III) were independently determined by two observers. Then, the stump of the AT was exposed during the operation. The rupture site and rupture shape were recorded and compared and analyzed with the MRI results. Consistency analyses (using Cohen's kappa coefficient or intraclass correlation coefficient-ICC) and calculation of diagnostic performance indexes were, respectively, conducted to evaluate the diagnostic value of the MRI.
RESULTS
This study included 47 consecutive patients with acute ATR, with an average age of 38.4 years. Among them, 40 were male, and seven were female. The intraoperative exploration demonstrated a total of 34 (72.3%), 10 (21.3%), and three (6.4%) patients with type I, II, and III ruptures, respectively. The average distance between the insertion site and the proximal broken end measured intraoperatively was 4.07 ± 1.57 cm. High or excellent consistencies were found for ATR classifications (kappa: 0.739-0.770, p < 0.001) and rupture sites (ICC: 0.962-0.979, p < 0.001) between two observers and between observers 1 and 2 and intraoperative findings. Tendinopathy was identified in 22 patients by MRI and confirmed during surgery.
CONCLUSIONS
MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.
Topics: Humans; Male; Female; Adult; Retrospective Studies; Achilles Tendon; Tendon Injuries; Orthopedic Procedures; Magnetic Resonance Imaging; Rupture; Acute Disease; Treatment Outcome
PubMed: 37749776
DOI: 10.1111/os.13845 -
Chinese Journal of Traumatology =... Jul 2022No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle. The objective of this literature review is to determine a therapeutic... (Review)
Review
PURPOSE
No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle. The objective of this literature review is to determine a therapeutic course of action.
METHODS
We conducted a literature review on the PubMed database using the following keywords (in French and English, respectively): "quadriceps/quadriceps", "droit antérieur/rectus femoris", "proximal/proximal", "chirurgie/surgical", "avulsion/avulsion". We collected 266 articles, 36 of them were selected, which were related to our topic: proximal rupture of the anterior rectus femoris. Patients with a proximal rupture of the rectus femoris, minor or major patient of traumatic origin were included in this study. Patients injured at another lesion level, or non-traumatic lesions of the proximal rectus femoris (tendinitis without ruptures, tumor or others) were excluded. For each patient, the indications, the type of treatment and the functional result were analyzed, with the time to recovery and the level of recovery from sports and professional activities (same sport/profession or not, same level or not) as the main criterion of judgment. Fisher exact test was used for statistical comparison.
RESULTS
The aims of conservative treatment are to be pain free for the patient, to fight hematoma and to rehabilitate the injury as quickly as possible. The surgical techniques are varied, with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendino-aponeurotic suture in place. The functional results are good for the majority of the treatments proposed, but the conservative treatment has a shorter recovery time (3 months vs. 4 months for the best surgical results). Highly displaced bone avulsion is the only indication for first-line surgical treatment.
CONSLUSION
The main disadvantage of conservative treatment is the risk of residual pain beyond 3 months (10%), justifying an MRI to guide secondary surgical treatment. We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.
Topics: Humans; Quadriceps Muscle; Rupture; Tendinopathy; Tendon Injuries; Tendons
PubMed: 34903464
DOI: 10.1016/j.cjtee.2021.11.004 -
Journal of Orthopaedic Surgery and... Sep 2021Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature... (Review)
Review
BACKGROUND
Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management.
METHODS
We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla's Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%).
CONCLUSIONS
Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed.
Topics: Humans; Middle Aged; Quadriceps Muscle; Retrospective Studies; Rupture; Tendon Injuries; Tendons
PubMed: 34481487
DOI: 10.1186/s13018-021-02696-9 -
Journal of the American Veterinary... Feb 2009To identify clinical, laboratory, and ultrasonographic characteristics associated with gallbladder disease and rupture in dogs.
OBJECTIVE
To identify clinical, laboratory, and ultrasonographic characteristics associated with gallbladder disease and rupture in dogs.
DESIGN
Retrospective case series.
ANIMALS
45 client-owned dogs.
PROCEDURES
Medical records of dogs with histologically confirmed gallbladder disease that had ultrasonographic evaluation were reviewed. Signalment, history, clinical signs, laboratory values, bacteriologic culture of bile, gallbladder status at surgery or necropsy (intact vs ruptured), histopathologic findings, radiographic findings, ultrasonographic findings, and outcome were analyzed.
RESULTS
The most common ultrasonographic findings were echogenic peritoneal fluid, thickened or laminated gallbladder wall, and echogenic reaction in the gallbladder fossa. Eighteen of 45 (40%) dogs had gallbladder rupture. Rupture was associated with histologic evidence of gallbladder necrosis, decreased serosal detail radiographically, and pericholecystic echogenic reaction, pericholecystic echogenic fluid, and generalized echogenic abdominal effusion ultrasonographically. Twenty-one of 45 (47%) dogs had mucocele, and 9 (43%) of those had gallbladder rupture. Eleven of 40 dogs had positive results of bacteriologic culture, and 5 of those had gallbladder rupture. Only 2 dogs had concurrent positive results of bacterial bile culture and gallbladder mucocele. Survival rate was 86% and not significantly related to presurgical bile leakage, positive results of bacterial culture, or mucocele.
CONCLUSIONS AND CLINICAL RELEVANCE
Ultrasonographic findings of pericholecystic reaction, localized or generalized echogenic peritoneal fluid, or decreased radiographic peritoneal detail should raise the index of suspicion for gallbladder rupture. Mucocele or bacterial gallbladder infection was the most common concurrent finding in dogs with gallbladder rupture.
Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Female; Gallbladder Diseases; Male; Mucocele; Retrospective Studies; Rupture; Ultrasonography
PubMed: 19210257
DOI: 10.2460/javma.234.3.359 -
Extensor Tendon Injury After Volar Locking Plating for Distal Radius Fractures: A Systematic Review.Hand (New York, N.Y.) Dec 2022Distal radius fractures are common orthopedic injuries. Treatment has varied historically, but volar locking plating currently predominates. Although flexor tendon... (Review)
Review
Distal radius fractures are common orthopedic injuries. Treatment has varied historically, but volar locking plating currently predominates. Although flexor tendon injury is a well-studied complication of this operation, extensor tendon injury is less well studied. The purpose of this review is to search the literature and present the epidemiology, presentation, and treatment of this complication. The Cochrane, EMBASE, PubMed, and SCOPUS databases were searched for the terms "volar" + "radius" + ("plate" OR "plating") + "extensor." Ninety final studies were included for analysis in this review. The incidence of extensor tendon rupture varies from 0% to 12.5%; the extensor pollicis longus is most commonly ruptured. The presentation and management of extensor tendon injury after injury, intraoperatively, and postoperatively are summarized. Radiographic views are described to detect screw prominence and minimize intraoperative risk. Extensor tendon injury after volar locking plate for distal radius fractures is an uncommon injury with several risk factors including dorsal screw prominence and fracture fragments. Removal of hardware and tendon transfers or reconstruction may be necessary to prevent loss of extensor mechanism.
Topics: Humans; Radius Fractures; Wrist Fractures; Fracture Fixation, Internal; Tendon Injuries; Rupture; Tendons
PubMed: 35168382
DOI: 10.1177/15589447211068186 -
The Canadian Veterinary Journal = La... Sep 2015The purpose of this retrospective case-control study was to identify factors associated with primary gastric rupture and to investigate if there were differences between...
The purpose of this retrospective case-control study was to identify factors associated with primary gastric rupture and to investigate if there were differences between etiologies of primary gastric rupture. Compared to the general colic population, Quarter horses were under-represented and Friesians and draft breeds were over-represented in 47 cases of primary gastric ruptures. Horses with primary gastric rupture typically presented with severe clinical and clinicopathological derangements. There were 24 idiopathic gastric ruptures, 20 gastric impaction associated ruptures, and 3 perforating gastric ulcers. Thoroughbred horses were over-represented in the idiopathic gastric rupture group compared to other breeds and etiologies. This study suggests the presence of important breed predispositions for development of gastric rupture. Further study is necessary to identify if these predispositions are associated with management factors or breed-specific disorders.
Topics: Animals; Female; Genetic Predisposition to Disease; Horse Diseases; Horses; Male; Retrospective Studies; Stomach Rupture
PubMed: 26345205
DOI: No ID Found -
Deutsches Arzteblatt International Jun 2023Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary... (Review)
Review
BACKGROUND
Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary surgical repair to conservative functional treatment.
METHODS
This review is based on publications retrieved by a selective search in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and meta-analyses on surgical versus conservative treatment from the years 1983 to 2023.
RESULTS
10 of 11 prospective randomized trials of surgical versus conservative treatment conducted between 1984 and 2017 did not reveal any significant difference in the overall outcome. These findings were confirmed in two meta-analyses and two systematic reviews that were published between 2007 and 2019. Isolated benefits in the surgical group were outweighed by a variety of postoperative complications. The anterior fibulotalar ligament (AFTL) was ruptured in 58% to 100% of cases, followed by the fibulocalcaneal ligament combined with the LFTA in 58% to 85%, and the posterior fibulotalar ligament (mostly incomplete ruptures) in 1.9% to 3%.
CONCLUSION
Conservative functional treatment is now the standard treatment in acute fibular ligament rupture of the ankle because it is low-risk, low-cost, and safe. Primary surgery is indicated in only 0.5% to 4% of cases. Physical examination for tenderness to palpation and for stability, as well as stress ultrasonography, can be used to differentiate sprains from ligamentous tears. MRI is superior only for the detection of additional injuries. Stable sprains can be successfully treated with an elastic ankle support for a few days, and unstable ligamentous ruptures with an orthosis for 5 to 6 weeks. Subsequent physiotherapy with proprioceptive exercises is the best way to prevent recurrent injury.
Topics: Humans; Ankle; Conservative Treatment; Ligaments; Sprains and Strains; Rupture
PubMed: 37198926
DOI: 10.3238/arztebl.m2023.0118 -
Journal of Vascular Surgery Jun 2015Elective abdominal aortic aneurysm (AAA) surgery relies on balancing the risk of the intervention against the risk of the aneurysm causing death. Although much is known... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Elective abdominal aortic aneurysm (AAA) surgery relies on balancing the risk of the intervention against the risk of the aneurysm causing death. Although much is known about intervention at 5.5 cm, little is known about the fate of the patient unfit for elective surgery at this threshold. Medical therapy and endovascular surgery have revolutionized management of aortic aneurysms in the last 20 years and are thought to have affected rupture rates.
METHODS
MEDLINE via PubMed, EMBASE, and the Cochrane Library Database were searched for studies reporting follow-up of untreated large AAA approach from inception to January 2014. Data were pooled using random-effects analysis with standardized mean differences and 95% confidence intervals (CIs) reported. The primary end points were rupture rates and all-cause mortality per year by AAA size.
RESULTS
The search strategy identified 1892 citations, of which 11 studies comprising 1514 patients experiencing 347 ruptured AAA were included. The overall incidence of ruptured AAA in patients with AAA >5.5 cm was 5.3% (95% CI, 3.1%-7.5%) per year. This represented cumulative yearly rupture rates of 3.5% (95% CI, -1.6% to 8.7%) in AAAs 5.5 to 6.0 cm, 4.1% (95% CI, -0.7% to 9.0%) in AAAs 6.1 to 7.0 cm, and 6.3% (95% CI, -1.8% to 14.3%) in AAAs >7.0 cm. There was no heterogeneity between studies (I(2) = 0%). Only 32% of these patients were offered repair on rupturing an AAA, with a perioperative mortality of 58% (95% CI, 32%-83%). The risk of death from causes other than AAA was higher than the risk of death from rupture.
CONCLUSIONS
Rupture rates of untreated AAA were lower than those currently quoted in the literature. Non-AAA-related mortality in this group of patients is high.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Cause of Death; Chi-Square Distribution; Contraindications; Elective Surgical Procedures; Humans; Patient Selection; Prognosis; Risk Assessment; Risk Factors; Time Factors; Vascular Surgical Procedures
PubMed: 25661721
DOI: 10.1016/j.jvs.2014.10.023 -
Journal of Shoulder and Elbow Surgery Oct 2023Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The...
BACKGROUND
Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair.
METHODS
This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging-verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed.
RESULTS
Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63).
CONCLUSION
Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
Topics: Humans; Female; Middle Aged; Adult; Aged; Male; Rotator Cuff Injuries; Treatment Outcome; Rotator Cuff; Tendon Injuries; Rupture; Lacerations; Magnetic Resonance Imaging; Arthroscopy
PubMed: 37178969
DOI: 10.1016/j.jse.2023.03.027