-
Journal of Orthopaedic Surgery and... Apr 2021This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with... (Comparative Study)
Comparative Study
OBJECTIVE
This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests.
METHODS
Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard.
RESULTS
The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ = 1.682, p = 0.195).
CONCLUSIONS
The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings.
LEVELS OF EVIDENCE
Level II/observational diagnostic studies TRIAL REGISTRATION: Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered.
Topics: Adult; Anterior Cruciate Ligament Injuries; Diagnostic Techniques and Procedures; Female; Humans; Male; Orthopedics; Physical Examination; Rupture; Young Adult
PubMed: 33853620
DOI: 10.1186/s13018-021-02381-x -
The Journal of Cardiovascular Surgery Apr 2005Most patients with a traumatic aortic rupture (TAR) were involved in high velocity motor vehicle accidents. Initial management of these patients should be according to... (Review)
Review
Most patients with a traumatic aortic rupture (TAR) were involved in high velocity motor vehicle accidents. Initial management of these patients should be according to the guidelines of the advanced trauma life support group (ATLS). Patients with a suspected TAR are preferably managed by controlled hypotension. TAR can be diagnosed by spiral CT angiography, additional angiography is not needed. Although results from conventional surgery have improved over the years, results from endovascular grafting are better with reduced mortality and paraplegia rates. Acute open surgery has become the second choice and patients are preferably managed by endovascular treatment. The endovascular graft can be placed with a minimal invasive procedure and delay in treatment because of accompanying injuries is avoided. Patients with a TAR treated by an endovascular graft should be kept under surveillance. For optimal patient care level I trauma centers should have thoracic endovascular grafts available for direct use.
Topics: Accidents, Traffic; Aorta, Thoracic; Aortic Rupture; Humans; Vascular Surgical Procedures
PubMed: 15793488
DOI: No ID Found -
Medicine Sep 2015Total rupture of extraocular muscles is an infrequent clinical finding. Here we conducted this retrospective study to evaluate their causes of injury, clinical features,... (Observational Study)
Observational Study
Total rupture of extraocular muscles is an infrequent clinical finding. Here we conducted this retrospective study to evaluate their causes of injury, clinical features, imaging, surgical management, and final outcomes in cases of isolated extraocular muscle rupture at a tertiary center in China. Thirty-six patients were identified (24 men and 12 women). Mean age was 34 years (range 2-60). The right eye was involved in 21 patients and the left 1 in 15. A sharp object or metal hook was the cause of this lesion in 16 patients, sinus surgery in 14 patients, traffic accident in 3 patients, orbital surgery in 2 patients, and conjunctive tumor surgery in 1 patient. The most commonly involved muscles were medial (18 patients) and inferior rectus muscles (13 patients). The function of the ruptured muscles revealed a scale of -3 to -4 defect of ocular motility and the amount of deviation in primary position varied from 10 to 140 PD (prism diopter). Computerized tomography (CT) confirmed the presence of ruptured muscles. An end-to-end muscle anastomosis was performed and 3 to 5 mm of muscle was resected in 23 patients. When the posterior border of the injured muscle could not be identified (13 patients), a partial tendon transposition was performed, together with recession of the antagonist in most patients, whereas a recession of the antagonist muscle plus a resection of the involved muscle with or without nasal periosteal fixation was performed in the remaining patients. After an average of 16.42 months of follow-up an excellent result was achieved in 23 patients and results of 13 patients were considered as a failure. In most patients, the posterior border of the ruptured muscle can be identified and an early surgery can be performed to restore function. Alternatively, a partial tendon transposition should be performed. When muscular rupture is suspected, an early orbital CT is required to confirm this possibility, which can then verify the necessity for an early surgical intervention.
Topics: Adolescent; Adult; Child; Child, Preschool; China; Eye Injuries; Female; Humans; Male; Middle Aged; Oculomotor Muscles; Retrospective Studies; Rupture; Young Adult
PubMed: 26426604
DOI: 10.1097/MD.0000000000001351 -
Journal of the American Veterinary... Jan 2018OBJECTIVE To determine the rate of and factors associated with survival to hospital discharge in dogs with uroabdomen. DESIGN Retrospective case series. ANIMALS 43 dogs...
OBJECTIVE To determine the rate of and factors associated with survival to hospital discharge in dogs with uroabdomen. DESIGN Retrospective case series. ANIMALS 43 dogs with uroabdomen confirmed at 2 veterinary teaching hospitals from 2006 through 2015. PROCEDURES Medical records were reviewed and data extracted regarding cause and location of urinary tract rupture, serum creatinine concentration and other variables at hospital admission, and outcomes. Variables were tested for associations with survival to hospital discharge. RESULTS Urinary tract rupture occurred in the urinary bladder (n = 24 [56%]), urethra (11 [26%]), kidney (2 [5%]), ureter (1 [2%]), both the urinary bladder and kidney (1 [2%]), and undetermined sites (4 [9%]). Rupture causes included traumatic (20 [47%]), obstructive (9 [21%]), and iatrogenic (7 [16%]) or were unknown (7 [16%]). Surgery was performed for 37 (86%) dogs; the defect was identified and surgically corrected in 34 (92%) of these dogs. Hypotension was the most common intraoperative complication. Nineteen dogs had information recorded on postoperative complications, of which 10 (53%) had complications that most often included death (n = 3) and regurgitation (3). Thirty-four (79%) dogs survived to hospital discharge. Dogs with intraoperative or postoperative complications were significantly less likely to survive than dogs without complications. Serum creatinine concentration at admission was not associated with survival to discharge. CONCLUSIONS AND CLINICAL RELEVANCE A high proportion of dogs with uroabdomen survived to hospital discharge. No preoperative risk factors for nonsurvival were identified. Treatment should be recommended to owners of dogs with uroabdomen.
Topics: Animals; Dog Diseases; Dogs; Female; Georgia; Louisiana; Male; Retrospective Studies; Rupture; Survival Analysis; Treatment Outcome; Urinary Tract
PubMed: 29244609
DOI: 10.2460/javma.252.1.92 -
Medicine Sep 2023There are multiple surgical options for treatment of chronic Achilles tendon (AT) rupture according to the classifications and length of defect. However, no gold...
There are multiple surgical options for treatment of chronic Achilles tendon (AT) rupture according to the classifications and length of defect. However, no gold standard method has been confirmed, and there is no clear evidence to support the superiority of 1 procedure over others. This study aimed to evaluate the long-term clinical outcome of flexor hallucis longus tendon (FHL) transfer for chronic AT rupture with large defect. Clinical data of patients treated with FHL transfer due to chronic AT rupture between January 2009 and October 2019 were reviewed retrospectively. All cases were presented with AT rupture for more than 4 weeks after injury. The gap between ruptured ends was > 5 cm after debridement in all patients. The harvest of FHL was performed through a single incision in accordance with AT rupture debridement in all cases. Clinical outcomes were assessed with AOFAS ankle-hindfoot scale, Achilles tendon total rupture score and AOFAS hallux metatarsophalangeal-interphalangeal scale. Twenty-eight patients were followed successfully for 62.6 ± 22.2 months. According to the complete datasets obtained from 28 patients, none of the tendons re-ruptured. The AOFAS ankle-hindfoot scale and Achilles tendon total rupture score at last follow-up visit was 90.4 ± 5.7 and 89.8 ± 5.3 respectively, which revealed statistically significant improvement from the preoperative score of 61.1 ± 6.7 and 53.8 ± 8.3. The AOFAS hallux metatarsophalangeal-interphalangeal scale at last follow-up visit was 87.5 ± 6.1. The FHL transfer through a single incision for chronic AT rupture with large defect is a safe and simple method with low risk of morbidity and complications.
Topics: Humans; Retrospective Studies; Achilles Tendon; Tendon Transfer; Treatment Outcome; Tendon Injuries; Rupture; Chronic Disease; Ankle Injuries
PubMed: 37773872
DOI: 10.1097/MD.0000000000035302 -
Revista Espanola de Enfermedades... Apr 2018This article is the first description of a spontaneous hepatic rupture in a young bodybuilder with a history of clenbuterol and ephedrine alkaloid use. The patient...
This article is the first description of a spontaneous hepatic rupture in a young bodybuilder with a history of clenbuterol and ephedrine alkaloid use. The patient presented with a sudden mid-epigastric pain and vomiting. Hemoglobin levels decreased a few hours later and a computed tomography scan was performed which revealed a rupture of the right liver capsule and hemoperitoneum. Two attempts at transarterial embolization did not control the bleeding and a right hemihepatectomy was performed. The pathological report identified a hepatic adenoma, a capsular tear and diffuse peliosis hepatis. The patient was discharged in a good condition after eleven days. Spontaneous hepatic ruptures are rare and life-threatening and are usually described in association with tumors, connective tissue diseases and gestosis. This article is a review of the available literature with regard to this condition, with a focus on its relation to peliosis hepatis and banned substance used by body image fanatics. The present case highlights the challenging diagnosis of this potentially fatal liver complication in a healthy appearing male, the risk associated with the online trade of performance enhancing drugs and its relation with peliosis hepatis.
Topics: Adrenergic beta-Agonists; Adult; Central Nervous System Stimulants; Clenbuterol; Ephedrine; Humans; Liver; Male; Peliosis Hepatis; Performance-Enhancing Substances; Rupture; Treatment Outcome; Weight Lifting
PubMed: 29313696
DOI: 10.17235/reed.2017.5103/2017 -
The Journal of Bone and Joint Surgery.... Oct 2011Controversy surrounds the most appropriate treatment method for patients with a rupture of the tendo Achillis. The aim of this study was to assess the long term rate of... (Review)
Review
Controversy surrounds the most appropriate treatment method for patients with a rupture of the tendo Achillis. The aim of this study was to assess the long term rate of re-rupture following management with a non-operative functional protocol. We report the outcome of 945 consecutive patients (949 tendons) diagnosed with a rupture of the tendo Achillis managed between 1996 and 2008. There were 255 female and 690 male patients with a mean age of 48.97 years (12 to 86). Delayed presentation was defined as establishing the diagnosis and commencing treatment more than two weeks after injury. The overall rate of re-rupture was 2.8% (27 re-ruptures), with a rate of 2.9% (25 re-ruptures) for those with an acute presentation and 2.7% (two re-ruptures) for those with delayed presentation. This study of non-operative functional management of rupture of the tendo Achillis is the largest of its kind in the literature. Our rates of re-rupture are similar to, or better than, those published for operative treatment. We recommend our regime for patients of all ages and sporting demands, but it is essential that they adhere to the protocol.
Topics: Achilles Tendon; Adolescent; Adult; Aged; Aged, 80 and over; Athletic Injuries; Child; Early Diagnosis; Female; Humans; Male; Middle Aged; Orthotic Devices; Recurrence; Rupture; Tendon Injuries; Treatment Outcome; Young Adult
PubMed: 21969435
DOI: 10.1302/0301-620X.93B10.26187 -
The Cochrane Database of Systematic... Apr 2016This review has been withdrawn, as of Issue 4, 2016, because it has been superseded by a new review (Monk AP, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ.... (Review)
Review
This review has been withdrawn, as of Issue 4, 2016, because it has been superseded by a new review (Monk AP, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD011166. DOI:10.1002/14651858.CD011166.pub2). The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Humans; Joint Instability; Randomized Controlled Trials as Topic; Recovery of Function; Rupture
PubMed: 27078618
DOI: 10.1002/14651858.CD001356.pub4 -
Scientific Reports Apr 2018It is not fully established whether leukocyte can predict the poor outcome for ruptured cerebral aneurysms (CA) or not. Here, we retrospectively analyzed the clinical...
It is not fully established whether leukocyte can predict the poor outcome for ruptured cerebral aneurysms (CA) or not. Here, we retrospectively analyzed the clinical data of 428 patients with ruptured CA between 2010 and 2015. Patients' demographic data, including gender, age, history of smoking, alcohol, hypertension, diabetes and hypercholesterolemia, Hunt-Hess and Fisher grade, occurrence of hydrocephalus, aneurysm location, time to surgery, delayed ischemic neurological deficit (DIND) and peak leukocyte of blood test from day 1 to 3 after aneurysmal rupture were recorded and analyzed. In the multivariable analysis model, gender, Fisher grade, time to surgery and hydrocephalus were not relevant to poor outcome. However, Hunt-Hess grade, DIND and preoperative leukocyte count (>13.84 × 10/L) were significantly associated with adverse outcome. The respective increased risks were 5.2- (OR5.24, 95% CI 1.67-16.50, p = 0.005), 6.2-(OR 6.24, 95% CI 3.55-10.99, p < 0.001) and 10.9-fold (OR 9.35, 95% CI 5.98-19.97, p < 0.001). The study revealed that Hunt-Hess grade, DIND and preoperative leukocyte count (>13.84 × 10/L) were independent risk factors for poor outcome of ruptured CA at 3 months. Higher leukocyte count is a convenient and useful marker to predict 3-month poor outcome for ruptured CA.
Topics: Adult; Aged; Decision Support Techniques; Female; Humans; Intracranial Aneurysm; Leukocyte Count; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Rupture; Young Adult
PubMed: 29643435
DOI: 10.1038/s41598-018-23934-x -
Orthopaedic Surgery Nov 2022The injury of the annular ligament can change the stress distribution and affect the stability of the elbow joint, but its biomechanical mechanism is unclear. The...
OBJECTIVE
The injury of the annular ligament can change the stress distribution and affect the stability of the elbow joint, but its biomechanical mechanism is unclear. The present study investigated the biomechanical effects of different flexion angles of the annular ligament on elbow joint stability.
METHODS
A cartilage and ligament model was constructed using SolidWorks software according to the magnetic resonance imaging results to simulate the annular ligament during normal, loosened, and ruptured conditions at different buckling angles (0°, 30°, 60°, 90°, and 120°). The fixed muscle strengths were 40 N (F1), 20 N (F2), 20 N (F3), 20 N (F4), and 20 N (F5) for the triceps, biceps, and brachial tendons and the base of the medial collateral ligament and lateral collateral ligament. The different elbow three-dimensional (3D) finite element models were imported into ABAQUS software to calculate and analyze the load, contact area, contact stress, and stress of the medial collateral ligament of the olecranon cartilage.
RESULTS
The results showed that the stress value of olecranon cartilage increased under different conditions (normal, loosened, and ruptured annular ligament) with elbow extension, and the maximum stress value of olecranon cartilage was 2.91 ± 0.24 MPa when the annular ligament was ruptured. The maximum contact area of olecranon cartilage was 254 mm with normal annular ligament when the elbow joint was flexed to 30°, while the maximum contact area of loosened and ruptured annular ligament was 283 and 312 mm at 60° of elbow flexion, and then decreased gradually. The maximum stress of the medial collateral ligament was 6.52 ± 0.23, 11.51 ± 0.78, and 18.74 ± 0.94 MPa under the different conditions, respectively.
CONCLUSION
When the annular ligament ruptures, it should be reconstructed as much as possible to avoid the elevation of stress on the surface of the medial collateral ligament of the elbow and the annular cartilage, which may cause clinical symptoms.
Topics: Humans; Collateral Ligaments; Elbow Joint; Finite Element Analysis; Range of Motion, Articular; Rupture
PubMed: 36106628
DOI: 10.1111/os.13452