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Fixation of Unstable Femoral Juvenile Osteochondritis Dissecans Lesions with Bioabsorbable Pins-Clinical and Radiographic Outcomes. J Clin Med 2022; 12:jcm12010276. [PMID: 36615076 PMCID: PMC9820957 DOI: 10.3390/jcm12010276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/27/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023] Open
Abstract
Juvenile Osteochondritis Dissecans (JOCD) is a common reason for knee pain among children. The aim of this case study was to report on clinical and radiographic outcomes after fixation of an osteochondral fragment with bioabsorbable pins in children with open growth plates. We hypothesized that surgical treatment with this technique will result in good function, high rates of radiographic healing and high return to sport rates. A total of 13 knees in 12 patients (6 male, 6 female) with a median of 13 years (11, 17) were evaluated retrospectively at a minimum clinical follow-up of 24 months. Inclusion criteria were defined as open growth plates and an unstable osteochondral lesion grade III or IV. The clinical outcome was evaluated utilizing three standardized patient-reported outcome scores (Tegner Activity Scale [TAS], Knee Injury and Osteoarthritis Outcome Score [KOOS], Lysholm Score). All patients underwent magnetic resonance imaging 15 months (3, 34) after surgical treatment and defect healing was evaluated utilizing a modified version of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Due to the small sample size, the data was reported descriptively. The interobserver variability was calculated with the Spearman rank correlation coefficient. Comparisons were made with Wilcoxon sign rank test (or sign test). At final follow-up the median KOOS Score was 98% (79.2%, 100%) and the median Lysholm Score was 94 (69, 100) points. The Tegner Activity Scale was 7 (4, 10) points preoperatively and 7 (4,10) points postoperatively (p = 0.5). Complete bony ingrowth occurred in 9 knees (69%), complete cartilage defect repair in 10 knees (77%) and integration to the border zone was found in 11 knees (85%) 15 (3, 34) months following surgical treatment. Fixation of osteochondral fragments with bioabsorbable pins resulted in good functional and radiographic outcomes, a high return to sport- and a low complication rate among children with open growth plates.
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Shakoor D, Kijowski R, Guermazi A, Fritz J, Roemer FW, Jalali-Farahani S, Eng J, Demehri S. Diagnosis of Knee Meniscal Injuries by Using Three-dimensional MRI: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2019; 290:435-445. [DOI: 10.1148/radiol.2018181212] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Delaram Shakoor
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - Richard Kijowski
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - Ali Guermazi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - Jan Fritz
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - Frank W. Roemer
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - Sahar Jalali-Farahani
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - John Eng
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC 4240, Baltimore, Md, 21287 (D.S., J.F., S.J.F., J.E., S.D.); Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, Wis (R.K.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.)
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Puig S, Kuruvilla YCK, Ebner L, Endel G. Magnetic resonance tomography of the knee joint. Skeletal Radiol 2015; 44:1427-34. [PMID: 26130068 DOI: 10.1007/s00256-015-2178-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/30/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the diagnostic performance of magnetic resonance imaging (MRI) in terms of sensitivity and specificity using a field strength of <1.0 T (T) versus ≥1.5 T for diagnosing or ruling out knee injuries or knee pathologies. METHODS The systematic literature research revealed more than 10,000 references, of which 1598 abstracts were reviewed and 87 full-text articles were retrieved. The further selection process resulted in the inclusion of four systematic reviews and six primary studies. RESULTS No differences could be identified in the diagnostic performance of low- versus high-field MRI for the detection or exclusion of meniscal or cruciate ligament tears. Regarding the detection or grading of cartilage defects and osteoarthritis of the knee, the existing evidence suggests that high-field MRI is tolerably specific but not very sensitive, while there is literally no evidence for low-field MRI because only a few studies with small sample sizes and equivocal findings have been performed. CONCLUSIONS We can recommend the use of low-field strength MRI systems in suspected meniscal or cruciate ligament injuries. This does, however, not apply to the diagnosis and grading of knee cartilage defects and osteoarthritis because of insufficient evidence.
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Affiliation(s)
- Stefan Puig
- Department of Interventional, Pediatric and Diagnostic Radiology Inselspital, University Hospital, University of Berne, Freiburgstr. 10, CH-3010, Berne, Switzerland,
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Richardson ML, Petscavage JM. Verification bias: an under-recognized source of error in assessing the efficacy of MRI of the meniscii. Acad Radiol 2011; 18:1376-81. [PMID: 21852159 DOI: 10.1016/j.acra.2011.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The sensitivity and specificity of magnetic resonance imaging (MRI) for diagnosis of meniscal tears has been studied extensively, with tears usually verified by surgery. However, surgically unverified cases are often not considered in these studies, leading to verification bias, which can falsely increase the sensitivity and decrease the specificity estimates. Our study suggests that such bias may be very common in the meniscal MRI literature, and illustrates techniques to detect and correct for such bias. MATERIALS AND METHODS PubMed was searched for articles estimating sensitivity and specificity of MRI for meniscal tears. These were assessed for verification bias, deemed potentially present if a study included any patients whose MRI findings were not surgically verified. Retrospective global sensitivity analysis (GSA) was performed when possible. RESULTS Thirty-nine of the 314 studies retrieved from PubMed specifically dealt with meniscal tears. All 39 included unverified patients, and hence, potential verification bias. Only seven articles included sufficient information to perform GSA. Of these, one showed definite verification bias, two showed no bias, and four others showed bias within certain ranges of disease prevalence. Only 9 of 39 acknowledged the possibility of verification bias. CONCLUSION Verification bias is underrecognized and potentially common in published estimates of the sensitivity and specificity of MRI for the diagnosis of meniscal tears. When possible, it should be avoided by proper study design. If unavoidable, it should be acknowledged. Investigators should tabulate unverified as well as verified data. Finally, verification bias should be estimated; if present, corrected estimates of sensitivity and specificity should be used. Our online web-based calculator makes this process relatively easy.
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Spahn G, Plettenberg H, Kahl E, Klinger HM, Mückley T, Hofmann GO. Near-infrared (NIR) spectroscopy. A new method for arthroscopic evaluation of low grade degenerated cartilage lesions. Results of a pilot study. BMC Musculoskelet Disord 2007; 8:47. [PMID: 17535439 PMCID: PMC1894633 DOI: 10.1186/1471-2474-8-47] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 05/29/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arthroscopy is a highly sensitive method of evaluating high-grade cartilage lesions but the detection of low-grade lesions is often is unreliable. Objective measurements are required. A novel NIRS (near-infrared-spectroscopy) device for detection of low-grade cartilage defects was evaluated in a preliminary clinical study. METHODS In 12 patients who had undergone arthroscopy, the cartilage lesions within the medial knee compartment were classified according to the ICRS protocol. With a NIR spectrometer system and an optical probe, similar in design to a hook used for routine arthroscopy, the optical properties of cartilage were measured during arthroscopy. RESULTS The mean ratio of 2 NIR absorption bands of intact cartilage 3.8 (range 2.3 to 8.7).was significantly lower than that of cartilage with grade 1 lesions (12.8, range 4.8 to 19.6) and grade 2 lesions (13.4, range 10.4 to 15.4).No differences were observed between grade 1 and grade 2 lesions. CONCLUSION NIRS can be used to distinguish between ICRS grade 1 lesions and healthy cartilage during arthroscopic surgeries. The results of this clinical study demonstrate the potential of NIRS to objectify classical arthroscopic grading systems.
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Affiliation(s)
- Gunter Spahn
- Center of Traumatology and Orthopaedic Surgery, Sophienstr. 16, 99817 Eisenach, Germany
| | - Holger Plettenberg
- Research Center of Medical Technology and Biotechnology, Geranienweg 7, 99947 Bad Langensalza, Germany
| | - Enrico Kahl
- Orthopaedic Clinic, Georg August University Göttingen, Postbox 3742, 37070 Göttingen, Germany
| | - Hans M Klinger
- Orthopaedic Clinic, Georg August University Göttingen, Postbox 3742, 37070 Göttingen, Germany
| | - Thomas Mückley
- Department of Trauma, Friedrich Schiller University of Jena, Erlanger Allee 101, 07747 Jena, Germany
| | - Gunther O Hofmann
- Department of Trauma, Friedrich Schiller University of Jena, Erlanger Allee 101, 07747 Jena, Germany
- Trauma Center Bergmannstrost Halle, Merseburger Str. 165, 06112 Halle, Germany
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Steckel H, Starman JS, Baums MH, Klinger HM, Schultz W, Fu FH. The double-bundle technique for anterior cruciate ligament reconstruction: a systematic overview. Scand J Med Sci Sports 2006; 17:99-108. [PMID: 17076829 DOI: 10.1111/j.1600-0838.2006.00600.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In traditional anterior cruciate ligament reconstruction, there is a subset of patients complaining of knee instability, especially rotational instability, and athletes not able to return to their preinjury level of sports activity. Currently, controversy exists over the usefulness of the double bundle technique (DBT) in addressing these problems. In order to evaluate the DBT, we completed a literature review from 1969 to February 2006 focusing on anatomy, magnetic resonance imaging, graft incorporation, biomechanics, kinematics, surgical techniques, complications and outcome. The DBT is not a standardized technique, which makes it difficult to compare results. Cadaver studies have proven biomechanical advantages with respect to ap-stability, but assessing the rotational stability remains difficult. There is a lack of available outcome studies with sufficient follow-up to demonstrate the potential advantages of DBT. The theoretical advantages of DBT require careful evaluation with outcome, biomechanical and kinematic studies. In addition, studies are needed to address issues such as graft incorporation and complications. An advantage offered by DBT is the possibility to identify rupture patterns that can lead to surgical preservation of an intact and augmentation of an injured bundle. The approach of augmentating a single bundle technique reconstruction with adequate anterior-posterior but poor rotational stability is promising.
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Affiliation(s)
- H Steckel
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Peterfy CG, Gold G, Eckstein F, Cicuttini F, Dardzinski B, Stevens R. MRI protocols for whole-organ assessment of the knee in osteoarthritis. Osteoarthritis Cartilage 2006; 14 Suppl A:A95-111. [PMID: 16750915 DOI: 10.1016/j.joca.2006.02.029] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 02/26/2006] [Indexed: 02/02/2023]
Abstract
One of the critical challenges in developing structure-modifying therapies for arthritis, especially osteoarthritis (OA), is measuring changes in progression of joint destruction. Magnetic resonance imaging (MRI) offers considerable promise in this regard. Not only can MRI quantify articular cartilage volume and morphology with high precision and accuracy, but it can also examine several other important articular components, and thus offer a unique opportunity to evaluate the knee and other joints as whole organs. On December 5 and 6, 2002, OMERACT (Outcome Measures in Rheumatology Clinical Trials) and OARSI (Osteoarthritis Research Society International), with support from various pharmaceutical companies listed at the beginning of this supplement, held a Workshop for Consensus on Osteoarthritis Imaging in Bethesda, MD. The aim of the Workshop was to provide a state-of-the-art review of imaging outcome measures for OA of the knee to help guide scientists and pharmaceutical companies who want to use MRI in multi-site studies of OA. Applications of MRI were initially reviewed by a multidisciplinary, international panel of expert scientists and physicians from academia, the pharmaceutical industry and regulatory agencies. The findings of the panel were then presented to a wider group of participants for open discussion. The following report summarizes the results of these discussions with respect to MRI acquisition techniques for whole-organ assessment of the knee in OA. The discussion reviews the selection and qualification of imaging sites for clinical trials, designing imaging protocols for whole-organ assessment of OA, and key considerations in image quality (IQ) control and data management.
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Ramnath RR. 3T MR Imaging of the Musculoskeletal System (Part II): Clinical Applications. Magn Reson Imaging Clin N Am 2006; 14:41-62. [PMID: 16530634 DOI: 10.1016/j.mric.2006.01.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The gain in SNR that is afforded by 3T MR imaging systems has tremendous clinical applications in the musculoskeletal system. The potential for demonstrating and enhancing the visibility of normal osseous, tendinous, cartilaginous, and ligamentous structures is exciting. Furthermore, harnessing this added signal to increase spatial resolution may improve our diagnostic abilities in various joints dramatically. Radiologists have enjoyed great success in assessing joint disease with current MR imaging field strengths; however, many intrinsic joint structures remain poorly evaluated, which leads to a golden opportunity for 3T MR imaging. The articular cartilage of the knee, the glenoid labrum of the shoulder, the intrinsic ligaments and TFC of the wrist, the collateral ligaments of the elbow, the labrum and articular cartilage of the hip, and the collateral ligaments of the ankle have been evaluated suboptimally on 1 .5T systems using routine nonarthrographic MR images. Because of the enhanced SNR, the higher spatial resolution, and the greater CNR of intrinsic joint structures at higher field strengths, 3T MR imaging has the potential to improve diagnostic abilities in the musculoskeletal system vastly, which translates into better patient care and management. The author's 2 years of clinical experience with musculoskeletal MR imaging on 3T systems has met and exceeded his expectations, and has bolstered the confidence of his orthopedic surgeons in his diagnoses. As coil technology advances and as the use of parallel imaging becomes more available in the extremities, the author expects to see even more dramatic improvements in image quality.
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