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Sokal PA, Norris R, Maddox TW, Oldershaw RA. The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:3287-3303. [PMID: 35150292 PMCID: PMC9464183 DOI: 10.1007/s00167-022-06898-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The diagnostic accuracy of clinical tests for anterior cruciate ligament injury has been reported in previous systematic reviews. Numerous studies in these reviews include subjects with additional knee ligament injury, which could affect the sensitivity of the tests. Meta-analyses have also been performed using methods that do not account for the non-independence of sensitivity and specificity, potentially overestimating diagnostic accuracy. The aim of this study was to report the diagnostic accuracy of clinical tests for anterior cruciate ligament tears (partial and complete) without concomitant knee ligament injury. METHODS A systematic review with meta-analysis was performed according to the PRISMA guidelines. Meta-analyses included studies reporting the specificity and/or sensitivity of tests with or without concomitant meniscal injury. Where possible, pooled diagnostic estimates were calculated with bivariate random-effects modelling to determine the most accurate effect sizes. Diagnostic accuracy values are presented for the anterior drawer, Lachman, Lever sign and pivot shift tests overall and in acute or post-acute presentations. RESULTS Pooled estimates using a bivariate model for overall sensitivity and specificity respectively were as follows: anterior drawer test 83% [95% CI, 77-88] and 85% [95% CI, 64-95]; Lachman test 81% [95% CI, 73-87] and 85% [95% CI, 73-92]; pivot shift test 55% [95% CI, 47-62] and 94% [95% CI, 88-97]; Lever sign test 83% [95% CI, 68-92] and 91% [95% CI, 83-95]. For specific presentations, the sensitivity and specificity of the Lachman test, respectively, were: complete tears 68% [95% CI, 54-79] and 79% [95% CI, 51-93]; post-acute injuries 70% [95% CI, 57-80] and 77% [95% CI, 53-91]. CONCLUSIONS The pivot shift and Lever sign were the best tests overall for ruling in or ruling out an anterior cruciate ligament tear, respectively. The diagnostic accuracy of the Lachman test, particularly in post-acute presentations and for complete tears, is lower than previously reported. Further research is required to establish more accurate estimates for the Lachman test in acute presentations and partial ligament tears using bivariate analysis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pawel A Sokal
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, L69 3GE, UK
| | - Richard Norris
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7AL, UK
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, Wirral, UK
| | - Rachel A Oldershaw
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.
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Evers BJ, Van Den Bosch MHJ, Blom AB, van der Kraan PM, Koëter S, Thurlings RM. Post-traumatic knee osteoarthritis; the role of inflammation and hemarthrosis on disease progression. Front Med (Lausanne) 2022; 9:973870. [PMID: 36072956 PMCID: PMC9441748 DOI: 10.3389/fmed.2022.973870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Knee injuries such as anterior cruciate ligament ruptures and meniscal injury are common and are most frequently sustained by young and active individuals. Knee injuries will lead to post-traumatic osteoarthritis (PTOA) in 25–50% of patients. Mechanical processes where historically believed to cause cartilage breakdown in PTOA patients. But there is increasing evidence suggesting a key role for inflammation in PTOA development. Inflammation in PTOA might be aggravated by hemarthrosis which frequently occurs in injured knees. Whereas mechanical symptoms (joint instability and locking of the knee) can be successfully treated by surgery, there still is an unmet need for anti-inflammatory therapies that prevent PTOA progression. In order to develop anti-inflammatory therapies for PTOA, more knowledge about the exact pathophysiological mechanisms and exact course of post-traumatic inflammation is needed to determine possible targets and timing of future therapies.
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Affiliation(s)
- Bob J. Evers
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- *Correspondence: Bob J. Evers
| | - Martijn H. J. Van Den Bosch
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Arjen B. Blom
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Peter M. van der Kraan
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | - Rogier M. Thurlings
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
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Agreement Between Clinical Examination and Magnetic Resonance Imaging in Acute Knee Trauma With Hemarthrosis. Clin J Sport Med 2022; 32:401-406. [PMID: 34117155 DOI: 10.1097/jsm.0000000000000950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hemarthrosis after knee trauma often indicates serious joint injury. Few studies have evaluated agreement between clinical examination and findings from magnetic resonance imaging (MRI). We aimed to describe the agreement between acute clinical examination and subacute MRI findings after acute knee trauma with hemarthrosis and the importance of the subspecialty of the examiner. DESIGN Longitudinal cohort study. Agreement with MRI findings was evaluated by logistic regression. SETTING Helsingborg hospital. PATIENTS Thousand one hundred forty-five consecutive patients with hemarthrosis after knee trauma. INTERVENTIONS Clinical examination and MRI. MAIN OUTCOME MEASURES agreement between clinical examination and findings from MRI. We considered the radiologist's report as the gold standard. RESULTS Median time (25th, 75th percentile) from injury to clinical examination was 2 (1, 7) days, and from injury to imaging was 8 (5, 15) days. The overall sensitivity and specificity of clinical examination versus MRI for major ligament injury or lateral patella dislocation (LPD) were 70% [95% confidence interval 67-73) and 66% (61-72), respectively. Orthopedic subspecialist knee had the highest agreement with anterior cruciate ligament rupture (adjusted odds ratios were 1.7 (95% confidence interval 1.2-2.3), 1.9 (1.2-3.0) and 5.9 (3.7-9.5) for orthopedic trainees, orthopedic subspecialists other, and orthopedic subspecialist knee, respectively]. For other ligament injuries and LPD, we did not find statistically significant differences. CONCLUSIONS Clinical diagnosis after acute knee injury is relatively unreliable versus MRI findings even when performed by orthopedic specialists. However, the agreement is improved when the examination is performed by an orthopedic knee subspecialist.
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Variability and Complexity of Knee Neuromuscular Control during an Isometric Task in Uninjured Physically Active Adults: A Secondary Analysis Exploring Right/Left and Dominant/Nondominant Asymmetry. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094762] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Work is needed to better understand the control of knee movement and knee health. Specifically, work is needed to further understand knee muscle force control variability and complexity and how it is organized on both sides of the body. The purpose of this study was to explore side-to-side comparisons of magnitude- and complexity-based measures of knee muscle force control to support future interpretations of complexity-based analyses and clinical reasoning in knee injury control. Participants (male/female n = 11/5) performed constant-force isometric efforts at 50% maximal effort. Force variability was quantified during the constant-force efforts using a coefficient of variation (CV%) and force complexity using approximate entropy (ApEn) and detrended fluctuation analysis (DFA) α. Outcomes were right/left and dominant/nondominant group-level and individual-level comparisons. A limb-symmetry index was calculated for each variable and clinically significant absolute asymmetry was defined (>15%). The only significant side-to-side difference was for right/left DFA α (p = 0.00; d = 1.12). Maximum absolute asymmetries were (right/left, dominant/nondominant): CV 18.2%, 18.0%; ApEn 34.5%, 32.3%; DFA α 4.9%, 5.0%. Different side-to-side comparisons yield different findings. Consideration for how side-to-side comparisons are performed (right/left, dominant/nondominant) is required. Because a significant difference existed for complexity but not variability, this indicates that both complexity-based and magnitude-based measures should be used when studying knee muscle force control.
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Ismail SA, Simic M, Salmon LJ, Roe JP, Pinczewski LA, Smith R, Pappas E. Side-to-Side Differences in Varus Thrust and Knee Abduction Moment in High-Functioning Individuals With Chronic Anterior Cruciate Ligament Deficiency. Am J Sports Med 2019; 47:590-597. [PMID: 30525874 DOI: 10.1177/0363546518812883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is evidence that frontal plane knee joint motion plays a crucial role in the pathogenesis of knee osteoarthritis, yet investigation of individuals with chronic anterior cruciate ligament-deficient (ACLD) knees remains sparse. PURPOSE To investigate (1) if individuals with chronic ACLD knees demonstrate higher biomechanical measures of medial knee load as compared with their anterior cruciate ligament-intact (ACLI) knees, (2) if differences in static knee alignment of the ACLD knee will demonstrate a difference in the magnitude of biomechanical measures of medial knee load when compared with the ACLI knee, and (3) the side-to-side concordance of varus thrust among individuals with chronic ACLD knees. STUDY DESIGN Descriptive laboratory study. METHODS Participants were sourced from a metropolitan orthopaedic surgeon group. Those who met the inclusion criteria and agreed to participate underwent a 3-dimensional gait analysis assessment to measure knee adduction moment (KAM), knee flexion moment (KFM), KAM peaks, KAM impulse, and varus thrust. Frontal plane knee static alignment was measured with a digital inclinometer fixed to medical calipers. The participants were divided according to their static knee alignment (neutral, varus, and valgus) for subgroup analysis. Peak knee angular velocity and frontal plane knee angle were used to establish if a participant was walking with a knee thrust. An individual was deemed to have knee thrust during gait if the largest frontal plane knee movement coincided with the peak knee angular velocity that occurred within the first 30% of stance phase. RESULTS Forty-five participants were recruited. The mean (SD) time from injury was 34.5 (55.6) months. ACLD knees did not demonstrate higher mean KAM and KFM ( P > .5) or early-stance peak KAM ( P = .3-.8) and KAM impulse ( P = .3-.9) as compared with ACLI knees as a whole group or when the varus, neutral, and valgus alignment subgroups were investigated separately. Twenty-three percent (n = 9) of the participants had a varus thrust at the ACLD or ACLI knee, 44% (n = 4) had a varus thrust at the ACLD knee, and 22% (n = 2) had varus thrust at both knees. CONCLUSION There were no side-to-side differences in mean KAM and KFM and early-stance peak KAM and KAM impulse among high-functioning individuals with chronic unilateral ACLD knees. There was a low prevalence of varus thrust among high-functioning individuals with chronic unilateral ACLD knees.
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Affiliation(s)
| | - Milena Simic
- The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Leo A Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
- University of Notre Dame, Medical School, Sydney, Australia
| | - Richard Smith
- The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia
| | - Evangelos Pappas
- The University of Sydney, Faculty of Health Sciences, Lidcombe, Australia
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Goff AJ, Page WS, Clark NC. Reporting of acute programme variables and exercise descriptors in rehabilitation strength training for tibiofemoral joint soft tissue injury: A systematic review. Phys Ther Sport 2018; 34:227-237. [PMID: 30388671 DOI: 10.1016/j.ptsp.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Strength training acute programme variables (APVs) can impact tibiofemoral joint injury outcomes. Exercise descriptors (EDs; e.g. patient-position) specify configurations within which APVs are applied. Evidence-based practice depends on adequate reporting of APVs and EDs to replicate strength training interventions in clinical practice. This systematic review assessed APV and ED reporting for adults with tibiofemoral joint injury (anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL)/medial collateral ligament (MCL)/lateral collateral ligament (LCL)/meniscus/hyaline cartilage (HC)). METHODS PRISMA guidelines were followed. Specific key-term combinations were employed and database searches performed. Descriptive/observational/experimental studies were included (2006-2018). Studies needed to report pre-defined APVs or EDs for ≥51% of all exercises to be included. Frequency counts were made of studies adequately reporting APVs and EDs. RESULTS Sixteen articles were included (ACL = 13; meniscus = 3). No PCL/MCL/LCL/HC articles were identified. Of nine APVs, five and four were consistently reported by the majority of ACL (≥7) and meniscal (≥2) studies, respectively. Of eight EDs, four were consistently reported by the majority of both ACL (≥8) and meniscal (≥2) studies. CONCLUSION Many APVs and EDs were not adequately reported. Future studies should better document APVs and EDs for higher standards of intervention reporting and enhanced translation of research to clinical practice.
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Affiliation(s)
- Anthony J Goff
- Health and Social Sciences, Singapore Institute of Technology, 10 Dover Drive, 138683, Singapore.
| | - William S Page
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldegrave Road, Twickenham, TW1 4SX, UK.
| | - Nicholas C Clark
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldegrave Road, Twickenham, TW1 4SX, UK.
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Rosemberg DL, Akkari M, Braga SDR, Lenza M, Martins FRP, Santili C. Hemarthrosis subtalar, a rare diagnosis. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2017; 52:228-232. [PMID: 28409144 PMCID: PMC5380797 DOI: 10.1016/j.rboe.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/23/2016] [Indexed: 11/17/2022]
Abstract
Type B hemophilia usually affects patients with a family history of this disease and has a typical clinical picture. However, in the present case it appeared in a patient outside the typical age with no family history of hematologic malignancies and with an unusual clinical picture.
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Affiliation(s)
- Dov Lagus Rosemberg
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
- Corresponding author.
| | - Miguel Akkari
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Susana dos Reis Braga
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Mario Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Claudio Santili
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Hemartrose subtalar, um diagnóstico raro. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Epidemiology of intra- and peri-articular structural injuries in traumatic knee joint hemarthrosis - data from 1145 consecutive knees with subacute MRI. Osteoarthritis Cartilage 2016; 24:1890-1897. [PMID: 27374877 DOI: 10.1016/j.joca.2016.06.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/02/2016] [Accepted: 06/11/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In patients with traumatic knee distorsion and hemarthrosis, to investigate the panorama of structural injury, as visualized on magnetic resonance imaging (MRI). DESIGN Cohort study of 1145 consecutive patients with traumatic knee distorsion who underwent MRI within median 8 days after injury. We present structural injury as visualized on MRI in relation to age, sex and activity at injury. Population based gender specific annual incidences of common structural injuries were calculated. RESULTS The majority of injuries (72%) occurred during sports. Overall, anterior cruciate ligament (ACL) rupture was the most common structural injury (52%), followed by meniscal tear (41%) and lateral patella dislocation (LPD, 17%). Only 12% of ACL tears were isolated with meniscal tear being the most common associated injury (55%). The annual incidence of ACL injury was 77 (70-85, 95% CI) per 100,000 inhabitants with significant differences between men (91, 80-103) and women (63, 53-73). In those aged 16 years and younger, LPD was the most frequent structural injury, both in boys (39%) and girls (43%). In this age group, the annual incidence of LPD was 88 (68-113) and higher in boys (113, 81-154) than in girls (62, 39-95). CONCLUSIONS ACL injury occurs in one out of two knees with traumatic hemarthrosis but only 12% are without concomitant structural injury. The overall rate of traumatic knee hemarthrosis and ACL injury is higher in men. In those aged 10-19 years, ACL rupture is more common among girls than boys whereas in those 16 years and younger, LPD is more common among boys than girls.
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van Galen KPM, Sanders YV, Vojinovic U, Eikenboom J, Cnossen MH, Schutgens REG, van der Bom JG, Fijnvandraat K, Laros-Van Gorkom BAP, Meijer K, Leebeek FWG, Mauser-Bunschoten EP. Joint bleeds in von Willebrand disease patients have significant impact on quality of life and joint integrity: a cross-sectional study. Haemophilia 2015; 21:e185-e192. [PMID: 25854528 DOI: 10.1111/hae.12670] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Joint bleeds (JB) are reported in a minority of patients with von Willebrand disease (VWD) but may lead to structural joint damage. Prevalence, severity and impact of JB in VWD are largely unknown. OBJECTIVES The aim of this study was to assess JB prevalence, onset, treatment and impact on health-related quality of life (HR-QoL) and joint integrity in moderate and severe VWD. METHODS In the Willebrand in the Netherlands study 804 moderate and severe VWD patients [von Willebrand factor (VWF) activity ≤30U dL(-1)] completed a questionnaire on occurrence, sites and consequences of JB. To analyse JB number, onset, treatment and impact on joint integrity we additionally performed a patient-control study on medical file data comparing patients with JB to age, gender, factor VIII (FVIII)- and VWF activity matched VWD patients without JB. RESULTS Of all VWD patients 23% (184/804) self-reported JB. These 184 patients reported joint damage more often (54% vs. 18%, P < 0.001) and had lower HR-QoL (SF36, P < 0.05) compared to VWD patients not reporting JB. Of 55 patients with available JB data, 65% had the first JB before age 16. These 55 patients used more clotting factor concentrate (CFC; median dose 43 vs. 0 IE FVIII kg(-1) year(-1) , P < 0.001), more often had X-ray joint damage (44% vs. 11%, P = 0.001] and chronic joint pain (44% vs. 18%, P = 0.008) compared to 55 control VWD patients without JB. CONCLUSION In conclusion, joint bleeds are reported by 23% of moderate and severe VWD patients, mostly start in childhood, are associated with more CFC use, joint pain, lower HR-QoL and significantly more radiological and self-reported joint damage.
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Affiliation(s)
- K P M van Galen
- Department of Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
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Kijowski R, Roemer F, Englund M, Tiderius CJ, Swärd P, Frobell RB. Imaging following acute knee trauma. Osteoarthritis Cartilage 2014; 22:1429-43. [PMID: 25278054 DOI: 10.1016/j.joca.2014.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 02/02/2023]
Abstract
Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma.
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Affiliation(s)
- R Kijowski
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
| | - F Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Radiology, Boston University, Boston, MA, USA
| | - M Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University, Boston, MA, USA
| | - C J Tiderius
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - P Swärd
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
| | - R B Frobell
- Department of Orthopedics, Clinical Sciences Lund, Lund, Sweden
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Smith TO, Lewis M, Song F, Toms AP, Donell ST, Hing CB. The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0829-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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HERMANS C, DE MOERLOOSE P, FISCHER K, HOLSTEIN K, KLAMROTH R, LAMBERT T, LAVIGNE-LISSALDE G, PEREZ R, RICHARDS M, DOLAN G. Management of acute haemarthrosis in haemophilia A without inhibitors: literature review, European survey and recommendations. Haemophilia 2011; 17:383-92. [DOI: 10.1111/j.1365-2516.2010.02449.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ockert B, Haasters F, Polzer H, Grote S, Kessler M, Mutschler W, Kanz KG. Der verletzte Meniskus: Wie sicher ist die klinische Untersuchung? Unfallchirurg 2009; 113:293-9. [DOI: 10.1007/s00113-009-1702-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Shaerf D, Banerjee A. Assessment and management of posttraumatic haemarthrosis of the knee. Br J Hosp Med (Lond) 2008; 69:459-60, 462-3. [PMID: 18783098 DOI: 10.12968/hmed.2008.69.8.30743] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traumatic haemarthrosis of the knee poses significant diagnostic difficulty in the acute phase. Orthopaedic follow up is essential. An update of current recommended practice is provided, and the pros and cons of arthroscopy and magnetic resonance imaging are discussed.
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Affiliation(s)
- Daniel Shaerf
- Department of Trauma and Orthopaedics, Barnet Hospital, Barnet
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Frobell RB, Lohmander LS, Roos HP. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scand J Med Sci Sports 2007; 17:109-14. [PMID: 17394470 DOI: 10.1111/j.1600-0838.2006.00559.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine the incidence of anterior cruciate ligament (ACL) injuries in the general population; the pathology associated with a knee sprain verified by magnetic resonance imaging (MRI); and the agreement between clinical findings and MRI. MATERIAL AND METHODS Inclusion criterion was an acute rotational trauma to the knee associated with effusion. One hundred and fifty-nine consecutive patients, mean age 27 years and 36% women, were included after clinical assessment at the orthopedic emergency unit. Patients were referred to an MRI examination (1.0 or 1.5 T) performed within a median of 8 days of the initial visit. RESULTS The annual incidence of MRI verified ACL injuries was 0.81/1000 inhabitants aged 10-64 years. Fifty-six percent (n=89) of those included had sustained an ACL injury of whom 38% had an associated medial meniscus tear. There was a poor agreement between initial clinical antero-posterior laxity and MRI verified presence of an ACL tear (kappa 0.281). Every second patellar dislocation was diagnosed as a ligament injury. CONCLUSION Our findings indicate that the incidence of ACL injuries is higher than previously described. We also show that the first clinical examination after an acute knee trauma has a low diagnostic value. Further assessment with MRI improves the chances of a correct diagnosis of intraarticular pathology and is recommended in the early phase after a rotational knee trauma.
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Affiliation(s)
- R B Frobell
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden.
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Chandratreya AP, Spalding TJW, Correa R. Development and efficiency of an acute knee trauma list. Injury 2006; 37:502-6. [PMID: 16368094 DOI: 10.1016/j.injury.2005.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 09/06/2005] [Accepted: 09/19/2005] [Indexed: 02/02/2023]
Abstract
Following acute knee trauma some patients will require urgent arthroscopy. Traditionally surgery is undertaken as in-patient on the general trauma list. This system leads to blockage of beds, repeated starving of the patient and out-of-hour's surgery in many cases. We introduced a dedicated Day Surgery knee trauma list (KTL) to reduce in-patient admissions, waiting time and cost. The typical indications for urgent knee arthroscopy are locked knees secondary to meniscal tears, loose bodies or cruciate ligament ruptures; acute osteochondral fractures; and children with acute meniscal tears. This retrospective review compares the study group: patients on the knee trauma list during the first 8 months following introduction, and the control group: patients on the general in-patient trauma list over a similar period immediately prior to implementation of the new list. There were 49 patients in the control group with an average stay in hospital of 2.5 days. Out-of-hour's operations were performed in 13 patients and 3 patients required a repeat arthroscopy. Fifty-three patients were treated in the knee study group. The significant operations were meniscal repair in 7, fixation of osteochondral fragments in 3. None of the patients required overnight stay. Control group patients were more likely to have surgery performed by inexperienced non-specialist knee surgeons, whereas specialist knee surgeons staffed the knee trauma list. Specialist surgeons were available to staff the knee trauma list. As the majority of the control group had spent an average of 2.2 nights in hospital, there has been considerable savings to the hospital. Introduction of the Day Surgical Knee trauma list has reduced unnecessary admissions per week; episodes of prolonged starving, cost and have improved patient satisfaction and management.
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Affiliation(s)
- A P Chandratreya
- Department of Trauma & Orthopaedics, University Hospitals Coventry & Warwickshire NHS Trust, Stoney Stanton Road, Coventry CV1 4FH, West Midlands, UK.
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Bugnone AN, Ramnath RR, Davis SB, Sedaros R. The quadruple cruciate sign of simultaneous bicompartmental medial and lateral bucket-handle meniscal tears. Skeletal Radiol 2005; 34:740-4. [PMID: 15895223 DOI: 10.1007/s00256-005-0915-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the second known case of bicompartmental bucket-handle tears of the medial and lateral menisci and the first documented case of the bucket-handle tears occurring simultaneously following trauma, which occurred after a motorcycle accident. Both bucket-handle fragments were displaced into the intercondylar notch. An anterior cruciate ligament tear was also present. Coronal images demonstrated four structures in the intercondylar notch: the anterior and posterior cruciate ligaments and the medial and lateral bucket-handle meniscal fragments.
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Affiliation(s)
- Alejandro N Bugnone
- Department of Radiology, University of Miami School of Medicine/Jackson Memorial Hospital, 1611 NW 12 Avenue, Miami, FL 33136, USA
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