Frequency of anterolateral ligament tears and ramp lesions in patients with anterior cruciate ligament tears and associated injuries indicative for these lesions-a retrospective MRI analysis

OBJECTIVES

To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated injuries indicative for these lesions.

METHODS

In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson's chi-square test. A p < 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni's correction was applied.

RESULTS

ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL.

CONCLUSIONS

ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions.

KEY POINTS

• ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases. • Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME. • ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.

An epidemiologic analysis of winter sport accidents on ski slopes comparing two seasons

BACKGROUND

The aim of this investigation was to provide a detailed analysis of accidents on ski slopes of Styrian resorts comparing two winter seasons.

METHODS

Accident data requiring the presence of the ski patrol of the seasons 2007/08 (10 skiing resorts with 1029 injuries) and 2014/15 (8 resorts with 1844 injuries) were recorded. Accidents were normalized to 1000 skier days and 10000 lift transports. Patients were followed to hospitals to obtain information about injured body region, final diagnosis and type of treatment.

RESULTS

A slight increase of injuries from 0.5 to 0.7 per 1000 skier-days was found (P=0.046). Overall, the knee was most commonly affected followed by shoulder, lower leg, head and forearm. While the shoulder was most often affected in men the knee was most commonly affected in women. Patients <15 years had a higher prevalence of forearm injuries. Comparing the two seasons the use of helmets and spine protectors increased, associated with decreased injuries of these body regions. The hospitalization rate was 26% in both seasons; patients <15 years required less inpatient treatment than older ones.

CONCLUSIONS

Different injury patterns between gender and age-groups have to be taken into account for future preventive measures. The increased acceptance of safety equipment was associated with reduced injury rates of the respective body regions. Results of the present study can facilitate to develop future injury prevention strategies in order to further decrease the number of casualties on ski slopes.

Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome

A patient was admitted reporting tingling pain and numbness in the right hand. Neurological examination--including nerve conduction studies--diagnosed carpal tunnel syndrome. Operative carpal tunnel release was performed without complications. Four months postoperatively the otherwise healthy patient presented again due to persistent complaints, although preoperative symptoms had improved. On this occasion, the patient reported loss of strength accompanied by rigidity in the wrist. Clinical examination showed some swelling adjacent to the operation wound. A postoperative ganglion cyst was suspected and a conservative treatment option--splinting the wrist--was chosen. Four weeks later the patient presented again with further swelling and increasing rigidity of the wrist. Surgical intervention was planned. Preoperative plain radiographs of the wrist revealed chronic palmar dislocation of the lunate to be the cause of the symptoms in our patient. Radiological signs of scapholunate advanced collapse arthritis (SLAC wrist) were also observed.

Transcatheter closure of postinfarction ventricular septal defects

Postinfarction ventricular septal defect (VSD) is a rare but fatal complication after myocardial infarction. Surgery for postinfarction VSD is considered the gold standard. However, it is associated with high morbidity and mortality, patient discomfort, need of cardiopulmonary bypass, sternotomy, and skin scarring. As a consequence, less invasive interventional techniques have been developed for postinfarction VSD closure. The current review focuses on patient selection, techniques, results, potential complications and outcome of percutaneous postinfarction closure.