1
|
Manatrakul R, Loeffler M, Bharadwaj UU, Joseph GB, Lansdown D, Feeley B, Baal JD, Guimaraes JB, Link TM. Clinical and radiologic outcomes in patients with meniscal root tears. BMC Musculoskelet Disord 2024; 25:232. [PMID: 38521904 PMCID: PMC10960405 DOI: 10.1186/s12891-024-07359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS Ninety patients were included. VAS pain scores were significantly (p < 0.01) lower after arthroscopic repair compared to conservative treatment (1.27±0.38vs.4±0.52) at the last follow-up visit with median (IQR) of 325 (180-1391) days. Increased meniscal extrusion (mm) was associated with higher odds of receiving non-surgical treatment (OR = 1.65, 95%CI 1.02-2.69, p = 0.04). The odds of having arthroscopic repair increased by 19% for every 1 mm increase in the distance of the tear from the root attachment (OR = 1.19, 95% CI: 1.05-1.36, p < 0.01). The odds of undergoing arthroscopic repair were reduced by 49% for every 1 mm increase in the extent of meniscal extrusion (OR = 0.51, 95% CI: 0.29-0.91, p = 0.02) as observed in the baseline MRI. CONCLUSIONS Patients who underwent arthroscopic repair had lower pain scores than patients with conservative treatment in the follow-up. Distance of the torn meniscus to the root attachment and the extent of meniscal extrusion were significant predictors for arthroscopic repair in the next three weeks (time from the baseline MRI to the surgery date).
Collapse
Affiliation(s)
- Rawee Manatrakul
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Maximilian Loeffler
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - Upasana U Bharadwaj
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Brian Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
| | - Julio B Guimaraes
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA
- Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
- Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
| |
Collapse
|
2
|
Berrigan WA, Bailowitz Z, Park A, Reddy A, Liu R, Lansdown D. A Greater Platelet Dose May Yield Better Clinical Outcomes for Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00206-8. [PMID: 38513880 DOI: 10.1016/j.arthro.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To determine whether the platelet dose administered during a platelet-rich plasma (PRP) injection for knee osteoarthritis (OA) affects clinical outcomes. METHODS A systematic review was performed by searching PubMed, Cochrane Library, and Embase for randomized controlled trials with at least 1 study arm using PRP for knee OA. Only studies that provided a platelet count, concentration, or dose with a minimum of 6-month outcome scores were included. Studies in which the PRP group had statistically significant positive outcomes were separated from those without statistical significance. The average platelet doses for studies with positive outcomes in the PRP group were compared with those without positive outcomes. RESULTS After exclusion criteria were applied, 29 studies were analyzed. Of the 29, there were 31 arms that used PRP as a treatment method, of which 28 had statistically significant positive outcomes at 6 months compared with the control group. The mean platelet dose in the 28 with a positive outcome was 5,500 ± 474 × 106, whereas the 3 that had no positive difference had a mean platelet dose of 2,302 ± 437 × 106 (P < .01). There were 18 studies with 12-month outcomes, with 16 of 18 having positive outcomes. The positive studies had an average platelet dose of 5,464 ± 511, whereas the studies that had no statistical difference had an average platelet dose of 2,253 ± 753 × 106 (P < .05). CONCLUSIONS Improved clinical outcomes from PRP injections for knee OA may be related to a greater platelet dose. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
Collapse
Affiliation(s)
- William A Berrigan
- Department of Orthopaedics, University of California San Francisco, San Francisco, California, U.S.A..
| | - Zach Bailowitz
- Department of Orthopedics, Kaiser Permanente Oakland, Oakland, California, U.S.A
| | - Anna Park
- University of California San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Aakash Reddy
- University of California Berkeley, Berkeley, California, U.S.A
| | - Ryan Liu
- University of California Berkeley, Berkeley, California, U.S.A
| | - Drew Lansdown
- Department of Orthopaedics, University of California San Francisco, San Francisco, California, U.S.A
| |
Collapse
|
3
|
Freshman RD, Zhang AL, Benjamin Ma C, Feeley BT, Ortiz S, Patel J, Dunn W, Wolf BR, Hettrich C, Lansdown D, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Bravman JT, Cox CL, Cvetanovich GL, Grant JA, Frank RM, Jones GL, Kuhn JE, Mair SD, Marx RG, McCarty EC, Miller BS, Seidl AJ, Smith MV, Wright RW. Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort. Orthop J Sports Med 2023; 11:23259671231206757. [PMID: 37900861 PMCID: PMC10612462 DOI: 10.1177/23259671231206757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. Purpose To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. Results A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). Conclusion Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.
Collapse
Affiliation(s)
- Ryan D. Freshman
- Investigation performed at the University of California–San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Jhillika Patel
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Warren Dunn
- Fondren Orthopedic Group, Houston, Texas, USA
| | - Brian R. Wolf
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Drew Lansdown
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | | | - Julie Y. Bishop
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | - Charles L. Cox
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John A. Grant
- MedSport, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel M. Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Grant L. Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John E. Kuhn
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Eric C. McCarty
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Adam J. Seidl
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rick W. Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
4
|
Wong V, Calivá F, Su F, Pedoia V, Lansdown D. Comparing bone shape models from deep learning processing of magnetic resonance imaging to computed tomography-based models. JSES Int 2023; 7:861-867. [PMID: 37719825 PMCID: PMC10499848 DOI: 10.1016/j.jseint.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background The purpose of this study was to develop a deep learning approach to automatically segment the scapular bone on magnetic resonance imaging (MRI) images and to compare the accuracy of these three-dimensional (3D) models with that of 3D computed tomography (CT). Methods Fifty-five patients with high-resolution 3D fat-saturated T2 MRI were retrospectively identified. The underlying pathology included rotator cuff tendinopathy and tears, shoulder instability, and impingement. Two experienced musculoskeletal researchers manually segmented the scapular bone. Five cross-validation training and validation splits were generated to independently train two-dimensional (2D) and 3D models using a convolutional neural network approach. Model performance was evaluated using the Dice similarity coefficient (DSC). All models with DSC > 0.70 were ensembled and used for the test set, which consisted of four patients with matching high-resolution MRI and CT scans. Clinically relevant glenoid measurements, including glenoid height, width, and retroversion, were calculated for two of the patients. Paired t-tests and Wilcoxon signed-rank tests were used to compare the DSC of the models. Results The 2D and 3D models achieved a best DSC of 0.86 and 0.82, respectively, with no significant difference observed. Augmentation of imaging data significantly improved 3D but not 2D model performance. In comparing clinical measurements of 3D MRI and CT, there was a mean difference ranging from 1.29 mm to 3.46 mm and 0.05° to 7.47°. Conclusion We have presented a fully automatic, deep learning-based strategy for extracting scapular shape from a high-resolution MRI scan. Further developments of this technology have the potential to allow for surgeons to obtain all clinically relevant information from MRI scans and reduce the need for multiple imaging studies for patients with shoulder pathology.
Collapse
Affiliation(s)
- Victoria Wong
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Francesco Calivá
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Center for Intelligent Imaging, Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
5
|
Davies MR, Kucirek N, Motamedi D, Ma CB, Feeley BT, Lansdown D. Relationship Between Preoperative Shoulder Osteoarthritis Severity Score and Postoperative PROMIS-UE Score After Rotator Cuff Repair. Orthop J Sports Med 2023; 11:23259671221143801. [PMID: 36636030 PMCID: PMC9829989 DOI: 10.1177/23259671221143801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 01/06/2023] Open
Abstract
Background Mild to moderate glenohumeral joint osteoarthritis is a common finding among patients who are evaluated for rotator cuff tears. However, the impact of preoperative shoulder joint degeneration on patient-reported outcomes after rotator cuff repair (RCR) is not well-established. Purpose To apply the magnetic resonance imaging (MRI)-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between preoperative shoulder pathology present on MRI and postoperative Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE) scores. Study Design Case-control study; Level of evidence, 3. Methods Seventy-one MRI scans corresponding to 71 patients were analyzed by 2 independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each subscore. Spearman correlations were calculated between averaged SOAS scores, patient characteristics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as P < .05 for univariate analyses and < .0125 for multivariate analyses using the Bonferroni correction. Results The mean PROMIS-UE score of this cohort was 51.5 ± 7.4, while the mean total SOAS score was 21.5 ± 8.4. There was a negative correlation between total SOAS score and postoperative PROMIS-UE score (r = -0.24; P = .040). Both cartilage wear (r = -0.33; P = .0045) and acromioclavicular joint degeneration (r = -0.24; P = .048) individually demonstrated negative correlations with PROMIS-UE score. When a multivariate linear regression with Bonferroni correction was applied to the significant variables identified in univariate analysis along with patient characteristics, none were independently correlated with PROMIS-UE score. Conclusion In this cohort of patients undergoing RCR, increasing preoperative total SOAS score was predictive of lower postoperative PROMIS-UE scores. SOAS subscores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and acromioclavicular joint degeneration. The cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient factors in multivariate analysis.
Collapse
Affiliation(s)
- Michael R. Davies
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Natalie Kucirek
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Daria Motamedi
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California, San
Francisco, San Francisco, California, USA.,Drew Lansdown, MD, Department of Orthopaedic Surgery, University
of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158, USA
()
| |
Collapse
|
6
|
Bradsell H, Waterman B, Lansdown D, Hevesi M, Jones K, Frank RM. Incorporating Biologics Into Your Sports Medicine Practice: Who, What, When, Why, and How? Instr Course Lect 2023; 72:431-444. [PMID: 36534871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Orthobiologic techniques can be used in the treatment of a variety of sports medicine pathologies, using an evidence-based approach focused on the value of all available approaches. The orthopaedic surgeon should be aware of the indications for and any technical pearls and pitfalls related to the use of orthobiologic agents as treatment for, or as an adjunct to management of, common sports medicine injuries and pathologies. Expected outcomes, including return to sport/activity, as well as potential complications and how to avoid them, should be considered. Although promising results have been reported, significant lack of high-level studies, inconsistent findings, and variability among current research make it challenging to reach a definitive conclusion about application, target populations, and overall effectiveness.
Collapse
|
7
|
Gatto AP, Hu DA, Feeley BT, Lansdown D. Dyslipidemia is associated with risk for rotator cuff repair failure: a systematic review and meta-analysis. JSES Rev Rep Tech 2022; 2:302-309. [PMID: 37588872 PMCID: PMC10426695 DOI: 10.1016/j.xrrt.2022.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Lipid deposition secondary to dyslipidemia (DLD) is shown to have a significant impact on tendon pathology, including tendon elasticity, fatty infiltration, and healing properties. Rotator cuff repair is a common procedure, susceptible to influence from many tear-related and patient-related characteristics. The purpose of this study was to determine the relationship between DLD and rotator cuff repair outcomes with analysis of retear risk and function. Methods PubMed, Embase, and SPORTDiscus were searched for all English-language, peer-reviewed studies between 2000 and the present, which analyzed relationships between patient-related factors and outcomes of rotator cuff repair. Studies that explicitly examined the effect of DLD on rotator cuff repair outcomes were chosen for inclusion. Included studies were assessed for methodological quality, and data were extracted for meta-analysis. Results Of the 3087 titles, 424 were screened by abstract, and 67 were reviewed in full. Inclusion criteria were met by 11 studies. Of these studies, 5 studies assessed retear, 2 studies measured function, 3 studies reported both retear and function, and 1 study evaluated the risk of retear necessitating a revision surgery. The studies report no significant difference in functional outcomes. Meta-analysis revealed that DLD patients had a significantly higher risk of retear after primary rotator cuff repair (odds ratio 1.32, 95% confidence interval 1.06-1.64). Conclusion DLD leads to an increased risk of retear after rotator cuff repair, although function appears to be unimpaired. DLD should be considered among other risk factors when counseling patients regarding expected rotator cuff repair outcomes.
Collapse
Affiliation(s)
- Andrew P. Gatto
- College of Osteopathic Medicine, Touro University California, Vallejo, CA, USA
| | - Daniel A. Hu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Brian T. Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Drew Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
8
|
Cogan CJ, Cevallos N, Freshman RD, Lansdown D, Feeley BT, Zhang AL. Evaluating Utilization Trends in Adhesive Capsulitis of the Shoulder: A Retrospective Cohort Analysis of a Large Database. Orthop J Sports Med 2022; 10:23259671211069577. [PMID: 35097146 PMCID: PMC8793616 DOI: 10.1177/23259671211069577] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Nonoperative and operative treatment modalities have been used for symptom management of adhesive capsulitis, but neither has been shown to significantly alter the long-term natural history. Purpose/Hypothesis: The purpose was to evaluate the current trends in resource and treatment strategy utilization for patients with adhesive capsulitis. It was hypothesized that (1) patients with idiopathic adhesive capsulitis will primarily undergo nonoperative treatment and (2) patients with systemic medical comorbidities will demonstrate relatively higher utilization of nonoperative therapies. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We searched the Mariner/PearlDiver database for Current Procedural Terminology and International Classification of Diseases codes to identify patients with adhesive capsulitis from 2010 to 2020 and to track their usage of diagnostic and therapeutic modalities, including radiography, magnetic resonance imaging (MRI), physical therapy, surgery, opioids, and injection. Patients with active records 1 year before and 2 years after initial diagnosis of adhesive capsulitis were eligible. Excluded were patients with secondary causes of adhesive capsulitis, such as fracture, infection, prior surgery, or other intra-articular pathology. Results: The median age of this 165,937-patient cohort was 58 years, with 67% being women. There was a high prevalence of comorbid diabetes (44.2%), thyroid disorder (29.6%), and Dupuytren contracture (1.3%). Within 2 years of diagnosis of adhesive capsulitis, diagnostic and therapeutic modality utilization included radiography (47.2%), opioids (46.7%), physical therapy (43.1%), injection (39.0%), MRI (15.8%), arthroscopic surgery (2.7%), and manipulation under anesthesia (2.5%). Over 68% of the diagnostic and therapeutic modalities were rendered from 3 months before to 3 months after diagnosis. Patients with diabetes, thyroid disorders, tobacco use, and obesity had greater odds for treatment with physical therapy, opioids, radiography, and injection when compared with patients without these comorbidities (odds ratio [OR] range, 1.05-2.21; P < .0001). Patients with diabetes and thyroid disorders had decreased odds for surgery (OR range, 0.88-0.91; P ≤ .003). Patients with Dupuytren contracture had increased odds for all therapeutic modalities (OR range, 1.20-1.68; P < .0001). Conclusion: Patients with adhesive capsulitis underwent primarily nonoperative treatment, with a high percentage utilizing opioids. The most active periods for treatment were from 3 months before diagnosis to 3 months after, and patients with medical comorbidities were more likely to undergo nonoperative treatment.
Collapse
Affiliation(s)
- Charles J. Cogan
- Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Nicolas Cevallos
- Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Ryan D. Freshman
- Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA
| |
Collapse
|
9
|
Waterman BR, Newgren J, Gowd AK, Cabarcas B, Lansdown D, Bach BR, Cole BJ, Romeo AA, Verma NN. Randomized Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-Reported Outcomes at Long-Term Follow-Up. Arthroscopy 2021; 37:3072-3078. [PMID: 33940126 DOI: 10.1016/j.arthro.2021.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate long-term patient-reported outcomes and revision surgery after arthroscopic rotator cuff repair with or without acromioplasty. METHODS Between 2007 and 2011, prospectively enrolled patients undergoing arthroscopic repair for full-thickness rotator cuff tears, with any acromial morphology, were randomized into either acromioplasty or nonacromioplasty groups. Patients with revision surgery, subscapularis involvement, advanced neurologic conditions, or death were excluded. Baseline and long-term follow-up questionnaires, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), University of California-Los Angeles (UCLA), Visual Analog Scale (VAS) for pain, and Constant scores were obtained. Rates of symptomatic retear, revision rotator cuff surgery, or secondary reoperation were recorded. Averages with standard deviation were calculated, and t-tests were used to compare outcomes of interest between cohorts. RESULTS In total, 69 of 90 patients (76.7%) were available at 92.4 months (± 10.5). There were 23 of 32 patients in the acromioplasty cohort and 24 of 37 patients in the nonacromioplasty cohort. Mean age for the nonacromioplasty cohort was 56.9 (± 7.6) years, whereas acromioplasty was 59.6 (± 6.8) years. Comparison of baseline demographics and intraoperative information revealed no significant differences, including age, sex, Workers' Compensation, acute mechanism of injury, tear size, degree of retraction, and surgical technique (e.g., single- vs. double-row). At final follow-up, there were no statistically significant differences according to ASES (P = .33), VAS pain (P = 0.79), Constant (P = .17), SST (P = .05), UCLA (P = .19), and Short Form-12 (SF-12) (P = .79) in patients with and without acromioplasty. Two patients with acromioplasty (5.6%) and 3 patients without acromioplasty (9.1%) sustained atraumatic recurrent rotator cuff tear with secondary repair (P = .99), and there was no significant difference in retear rates or patient-reported outcome measures by acromial morphology. CONCLUSIONS This randomized trial, with mean 7.5-year follow-up, found no difference in validated patient-reported outcomes, retear rate, or revision surgery rate between patients undergoing rotator cuff repair with or without acromioplasty. LEVEL OF EVIDENCE II, prospective randomized controlled trial.
Collapse
Affiliation(s)
- Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A..
| | - Jon Newgren
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brandon Cabarcas
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Drew Lansdown
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| |
Collapse
|
10
|
Bravo-Illanes G, Halvorson RT, Matthew RP, Lansdown D, Ma CB, Bajcsy R. IMU Sensor Fusion Algorithm for Monitoring Knee Kinematics in ACL Reconstructed Patients. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5877-5881. [PMID: 31947187 DOI: 10.1109/embc.2019.8857431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this paper we propose a sensor embedded knee brace to monitor knee flexion and extension and other lower limb joint kinematics after anterior cruciate ligament (ACL) injury. The system can be easily attached to a standard post-surgical brace and uses a novel sensor fusion algorithm that does not require calibration. The wearable system and the sensor fusion algorithm were validated for various physical therapy exercises against a validated motion capture system. The proposed sensor fusion algorithm demonstrated significantly lower root-mean-square error (RMSE) than the benchmark Kalman filtering algorithm and excellent correlation coefficients (CCC and ICC). The demonstrated error for most exercises was lower than other devices in the literature. The quantitative measures obtained by this system can be used to obtain longitudinal range-of-motion and functional biomarkers. These biomarkers can be used to improve patient outcomes through the early detection of at-risk patients, tracking patient function outside of the clinic, and the identification of relationships between patient presentation, intervention, and outcomes.
Collapse
|
11
|
Lansdown D, Cheung EC, Xiao W, Lee A, Zhang AL, Feeley BT, Benjamin Ma C. Do Preoperative and Postoperative Glenoid Retroversion Influence Outcomes After Reverse Total Shoulder Arthroplasty? J Shoulder Elb Arthroplast 2020; 4:2471549220912552. [PMID: 34497960 PMCID: PMC8282142 DOI: 10.1177/2471549220912552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background There are limited data on the effect of glenoid retroversion in clinical
outcomes following reverse total shoulder arthroplasty (RTSA). The purpose
of this study was to evaluate if surgical correction of retroversion affects
outcomes following RTSA. Methods An institutional database was utilized to identify 177 patients (mean age:
68.2 ± 10.1 years) with minimum 2-year follow-up after primary RTSA. Glenoid
version was measured on preoperative and postoperative radiographs. American
Shoulder and Elbow Surgeons (ASES) scores and range of motion were collected
before and after RTSA. Change in retroversion was determined by comparing
preoperative and postoperative glenoid retroversion on radiographs using
paired Wilcoxon signed-rank test. Spearman’s rank correlation was used to
investigate relationships between ASES scores and glenoid retroversion. Results The mean postoperative ASES composite score (75.5 ± 22.7) was significantly
higher than preoperative (36.8 ± 19.2; P < .0001). The
mean preoperative glenoid retroversion was 9.1 ± 6.7° compared to 6.5 ± 5.1°
postoperatively (P < .0001). There was no correlation
between postoperative ASES scores and preoperative retroversion
(r = .014, P = .85) or postoperative
retroversion (r = −.043, P = .57). There
was no statistical relationship between postoperative retroversion and range
of motion, though there is a risk of inadequate power given the sample
size. Conclusions Patient-reported outcomes and range of motion measurements following RTSA at
short-term follow-up appear to be independent of either preoperative or
postoperative glenoid retroversion.
Collapse
Affiliation(s)
- Drew Lansdown
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
- Drew Lansdown, University of California San
Francisco, 1500 Owens Street, Suite 170, San Francisco, CA 94158, USA.
| | - Edward C Cheung
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
| | - Weiyuan Xiao
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
| | - Austin Lee
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California San
Francisco, San Francisco, California
| |
Collapse
|
12
|
|
13
|
Waterman BR, Hannon C, Cotter EJ, Lansdown D, Frank RM. Clinical Outcomes of Multiple Osteochondral Allograft Transplantation of the Knee: an Analysis of Snowman Technique and Multifocal Lesions. Arthroscopy 2018. [DOI: 10.1016/j.arthro.2018.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
14
|
Forsythe B, Lansdown D, Zuke WA, Verma NN, Cole BJ, Bach BR, Inoue N. Dynamic 3-Dimensional Mapping of Isometric Anterior Cruciate Ligament Attachment Sites on the Tibia and Femur: Is Anatomic Also Isometric? Arthroscopy 2018; 34:2466-2475. [PMID: 30077270 DOI: 10.1016/j.arthro.2018.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to (1) map the length changes of the medial wall of the lateral femoral condyle (MWLFC) with respect to various points about the tibial anterior cruciate ligament (ACL) footprint to determine the area that demonstrates the least amount of length change through full range of motion and (2) to identify a range of flexion that would be favorable for graft tensioning. METHODS Six fresh-frozen cadaveric knees were obtained from screened individuals with no prior history of arthritis, cancer, surgery, or any ligamentous knee injury. For each knee, 3-dimensional computed tomography point-cloud models were obtained in succession from 0° to 135°. A point grid was placed on the MWLFC and the tibia. Intra-articular length was calculated for each point on the femur to the tibia at all flexion angles and grouped to represent areas for bone tunnels. Normalized length changes were compared. RESULTS Areas anterior/distal on the MWLFC increased with increasing flexion, and areas proximal/posterior decreased with increasing flexion. The area about the intersection of the lateral intercondylar ridge and the bifurcate ridge was most isometric throughout flexion as no significant change in ligament length was found throughout flexion. The normalized length changes from the central position of the tibia showed no significant difference compared with the anterior or posterior tibial position. CONCLUSIONS No area of the MWLFC is truly isometric through flexion. Femoral tunnel placement slightly anterior to the center of the anteromedial and posterolateral bundles was most isometric. Minimal length change occurs between 10° and 40°, which reflects the range where graft tensioning was most often performed. The results of this study provide further support for an anatomic ACL reconstruction. CLINICAL RELEVANCE: The femoral tunnel location for ACL reconstruction with the least amount of length change through range of motion should encompass the direct fibers of the ACL.
Collapse
Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - William A Zuke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
15
|
Lansdown D, Bernardoni ED, Cotter EJ, Romeo AA, Verma NN. Arthroscopic Anterior Shoulder Stabilization With Incorporation of a Comminuted Bony Bankart Lesion. Arthrosc Tech 2017; 6:e2101-e2106. [PMID: 29349003 PMCID: PMC5766326 DOI: 10.1016/j.eats.2017.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/04/2017] [Indexed: 02/03/2023] Open
Abstract
Bony Bankart lesions are a common finding in patients with anterior glenohumeral dislocation. Although there are no defined guidelines, small bony Bankart fractures are typically treated arthroscopically with suture anchors. The 2 main techniques used are double- and single-row suture anchor stabilization, with debate over superiority. Biomechanical studies have shown improved reduction and stabilization with the double-row over the single-row suture anchor technique; however, this has not been reported for small or comminuted bony fragments. Both techniques have shown promising preliminary clinical outcomes. In this Technical Note, we describe our preferred technique for arthroscopic instability repair using a single-row all-suture anchor method with the incorporation of a comminuted bony Bankart fragment in the lateral decubitus position.
Collapse
Affiliation(s)
- Drew Lansdown
- Address correspondence to Drew Lansdown, M.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.Department of Orthopaedic SurgeryRush University Medical Center1611 W Harrison StSte 300ChicagoIL60612U.S.A.
| | | | | | | | | |
Collapse
|
16
|
Abstract
Bone morphology is one feature that contributes to knee kinematics. The geometry of the tibia and femur vary across individuals, and these differences can influence the risk of anterior cruciate ligament (ACL) injury and of failure after isolated ACL reconstruction. There has been renewed interest in lateral extra-articular stabilization procedures to supplement an ACL reconstruction, although which patients benefit most from these procedures remains unclear. This article reviews the impact of bone morphology on knee kinematics, including tibial slope, depth of the medial tibial plateau, intercondylar notch shape, tibial eminence volume, and sphericity of the femoral condyles.
Collapse
Affiliation(s)
- Drew Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, Suite 186, San Francisco, CA 94158, USA
| | - Chunbong Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, Suite 186, San Francisco, CA 94158, USA.
| |
Collapse
|
17
|
Li X, Pedoia V, Kumar D, Rivoire J, Wyatt C, Lansdown D, Amano K, Okazaki N, Savic D, Koff MF, Felmlee J, Williams SL, Majumdar S. Cartilage T1ρ and T2 relaxation times: longitudinal reproducibility and variations using different coils, MR systems and sites. Osteoarthritis Cartilage 2015; 23:2214-2223. [PMID: 26187574 PMCID: PMC4663102 DOI: 10.1016/j.joca.2015.07.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 06/15/2015] [Accepted: 07/06/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the longitudinal reproducibility and variations of cartilage T1ρ and T2 measurements using different coils, MR systems and sites. METHODS Single-Site study: Phantom data were collected monthly for up to 29 months on four GE 3T MR systems. Data from phantoms and human subjects were collected on two MR systems using the same model of coil; and were collected on one MR system using two models of coils. Multi-site study: Three participating sites used the same model of MR systems and coils, and identical imaging protocols. Phantom data were collected monthly. Human subjects were scanned and rescanned on the same day at each site. Two traveling human subjects were scanned at all three sites. RESULTS Single-Site Study: The phantom longitudinal RMS-CVs ranged from 1.8% to 2.7% for T1ρ and 1.8-2.8% for T2. Significant differences were found in T1ρ and T2 values using different MR systems and coils. Multi-Site Study: The phantom longitudinal RMS-CVs ranged from 1.3% to 2.6% for T1ρ and 1.2-2.7% for T2. Across three sites (n = 16), the in vivo scan-rescan RMS-CV was 3.1% and 4.0% for T1ρ and T2, respectively. Phantom T1ρ and T2 values were significantly different between three sites but highly correlated (R > 0.99). No significant difference was found in T1ρ and T2 values of traveling controls, with cross-site RMS-CV as 4.9% and 4.4% for T1ρ and T2, respectively. CONCLUSION With careful quality control and cross-calibration, quantitative MRI can be readily applied in multi-site studies and clinical trials for evaluating cartilage degeneration.
Collapse
Affiliation(s)
- Xiaojuan Li
- University of California, San Francisco, CA, USA
| | | | - Deepak Kumar
- University of California, San Francisco, CA, USA
| | | | - Cory Wyatt
- University of California, San Francisco, CA, USA
| | | | - Keiko Amano
- University of California, San Francisco, CA, USA
| | | | | | | | | | | | | |
Collapse
|
18
|
Wyatt C, Kumar D, Subburaj K, Lee S, Nardo L, Narayanan D, Lansdown D, Vail T, Link TM, Souza RB, Majumdar S. Cartilage T1ρ and T2 Relaxation Times in Patients With Mild-to-Moderate Radiographic Hip Osteoarthritis. Arthritis Rheumatol 2015; 67:1548-56. [PMID: 25779656 DOI: 10.1002/art.39074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 02/10/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To analyze region-specific T1ρ and T2 relaxation times of the hip joint cartilage in relation to presence or absence of radiographic hip osteoarthritis (OA) and presence or absence of magnetic resonance imaging (MRI)-detected cartilage defects. METHODS Weight-bearing radiographs and 3T MRI studies of the hip were obtained from 84 volunteers. Based on Kellgren/Lawrence (K/L) scoring of the radiographs, 54 subjects were classified as healthy controls (K/L grade ≤1) and 30 were classified as having mild or moderate radiographic hip OA (K/L grades 2 or 3, respectively). Two-dimensional fat-suppressed fast spin-echo MRI sequences were used for semiquantitative clinical scoring of cartilage defects, and a T1ρ/T2 sequence was used to quantitatively assess the cartilage matrix. The femoral and acetabular cartilage was then segmented into 8 regions and the mean T1ρ/T2 values were calculated. Differences in T1ρ and T2 relaxation times were compared between subjects with and those without radiographic hip OA, and those with and those without femoral or acetabular cartilage defects. RESULTS Higher T1ρ and T2 relaxation times in the anterior superior and central regions of the acetabular cartilage were seen in individuals with radiographic hip OA and those with acetabular cartilage defects compared to their respective controls (P < 0.05). In the femoral cartilage, the differences in T1ρ and T2 were not significant for any of the comparisons. Significant differences in the T1ρ and T2 values (each P < 0.05) were found in more subregions of the cartilage and across the whole cartilage when subjects were stratified based on the presence of MRI-detected cartilage defects than when they were stratified based on the presence of radiographic hip OA. CONCLUSION T1ρ and T2 relaxation parameters are sensitive to the presence of cartilage degeneration. Both parameters may therefore support MRI evidence of cartilage defects of the hip.
Collapse
Affiliation(s)
| | | | | | - Sonia Lee
- University of California, San Francisco
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Zaid M, Lansdown D, Su F, Pedoia V, Tufts L, Rizzo S, Souza RB, Li X, Ma CB. Abnormal tibial position is correlated to early degenerative changes one year following ACL reconstruction. J Orthop Res 2015; 33:1079-86. [PMID: 25721417 PMCID: PMC7238841 DOI: 10.1002/jor.22867] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/08/2015] [Indexed: 02/04/2023]
Abstract
Altered knee kinematics following ACL reconstruction may predispose patients to the development of early onset post-traumatic osteoarthritis. The goal of our study was to examine the longitudinal interrelationship between altered tibial position relative to the femur and cartilage health measured by quantitative T1ρ MRI. Twenty-five patients with isolated unilateral ACL injury underwent kinematic and cartilage T1ρ MRI at baseline prior to ACL reconstruction and then at 1-year post-reconstruction. Tibial position relative to the femur in the anterior-posterior plane was calculated as well as cartilage T1ρ relaxation values in the injured and uninjured knee. At baseline prior to ACL reconstruction, the tibia was in a significantly more anterior position relative to the femur in the ACL deficient knee compared to the healthy contralateral knee. This difference was no longer present at 1-year follow-up. Additionally, the side-side difference in tibial position correlated to increased cartilage T1ρ relaxation values in the medial compartment of the knee 1-year post-reconstruction. Altered tibial position following ACL reconstruction is correlated with detectable cartilage degeneration as soon as 1 year following ACL reconstruction.
Collapse
Affiliation(s)
- Musa Zaid
- University of California San Francisco School of Medicine, San Francisco
| | - Drew Lansdown
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco
| | - Favian Su
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Lauren Tufts
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Sarah Rizzo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco
| |
Collapse
|
20
|
Abstract
UNLABELLED The prevalence of vertebral fractures on routine chest radiographs of elderly Caucasian women was only 1.3 times higher than in African American (AA) women, a difference considerably smaller than reported in population studies. AAs with medical problems may have higher risk of vertebral fractures than previously suspected. INTRODUCTION Earlier studies noted a 1.9- to 3.7-fold higher prevalence of vertebral fractures in Caucasian (CA) compared to African American (AA) women. These studies, however, may have suffered from selection bias. We reported that among women referred for bone density testing, the prevalence of vertebral fractures in AA was the same as in CA women. Suspecting that the latter might have been due to a referral bias, we examined the racial difference in the prevalence of vertebra fractures on chest radiographs of patients seeking general medical care, not selected for osteoporosis. METHODS Consecutive chest radiographs (N = 1,200) of women over age 60 were evaluated using Genant's semi-quantitative method. Patients' race and the presence of diseases or medications associated with increased fracture risk were ascertained from the electronic medical records. RESULTS Among 1,011 women (76% AA) with usable radiographs, 11% had moderate or severe vertebral fractures. The prevalence of vertebral fractures was 10.3% in 773 AA and 13% in 238 CA women (p = 0.248 for difference between races). The lack of difference persisted after controlling for age, smoking, use of glucocorticoids, or presence of cancer, rheumatoid arthritis, organ transplantation, and end-stage renal disease. Among all subjects, CA women were more likely to be diagnosed and treated for osteoporosis (p <0.001). CONCLUSION Among subjects seeking medical care, the difference in the prevalence of vertebral fractures between AA and CA women is smaller than previously suspected. Greater attention to the detection of vertebral fractures and the management of osteoporosis is warranted in AA women with medical problems.
Collapse
Affiliation(s)
- D. Lansdown
- Section of Endocrinology, Department of Medicine, University of Chicago, 5841 S. Maryland, MC1027, Chicago, IL 60637 USA
- Present Address: Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA USA
| | - B. Bennet
- Section of Endocrinology, Department of Medicine, University of Chicago, 5841 S. Maryland, MC1027, Chicago, IL 60637 USA
- Present Address: Dreyer Medical Clinic, Aurora, IL USA
| | - S. Thiel
- Department of Radiology, University of Chicago, Chicago, IL USA
- Present Address: Suburban Imaging, Minneapolis, MN USA
| | - O. Ahmed
- Department of Radiology, University of Chicago, Chicago, IL USA
| | - L. Dixon
- Department of Radiology, University of Chicago, Chicago, IL USA
| | - T. J. Vokes
- Section of Endocrinology, Department of Medicine, University of Chicago, 5841 S. Maryland, MC1027, Chicago, IL 60637 USA
| |
Collapse
|