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Loozen LD, Younger AS, Veljkovic AN. Preoperative and Postoperative Imaging and Outcome Scores for Osteochondral Lesion Repair of the Ankle. Foot Ankle Clin 2024; 29:235-252. [PMID: 38679436 DOI: 10.1016/j.fcl.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Cartilage lesions to the ankle joint are common and can result in pain and functional limitations. Surgical treatment aims to restore the damaged cartilage's integrity and quality. However, the current evidence for establishing best practices in ankle cartilage repair is characterized by limited quality and a low level of evidence. One of the contributing factors is the lack of standardized preoperative and postoperative assessment methods to evaluate treatment effectiveness and visualize repaired cartilage. This review article seeks to examine the importance of preoperative imaging, classification systems, patient-reported outcome measures, and radiological evaluation techniques for cartilage repair surgeries.
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Affiliation(s)
- Loek D Loozen
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada.
| | - Alastair S Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada
| | - Andrea N Veljkovic
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Footbridge Clinic for Integrated Orthopaedic Care, 221 Keefer Place, Vancouver, British Columbia, V6B 6C1, Canada; University of British Columbia, Adult Foot and Ankle Reconstructive Surgery, Department of Orthopaedics, Vancouver, British Columbia, Canada
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Primetis E, Drakopoulos D, Sieron D, Meusburger H, Szyluk K, Niemiec P, Obmann VC, Peters AA, Huber AT, Ebner L, Delimpasis G, Christe A. Knee Diameter and Cross-Sectional Area as Biomarkers for Cartilage Knee Degeneration on Magnetic Resonance Images. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010027. [PMID: 36676651 PMCID: PMC9865157 DOI: 10.3390/medicina59010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Osteoarthritis (OA) of the knee is a degenerative disorder characterized by damage to the joint cartilage, pain, swelling, and walking disability. The purpose of this study was to assess whether demographic and radiologic parameters (knee diameters and knee cross-sectional area from magnetic resonance (MR) images) could be used as surrogate biomarkers for the prediction of OA. Materials and Methods: The knee diameters and cross-sectional areas of 481 patients were measured on knee MR images, and the corresponding demographic parameters were extracted from the patients' clinical records. The images were graded based on the modified Outerbridge arthroscopic classification that was used as ground truth. Receiver-operating characteristic (ROC) analysis was performed on the collected data. Results: ROC analysis established that age was the most accurate predictor of severe knee cartilage degeneration (corresponding to Outerbridge grades 3 and 4) with an area under the curve (AUC) of the specificity-sensitivity plot of 0.865 ± 0.02. An age over 41 years was associated with a sensitivity and specificity for severe degeneration of 82.8% (CI: 77.5-87.3%), and 76.4% (CI: 70.4-81.6%), respectively. The second-best degeneration predictor was the normalized knee cross-sectional area, with an AUC of 0.767 ± 0.04), followed by BMI (AUC = 0.739 ± 0.02), and normalized knee maximal diameter (AUC = 0.724 ± 0.05), meaning that knee degeneration increases with increasing knee diameter. Conclusions: Age is the best predictor of knee damage progression in OA and can be used as surrogate marker for knee degeneration. Knee diameters and cross-sectional area also correlate with the extent of cartilage lesions. Though less-accurate predictors of damage progression than age, they have predictive value and are therefore easily available surrogate markers of OA that can be used also by general practitioners and orthopedic surgeons.
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Affiliation(s)
- Elias Primetis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dionysios Drakopoulos
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dominik Sieron
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Hugo Meusburger
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 St., 41-940 Piekary Slaskie, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Verena C. Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Alan A. Peters
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Georgios Delimpasis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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Trang G, Del Sol SR, Jenkins S, Bryant S, Gardner B, Chakrabarti MO, McGahan PJ, Chen JL. Evaluation of Osteochondral Allograft Transplant Using In-Office Needle Arthroscopy. Arthrosc Tech 2022; 11:e2243-e2248. [PMID: 36632378 PMCID: PMC9827059 DOI: 10.1016/j.eats.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
In-office needle arthroscopy (IONA) has been available in various iterations for decades. Studies have described it as comparable if not superior to magnetic resonance imaging for identifying intra-articular pathology with associated cost savings per patient. A new IONA system has been brought to market with a modernized user interface and disposable handpieces offering the opportunity to address intra-articular pathology. This article outlines the use of this IONA system for the postoperative evaluation of an osteochondral allograft transplant.
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Affiliation(s)
- Garrett Trang
- The University of Arizona College of Medicine–Phoenix, Phoenix, Arizona, USA,Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA,Address correspondence to Garrett Trang, B.S., Advanced Orthopaedics and Sports Medicine, 450 Sutter St, Ste 400, San Francisco, CA 94108, USA
| | - Shane Rayos Del Sol
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sarah Jenkins
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - Stewart Bryant
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - Brandon Gardner
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | | | - Patrick J. McGahan
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
| | - James L. Chen
- Advanced Orthopaedics and Sports Medicine, San Francisco, California, USA
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Sieroń D, Jabłońska I, Niemiec P, Lukoszek D, Szyluk K, Platzek I, Meusburger H, Delimpasis G, Christe A. Relationship between Outerbridge Scale and Chondropathy Femorotibial Joint in Relation to Gender and Age-The Use of 1.5T and 3.0T MRI Scanners. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111634. [PMID: 36422173 PMCID: PMC9697703 DOI: 10.3390/medicina58111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Background and Objective: Magnetic resonance imaging (MRI) enables the effective evaluation of chondromalacia of the knee joint. Cartilage disease is affected by many factors, including gender, age, and body mass index (BMI). The aim of this study was to check the relationship between the severity of chondromalacia of the femoro-tibial joint and age, gender, and BMI assessed with 1.5T and 3.0T MRI scanners. Materials and Methods: The cross-observational study included 324 patients—159 (49%) females and 165 (51%) males aged 8−87 (45.1 ± 20.9). The BMI of study group was between 14.3 and 47.3 (27.7 ± 5.02). 1.5T and 3.0T MRI scanners were used in the study. The articular cartilage of the knee joint was assessed using the Outerbridge scale. Results: The age of the patients showed a significant correlation with Outerbrige for each compartment of the femorotibial joint (Spearman’s rank correlation rho: 0.69−0.74, p < 0.0001). A higher correlation between BMI and Outerbridge was noted in the femur medial (rho = 0.45, p < 0.001) and the tibia medial (rho = 0.43, p < 0.001) than in the femur lateral (rho = 0.29, p < 0.001) and the tibia lateral compartment (rho = 0.34, p < 0.001). Conclusions: The severity of chondromalacia significantly depends on age and BMI level, regardless of gender.
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Affiliation(s)
- Dominik Sieroń
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Correspondence:
| | - Izabella Jabłońska
- Recreation and Treatment Center “Glinik” 1, Wysowa-Zdrój 101 str, 38-316 Wysowa-Zdrój, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752 Katowice, Poland
| | - Dawid Lukoszek
- Dawid Lukoszek Physiotherapy Osteopathy, 42-690 Hanusek, Poland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940 Piekary Śląskie, Poland
| | - Ivan Platzek
- Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307 Dresden, Germany
| | - Hugo Meusburger
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Georgios Delimpasis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
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Magnetic resonance imaging is able to detect patellofemoral focal cartilage injuries: a systematic review with meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 31:2469-2481. [PMID: 36266368 DOI: 10.1007/s00167-022-07203-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 02/14/2023]
Abstract
PURPOSE The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage injuries. METHODS A systematic review was conducted on PubMed, EMBASE and Cochrane Library databases (up to July 1st 2022) to search for studies that reported the diagnostic accuracy of MRI to detect and grade PF cartilage injuries as compared to diagnostic arthroscopy. Risk of bias was judged using the QUADAS-2 tool. Quantitative syntheses were performed to calculate the diagnostic accuracy metric-sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios, diagnostic odds ratio (DOR)-and presented as median with 25% and 75% percentiles. The summary receiver operating characteristic (SROC) curves were also calculated. Diagnostic accuracy metrics were calculated for all PF cartilage injuries and then sub-grouped by patellar and trochlear lesions. Diagnostic accuracy was also calculated according to the grading of cartilage injuries. RESULTS Forty-five studies were included for qualitative analyses and forty studies were included for quantitative synthesis. A total of 3534 participants with a weighted mean age of 38.1 years were included. Diagnostic accuracy was generally high: sensitivity (0.8, 0.6-1.0), specificity (0.9, 0.8-1.0), LR+ (6.4, 3.1-15.3), LR- (0.3, 0.2-0.4) and DOR (21.3, 9.9-121.1). The area under the curve (AUC) of the SROC was 0.9. The diagnostic accuracy was slightly higher for patellar (sensitivity 0.8, specificity 0.8, LR+ 5.3, LR- 0.2, DOR 28.8) than for trochlear lesions (sensitivity 0.7, specificity 0.9, LR+ 5.5, LR- 0.4, DOR 14.3). The sensitivity was generally higher when grading advanced (vs. early or intermediate) cartilage injuries of the patella. CONCLUSION The MRI is able to diagnose PF cartilage injuries with reasonably high diagnostic accuracy (as compared to arthroscopy). Clinicians can rely on MRI to reliably diagnose PF cartilage injuries (with some limitations) which will play an important role in deciding for surgical or non-operative treatment. LEVEL OF EVIDENCE Level III.
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Cheng KY, Lombardi AF, Chang EY, Chung CB. Knee Cartilage Imaging. Clin Sports Med 2021; 40:677-692. [PMID: 34509205 DOI: 10.1016/j.csm.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Articular cartilage injury and degeneration represent common causes of knee pain, which can be evaluated accurately and noninvasively using MRI. This review describes the structure of cartilage focusing on its histologic appearance to emphasize that structure will dictate patterns of tissue failure as well as MR appearance. In addition to identifying cartilage loss, MRI can demonstrate signal changes that correspond to intrinsic structural abnormalities which place the cartilage at risk for subsequent more serious injury or premature degeneration, allowing for earlier intervention and treatment of important causes of pain and morbidity.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA
| | - Alecio F Lombardi
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Eric Y Chang
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA
| | - Christine B Chung
- Department of Radiology, UC San Diego Health, 200 W. Arbor Drive MC 8226, San Diego, CA 92103, USA; VA San Diego Healthcare System, Radiology Service, 3350 La Jolla Village Drive, MC 114, San Diego, CA 92161, USA.
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Cai G, Aitken D, Laslett LL, Hill C, Wluka AE, March L, Cicuttini F, Pelletier JP, Martel-Pelletier J, Jones G. The association between change in bone marrow lesion size and change in tibiofemoral cartilage volume and knee symptoms. Rheumatology (Oxford) 2021; 60:2791-2800. [PMID: 33253381 DOI: 10.1093/rheumatology/keaa716] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/26/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To describe the association between change in subchondral bone marrow lesions (BMLs) and change in tibiofemoral cartilage volume and knee symptoms in patients with symptomatic knee OA. METHODS In total, 251 participants (mean 61.7 years, 51% female) were included. Tibiofemoral cartilage volume was measured at baseline and 24 months, and BML size at baseline, 6 and 24 months. Knee pain and function scores were evaluated at baseline, 6 and 24 months. Change in total and compartment-specific BML size was categorized according to the Least Significance Criterion. Linear mixed-effects models were used to evaluate the associations of change in BMLs over 6 and 24 months with change in cartilage volume over 24 months and knee symptoms over 6 and 24 months. RESULTS Total BML size enlarged in 26% of participants, regressed in 31% and remained stable in 43% over 24 months. Compared with stable BMLs in the same compartment, enlarging BMLs over 24 months were associated with greater cartilage loss (difference: -53.0mm3, 95% CI: -100.0, -6.0), and regressing BMLs were not significantly associated with reduced cartilage loss (difference: 32.4mm3, 95% CI: -8.6, 73.3) over 24 months. Neither enlargement nor regression of total BML size over 6 and 24 months was associated with change in knee pain and function over the same time intervals. CONCLUSIONS In subjects with symptomatic knee osteoarthritis and BMLs, enlarging BMLs may lead to greater cartilage loss but regressing lesions are not associated with reduced cartilage loss while neither is associated with change in knee symptoms.
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Affiliation(s)
- Guoqi Cai
- Department of Endocrinology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.,Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
| | - Laura L Laslett
- Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
| | - Catherine Hill
- Department of Rheumatology, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Lyn March
- Institute of Bone and Joint Research, The University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
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Singh N, Hanekom H, Suleman FE. The accuracy of magnetic resonance imaging diagnosis of non-osseous knee injury at Steve Biko Academic Hospital. SA J Radiol 2019; 23:1754. [PMID: 31754541 PMCID: PMC6837829 DOI: 10.4102/sajr.v23i1.1754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/25/2019] [Indexed: 01/13/2023] Open
Abstract
Background Preoperative magnetic resonance imaging (MRI) has internationally been proven to reduce unnecessary knee arthroscopies and assist with surgical planning. This has the advantage of avoiding unnecessary surgery and the associated anaesthetic risk, as well as reducing costs. No data were found in the recently published literature assessing the accuracy of MRI interpretation of knee ligament injury in the public sector locally. Objectives This pilot study aimed to determine the accuracy of MRI in detecting non-osseous knee injury in a resource-limited tertiary-level academic hospital in Pretoria, South Africa, compared to the gold standard arthroscopy findings. Method This was an exploratory retrospective analysis of 39 patients who had MRI and arthroscopy at Steve Biko Academic Hospital (SBAH). True positive, true negative, false positive and false negative results were extrapolated from findings in both modalities and translated into sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each structure. Results Negative predictive values were recorded as 97%, 81%, 90% and 100% (anterior cruciate ligament [ACL], medial meniscus [MM], lateral meniscus [LM] and posterior cruciate ligament [PCL], respectively), which were comparative to recently published international literature. The PPV results were lower than those previously evaluated at 55%, 58%, 55% and not applicable. The sensitivities and specificities of the ligaments were 83%, 58%, 83% and not applicable; and 87%, 81%, 70% and not applicable, respectively. Conclusion Magnetic resonance imaging was found to be sensitive and specific, with a high NPV noted in all structures evaluated. Negative results can therefore be used to avoid unnecessary surgery to the benefit of the patient and state. The study reiterates that high accuracy can be obtained from MRI on a 1.5-tesla non-dedicated scanner, with interpretation by generalist radiologists.
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Affiliation(s)
- Nashil Singh
- Department of Radiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Heleen Hanekom
- Department of Radiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Farhana E Suleman
- Department of Radiology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
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Cheng Q, Zhao FC. Comparison of 1.5- and 3.0-T magnetic resonance imaging for evaluating lesions of the knee: A systematic review and meta-analysis (PRISMA-compliant article). Medicine (Baltimore) 2018; 97:e12401. [PMID: 30235710 PMCID: PMC6160024 DOI: 10.1097/md.0000000000012401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND With conflicting results in the literature, it remains unclear whether a higher field strength automatically increases the sensitivity and specificity of magnetic resonance imaging (MRI) for detecting pathological lesions in the knee. Therefore, we performed a systematic review and meta-analysis of studies comparing the diagnostic accuracy of 1.5- and 3.0-T MRI for lesions within the knee. METHODS Sixteen studies were included in the meta-analysis of the diagnostic accuracy of MRI for lesions of the knee joint, and areas under the curve (AUC) derived from the summary receiver operating characteristic curve analysis were determined for comparison of the diagnostic accuracy with differing magnetic field strength as well as for lesions in different tissues of the knee. Separate meta-analyses were performed for the diagnosis of lesions within articular cartilage, ligaments, and meniscus. RESULTS For lesions within the articular cartilage, the AUC for 1.5-T MRI differed significantly from that for 3.0-T MRI (Z = 3.4, P < .05). However, for lesions within the ligaments and meniscus, the AUC values for 1.5-T MRI did not differ significantly from those for 3.0-T MRI (Z = 0.32, P > .05, and Z = 0.33, P > .05, respectively). CONCLUSION Our results indicate that both 1.5-T and 3.0-T MRI offer high diagnostic accuracy and clinical relevance for knee injuries involving the meniscus or a ligament. However, the present meta-analysis indicates that 3.0-T MRI does offer greater diagnostic accuracy than 1.5-T MRI for articular cartilage lesions.
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Gómez JE, Molina DD, Rettig SD, Kan JH. Bone Bruises in Children and Adolescents Not Associated With Ligament Ruptures. Orthop J Sports Med 2018; 6:2325967118786960. [PMID: 30109238 PMCID: PMC6083756 DOI: 10.1177/2325967118786960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Clinical characteristics of uncomplicated bone bruises (ie, not associated with a ligament rupture, meniscal tear, or fracture of the knee) in young athletes have scarcely been reported. Purpose: To identify mechanisms of injury, characterize bone bruise patterns, and identify clinical factors relating to recovery in young patients suffering uncomplicated bone bruises about the knee. Study Design: Case series; Level of evidence, 4. Methods: A review of clinical records and magnetic resonance imaging (MRI) findings of patients seen at a single institution was completed. Results: We identified 62 children and teenagers (mean age, 13.9 years; range, 8-18 years) who had a total of 101 bone bruises on MRI. The injuries occurred during a variety of organized and recreational sporting activities, the most common being football, basketball, and soccer. The majority (61.4%) of bone bruises occurred as a result of noncontact mechanisms. Patients reported a mean pain scale score of 6.3 of 10 (range, 2-10) on presentation. Frequent clinical findings included non–joint-line tenderness (64.5%), limited range of motion (58.1%), joint-line tenderness (54.8%), and positive meniscal signs (50.0%). The majority of bone bruises (61.4%) were located medially, and the most common bone bruise type was subcortical (58.4%), followed by medullary/reticular (35.6%) and articular impaction (5.9%). The only factor related to time to recovery was mechanism of injury; patients reporting a noncontact mechanism required significantly more time to recover than those reporting a contact mechanism (mean, 99.7 ± 74.8 vs 65.7 ± 38.8 days, respectively; F = 3.753, P = .049). Conclusion: In this case series of 62 pediatric patients with non–anterior cruciate ligament (ACL) bone bruises, the majority occurred in the medial compartment, suggesting that these bone bruises result from a mechanism distinct from the pivot-shift mechanism, classically thought to cause ACL injuries.
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Affiliation(s)
- Jorge E. Gómez
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Daren D. Molina
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Shaylon D. Rettig
- Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - J. Herman Kan
- Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
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