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Yi J, Hahn S, Lee HJ, Lee Y, Bang JY, Kim Y, Lee J. Thin-slice elbow MRI with deep learning reconstruction: Superior diagnostic performance of elbow ligament pathologies. Eur J Radiol 2024; 175:111471. [PMID: 38636411 DOI: 10.1016/j.ejrad.2024.111471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/31/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE With the slice thickness routinely used in elbow MRI, small or subtle lesions may be overlooked or misinterpreted as insignificant. To compare 1 mm slice thickness MRI (1 mm MRI) with deep learning reconstruction (DLR) to 3 mm slice thickness MRI (3 mm MRI) without/with DLR, and 1 mm MRI without DLR regarding image quality and diagnostic performance for elbow tendons and ligaments. METHODS This retrospective study included 53 patients between February 2021 and January 2022, who underwent 3 T elbow MRI, including T2-weighted fat-saturated coronal 3 mm and 1 mm MRI without/with DLR. Two radiologists independently assessed four MRI scans for image quality and artefacts, and identified the pathologies of the five elbow tendons and ligaments. In 19 patients underwent elbow surgery after elbow MRI, diagnostic performance was evaluated using surgical records as a reference standard. RESULTS For both readers, 3 mm MRI with DLR had significant higher image quality scores than 3 mm MRI without DLR and 1 mm MRI with DLR (all P < 0.01). For common extensor tendon and elbow ligament pathologies, 1 mm MRI with DLR showed the highest number of pathologies for both readers. The 1 mm MRI with DLR had the highest kappa values for all tendons and ligaments. For reader 1, 1 mm MRI with DLR showed superior diagnostic performance than 3 mm MRI without/with DLR. For reader 2, 1 mm MRI with DLR showed the highest diagnostic performance; however, there was no significant difference. CONCLUSIONS One mm MRI with DLR showed the highest diagnostic performance for evaluating elbow tendon and ligament pathologies, with similar subjective image qualities and artefacts.
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Affiliation(s)
- Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea.
| | - Ho-Joon Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Yedaun Lee
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
| | - Youngbok Kim
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea
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Jauffrit D, Heraudet P, Tibbo M, Erbland A, Carlier Y, Mansat P, Laumonerie P. Simple acute postero-lateral elbow dislocation: A historical perspective. Injury 2024; 55:111353. [PMID: 38266328 DOI: 10.1016/j.injury.2024.111353] [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] [Received: 10/12/2023] [Revised: 12/31/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE The aims of this study were to summarize (1) the historical knowledge of the posterolateral elbow dislocation (PLED) pattern and the biomechanical, radiographic, and clinical data that engendered its evolution; and (2) to help clinicians better understand the management of PLED. METHODS A literature search was performed using Ovid, Scopus and Cochrane Library, and the Medical Subject Headings vocabulary. Results are discussed as a chronologic review of the relevant literature between 1920-2022. RESULTS In 1966 Osborn and Cotterill were the first to describe posterolateral rotatory instability (PLRI) causing the PLED. Several theories on PLED were then published by others surgeons as our understanding of elbow biomechanics continued to improve. Multiple treatment protocols have been designed based on the aforementioned theories. Conservative and surgical treatment for PLED provides excellent functional outcomes. However, high rates of persistent pain stiffness and instability have been reported long-term, and no single approach to treatment has been widely accepted. CONCLUSION Despite a growing body of biomechanical evidence, there is no consensus surgical indication for the treatment of PLED. Both conservative and surgical management result in satisfactory functional outcomes after PLED. However, elevated rates of residual pain, and instability have also been described and may limit heavy labor and sports participation. The next challenge for elbow surgeons will be to identify those patients who would benefit from surgical stabilization following PLED.
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Affiliation(s)
- Daphné Jauffrit
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France
| | - Paul Heraudet
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France
| | - Meagan Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, US
| | - Alexandra Erbland
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France
| | - Yacine Carlier
- Centre de l'Arthrose, Clinique du Sport, Mérignac 33700, France
| | - Pierre Mansat
- Department of orthopedic surgery, Hôpital Pierre Paul Riquet, Toulouse 31300 France
| | - Pierre Laumonerie
- Department of orthopedic surgery, Hôpital Pellegrin, Bordeaux 31600 France.
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Pott CMJM, de Klerk HH, Priester-Vink S, Eygendaal D, van den Bekerom MPJ. Treatment Outcomes of Simple Elbow Dislocations: A Systematic Review of 1,081 Cases. JBJS Rev 2024; 12:01874474-202401000-00001. [PMID: 38181107 DOI: 10.2106/jbjs.rvw.23.00135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND The treatment of simple elbow dislocations (SEDs) has become more functional last decade with a tendency to shorter immobilization of the elbow, whereas simultaneously, surgical stabilization has been promoted by some authors. The primary aim of this study was to systematically review the literature and analyze the outcomes and complications of different treatment options for acute and persistent SEDs, including operative and nonoperative treatments with varying immobilization periods. METHODS A literature search was performed based on the online medical databases MEDLINE, Embase, and the Cochrane databases. Articles presenting patients with a SED were eligible for inclusion. When an SED persists for >3 weeks, it is categorized as persistent. Various outcome measures were assessed, including the range of motion (ROM), patient-reported outcome measures, and complication rates. To get insight into the severity of complications, all complications were categorized as minor or major. The Methodological Index for Nonrandomized Studies was used to assess the methodological quality of nonrandomized studies. The risk of bias in the randomized studies was assessed with the Cochrane risk-of-bias tool. RESULTS A total of 37 articles were included with 1,081 dislocated elbows (1,078 patients). A fair quality of evidence was seen for the nonrandomized studies and a low risk of bias for the randomized study. Nonoperative treatment was administered to 710 elbows, with 244 elbows treated with early mobilization, 239 with 1- to 3-week immobilization, and 163 with ≥3-week immobilization. These groups showed a ROM flexion-extension arc (ROM F/E) of 137, 129, and 131°, respectively. Surgical treatment as open reduction and ligament repair or reconstruction was performed in 228 elbows and showed a ROM F/E of 128°. All persistent SEDs were treated surgically and showed a ROM F/E of 90°. CONCLUSION The early mobilization treatment showed the most consistent satisfactory outcomes in the literature compared with the other treatment options. Nevertheless, there remains ambiguity regarding which patients would benefit more from surgery than nonoperative treatment. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Charlotte M J M Pott
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
| | - Huub H de Klerk
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, University Medical Center Groningen (UMCG) and Groningen University, Groningen, the Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Lytle J, Meyers A, Ballard E, Fallahi AK, Nelson R. Global elbow instability: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:120-124. [PMID: 37588066 PMCID: PMC10426550 DOI: 10.1016/j.xrrt.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Jacob Lytle
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | - Amy Meyers
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | - Eric Ballard
- Orthopedic Surgery Department, Ascension Genesys Hospital, Grand Blanc, MI, USA
- Michigan State University, Statewide Campus System, East Lansing, MI, USA
| | | | - Ryan Nelson
- Greater Michigan Orthopedics, Grand Blanc, MI, USA
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Edelmuth DGL, Helito PVP, Correa MFDP, Bordalo-Rodrigues M. Acute Ligament Injuries of the Elbow. Semin Musculoskelet Radiol 2021; 25:580-588. [PMID: 34706388 DOI: 10.1055/s-0041-1729959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Ulnar collateral, radial collateral, lateral ulnar collateral, and annular ligaments can be injured in an acute trauma, such as valgus stress in athletes and elbow dislocation. Recognizing normal anatomy in magnetic resonance imaging and ultrasonography studies is important to identify ligamentous abnormalities in these imaging modalities.
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Affiliation(s)
- Diogo Guilherme Leão Edelmuth
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo Victor Partezani Helito
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
| | | | - Marcelo Bordalo-Rodrigues
- Radiology Department - Hospital Sirio Libanes, São Paulo, Brazil.,Radiology Department - Orthopedic Institute - Clinics Hospital - University of São Paulo Medical School, São Paulo, Brazil
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