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Ayeni OR. Defining hip cartilage repair: a modified delphi study to establish the Magnetic Resonance Evaluation of the Repair of Cartilage in the Hip (MERCH) score. J Exp Orthop 2023; 10:129. [PMID: 38051413 DOI: 10.1186/s40634-023-00676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To develop a standardized scoring system to evaluate pre- to post-operative repair or reconstruction of hip cartilage using magnetic resonance imaging (MRI). METHODS A two-phase modified Delphi study was conducted. Phase 1 involved a survey with suggested criteria and diagrams to define various stages of articular cartilage repair and phase 2 involved an expert consensus meeting that discussed the survey responses and voted on final scoring criteria. The survey was emailed to members of the Canadian Hip Preservation Research Collaborative (CHIPR) and respondents included both board certified orthopedic surgeons as well as musculoskeletal radiologists. RESULTS Overall, there were 17 survey respondents from Canada and most (47%, 8/17) participants agreed that the minimum MRI protocol needed to evaluate cartilage repair was a 3.0 T MRI and 94% (17/18) agreed that the minimum time post-operatively that they felt they would be able to accurately evaluate cartilage repair on an MRI was 12 months. Following phases 1 and 2, the final Magnetic Resonance Evaluation of the Repair of Cartilage in the Hip (MERCH) score was developed with 7 domains, 3 criteria per domain: 1) volume fill of cartilage defect, 2) integration into adjacent cartilage, 3) surface of the repair tissue, 4) structure of the repair tissue, 5) bony overgrowth, 6) subchondral changes, and 7) delamination. The score ranges from 60 (optimal) to -20 points (worst/none). CONCLUSIONS This consensus project established a new MRI scoring system to evaluate post-operative cartilage restoration of the hip. The implementation of the MERCH score is essential in our ability to guide patient management and expectations in a rapidly evolving field and will help with standardizing our evaluation of cartilage repair in future research trials. LEVEL OF EVIDENCE Level II Diagnostic.
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Affiliation(s)
- Olufemi R Ayeni
- McMaster University Medical Centre, Hamilton, 1200 Main St West, 4E15, ON, L8N 3Z5, Canada.
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2
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Barco R, Gonzalez-Escobar S, Acerboni-Flores F, Vaquero-Picado A. Acute elbow dislocation: a critical appraisal of the literature. JSES Int 2023; 7:2560-2564. [PMID: 37969505 PMCID: PMC10638560 DOI: 10.1016/j.jseint.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The purpose of this study was to perform a narrative review of acute elbow dislocation (AED). There are certain aspects of the management of AED that are controversial, including type and length of immobilization, indications for surgery, type of surgery, and new evidence available. Material and methods A literature search was performed using MEDLINE and Embase databases for studies regarding AED. Preference was given to studies according to their level of evidence. Studies regarding the outcome of conservative and surgical treatment, including patient-reported outcomes, complications, and conversion to stabilization or revision surgery were included. Results We found only 1 level I study and 3 level II randomized clinical trials. The rest consisted of level III-V evidence. Conservative care continues to be the standard of care for stable AEDs. Shorter immobilization periods are favored when possible. A consensus definition of an unstable elbow still needs to be improved. Unstable simple elbow dislocation may benefit from surgical intervention with different techniques showing similar outcomes. Advances in surgical procedures and suture designs, including tapes, and ligament augmentation, need to prove their role in managing acute elbow instability. Conclusion There is a need for higher quality studies after the reduction of an AED, including discerning the outcome of specific patterns of injury and particular groups of patients like high-level athletes or people with preoperative laxity. Comparison between different surgical techniques is warranted, including arthroscopic techniques and types of ligament augmentation to promote early motion and reduce postoperative stiffness.
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Affiliation(s)
- Raul Barco
- Upper Limb Unit, Hospital Universitario La Paz, Fundación Instituto de Investigación IDIPaz, Madrid, Spain
| | | | - Francesc Acerboni-Flores
- Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Atónoma de Barcelona, Sabadell, Spain
| | - Alfonso Vaquero-Picado
- Upper Limb Unit, Hospital Universitario La Paz, Fundación Instituto de Investigación IDIPaz, Madrid, Spain
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3
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Bilger R, Laumonerie P, Barret H, Lapègue F, Mansat P, Sans N, Faruch-Bilfeld M. Ultrasonography: an interesting imaging method for ligament assessment during the acute phase of closed elbow injuries. J Med Ultrason (2001) 2022; 49:739-746. [PMID: 35943621 DOI: 10.1007/s10396-022-01246-y] [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: 01/19/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate whether ultrasonography can be used to explore the medial and lateral ligament structures during the acute phase of a closed elbow injury. METHODS A single-center, prospective study performed between December 2019 and June 2020, including patients who suffered a radial head fracture or elbow dislocation. Two radiologists did a blinded analysis using ultrasonography of visibility, injury grade, and presence of bone avulsion for the radial collateral ligament (RCL), lateral ulnar collateral ligament (LUCL), annular ligament (AL), and anterior (MCLant) and posterior bundles (MCLpost) of the medial collateral ligament. The inter-rater agreement was calculated. The ultrasonography findings were compared with the intraoperative findings in the patients who subsequently underwent surgery. RESULTS Forty patients were included (28 radial head fractures and 12 elbow dislocations). The inter-rater agreement was strong for all the study parameters (kappa between 0.65 and 1), except for the visibility of the LUCL (kappa 0.52) and the visibility and appearance of the MCLpost (kappa 0.54 and 0.47, respectively). The injured ligaments were thicker than their contralateral counterparts (p < 0.05). In the 10 patients who underwent surgery, the radiological-surgical correlation was 100% for the RCL and medial ligaments and 70% for the LUCL. CONCLUSION Ultrasonography is a reproducible examination that can be used to assess the damage to elbow ligaments during the acute phase following an injury. This examination could be incorporated into the exploration protocol for elbow injuries during the preoperative assessment and to adapt the treatment.
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Affiliation(s)
- Romain Bilger
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France.
| | - Pierre Laumonerie
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France.,Service de Chirurgie Orthopédique, Hôpital Pellegrin, 33000, Bordeaux, France
| | - Hugo Barret
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Franck Lapègue
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Pierre Mansat
- Service de Chirurgie Orthopédique, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Nicolas Sans
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
| | - Marie Faruch-Bilfeld
- Service d'Imagerie Ostéoarticulaire, Centre Hospitalier Universitaire de Toulouse, Allée Jean Dausset, 31300, Toulouse, France
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4
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MRI of the Elbow: Interpretation of Common Orthopaedic Injuries. J Am Acad Orthop Surg 2022; 30:e573-e583. [PMID: 34979530 DOI: 10.5435/jaaos-d-21-00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 11/13/2021] [Indexed: 02/01/2023] Open
Abstract
MRI is a valuable diagnostic tool that has become an essential part of an orthopaedic surgeon's practice. When acquired in the appropriate clinical setting, an MRI can direct patient management as surgical versus nonsurgical, guide surgical decision making, and even predict patient outcomes. The quality of MRI obtained and quality of the radiology report received varies. Ultimately, the orthopaedic surgeon must interpret the available imaging and apply these findings to treat the patient. The current day practicing orthopaedic surgeon should be familiar with interpreting common MRIs. Although subspecialized orthopaedic surgeons usually have experience and understanding of MRIs in their field, the general orthopaedic surgeon and those in-training will encounter the gamut of musculoskeletal MRIs. This review focuses on common injuries that can occur in the elbow and provides an approach to minimize missed findings.
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5
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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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Schnetzke M, Ellwein A, Maier D, Wagner FC, Grützner PA, Guehring T. Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism. Arch Orthop Trauma Surg 2021; 141:1649-1657. [PMID: 32780199 PMCID: PMC8437923 DOI: 10.1007/s00402-020-03541-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of the present study was to analyze the injury pattern and thus the dislocation mechanism after simple elbow dislocation using radiographs and magnetic resonance imaging (MRI) data sets. MATERIALS AND METHODS The MRI data sets of 64 patients with a mean age of 44 years (18-77 years) were analyzed retrospectively. The inclusion criteria for the study were (1) radiograph with confirmed simple elbow dislocation, (2) low-energy trauma, (3) MRI of the affected elbow ≤ 3 weeks after trauma. The dislocation direction was determined using radiographs. The integrity of the lateral collateral ligament complex (LCLC), common extensor origin (CEO), anterior capsule (AC), medial collateral ligament (MCL), and common flexor origin (CFO) as well as the joint congruity were assessed based on MRI. RESULTS 34 patients (53%) had a posterolateral, 26 patients (41%) a posterior, and 4 patients (6%) a posteromedial dislocation. LCLC and AC were affected in 64 out of 64 patients (100%). MCL was affected in 58 patients (91%). CEO were affected in 25 patients (39%) and the CFO in 20 patients (31%). In 11 patients (17%) the injury pattern was more pronounced medially than laterally (MCL, CFO, LCLC), with 2 of these patients exhibiting only a partial LCLC tear. All cases with joint incongruency (n = 12, 19%) showed CEO and/or CFO involvement. CONCLUSIONS Simple elbow dislocation leads to a very heterogeneous spectrum of soft tissue injury pattern. A small proportion of patients showed medially pronounced injury patterns. These findings strongly indicate existence of a "reversed Horii circle" with an underlying valgus mechanism (medial force induction) originating and continuing from medial to anterior.
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Affiliation(s)
- Marc Schnetzke
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen on the Rhine, Germany.
- ATOS Clinic Heidelberg, German Joint Center Heidelberg, Heidelberg, Germany.
| | - Alexander Ellwein
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
| | - Dirk Maier
- Faculty of Medicine Medical Center, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Ferdinand Christian Wagner
- Faculty of Medicine Medical Center, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Paul-Alfred Grützner
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen on the Rhine, Germany
| | - Thorsten Guehring
- Shoulder and Elbow Surgery, Arcus Sportklinik ARCUS Kliniken, Rastatter Str. 17-19, 75179, Pforzheim, Germany
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7
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Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury. INTERNATIONAL ORTHOPAEDICS 2020; 45:265-273. [PMID: 33200244 DOI: 10.1007/s00264-020-04875-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this current study was to assess elbow ligament tears after dislocation using magnetic resonance imaging (MRI) and to correlate any pre-operative imaging with intra-operative findings of elbow ligament tears. METHODS We prospectively included 32 patients with acute elbow dislocation investigated by MRI at a means of five days from dislocation. A simple elbow dislocation was diagnosed in 14 patients (44%); associated bone injuries were identified in 18 elbows (56%). Surgical repair of elbow ligaments was carried out in 23 patients, and nine cases were treated non-operatively. A blinded MRI evaluation of all 32 elbows was performed by an orthopaedic surgeon (rater 1) and a musculoskeletal radiologist (rater 2). RESULTS Inter-rater agreement for MRI evaluation of 32 was poor for lateral ulnar collateral ligament (LUCL) tears, fair for radial collateral ligament (RCL), moderate for annular ligament (AL), and fair for ulnar collateral ligament (UCL). All tears were reported as complete by rater 1; 13/32 partial tears were identified by rater 2 (LUCL = 2, RCL = 2, UCL = 9). Correlation between surgical and MRI findings showed good inter-rater agreement for LUCL and AL tears in both raters. Agreement for RCL tear was poor for rater 1 and fair for rater 2; agreement for UCL tear was fair for rater 1 and poor for rater 2. Intra-operative findings showed ten radial head fractures (RHFs) and ten coronoid fractures (CFs). LUCL tears were found in the four cases of type II RHFs and in 3/4 cases of CFs. Bone injuries and ligament tears were not significantly associated. CONCLUSION MRI scan supported surgeons to identify soft tissue injuries and to address the most suitable surgical approach after acute elbow dislocation. Inter-observer agreement for intra-operative findings was high for LCL complex injuries and poor for UCL.
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8
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Common Extensor Complex Is a Predictor to Determine the Stability in Simple Posterolateral Elbow Dislocation: Analysis of MR Images of Stable vs. Unstable Dislocation. J Clin Med 2020; 9:jcm9103094. [PMID: 32992826 PMCID: PMC7601526 DOI: 10.3390/jcm9103094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 11/17/2022] Open
Abstract
Simple posterolateral elbow dislocations (SPLED) may be treated nonoperatively using closed reduction, followed by controlled mobilization. However, the extent of soft tissue injuries might affect the choice of treatment, rehabilitation approach, and prognosis. The purpose of this study is to compare the characteristics of soft tissue injuries between patients with unstable and stable SPLED using MRI findings. Thirty MRIs of elbows with SPLED (unstable group (n = 15); stable group (n = 15)) were randomly reviewed by two experienced musculoskeletal radiologists. Soft tissue injuries were characterized as an intact, partial tear or complete tear for the: medial collateral ligament (MCL) complex, common flexor complex, lateral collateral ligament (LCL) complex, common extensor complex, anterior capsule, and posterior capsule. Moderate to substantial interobserver reliability and substantial to perfect intraobserver reliability were observed for medial and lateral complexes in SPLED. The proportion of soft-tissue injuries of the common extensor complex were significantly different between the unstable (four partial tears and 11 complete tears) and stable groups (11 partial tears and four complete tears). In conclusion, based on MRI findings, the degree of common extensor complex injuries may be a predictor of stability and help inform treatment decisions for SPLED.
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Kim H, Kholinne E, Kwak JM, Park D, Shin MJ, Kim DM, Lim TK, Koh KH, Jeon IH. Distribution of Osteochondral Lesions in Patients With Simple Elbow Dislocations Based on MRI Analysis. Orthop J Sports Med 2020; 8:2325967120946269. [PMID: 32923505 PMCID: PMC7457416 DOI: 10.1177/2325967120946269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/30/2020] [Indexed: 01/14/2023] Open
Abstract
Background: The clinical relationship between osteochondral lesions and long-term
outcomes and patterns in the elbow joint has not yet been established. A
sole evaluation from plain standard radiography may underestimate the
severity of bony lesions in patients with simple dislocations. It has been
suggested that the mechanism of a posterior elbow dislocation could be
inferred from the pattern of bony contusions and osteochondral lesions
visible on magnetic resonance imaging (MRI) in patients with simple elbow
dislocations. Purpose/Hypothesis: The purpose of this study was to describe the incidence and distribution of
osteochondral lesions based on MRI findings in patients with simple elbow
dislocations. We hypothesized that (1) osteochondral lesions are
consistently found in patients with simple elbow dislocations and (2) the
distribution and severity of osteochondral lesions may explain the mechanism
of the simple elbow dislocation. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of 43 patients with simple elbow dislocations was
performed in tertiary-level hospitals from January 2010 to August 2019. Two
orthopaedic surgeons separately assessed the initial plain radiographs and
MRI scans. Osteochondral lesions were evaluated and categorized based on
whether they were located (1) on the lateral side (posterolateral capitellum
and radial head; type 1) or (2) on the medial side (posterior trochlea and
anteromedial facet of the coronoid; type 2). The severity of the
osteochondral lesions was assessed according to the Anderson
classification. Results: Of the 43 patients, 21 (48.8%) presented with osteochondral lesions on MRI.
The type 1 pattern of osteochondral lesions was the most frequently observed
on MRI in patients with simple elbow dislocations (69.8% of cases), and
these were confirmed by simple radiography. Posterolateral capitellum
osteochondral lesions were found in 13 patients. Among them, 10 (76.9%) were
advanced-stage lesions (stages III and IV according to the Anderson
classification). Conclusion: Osteochondral lesions were found on MRI after simple elbow dislocations at a
rate of 48.8%. Osteochondral lesions in the posterolateral capitellum were
associated with an advanced stage. Clinically, these findings may help
surgeons in the diagnosis of osteochondral lesions and in determining how to
manage patients with the progression of arthritic changes.
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Affiliation(s)
- Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Jin Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Kang Lim
- Department of Orthopedic Surgery, Eulji Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. This article aims to describe the normal imaging anatomy and biomechanics of the elbow, the most commonly used MRI protocols and techniques, and common MRI findings related to tendinopathy, ligamentous and osteochondral injuries, and instability of the elbow.
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11
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MRI in acute simple elbow dislocations: correlation of preoperative imaging and intraoperative findings of collateral ligaments and associated soft tissue injuries. Musculoskelet Surg 2020; 106:127-132. [PMID: 32803410 DOI: 10.1007/s12306-020-00678-4] [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: 12/05/2019] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of our study was the evaluation of correspondence among collateral ligaments and other soft tissue injuries detected by MRI and by intraoperative findings in a consecutive series of patients treated for simple elbow dislocation. METHODS After clinical and MRI examination, 16 out of 59 consecutive patients with moderate or severe instability after simple elbow dislocation were addressed to surgical treatment. There were 14 men and 2 women. The mean age was 39.6 years (range 16-69 years). RESULTS MRI showed full-thickness lesion of MCL in 9/16 patients (53.3%) and partial lesion in 6/16 patients (40%), and in 1 case, the MCL was considered intact. On the lateral side, MRI showed complete injury of LCL in 7/16 patients (46.6%) and partial injury in 7/16 patients (40%). No lesions of LCL were observed in 2 patients (13.4%). MCL was surgically explored in all the patients. We observed 10/16 full-thickness lesions (62.5%) and 6/16 partial lesions (37.5%). LCL was surgically explored in 11/16 patients. We observed 6/11 full-thickness lesions (54.6%) and 5/11 partial lesions (45.4%). In 3 cases, associated soft tissue injuries were detected. The rate of concordance between MRI and surgical findings was 87.5% (14/16 cases) on the medial side and 90.9% (10/11 cases) on the lateral side. CONCLUSION Our study demonstrated that MRI is a reliable and useful tool to investigate collateral ligaments and soft tissue injuries around the elbow and to plan the most adequate surgical treatment.
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Jaimes C, Yang E, Connaughton P, Robson CD, Robertson RL. Diagnostic equivalency of fast T2 and FLAIR sequences for pediatric brain MRI: a pilot study. Pediatr Radiol 2020; 50:550-559. [PMID: 31863192 DOI: 10.1007/s00247-019-04584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/21/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Faster and motion robust magnetic resonance imaging (MRI) sequences are desirable in pediatric brain MRI as they can help reduce the need for monitored anesthesia care, which is a costly and limited resource that carries medical risks. OBJECTIVE To evaluate the diagnostic equivalency of commercially available accelerated motion robust MR sequences relative to standard sequences. MATERIALS AND METHODS This was an institutional review board-approved prospective study. Subjects underwent a clinical brain MRI using conventional multiplanar images at 3 Tesla followed by fast axial T2 and FLAIR (fluid-attenuated inversion recovery) sequences optimized for an approximately 50% reduction in acquisition time. Conventional and fast images from each subject were reviewed by two blinded pediatric neuroradiologists. The readers evaluated the presence of 12 findings. Intra-observer agreement was estimated for fast versus conventional sequences. For each set of sequences, interobserver agreement calculations and chi-square tests were used to evaluate differences between fast and conventional acquisitions. An independent third reader reviewed the intra-observer discrepancies and adjudicated them as being more conspicuous on fast sequence, conventional sequence or the equivalent. The readers also were asked to rate motion artifacts with a previously validated score. RESULTS Images from 77 children (mean age: 11.3 years) were analyzed. Intra-observer agreement (fast versus conventional) ranged between 89.2% and 92.3%. Interobserver agreement ranged between 86.1% and 88.4%. Interobserver agreement was significantly higher for conventional FLAIR relative to fast FLAIR for small (<5 mm) foci of T2 in the white matter. Otherwise, interobserver agreement was not different between the fast and conventional sequences. For awake subjects, fast sequences had significantly fewer artifacts (P<0.05). CONCLUSION Conventional T2 and FLAIR sequences can be optimized to shorten acquisition while maintaining diagnostic equivalency. These faster sequences were also less susceptible to motion artifacts.
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Affiliation(s)
- Camilo Jaimes
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA.,Fetal Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Boston, MA, USA
| | - Edward Yang
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | | | - Caroline D Robson
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Richard L Robertson
- Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA. .,Department of Radiology, Harvard Medical School, Boston, MA, USA.
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13
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Luokkala T, Temperley D, Basu S, Karjalainen TV, Watts AC. Analysis of magnetic resonance imaging-confirmed soft tissue injury pattern in simple elbow dislocations. J Shoulder Elbow Surg 2019; 28:341-348. [PMID: 30414825 DOI: 10.1016/j.jse.2018.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/03/2018] [Accepted: 08/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The elbow is the second most commonly dislocated joint. Stability depends on the degree of soft tissue injury, with 2 proposed patterns, one starting laterally and the other medially. The purpose of this study was to describe the injured structures observed in magnetic resonance images (MRIs) in a prospective cohort of simple elbow dislocations. METHODS We evaluated 17 consecutive cases of simple elbow dislocations. Two musculoskeletal radiologists assessed the initial x-ray images and MRIs performed for all elbows. Radiologists evaluated the following soft tissue structures: medial collateral ligament complex (MCL), flexor-pronator muscle mass origin, anterior capsule (AC), posterior capsule, lateral collateral ligament complex (LCL), and extensor muscle mass origin. The radiologists were blinded to the study hypothesis. RESULTS The initial radiographs in 16 patients showed the dislocation was posterolateral in 12, posterior in 3, and posteromedial in 1. We observed complete AC tear in 12 patients, MCL in 10, and LCL in 9. The inter-rater reliability for the radiologists was 0.70 (substantial) for MRI. CONCLUSIONS In our series after simple elbow dislocation, complete AC tears were most common, followed by MCL and LCL tears. No single mechanism-related soft tissue injury pattern of simple elbow dislocation was observed, and different grades of soft tissue injury exist.
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Affiliation(s)
- Toni Luokkala
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh National Health Service Foundation Trust, Wigan, UK; Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - David Temperley
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh National Health Service Foundation Trust, Wigan, UK
| | - Subhasis Basu
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh National Health Service Foundation Trust, Wigan, UK
| | | | - Adam C Watts
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh National Health Service Foundation Trust, Wigan, UK
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Abehsera E, Guerre E, Duriez P, El Rafei M, Fontaine C, Chantelot C. Ligaments injuries check-up and assessment of their healing potential in simple posterolateral elbow dislocation: about 25 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:785-792. [PMID: 30649622 DOI: 10.1007/s00590-019-02374-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 01/04/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2 months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability. PATIENTS AND METHODS Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included. Each patient had an MRI scan of their traumatised elbow on the day of the dislocation and then again 2 months later. The assessment was performed thanks to a clinical examination and calculation of functional recovery scores. The Mann-Whitney U test was used to research a correlation between the healing of ligaments injuries and clinical course. RESULTS Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2 months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up. CONCLUSION Elbow dislocation is particularly damaging for ligaments. There is no predominance on medial or lateral ligament for rupture. The low healing rate 2 months after the initial dislocation could be explained by performing a follow-up MRI scan too early.
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Affiliation(s)
- Eric Abehsera
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France.
- Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France.
| | - Elvire Guerre
- Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Pauline Duriez
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Mazen El Rafei
- Service d'Imagerie de l'Appareil Locomoteur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Christian Fontaine
- Service d'Orthopédie B, Chirurgie de la Main et Membre Supérieur, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
| | - Christophe Chantelot
- Service de Chirurgie Orthopédique et Traumatologique, CHRU de Lille, Avenue du Professeur Emile Laine, Lille, France
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Instabilität nach operativer und konservativer Versorgung von isolierten Mason-II-Frakturen. Unfallchirurg 2018; 122:219-224. [DOI: 10.1007/s00113-018-0504-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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