High validity of measuring the width and volume of medial meniscal extrusion three-dimensionally using an MRI-derived tibial model

Multimodal Magnetic Resonance Imaging to Diagnose Knee Osteoarthritis under Artificial Intelligence

This work aimed to investigate the application value of the multimodal magnetic resonance imaging (MRI) algorithm based on the low-rank decomposition denoising (LRDD) in the diagnosis of knee osteoarthritis (KOA), so as to offer a better examination method in the clinic. Seventy-eight patients with KOA were selected as the research objects, and they all underwent T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fat suppression T2WI (SE-T2WI), and fat saturation T2WI (FS-T2WI). All obtained images were processed by using the I-LRDD algorithm. According to the degree of articular cartilage lesions under arthroscopy, the patients were divided into a group I, a group II, a group III, and a group IV. The sensitivity, specificity, accuracy, and consistency of KOA diagnosis of T1WI, T2WI, SE-T2WI, and FS-T2WI were analyzed by referring to the results of arthroscopy. The results showed that the peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM) of the I-LRDD algorithm used in this work were higher than those of image block priori denoising (IBPD) and LRDD, and the time consumption was lower than that of IBDP and LRDD (p < 0.05). The sensitivity, specificity, accuracy, and consistency (Kappa value) of multimodal MRI in the diagnosis of KOA were 88.61%, 85.3%, 87.37%, and 0.73%, respectively, which were higher than those of T1WI, T2WI, SE-T2WI, and FS-T2WI. The sensitivity, specificity, accuracy, and consistency of multimodal MRI in diagnosing lesions in group IV were 95%, 96.10%, 95.88%, and 0.70%, respectively, which were much higher than those in groups I, II, and III (p < 0.05). In conclusion, the LRDD algorithm shows a good image processing efficacy, and the multimodal MRI showed a good diagnosis effect on KOA, which was worthy of promotion clinically.

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

BACKGROUND

Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated.

OBJECTIVE

To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains.

DESIGN

Systematic review.

DATA SOURCES

Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series.

RESULTS

9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain.

CONCLUSION

233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures.

PROSPERO REGISTRATION

CRD42020156763.

Magnetic Resonance Imaging Versus Computed Tomography for Three-Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review

Magnetic resonance imaging (MRI) is increasingly utilized as a radiation‐free alternative to computed tomography (CT) for the diagnosis and treatment planning of musculoskeletal pathologies. MR imaging of hard tissues such as cortical bone remains challenging due to their low proton density and short transverse relaxation times, rendering bone tissues as nonspecific low signal structures on MR images obtained from most sequences. Developments in MR image acquisition and post‐processing have opened the path for enhanced MR‐based bone visualization aiming to provide a CT‐like contrast and, as such, ease clinical interpretation. The purpose of this review is to provide an overview of studies comparing MR and CT imaging for diagnostic and treatment planning purposes in orthopedic care, with a special focus on selective bone visualization, bone segmentation, and three‐dimensional (3D) modeling. This review discusses conventional gradient‐echo derived techniques as well as dedicated short echo time acquisition techniques and post‐processing techniques, including the generation of synthetic CT, in the context of 3D and specific bone visualization. Based on the reviewed literature, it may be concluded that the recent developments in MRI‐based bone visualization are promising. MRI alone provides valuable information on both bone and soft tissues for a broad range of applications including diagnostics, 3D modeling, and treatment planning in multiple anatomical regions, including the skull, spine, shoulder, pelvis, and long bones.

The effect of restored medial knee anatomy in total knee arthroplasty with the flexion first balancer technique on mid-flexion laxity and functional outcome

Background

The Flexion First Balancer (FFB) technique for total knee arthroplasty (TKA) was developed to maintain the isometry of the medial collateral ligament (MCL) by restoring the medial anatomy of the knee. Inability to correct MCL isometry could hypothetically result in an increased mid-flexion laxity. The aim of the current study was to evaluate if the FFB technique results in improved functional outcome and less mid-flexion laxity compared to Measured Resection (MR).

Methods

A cross-sectional study was performed comparing 27 FFB patients with 28 MR patients. Groups were matched for age, gender, BMI and ASA classification. All patient received the cruciate retained type, Vanguard Complete Knee System (Biomet Orthopedics, Warsaw, IN, USA). Stress X-rays of the knee with 30 degrees of flexion were made to assess varus-valgus laxity. Furthermore, three tests were conducted to asses functional outcome: a 6 min walk test, a stair climb test and quadriceps peak force measurements. Mean follow-up was respectively 2.6 (SD 0.4) and 3.9 years (SD 0.2).

Results

The MR group showed a postoperative elevation in joint line in contrast to the FFB group, the mean difference between the two groups was 3 mm (p < 0.001). No differences in total laxity between the two groups was found. The FFB group showed a higher quadriceps peak force (1.67 (SD 0.55) N/BMI) in comparison with the MR group (1.38 (SD 0.48) N/BMI) (p < 0.05). All other outcome parameters were comparable between the two groups (p: n.s.). Correlation analysis showed a moderate negative correlation between joint line elevation and quadriceps peak force (r = − 0.29, p < 0.05).

Conclusion

The FFB technique did not lead to less coronal laxity in the mid-flexion range compared to MR. Although peak quadriceps force was significantly higher for the FFB group no clinically relevant benefits could be identified for the patients with regards to functional outcome. Therefore, minor deviations in joint line seems to have no effect on functional outcome after TKA.

Trial registration

ISRCTN, ISRCTN85351296. Registered 23 april 2021 - Retrospectively registered, https://www.isrctn.com/ISRCTN85351296