Introduction. There is a challenge to detect partial tear of the ACL, the number of bundle injured and the proportion of fibers torn. The MRI was shown efficient to individualize the two anteromedial (AM) and posterolateral (PL) bundles of the ACL. The purpose of this study was to assess the ability of the MRI to detect partial tears of the ACL on axial views to display the AM and PL bundles. Materials and methods. This retrospective study included 48 patients (19 partial tears of the ACL, 16 complete rupture of the ACL and 13 normal knee) who underwent both arthroscopy and MRI examinations of the knee. The conventional MRI protocol included one sagittal T1- weighted sequence and 3 proton-density fat sat. The images from MRI were analysis by a radiologist specialized in musculoskeletal imaging who was blinding to the arthroscopic findings. The criteria for the analysis of MRI were divided into primary (those involving the ACL himself) and secondary signs (associated abnormalities). The primary signs included the horizontalisation of the ACL (ACL axis), the global ACL signal intensity and the signal intensity of each AM and PL bundle. The secondary signs included bone bruise, osteochondral impaction, popliteus muscle injury, medial collateral ligament injury and joint effusion. The ACL was classified as normal, partially or totally torn. The rupture of the AM and PL bundle was specified. Results. In our study, MRI was found to have a 75% sensitivity and a 73% specificity for the diagnosis of partial tears of the ACL. The sensitivity to detect AM bundle lesion was 88% but the specificity was 50%. The lack of horizontalisation of the ACL was a very good sign, for partial tears of the ACL, with a sensitivity of 84% and a specificity of 81% (p<0.05). Regarding the secondary signs, there was no significant difference to distinguish partial and complete tear. However, we found that there was a greater probability to find a partial tear of the ACL with the lack of joint effusion, bone bruise and medial collateral ligament injury. Quantifying the proportion of injured fibers was unsuccessful and was found as a failure of the MRI. Conclusions. MRI exhibited lower sensitivity and specificity for partial tear than for complete rupture of the ACL. However 3 important arguments can guide us: the lack of horizontalisation of the ACL, a continuous ACL signal, the display of one of two bundles on the axial view

INTRODUCTION. A detailed clinical examination and investigations are required to evaluate the cause of persisting groin pain following a metal on metal (MoM) hip replacement. Adverse reaction to metallic debris (ARMD) is an emerging problem with MoM hip replacements. It is an umbrella term encompassing metallosis, pseudo-tumors and aseptic lymphocytic vasculitis associated lesions (ALVAL). The role of imaging in the diagnosis of this complex problem is still unclear. A study was undertaken to evaluate the efficacy of ultrasound in diagnosis of ARMD following a MoM hip replacement. METHODS. The study group included 35 patients with a clinical and histological diagnosis of ARMD, who had a preoperative ultrasound. All ultrasound procedures were performed on the anterior and lateral aspects of the painful hip with a high frequency probe of 9–13 MHz (Sonoline Antares – Siemens). RESULTS. All patients diagnosed with ARMD had abnormalities identified on ultrasound. Fluid inside the joint was noted in 30 out of 35 procedures (85.7 %). Fluid outside the joint was noted in 33 procedures (94.3 %). Amongst the patients with fluid outside the joint, 32 had iliopsoas and 30 had trochanteric bursitis. Echogenic reflections were noted in 31 out of 35 procedures (88.6 %). Considerable attenuation or absence of iliopsoas and gluteus tendon reflection was seen in many patients with echogenic fluid collections on the anterior and trochanteric aspects of hip. Progression of such changes was noted on further 5 patients, who had a repeat ultrasound within an interval of 3–6 months. 1 patient had a progression from anechogenic to echogenic joint effusion. DISCUSSION. Different radiological investigations including MRI scan have been used for evaluation of painful MoM hip arthroplasty. To our knowledge, this is the first study to demonstrate the efficacy of ultrasound in diagnosis of ARMD. Floating echogenic reflections and fluid collections around iliopsoas and gluteus medius/minimus tendons is highly suggestive of ARMD. Ultrasound is a cheap, non-invasive and dynamic investigation and has been shown to be reliable in diagnosis of ARMD

Introduction. Interest in platelet-derived growth factors has been increasing as an adjunct in surgical techniques for tissue repair. Its use in ligament injuries repair has been studied mainly in animals. The authors intend to study growth factors influence in ACL repair using BTB graft. Material. 20 individuals underwent ACL rupture BTB arthroscopic repair, using Double Incision Mini-Invasive Technique. MRI (3-Tesla) images. GPSIII ® System to obtain Platelet-Rich Plasma (PRP) thrombin activated. Methods. Prospective study consisting of 2 groups of 10 patients each. Surgical technique, fixation method and postoperative protocol were the same. In the study group (SG-10 patients) graft was imbued with PRP and the remaing plasma was intra-articularly injected. The MRIs took place 6 weeks and 6 months after the procedure with and without gadolinium-DTPA enhancement. Evaluation was performed blindly by independent radiologists concerning femoral tunnel integration, sinovialization process and nonspecific synovitis. Clinical and functional status evaluation: IKDC. Statistical analysis in SPSS®. Results. Radiological evaluation was similar in both groups. In the Study Group at 6 weeks we verified less joint effusion and synovitis. At 6 months: no diference in integration in femoral tunnel, and in granulation tissue around the femoral tunnel in graft sinovialization. IKDC (mean ± SD) with PRP: pre-operative −45,66 ±6,98, post-operative −94,35 ±3,54 (Age-29 ± 10), without PRP: preoperative −48,02 ±12,68, post-operative −91,7 ±6,99 (Age −31 ±10). There are no statistical differences between the groups with and without PRP in clinical and functional assessments and MRI images. Discussion. The use of technology to accelerate and improve the processes of tissue repair and integration is of great interest in repairing the ACL. Studies in humans are rare, with low level of evidence and contradictory results. Although the limitations of this study, it seems to us that the use of growth factors has no advantages in the process of PT graft integration at 6 months. Conclusion. PRP doesn't seem to contribute to enhancement of the ligamentation process and articular rehabilitation when used as a step of BTB technique

Aims

The aim of this study was to evaluate the diagnostic value of preoperative serum CRP, white blood cell count (WBC), percentage of neutrophils (%N), and neutrophil to lymphocyte ratio (NLR) when using the fracture-related infection (FRI) consensus definition.

Aims

This study aimed to investigate the role of quantitative histological analysis in the diagnosis of fracture-related infection (FRI).

Neurogenic heterotopic ossification (NHO) is a disorder of aberrant bone formation affecting one in five patients sustaining a spinal cord injury or traumatic brain injury. Ectopic bone forms around joints in characteristic patterns, causing pain and limiting movement especially around the hip and elbow. Clinical sequelae of neurogenic heterotopic ossification include urinary tract infection, pressure injuries, pneumonia and poor hygiene, making early diagnosis and treatment clinically compelling. However, diagnosis remains difficult with more investigation needed. Our pathophysiological understanding stems from mechanisms of basic bone formation enhanced by evidence of systemic influences from circulating humor factors and perhaps neurological ones. This increasing understanding guides our implementation of current prophylaxis and treatment including the use of non-steroidal anti-inflammatory drugs, bisphosphonates, radiation therapy and surgery and, importantly, should direct future, more effective ones.