Closed suction subfascial drainage is widely used after instrumented posterior spinal fusion in patients with a spinal deformity. The aim of this study was to determine the effect of this wound drainage on the outcomes in patients with adolescent idiopathic scoliosis (AIS). This was a further analysis of a randomized, multicentre clinical trial reporting on patients after posterior spinal fusion using segmental pedicle screw instrumentation. In this study the incidence of deep surgical site infection (SSI) and chronic postoperative pain at two years’ follow-up are reported. We conducted a randomized, multicentre clinical trial on adolescents undergoing posterior spinal fusion for AIS using segmental pedicle screw instrumentation. A total of 90 consecutive patients were randomized into a ‘drain’ or ‘no drain’ group at the time of wound closure, using the sealed envelope technique (1:1). The primary outcomes in the initial study were the change in the level of haemoglobin in the blood postoperatively and total blood loss. A secondary outcome was the opioid consumption immediately after surgery. The aim of this further study was to report the rate of deep SSI and persistent postoperative pain, at two years' follow-up.Aims
Methods
The objective of this study was to compare the two-year migration and clinical outcomes of a new cementless hydroxyapatite (HA)-coated titanium acetabular shell with its previous version, which shared the same geometrical design but a different manufacturing process for applying the titanium surface. Overall, 87 patients undergoing total hip arthroplasty (THA) were randomized to either a Trident II HA or Trident HA shell, each cementless with clusterholes and HA-coating. All components were used in combination with a cemented Exeter V40 femoral stem. Implant migration was measured using radiostereometric analysis (RSA), with radiographs taken within two days of surgery (baseline), and at three, 12, and 24 months postoperatively. Proximal acetabular component migration was the primary outcome measure. Clinical scores and patient-reported outcome measures (PROMs) were collected at each follow-up.Aims
Methods
It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer fracture redisplacements and better one-year outcomes compared to plaster splinting. In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure.Aims
Methods
Repeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort. This is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS.Aims
Methods
Conflicting clinical results are reported for the ATTUNE Total Knee Arthroplasty (TKA). This randomized controlled trial (RCT) evaluated five-year follow-up results comparing cemented ATTUNE and PFC-Sigma cruciate retaining TKAs, analyzing component migration as measured by radiostereometric analysis (RSA), clinical outcomes, patient-reported outcome measures (PROMs), and radiological outcomes. A total of 74 primary TKAs were included in this single-blind RCT. RSA examinations were performed, and PROMs and clinical outcomes were collected immediate postoperatively, and at three, six, 12, 24, and 60 months’ follow-up. Radiolucent lines (RLLs) were measured in standard anteroposterior radiographs at six weeks, and 12 and 60 months postoperatively.Aims
Methods
The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications.Aims
Methods
The aim of this study was to compare the mid-term patient-reported outcome, bone remodelling, and migration of a short stem (Collum Femoris Preserving; CFP) with a conventional uncemented stem (Corail). Of 81 patients who were initially enrolled, 71 were available at five years’ follow-up. The outcomes at two years have previously been reported. The primary outcome measure was the clinical result assessed using the Oxford Hip Score (OHS). Secondary outcomes were the migration of the stem, measured using radiostereometric analysis (RSA), change of bone mineral density (BMD) around the stem, the development of radiolucent lines, and additional patient-reported outcome measures (PROMs).Aims
Methods
To compare changes in gait kinematics and walking speed 24 months after conventional (C-MLS) and minimally invasive (MI-MLS) multilevel surgery for children with diplegic cerebral palsy (CP). A retrospective analysis of 19 children following C-MLS, with mean age at surgery of 12 years five months (seven years ten months to 15 years 11 months), and 36 children following MI-MLS, with mean age at surgery of ten years seven months (seven years one month to 14 years ten months), was performed. The Gait Profile Score (GPS) and walking speed were collected preoperatively and six, 12 and 24 months postoperatively. Type and frequency of procedures as part of MLS, surgical adverse events, and subsequent surgery were recorded.Aims
Methods
A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided ligament balancing improved complication rates, radiological alignment, or patient-reported outcomes (PROMs) compared with a historical control group using conventional instrumentation. This retrospective cohort study included 371 TKAs performed by a single surgeon sequentially. A historical control group, with the use of intramedullary guides for distal femoral resection and surgeon-guided ligament balancing, was compared with a group using accelerometer-based navigation for distal femoral resection and surgeon-guided balancing (group 1), and one using navigated femoral resection and sensor-guided balancing (group 2). Primary outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS) and Knee injury and Osteoarthritis Outcome (KOOS) scores measured preoperatively and at six weeks and 12 months postoperatively. The position of the components and the mechanical axis of the limb were measured postoperatively. The postoperative range of motion (ROM), haematocrit change, and complications were also recorded.Aims
Methods
The purpose of this exploratory study was to investigate if the 24-hour activity profile (i.e. waking activities and sleep) objectively measured using wrist-worn accelerometry of patients scheduled for total hip arthroplasty (THA) improves postoperatively. A total of 51 THA patients with a mean age of 64 years (24 to 87) were recruited from a single public hospital. All patients underwent THA using the same surgical approach with the same prosthesis type. The 24-hour activity profiles were captured using wrist-worn accelerometers preoperatively and at 2, 6, 12, and 26 weeks postoperatively. Patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS)) were collected at all timepoints except two weeks postoperatively. Accelerometry data were used to quantify the intensity (sedentary, light, moderate, and vigorous activities) and frequency (bouts) of activity during the day and sleep efficiency. The analysis investigated changes with time and differences between Charnley class.Aims
Patients and Methods
Modular dual mobility (DM) prostheses in which a cobalt-chromium liner is inserted into a titanium acetabular shell ( This was a prospective study of patients between 18 and 65 years of age, with a body mass index (BMI) < 35 kg/m2 and University of California at Los Angeles (UCLA) activity score > 6, who received a modular cobalt-chromium acetabular liner, highly crosslinked polyethylene mobile bearing, and cementless titanium femoral stem for their primary THA. Patients with a history of renal disease and metal hardware elsewhere in the body were excluded. A total of 43 patients (30 male, 13 female; mean age 52.6 years (Aims
Patients and Methods
We sought to determine whether specific characteristics
of vertebral fractures in elderly men are associated with low bone
mineral density (BMD) and osteoporosis. Mister osteoporosis Sweden is a population based cohort study
involving 3014 men aged 69 to 81 years. Of these, 1427 had readable
lateral radiographs of the thoracic and lumbar spine. Total body
(TB) BMD (g/cm²) and total right hip (TH) BMD were measured by dual
energy x-ray absorptiometry. The proportion of men with osteoporosis
was calculated from TH BMD. There were 215 men (15.1%) with a vertebral
fracture. Those with a fracture had lower TB BMD than those without
(p <
0.001). Among men with a fracture, TB BMD was lower in those
with more than three fractures (p = 0.02), those with biconcave
fractures (p = 0.02) and those with vertebral body compression of
>
42% (worst quartile) (p = 0.03). The mean odds ratio (OR) for
having osteoporosis when having any type of vertebral fracture was
6.1 (95% confidence interval (CI) 3.9 to 9.5) compared with those
without a fracture. A combination of more than three fractures and
compression in the worst quartile had a mean OR of 114.2 (95% CI
6.7 to 1938.3) of having osteoporosis compared with those without
a fracture. We recommend BMD studies to be undertaken in these subcohorts
of elderly men with a vertebral fracture. Cite this article: 2015;97-B:1106–10.
Since long-term outcome of teres major tendon transfer surgery
for irreparable posterosuperior rotator cuff (RC) tears is largely
unknown, the primary aim of this study was to evaluate the long-term
outcome of the teres major transfer. We also aimed to report on
the results of a cohort of patients with a similar indication for
surgery that underwent a latissimus dorsi tendon transfer. In this prospective cohort study, we reported on the long-term
results of 20 consecutive patients with a teres major tendon transfer
for irreparable massive posterosuperior RC tears. Additionally,
we reported on the results of the latissimus dorsi tendon transfer
(n = 19). The mean age was 60 years (47 to 77). Outcomes included
the Constant score (CS), and pain at rest and during movement using
the Visual Analogue Scale (VAS).Aims
Patients and Methods
The aims of this study were to characterize the frequency of
missing data in the National Surgical Quality Improvement Program
(NSQIP) database and to determine how missing data can influence
the results of studies dealing with elderly patients with a fracture
of the hip. Patients who underwent surgery for a fracture of the hip between
2005 and 2013 were identified from the NSQIP database and the percentage
of missing data was noted for demographics, comorbidities and laboratory
values. These variables were tested for association with ‘any adverse
event’ using multivariate regressions based on common ways of handling
missing data.Aims
Patients and Methods
The primary aim of this independent prospective randomised trial
was to compare serum metal ion levels for ceramic-on-metal (CoM)
and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty
(THA). Our one-year results demonstrated elevation in metal ion
levels above baseline with no significant difference between the
CoM and MoM groups. This paper reviews the five-year data. The implants used in each patient differed only in respect to
the type of femoral head (ceramic or metal). At five-year follow-up
of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available
for comparison.Aims
Patients and Methods
The aim of this prospective randomised study was to compare the
time course of clinical improvement during the first two years following
a closing or opening wedge high tibial osteotomy (HTO). It was hypothesised
that there would be no differences in clinical outcome between the
two techniques. Between 2007 and 2013, 70 consecutive patients were randomly
allocated to undergo either a closing or opening wedge HTO. All
patients had medial compartment osteoarthritis (OA), and were aged
between 30 years and 60 years. They were evaluated by independent
investigators pre-operatively and at three and six months, and one
and two years post-operatively using the Knee Injury and Osteoarthritis
Outcome Score (KOOS), the Oxford Knee Score (OKS), the Lysholm score,
the Tegner activity score, the University of California, Los Angeles
(UCLA) activity scale and range of movement (ROM).Aims
Patients and Methods
The PROximal Fracture of the Humerus Evaluation by Randomisation
(PROFHER) randomised clinical trial compared the operative and non-operative
treatment of adults with a displaced fracture of the proximal humerus
involving the surgical neck. The aim of this study was to determine
the long-term treatment effects beyond the two-year follow-up. Of the original 250 trial participants, 176 consented to extended
follow-up and were sent postal questionnaires at three, four and
five years after recruitment to the trial. The Oxford Shoulder Score
(OSS; the primary outcome), EuroQol 5D-3L (EQ-5D-3L), and any recent
shoulder operations and fracture data were collected. Statistical
and economic analyses, consistent with those of the main trial were
applied.Aims
Patients and Methods
The purpose of this study was to investigate the prevalence of
sarcopenia and to examine its impact on patients with degenerative
lumbar spinal stenosis (DLSS). This case-control study included two groups: one group consisting
of patients with DLSS and a second group of control subjects without
low back or neck pain and related leg pain. Five control cases were
randomly selected and matched by age and gender (n = 77 cases and
n = 385 controls) for each DLSS case. Appendicular muscle mass,
hand-grip strength, sit-to-stand test, timed up and go (TUG) test,
and clinical outcomes, including the Oswestry Disability Index (ODI)
scores and the EuroQol EQ-5D were compared between the two groups.Aims
Patients and Methods
The primary purpose of this study of metal-on-metal
(MoM) hip resurfacing was to compare the effect of using a cementless
or cemented femoral component on the subsequent bone mineral density
(BMD) of the femoral neck. This was a single-centre, prospective, double-blinded control
trial which randomised 120 patients (105 men and 15 women) with
a mean age of 49.4 years (21 to 68) to receive either a cemented
or cementless femoral component. Follow-up was to two years. Outcome
measures included total and six-point region-of-interest BMD of
the femoral neck, radiological measurements of acetabular inclination,
neck-shaft and stem-shaft angles, and functional outcome scores
including the Harris hip score, the Western Ontario and McMaster
Universities Osteoarthritis Index and the University of California
at Los Angeles activity scale. In total, 17 patients were lost to follow-up leaving 103 patients
at two years. There were no revisions in the cementless group and
three revisions (5%) in the cemented group (two because of hip pain
and one for pseudotumour). The total BMD was significantly higher in the cementless group
at six months (p <
0.001) and one year (p = 0.01) than in the
cemented group, although there was a loss of statistical significance
in the difference at two years (p = 0.155). All patient outcomes improved significantly: there were no significant
differences between the two groups. The results show better preservation of femoral neck BMD with
a cementless femoral component after two years of follow-up. Further
investigation is needed to establish whether this translates into
improved survivorship. Cite this article:
Obesity is a risk factor for complications following
many orthopaedic procedures. The purpose of this study was to investigate
whether obesity was an independent risk factor increasing the rate
of complications following periacetabular osteotomy (PAO) and to
determine whether radiographic correction after PAO was affected
by obesity. We retrospectively collected demographic, clinical and radiographic
data on 280 patients (231 women; 82.5% and 49 men; 17.5%) who were
followed for a mean of 48 months (12 to 60) after PAO. A total of
65 patients (23.2%) were obese (body mass index (BMI) >
30 kg/m2).
Univariate and multivariate analysis demonstrated that BMI was an independent
risk factor associated with the severity of the complications. The
average probability of a patient developing a major complication
was 22% (95% confidence interval (CI) 11.78 to 38.21) for an obese
patient compared with 3% (95% CI 1.39 to 6.58) for a non-obese patient
The odds of a patient developing a major complication were 11 times
higher (95% CI 4.71 to 17.60, p <
0.0001) for an obese compared
with a non-obese patient. Following PAO surgery, there was no difference in radiographic
correction between obese and non-obese patients. PAO procedures
in obese patients correct the deformity effectively but are associated
with an increased rate of complications. Cite this article:
Injuries to the spinal cord may be associated with increased healing of fractures. This can be of benefit, but excessive bone growth can also cause considerable adverse effects. We evaluated two groups of patients with fractures of the spinal column, those with neurological compromise (n = 10) and those without (n = 15), and also a control group with an isolated fracture of a long bone (n = 12). The level of transforming growth factor-beta (TGF-β), was measured at five time points after injury (days 1, 5, 10, 42 and 84). The peak level of 142.79 ng/ml was found at day 84 in the neurology group (p <
0.001 Our findings suggest that TGF-β may have a role in the increased bone turnover and attendant complications seen in patients with acute injuries to the spinal cord.
The aim of this study was to determine the effect
of radial extracorporeal shock-wave therapy (rESWT) on patients with
chronic tendinitis of the rotator cuff. This was a randomised controlled
trial in which 82 patients (mean age 47 years (24 to 67)) with chronic
tendinitis diagnosed clinically were randomly allocated to a treatment
group who received low-dose rESWT (three sessions at an interval
10 to 14 days, 2000 pulses, 0.11 mJ/mm2, 8 Hz) or to
a placebo group, with a follow-up of six months. The patients and
the treating orthopaedic surgeon, who were both blinded to the treatment,
evaluated the results. A total of 44 patients were allocated to
the rESWT group and 38 patients to the placebo group. A visual analogue
scale (VAS) score for pain, a Constant–Murley (CMS) score and a simple
shoulder test (SST) score significantly improved in both groups
at three and six months compared with baseline (all p ≤ 0.012).
The mean VAS was similar in both groups at three (p = 0.43) and
six months (p = 0.262). Also, the mean CMS and SST scores were similar
in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or
improve function in patients chronic rotator cuff tendinitis compared
with placebo treatment. Cite this article:
Follow-up radiographs are usually used as the
reference standard for the diagnosis of suspected scaphoid fractures. However,
these are prone to errors in interpretation. We performed a meta-analysis
of 30 clinical studies on the diagnosis of suspected scaphoid fractures,
in which agreement data between any of follow-up radiographs, bone scintigraphy,
magnetic resonance (MR) imaging, or CT could be obtained, and combined
this with latent class analysis to infer the accuracy of these tests
on the diagnosis of suspected scaphoid fractures in the absence
of an established standard. The estimated sensitivity and specificity
were respectively 91.1% and 99.8% for follow-up radiographs, 97.8%
and 93.5% for bone scintigraphy, 97.7% and 99.8% for MRI, and 85.2%
and 99.5% for CT. The results were generally robust in multiple
sensitivity analyses. There was large between-study heterogeneity
for the sensitivity of follow-up radiographs and CT, and imprecision
about their sensitivity estimates. If we acknowledge the lack of a reference standard for diagnosing
suspected scaphoid fractures, MRI is the most accurate test; follow-up
radiographs and CT may be less sensitive, and bone scintigraphy
less specific.
We undertook a randomised controlled trial to
compare the piriformis-sparing approach with the standard posterior approach
used for total hip replacement (THR). We recruited 100 patients
awaiting THR and randomly allocated them to either the piriformis-sparing
approach or the standard posterior approach. Pre- and post-operative
care programmes and rehabilitation regimes were identical for both
groups. Observers were blinded to the allocation throughout; patients
were blinded until the two-week assessment. Follow-up was at six
weeks, three months, one year and two years. In all 11 patients
died or were lost to follow-up. There was no significant difference between groups for any of
the functional outcomes. However, for patients in the piriformis-sparing
group there was a trend towards a better six-minute walk test at
two weeks and greater patient satisfaction at six weeks. The acetabular
components were less anteverted (p = 0.005) and had a lower mean
inclination angle (p = 0.02) in the piriformis-sparing group. However,
in both groups the mean component positions were within Lewinnek’s
safe zone. Surgeons perceived the piriformis-sparing approach to
be significantly more difficult than the standard approach (p =
0.03), particularly in obese patients. In conclusion, performing THR through a shorter incision involving
sparing piriformis is more difficult and only provides short-term
benefits compared with the standard posterior approach.
This study prospectively compared the efficacy of kyphoplasty using a Jack vertebral dilator and balloon kyphoplasty to treat osteoporotic compression fractures between T10 and L5. Between 2004 and 2009, two groups of 55 patients each underwent vertebral dilator kyphoplasty and balloon kyphoplasty, respectively. Pain, function, the Cobb angle, and the anterior and middle height of the vertebral body were assessed before and after operation. Leakage of bone cement was recorded. The post-operative change in the Cobb angle was significantly greater in the dilator kyphoplasty group than in the balloon kyphoplasty group (−9.51° ( These findings suggest that vertebral dilator kyphoplasty can facilitate better correction of kyphotic deformity and may ultimately be a safer procedure in reducing leakage of bone cement.
Our aim in this retrospective study of 52 children with spastic hemiplegia was to determine the factors which affected the amount of residual pelvic rotation after single-event multilevel surgery. The patients were divided into two groups, those who had undergone femoral derotation osteotomy and those who had not. Pelvic rotation improved significantly after surgery in the femoral osteotomy group (p <
0.001) but not in the non-femoral osteotomy group. Multiple regressions identified the following three independent variables, which significantly affected residual pelvic rotation: the performance of femoral derotation osteotomy (p = 0.049), the pre-operative pelvic rotation (p = 0.003) and the post-operative internal rotation of the hip (p = 0.001). We concluded that there is a decrease in the amount of pelvic rotation after single-event multilevel surgery with femoral derotation osteotomy. However, some residual rotation may persist when patients have severe rotation before surgery.
In order to compare the outcome from surgical repair and physiotherapy, 103 patients with symptomatic small and medium-sized tears of the rotator cuff were randomly allocated to one of the two approaches. The primary outcome measure was the Constant score, and secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score, the Short Form 36 Health Survey and subscores for shoulder movement, pain, strength and patient satisfaction. Scores were taken at baseline and after six and 12 months by a blinded assessor. Nine patients (18%) with insufficient benefit from physiotherapy after at least 15 treatment sessions underwent secondary surgical treatment. Analysis of between-group differences showed better results for the surgery group on the Constant scale (difference 13.0 points, p − 0.002), on the American Shoulder and Elbow surgeons scale (difference 16.1 points, p <
0.0005), for pain-free abduction (difference 28.8°, p = 0.003) and for reduction in pain (difference on a visual analogue scale −1.7 cm, p <
0.0005).
We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity. The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively. The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.
Our aim in this prospective study was to determine the best diagnostic method for discriminating between patients with and without osteochondral lesions of the talus, with special relevance to the value of MRI compared with the new technique of multidetector helical CT. We compared the diagnostic value of history, physical examination and standard radiography, a 4 cm heel-rise view, helical CT, MRI, and diagnostic arthroscopy for simultaneous detection or exclusion of osteochondral lesions of the talus. A consecutive series of 103 patients (104 ankles) with chronic ankle pain was included in this study. Of these, 29 with 35 osteochondral lesions were identified. Twenty-seven lesions were located in the talus. Our findings showed that helical CT, MRI and diagnostic arthroscopy were significantly better than history, physical examination and standard radiography for detecting or excluding an osteochondral lesion. Also, MRI and diagnostic arthroscopy performed better than a mortise view with a 4 cm heel-rise. We did not find a statistically significant difference between helical CT and MRI. Diagnostic arthroscopy did not perform better than helical CT and MRI for detecting or excluding an osteochondral lesion.
