RESUMEN
BACKGROUND: The diagnosis of anterior cruciate ligament (ACL) tear relies on clinical evaluation and magnetic resonance imaging (MRI). Direct and indirect signs of ACL tear have been described with MRI evaluation. Posterior cruciate ligament (PCL) buckling has been described as an indirect radiographic sign of an ACL tear. PURPOSE: The aim of the present study was to assess the variations in PCL buckling angles in patients with ACL tears and in patients with isolated lesions in the posterior horn of the medial meniscus. In addition, the influence of different patterns of medial meniscus tears in ACL-deficient knees was investigated. Finally, the influences of risk factors such as tibial slope, delay from injury to surgery, absence of medial meniscus tear, degree of Lachman and pivot shift testing were also assessed. STUDY DESIGN: This was a cohort study. METHODS: A total of 154 patients (78 in the group with ACL tear and 76 in the control group) were assessed with MRI and lateral weight-bearing X-ray to assess PCL buckling angle and tibial slope by two independent observers. The presence of a medial meniscus bucket handle or ramp lesion of the medial meniscus was assessed and recorded at the time of surgery. RESULTS: PCL buckling angle measurement was highly reliable, with an ICC of 0.866 and 0.894, respectively, in the study group and the control group for interobserver reliability. The intrarater reliability was found to be high in PCL buckling angle for the study group [ICC = 0.955] and the control group [ICC = 0.943]. The mean angle in patients with ACL tear was 110.7 ± 15.2° and 115.3 ± 16.2° (for the two examiners) and 111.4 ± 12° and 114 ± 14.5° (for the two examiners) in patients with an intact, healthy ACL. An association emerged between bucket handle tears of the medial meniscus (p = 0.010) and a decreased PCL buckling angle and between ramp lesions of the medial meniscus and increased PCL buckling angle both (p = 0.024). CONCLUSIONS: Good inter- and intraobserver reliability for the measurement of the PCL buckling angle was observed. Increased PCL buckling angle values were observed in patients with concomitant ACL and bucket handle tears of the medial meniscus, while decreased angle values were observed in those who had ACL tear and ramp lesion of the medial meniscus. No statistically significant difference in the PCL buckling angle emerged between patients with ACL tears and those who had a healthy, intact ACL.
RESUMEN
PURPOSE: Irreparable rotator cuff tears are disabling and can severely affect daily life activities, especially when young and active patients are involved. The definition is still debated, and they can have several clinical presentations. The treatment depends on the clinical presentation and the patient's age. METHODS: The survey was developed by the ESSKA U45 Committee and was uploaded on the ESSKA website. Fifty-seven questionnaires were returned. Several aspects of the diagnosis and treatment of massive irreparable cuff tears were investigated. Moreover, treatment options for specific clinical scenarios were given for posterior-superior and anterior-superior cuff tears in young and old patients. RESULTS: Fatty degeneration of the muscles was the most common criterion to define an irreparable tear (59.7%). In young patients with external rotation with the arm at side lag, partial repair of the cuff was the most common option (41.8%); in case of external rotation with the arm at side + external rotation at 90° of abduction lag without pseudoparalysis, the most common option was partial repair of the cuff + latissimus dorsi or lower trapezius transfer (39.3%), and in case of external rotation with the arm at side + external rotation at 90° of abduction lag with pseudoparalysis, partial repair of the cuff + latissimus dorsi or lower trapezius transfer was still the most common option (25.5%). The same scenarios in old patients yielded the following results: reverse prosthesis (49.1%), reverse prosthesis (44.6%) and reverse prosthesis ± latissimus dorsi or lower trapezius transfer (44.6%), respectively. CONCLUSIONS: The present survey clearly confirms that biological options (partial cuff repairs and tendon transfers) are the reference in the case of young patients with deficient cuffs (both posterior and anterior). Reverse shoulder prosthesis is the most common treatment option in old patients in all clinical scenarios. LEVEL OF EVIDENCE: Level IV.