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BACKGROUND: Magnetic resonance imaging (MRI) of the head and neck region is notably challenging due to the complex anatomy and the critical need for high-resolution imaging to accurately diagnose various pathologies. The two prominent MRI techniques used in this context are turbo spin echo (TSE) and echo-planar diffusion-weighted imaging (EP-DWI). TSE is recognized for providing high-resolution anatomical images, whereas EP-DWI offers functional imaging that highlights the diffusion of water molecules, essential for detecting early pathological changes. This study aims to compare the image quality of TSE and EP-DWI in the head and neck region to assess their diagnostic efficacy and clinical utility. METHODS: This retrospective study was conducted at Saveetha Medical College and Hospital over six months. A total of 100 patients (50 males and 50 females, aged 18-65 years) with various head and neck pathologies were included. Patients underwent both TSE and EP-DWI sequences using a Philips MULTIVA 1.5 T scanner. Image quality was assessed based on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), artifact presence, and lesion detection. Two experienced radiologists independently reviewed the images, with inter-observer agreement calculated using Cohen's kappa coefficient. RESULTS: The mean SNR for TSE was significantly higher than EP-DWI (45.2 vs. 28.7, p<0.01), indicating superior image clarity and detail in TSE images. TSE demonstrated a higher mean CNR compared to EP-DWI (25.4 vs. 15.8, p<0.01), suggesting better differentiation between different tissue types and pathologies. Artifacts were more frequent in EP-DWI images (45% vs. 15%), with motion artifacts being the most common. TSE detected more lesions (120 vs. 95), with more precise delineation of lesions. The inter-observer agreement was excellent for both TSE and EP-DWI, with kappa values of 0.85 and 0.80, respectively. CONCLUSION: TSE MRI provides superior image quality compared to EP-DWI for evaluating the head and neck region. The enhanced SNR and CNR in TSE images result in clearer and more detailed visualizations of anatomical structures and pathological changes, with fewer artifacts. While EP-DWI is valuable for functional imaging, its role should be complementary to TSE. The study suggests that TSE should be the preferred modality for detailed anatomical assessment in the head and neck region. Further studies with larger sample sizes and advanced imaging techniques may provide additional insights into optimizing MRI protocols for head and neck imaging.
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Background: Meniscal injuries frequently require surgical intervention to restore knee joint function and stability. Intraoperative platelet-rich plasma (PRP) injection has emerged as a potential adjunctive therapy to enhance tissue healing post-meniscal repair. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in terms of pain relief, functional recovery, and overall success rates in patients undergoing meniscal repair procedures. Methods: A comprehensive search strategy was employed to identify relevant studies across Scopus, PubMed, Embase, and the Cochrane Library databases. The inclusion criteria encompassed human studies, including randomized controlled trials (RCTs), cohorts, and case-control studies, focusing on intraoperative platelet-rich plasma (PRP) use post-meniscal repair and reporting outcomes related to pain, functionality, and cure rates. Exclusion criteria comprised animal studies, non-English publications, studies lacking relevant outcome measures, and those with insufficient data. Two reviewers independently screened titles and abstracts, resolving disagreements through consensus or consultation with a third reviewer, followed by a full-text assessment for potentially eligible studies. Data extraction was conducted independently by two reviewers using a standardized form. The reliability of observational studies was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses and pooled effect estimates for main outcomes were computed using RevMan 5.3, a meta-analysis tool. Results: The demographic analysis revealed that the PRP group had an average age of 41.39 years, while the control group had an average age of 42.1 years. In terms of gender distribution, the PRP group consisted of 61 men and 29 women, while the control group had 62 men and 34 women. Pain ratings showed a preference for PRP with a mean difference of 4.83 (p = 0.13). However, there was no significant difference in Lysholm scores (mean difference: - 0.44, p = 0.91) or IKDC scores (mean difference: 2.80, p = 0.14) between the PRP and control groups. Similarly, ROM measures did not show a statistically significant difference, with a mean difference of 2.80 (p = 0.18). Additionally, there was no significant distinction in failure rates between the PRP and control groups, as indicated by a weighted mean difference of 0.71 (p = 0.52). These findings suggest that while PRP may offer some benefits in pain relief, its impact on functional recovery, range of motion, and failure rates following meniscal repair procedures is inconclusive. Conclusion: The current evidence regarding the effect of intraoperative platelet-rich plasma (PRP) injection on patients undergoing meniscal repair remains inconclusive. While some studies suggest potential benefits in terms of pain relief and functional recovery, others show no significant differences compared to control groups. The impact of PRP therapy on overall success rates, including rates of re-tear and revision surgery, is also uncertain. Further well-designed randomized controlled trials with larger sample sizes are needed to provide more robust evidence and guide clinical practice in orthopedic surgery.
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Background: Exosomes are the smallest extracellular vesicles (30-150 nm) secreted by all cell types, including synovial fluid. However, because biological fluids are complex, heterogeneous, and contain contaminants, their isolation is difficult and time-consuming. Furthermore, the pathophysiology of osteoarthritis (OA) involves exosomes carrying complex components that cause macrophages to release chemokines and proinflammatory cytokines. This narrative review aims to provide in-depth insights into exosome biology, isolation techniques, role in OA pathophysiology, and potential role in future OA therapeutics. Methods: A literature search was conducted using PubMed, Scopus, and Web of Science databases for studies involving exosomes in the osteoarthritis using keywords "Exosomes" and "Osteoarthritis". Relevant articles in the last 15 years involving both human and animal models were included. Studies involving exosomes in other inflammatory diseases were excluded. Results: Despite some progress, conventional techniques for isolating exosomes remain laborious and difficult, requiring intricate and time-consuming procedures across various body fluids and sample origins. Moreover, exosomes are involved in various physiological processes associated with OA, like cartilage calcification, degradation of osteoarthritic joints, and inflammation. Conclusion: The process of achieving standardization, integration, and high throughput of exosome isolation equipment is challenging and time-consuming. The integration of various methodologies can be employed to effectively address specific issues by leveraging their complementary benefits. Exosomes have the potential to effectively repair damaged cartilage OA, reduce inflammation, and maintain a balance between the formation and breakdown of cartilage matrix, therefore showing promise as a therapeutic option for OA.
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Tuberculosis (TB) is a widespread global disease that significantly impacts daily life. Skeletal TB comprises about 10-35% of all TB cases. Significant research on the spine and hip exists, but due to the rarity of cases, the management of TB is less explored. Furthermore, exercising the option of total knee arthroplasty (TKA) in TB knees is still in its initial stages. This systematic review aims to identify and comprehend the difficulties associated with diagnosing TB-affected knees, their treatment outcomes, and complications related to TKA. A systematic review of existing English literature retrieved from PubMed, Google Scholar, and Web of Science databases was performed using the PRISMA guidelines. A case series of arthroplasty performed on TB knees included a description of the diagnostic approach, clinical outcome, and complication rates. Moreover, studies involving case series with follow-up functional outcomes were included. The Coleman Methodology was used to assess the quality of the studies. A total of six studies (75 knees) were systematically reviewed in this study. The diagnosis of TB knee is multimodal, with MRI being a reliable tool. Administering anti-TB chemotherapy is essential during the perioperative period. Regarding recurrence, a two-stage TKA has a lower risk of recurrence. It is plausible to state that anti-TB chemotherapy needs to be initiated in the perioperative period to prevent the chances of recurrences. Two-stage TKA is reserved for patients who require soft tissue debridement despite adequate chemotherapy.
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Introduction: Ramp lesions, often associated with anterior cruciate ligament (ACL) injuries, exhibit a varied incidence rate of 9-42%, increasing with delayed ACL reconstruction. These lesions, resulting from abnormal tibial movements and semimembranosus muscle contraction, are challenging to diagnose due to their hidden nature in standard magnetic resonance imaging and arthroscopy procedures. Case Report: This report examines the case of a ramp lesion in the context of a multi-ligament injured knee of a 34-year-old male. The patient had a complete ACL, medial collateral ligament, and avulsion of the posterior cruciate ligament with a type 1 ramp lesion. These findings were confirmed by arthroscopy and were treated with arthroscopic reconstruction of the ligament and all inside repair of the ramp lesion. We report the pertinent imaging findings relevant to the ramp lesions. Conclusion: Ramp lesions present a significant diagnostic and treatment challenge in orthopedic practice. Enhanced imaging techniques and a deeper understanding of their pathophysiology are crucial for an accurate diagnosis.
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BACKGROUND: The morphology of the distal femur's intercondylar notch has been implicated in the susceptibility to and severity of cruciate ligament injuries. While previous research has primarily focused on isolated anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, the relationship between notch morphology and combined cruciate injuries remains less understood. OBJECTIVE: This study aimed to explore the association between femoral notch morphology and the severity of combined cruciate ligament injuries in adult males. METHODS: In this retrospective cohort study, MRI scans from 118 adult male participants with and without knee dislocations (60 cases with Schenk classification Type II or higher knee dislocations and 58 controls) were analyzed. The study period ranged from 2015 to 2023. Femoral notch width, notch width index (NWI), and notch shape (U shape, A shape) were assessed using a Philips Multiva 1.5 Tesla system (Philips, Amsterdam, Netherlands). The statistical significance of differences in measurements between cases and controls was evaluated using independent sample t-tests performed with IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY). RESULTS: The case group exhibited a significantly smaller mean femoral notch width (15.88 mm ± 2.7 mm) and NWI (0.238 ± 0.58) compared to the control group (notch width 18.29 mm ± 3.4 mm, NWI 0.25 ± 0.31), with p-values of 0.004 for both measurements. The notch shape was predominantly A-shaped in the case group (n = 49) as opposed to U-shaped in the control group (n = 41). CONCLUSIONS: The study identifies a significant association between reduced femoral notch dimensions and the severity of complex cruciate ligament injuries. These findings support the notion that specific femoral notch morphologies may predispose individuals to more severe ligamentous injuries.
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Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon neurological condition marked by changes in the skeletal structure, cerebral hemiatrophy, and ventriculomegaly. Manifesting primarily in early life, DDMS presents with seizures, hemiplegia, facial asymmetry, and intellectual disabilities. There are congenital and acquired types of DDMS, with ischemia being the most common cause of the latter. Three cases are presented here to highlight the radiological and clinical characteristics of DDMS. The first case involves a 27-year-old male with generalized seizures and right-sided hemiparesis since childhood, along with developmental delays and facial asymmetry. The second case features a 20-year-old male with recurrent seizures and developmental delays. The third case involves a 25-year-old female with uncontrolled seizures and learning difficulties since childhood. The clinical and radiological characteristics of DDMS are demonstrated in all three cases, emphasizing the significance of early detection and differential diagnosis. Imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), which demonstrate ipsilateral ventriculomegaly, brain atrophy, and associated bone abnormalities, are highly helpful in the diagnosis. Differential diagnoses include Sturge-Weber syndrome, linear nevus sebaceous syndrome (LNSS), Silver-Russell syndrome, Fishman syndrome, and Rasmussen encephalitis. Treatment aims at managing seizures and associated disabilities, with hemispherectomy considered for eligible cases. This case series underscores the significance of prompt diagnosis and multidisciplinary management in improving outcomes for individuals with DDMS.