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BACKGROUND: Lisfranc injuries are known to be rare and often overlooked injuries that can cause long-term disability and pain when missed or treated incorrectly. The wide variety of Lisfranc injuries ranges from subtle ligament distensions to open fracture dislocations. The treatment of Lisfranc joint injuries is still controversial and very little is known about what types of injury can be treated nonoperatively. The current literature provides only two randomized studies on dislocated Lisfranc injuries. These studies have shown that primary arthrodesis (PA) leads to a similar or better outcome and results in fewer secondary operations when compared with open reduction and internal fixation (ORIF) in ligamentous injuries. There have been no previous randomized studies of the nonoperative versus operative treatment of Lisfranc injuries. Therefore, the purpose of this study is to compare the operative and nonoperative treatment of non-dislocated Lisfranc injuries and to compare the ORIF and PA treatment of dislocated Lisfranc injuries. METHODS: This study is a prospective, randomized, national multi-center trial. The trial comprises two strata: Stratum I compares cast-immobilization versus open reduction and internal fixation (ORIF) treatment of non-dislocated Lisfranc joint injuries. Stratum II compares PA versus ORIF in the treatment of dislocated injuries of the Lisfranc joint. The main hypothesis of stratum I is that the nonoperative treatment of non-dislocated Lisfranc injuries achieves a similar outcome compared with operative treatment (ORIF). The hypothesis of stratum II is that PA of dislocated Lisfranc injuries yields a similar functional outcome compared with ORIF, but that PA results in fewer secondary operations than ORIF. The main outcome measure is the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot score and the secondary outcome measures are Visual-Analogue-Scale Foot and Ankle (VAS-FA), Visual-Analogue-Scale (VAS), rate of secondary operations and other treatment-related complications. The results will be analyzed after the 2-year follow-up period. DISCUSSION: This publication presents a prospective, randomized, national multi-center trial study protocol. It provides details of patient flow, randomization, aftercare and methods of analysis of the material and ways to present and publish the results. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02953067 24.10.2016.
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Artrodesis , Moldes Quirúrgicos , Traumatismos de los Pies/terapia , Articulaciones del Pie/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/terapia , Luxaciones Articulares/terapia , Reducción Abierta , Adolescente , Adulto , Moldes Quirúrgicos/efectos adversos , Protocolos Clínicos , Finlandia , Traumatismos de los Pies/diagnóstico por imagen , Traumatismos de los Pies/fisiopatología , Articulaciones del Pie/diagnóstico por imagen , Articulaciones del Pie/lesiones , Articulaciones del Pie/fisiopatología , Fijación Interna de Fracturas/efectos adversos , Curación de Fractura , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/fisiopatología , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/fisiopatología , Persona de Mediana Edad , Reducción Abierta/efectos adversos , Estudios Prospectivos , Proyectos de Investigación , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Tunnel enlargement is frequently seen in short-term follow-up after anterior cruciate ligament reconstruction (ACLR). According to new evidence, tunnel enlargement may be followed by tunnel narrowing, but the long-term evolution of the tunnels is currently unknown. HYPOTHESIS/PURPOSE: The hypothesis was that tunnel enlargement is followed by tunnel narrowing caused by ossification as seen in follow-up using magnetic resonance imaging (MRI). The purpose of this study was to evaluate the ossification pattern of the tunnels, the communication of the 2 femoral and 2 tibial tunnels, and screw absorption findings in MRI. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty-one patients underwent anatomic double-bundle ACLR with hamstring grafts and bioabsorbable interference screw fixation and were followed with MRI and clinical evaluation at 2 and 5 years postoperatively. RESULTS: The mean tunnel enlargement at 2 years was 58% and reduced to 46% at 5 years. Tunnel ossification resulted in evenly narrowed tunnels in 44%, in conical tunnels in 48%, and fully ossified tunnels in 8%. Tunnel communication increased from 13% to 23% in the femur and from 19% to 23% in the tibia between 2 and 5 years and was not associated with knee laxity. At 5 years, 54% of the screws were not visible, with 35% of the screws replaced by a cyst and 19% fully ossified. Tunnel cysts were not associated with worse patient-reported outcomes or knee laxity. Patients with a tibial anteromedial tunnel cyst had higher Lysholm scores than patients without a cyst (93 and 84, P = .03). CONCLUSION: Tunnel enlargement was followed by tunnel narrowing in 5-year follow-up after double-bundle ACLR. Tunnel communication and tunnel cysts were frequent MRI findings and not associated with adverse clinical evaluation results.
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BACKGROUND: Puumala hantavirus (PUUV) induces an acute tubulointerstitial nephritis and acute kidney injury (AKI). Our aim was to evaluate the prognosis of severe AKI associated with PUUV infection. METHODS: We examined 556 patients who were treated at Tampere University Hospital during 1982-2013 for acute, serologically confirmed PUUV infection. Plasma creatinine was measured during hospitalization, convalescence, and 1, 2, and 5 years after the acute infection. RESULTS: Plasma creatinine concentration was elevated (>100 µmol/l) in 459 (83%) patients, while altogether 189 patients (34%) had severe AKI defined as Kidney Disease: Improving Global Outcomes (KDIGO) stage 3, that is, plasma creatinine ≥353.6 µmol/l (4.0 mg/dl) or need of dialysis. There were no fatal cases during the hospitalization or the following 3 months. Fatality rate during the years following PUUV infection did not differ between patients who had suffered from severe AKI versus those without severe AKI. Post-hospitalization plasma creatinine values were available for 188 (34%) patients. One month after the acute infection, patients with prior severe AKI had higher median plasma creatinine concentration (82 µmol/l, range 54-184) than patients without severe AKI (74 µmol/l, range 55-109, p = 0.005). After 1 year, no significant difference existed in median plasma creatinine concentrations between patients with (71 µmol/l, range 36-123) and without prior severe AKI (72 µmol/l, range 34-116, p = 0.711). After 5 years all but 1 patient had normal creatinine levels. CONCLUSIONS: In contrast to the worldwide well-accepted KDIGO criteria, severe AKI associated with PUUV infection is not associated with excess fatality but has a very good prognosis, both in the short and long terms.
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Lesión Renal Aguda/etiología , Fiebre Hemorrágica con Síndrome Renal/complicaciones , Fiebre Hemorrágica con Síndrome Renal/terapia , Virus Puumala , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/terapia , Adolescente , Adulto , Anciano , Recuento de Células Sanguíneas , Estudios de Cohortes , Creatinina/sangre , Femenino , Finlandia/epidemiología , Tasa de Filtración Glomerular , Fiebre Hemorrágica con Síndrome Renal/mortalidad , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Pronóstico , Radiografía Torácica , Diálisis Renal/estadística & datos numéricos , Adulto JovenRESUMEN
PURPOSE: This study aimed to evaluate the association between magnetic resonance imaging (MRI) findings of tunnel communication and increased graft signal intensity (SI) and clinical evaluation of knee stability and outcome after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS: Fifty-nine patients were evaluated with 1.5 T MRI and with clinical evaluation 2 years after DB ACL reconstruction. The MRI finding of tunnel communication was defined as the absence of a bony bridge between the anteromedial (AM) and posterolateral (PL) tunnels. The SI of the intra-articular portion of both grafts was analyzed on proton-density (PD)-weighted and T2-weighted images and graded on a scale, with I being a normal SI similar to that of the posterior cruciate ligament, II being > 50% of the graft having a normal SI, and III being < 50% of the graft having a normal SI. The clinical evaluation of knee stability and function included KT-1,000 arthrometric side-to-side difference, pivot shift test, and International Knee Documentation Committee (IKDC) and Lysholm knee evaluation scores. The association between the MRI findings and the clinical findings was calculated using the Fisher exact test and the 2-tailed t test. RESULTS: Tunnel communication was seen in the femur in 10% of patients and in the tibia in 27% of patients. Increased graft SI was seen in 15% of the AM grafts and 59% of the PL grafts. No statistically significant association (P < .05) between the MRI findings of tunnel communication or increased graft SI and knee laxity was found. CONCLUSIONS: The MRI findings of tunnel communication or increased graft SI were not associated with knee laxity 2 years after DB ACL reconstruction. Tibial tunnel communication was associated with increased range of movement with flexion, and increased AM graft SI was associated with reduced range of flexion in the knee. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Fémur/cirugía , Inestabilidad de la Articulación/cirugía , Osteotomía/métodos , Tibia/cirugía , Adulto , Ligamento Cruzado Anterior/cirugía , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico , Rodilla/cirugía , Articulación de la Rodilla/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Factores de Tiempo , Trasplantes , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI) findings of a reconstructed anterior cruciate ligament (ACL) have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee. METHODS: This study is a level II, prospective clinical and MRI study (NCT02000258). The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used. RESULTS: We found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations. CONCLUSION: Anterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this has no effect on the clinical recovery of the patient.
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The pathogenesis of thrombocytopenia in Puumala hantavirus (PUUV) infection is probably multifactorial. We aimed to evaluate the possible spleen enlargement during acute PUUV infection, and to determine its association with thrombocytopenia and disease severity. Magnetic resonance imaging (MRI) of the spleen was performed in 20 patients with acute PUUV infection. MRI was repeated 5-8 months later. The change in spleen length was compared with markers describing the severity of the disease. In all patients, the spleen length was increased in the acute phase compared with the control phase (median 129 mm vs 111 mm, p < 0.001). The change correlated with maximum C-reactive protein value (r = 0.513, p = 0.021) and inversely with maximum leukocyte count (r = -0.471, p = 0.036), but not with maximum serum creatinine level or minimum platelet count. Enlarged spleen, evaluated by MRI, was shown to be a common finding during acute PUUV infection. However, it does not associate with thrombocytopenia and acute kidney injury.
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Fiebre Hemorrágica con Síndrome Renal/diagnóstico , Fiebre Hemorrágica con Síndrome Renal/patología , Virus Puumala/aislamiento & purificación , Esplenomegalia/etiología , Esplenomegalia/patología , Trombocitopenia/etiología , Adolescente , Adulto , Anciano , Proteína C-Reactiva/análisis , Creatinina/sangre , Femenino , Humanos , Recuento de Leucocitos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Radiografía , Bazo/diagnóstico por imagen , Bazo/patología , Adulto JovenRESUMEN
BACKGROUND: The double-bundle (DB) reconstruction of the anterior cruciate ligament (ACL) has gained popularity in recent years. The positioning of anteromedial (AM) and posterolateral (PL) tunnels is aimed at the anatomic femoral and tibial attachments of AM and PL bundles of the native ACL. PURPOSE: To use magnetic resonance imaging (MRI) to evaluate the tunnel locations and tunnel findings in DB ACL reconstruction. MATERIAL AND METHODS: Sixty-six patients with DB ACL reconstruction were evaluated with 1.5-T MRI 2 years postoperatively. Two musculoskeletal radiologists separately measured the locations and the diameters of the tunnels. Inter-observer agreements were estimated according to the method of Bland and Altman. RESULTS: In the femur, the mean AM tunnel location was 32% from the proximal condylar surface and 18% from the notch roof. The mean PL tunnel location was 42% and 43%, respectively. In the tibia, the mean AM tunnel location was 54% of the lateral-to-medial tibial width and 42% of the anterior-to-posterior tibial depth. The mean PL tunnel location was 54% and 56%, respectively. The mean tunnel enlargement was 3.8 mm (56%). Tunnel communication was seen in seven patients (11%) in the femur and in 19 patients (29%) in the tibia. Greater femoral AM tunnel distance from the proximal condylar surface was associated with more tunnel enlargement, and more posterior tibial PL tunnel location was associated with less tunnel enlargement. CONCLUSION: The tunnel locations of DB ACL reconstruction can be evaluated with MRI. Tunnel location was associated with tunnel enlargement that in turn was associated with tunnel communication.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Imagen por Resonancia Magnética/métodos , Osteotomía/métodos , Adulto , Femenino , Fémur/anatomía & histología , Humanos , Articulación de la Rodilla/anatomía & histología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Tibia/anatomía & histología , Resultado del TratamientoRESUMEN
The purpose of the study was to assess the 1-year outcome of definitive reactive arthritis (ReA) after a waterborne outbreak. A cohort of 21 patients (15 females and 6 males, median age 54 years) with ReA related to an extensive waterborne outbreak in Finland was clinically followed-up by rheumatologists with visits at baseline, at 1 month and 3, 6 and 12 months. Although the outcome was in general favourable, 1/3 of the patients had chronic course; 7 (33 %) of the 21 patients needed disease-modifying anti-rheumatic drugs (DMARDs) and even 8 (38 %) of them used glucocorticoids at 12 months. Four (19 %) were using non-steroidal anti-inflammatory drugs and nine (43 %) other analgesics. Many patients had articular pain and impaired physical function still at 12 months, even though inflammatory parameters and the number of swollen joints were low. Only one patient (5 %) was human leucocyte antigen-B27-positive. She had the most severe ReA and also additional infectious arthritis caused by Salmonella serotype enteritidis leading to osteonecrosis of her hip joint with subsequent need for arthroplasty. ReA as observed in our study was overall fairly mild, but in many individuals, postinfectious arthralgia and DMARD use continued at least up to 1 year.
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Artralgia/etiología , Artralgia/terapia , Artritis Reactiva/etiología , Artritis Reactiva/terapia , Gastroenteritis/complicaciones , Adulto , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Antirreumáticos/uso terapéutico , Brotes de Enfermedades , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Gastroenteritis/epidemiología , Glucocorticoides/uso terapéutico , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Osteonecrosis/microbiología , Prohibitinas , Estudios Prospectivos , Aguas del Alcantarillado , Resultado del Tratamiento , Microbiología del Agua , Contaminantes del Agua/efectos adversos , Abastecimiento de AguaRESUMEN
PURPOSE: To investigate whether the locations of the grafts in single-bundle (SB) anterior cruciate ligament (ACL) reconstruction have changed to more anatomical as the double-bundle (DB) method has become more familiar. METHODS: Operation using anteromedial (not transtibial) portal and freehand technique [Group A (N = 25) in 2003, Group B (N = 25) in 2007]. The evaluation methods preoperatively and at the 2-year follow-up (two blinded examiners): clinical examination, stability measurement (KT-1000 arthrometer), the International Knee Documentation Committee (IKDC), and the Lysholm knee scores. A musculoskeletal radiologist made tunnel measurements from the magnetic resonance imaging (MRI). RESULTS: The average tunnel placement in the femoral side: from Blumensaat's line 27 % (Group A) and 26 % (Group B), from the posterior edge of the femur 32 % (Group A) and 29 % (Group B). The average tunnel placement in the tibial side: from the anterior edge 45 % (Group A) and 45 % (Group B), from the lateral side 57 % (Group A) and 54 % (Group B) (P = 0.024). Graft failures ending up to revision ACL surgery: 4 (Group A) and 0 (Group B) (P = 0.045). Operation time reduced 19 min (P = 0.001). CONCLUSION: Tunnel placement at the femoral side was already very low (anatomical) in patients operated in 2003. No significant difference was found when comparing to the patients operated in 2007. There were significantly more graft failures in the Group A, suggesting that the use of the DB method in ACL surgery in 2007 may have also improved the technique and results of the SB ACL reconstruction. LEVEL OF EVIDENCE: Prospective comparative study, Level II.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Fémur/cirugía , Tendones/trasplante , Tibia/cirugía , Adulto , Femenino , Fémur/diagnóstico por imagen , Humanos , Masculino , Radiografía , Tibia/diagnóstico por imagen , Adulto JovenRESUMEN
BACKGROUND: Surgical technique is essential in anterior cruciate ligament (ACL) reconstruction. PURPOSE: This randomized 5-year study tested the hypothesis that double-bundle ACL reconstruction with hamstring autografts and aperture screw fixation has fewer graft ruptures and rates of osteoarthritis (OA) and better stability than single-bundle reconstruction. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Ninety patients were randomized: double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). The following evaluation methods were used: clinical examination, KT-1000 arthrometer measurement, and International Knee Documentation Committee (IKDC) and Lysholm knee scores. Additionally, radiographic evaluation was made by a musculoskeletal radiologist who was unaware of the patients' clinical and surgical data. A single orthopaedic surgeon performed all the operations, and clinical follow-up assessments were made in a blinded manner by an independent examiner. RESULTS: Preoperatively, there were no differences between the groups. Eleven patients (7 in the SBB group, 3 in the SBM group, and 1 in the DB group) had a graft failure during the follow-up and went on to ACL revision surgery (P < .043). Of the remaining 79 patients, a 5-year follow-up was performed for 65 patients (20 in the DB group, 21 in the SBB group, and 24 in the SBM group) who had their grafts intact. At 5 years, there was no statistically significant difference in the pivot-shift or KT-1000 arthrometer tests. In the DB group, 20% of the patients had OA in the medial femorotibial compartment and 10% in the lateral compartment, while the corresponding figures were 33% and 18% in the single-bundle groups, again an insignificant finding. Further, no significant group differences were found in the knee scores. CONCLUSION: The double-bundle surgery resulted in significantly fewer graft failures and subsequent revision ACL surgery than the single-bundle surgeries during the 5-year follow-up. Knee stability and OA rates were similar at 5 years. In view of the size of the groups, some caution should be exercised when interpreting the lack of difference in the secondary outcomes.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Tornillos Óseos , Articulación de la Rodilla/cirugía , Tendones/trasplante , Implantes Absorbibles , Adulto , Lesiones del Ligamento Cruzado Anterior , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Femenino , Humanos , Inestabilidad de la Articulación/etiología , Masculino , Persona de Mediana Edad , Osteoartritis/etiología , Estudios Prospectivos , Rotura/etiología , Trasplante Autólogo , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Hantaviruses are important human pathogens that cause clinical diseases characterized by renal and cardiopulmonary manifestations. Their pathogenesis is currently poorly understood. We have studied the role of the complement system in the pathogenesis of Puumala (PUUV) hantavirus infection. MATERIAL AND METHODS: We studied the activation of complement by measuring the terminal complement complex SC5b-9 and complement component C3 and C4 levels in patients with acute PUUV infection. Several laboratory parameters and clinical findings reflecting the severity of PUUV-HFRS were evaluated with regard to complement activation. RESULTS: The levels of SC5b-9 were significantly increased and C3 decreased in the acute stage as compared to the levels at full recovery (P < 0.001). We found that SC5b-9 levels were higher in patients with chest X-ray abnormalities than in patients with a normal X-ray during the acute stage (P = 0.028). Furthermore, SC5b-9 and C3 levels showed significant correlation with several clinical and laboratory parameters that reflect the severity of the acute PUUV infection. CONCLUSIONS: We showed that the complement system becomes activated via the alternative pathway in the acute stage of PUUV infection and the level of activation correlates with disease severity. The results further suggest that complement activation may contribute to the pathogenesis of acute PUUV infection.
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Activación de Complemento , Fiebre Hemorrágica con Síndrome Renal/inmunología , Virus Puumala , Adulto , Anciano , Complemento C3/fisiología , Complemento C4/fisiología , Complejo de Ataque a Membrana del Sistema Complemento/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
PURPOSE: To evaluate lung high-resolution computed tomography (HRCT) findings in patients with Puumala hantavirus-induced nephropathia epidemica (NE), and to determine if these findings correspond to chest radiograph findings. MATERIALS AND METHODS: HRCT findings and clinical course were studied in 13 hospital-treated NE patients. Chest radiograph findings were studied in 12 of them. RESULTS: Twelve patients (92%) showed lung parenchymal abnormalities in HRCT, while only 8 had changes in their chest radiography. Atelectasis, pleural effusion, intralobular and interlobular septal thickening were the most common HRCT findings. Ground-glass opacification (GGO) was seen in 4 and hilar and mediastinal lymphadenopathy in 3 patients. Atelectasis and pleural effusion were also mostly seen in chest radiographs, other findings only in HRCT. CONCLUSION: Almost every NE patient showed lung parenchymal abnormalities in HRCT. The most common findings of lung involvement in NE can be defined as accumulation of pleural fluid and atelectasis and intralobular and interlobular septal thickening, most profusely in the lower parts of the lung. As a novel finding, lymphadenopathy was seen in a minority, probably related to capillary leakage and overall fluid overload. Pleural effusion is not the prominent feature in other viral pneumonias, whereas intralobular and interlobular septal thickening are characteristic of other viral pulmonary infections as well. Lung parenchymal findings in HRCT can thus be taken not to be disease-specific in NE and HRCT is useful only for scientific purposes.
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Fiebre Hemorrágica con Síndrome Renal/complicaciones , Fiebre Hemorrágica con Síndrome Renal/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To demonstrate the magnetic resonance imaging (MRI) findings of double-bundle (DB) anterior cruciate ligament (ACL) reconstruction grafts. MATERIALS AND METHODS: Sixty-six patients with DB ACL reconstruction were evaluated with MRI 2 years postoperatively. Graft thickness was measured separately by two musculoskeletal radiologists. The MRI findings of graft disruption, signal intensity (SI) changes, cystic degeneration, arthrofibrosis, and impingement were analyzed. The statistical significance of the association between MRI findings was calculated. RESULTS: The mean anteromedial (AM) graft thickness was reduced 9% and the mean posterolateral (PL) graft thickness was reduced 18% from the original graft thickness. Disruption was seen in 3% of AM grafts and 6% of PL grafts and a partial tear in 8 and 23%, respectively. Both grafts were disrupted in 3% of patients. Increased SI was seen in 14% of intact AM grafts and in 60% of partially torn AM grafts (p = 0.032). In PL grafts the increased SI was seen in 51% of the intact grafts and in 93% of the partially torn grafts (p = 0.005). Cystic degeneration was seen in 8% of AM grafts and in 5% of PL grafts. Diffuse arthrofibrosis was seen in 5% of patients and a localized cyclops lesion in 3% of patients. Impingement of the AM graft was seen in 8% of patients. CONCLUSION: Both grafts were disrupted in 3% of patients. Also, the frequencies of other complications were low. The use of orthogonal sequences in the evaluation of the PL graft SI seems to cause volume-averaging artefacts.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/patología , Ligamento Cruzado Anterior/trasplante , Imagen por Resonancia Magnética/métodos , Procedimientos de Cirugía Plástica/métodos , Trasplantes , Adulto , Ligamento Cruzado Anterior/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
PURPOSE: Determination of the cup orientation after metal-on-metal hip resurfacing may provide important information in the postoperative follow-up. We present a mathematical method based on a previously described approach to assess the version and inclination of the cup in the metal-on-metal bearing without a separate software computation from plain radiographs. The aim of the study was to assess the intra- and inter-observer reliability of this method. METHODS: Calculation of version and inclination were done twice for 20 hip resurfacings by four observers. Intra-observer reliability was estimated by mean error and correlation of the two sets of measurement for version and inclination. Bland-Altman plots, intra-class coefficient and mean error were used to assess the inter-observer reliability of the measurements. RESULTS: Intra-observer correlation for version measurement ranged from 0.74 to 0.94. Correlation for inclination varied between 0.94 and 0.97. Upper and lower limits of agreement in Bland-Altman plots for version measurements between observers ranged from 4.1 to 7.2 degrees and from -3.2 to -8.3 degrees, respectively. For inclination measurements the upper and lower limits ranged from 3.1 to 5.3 degrees and from -2.7 to -6.0 degrees. CONCLUSIONS: Mean errors, correlation coefficients and 95% limits of agreement were on an acceptable level. We believe that this method is applicable for clinical use.
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Artroplastia de Reemplazo de Cadera/métodos , Desviación Ósea/diagnóstico , Articulación de la Cadera/patología , Prótesis de Cadera/efectos adversos , Ajuste de Prótesis/métodos , Artroplastia de Reemplazo de Cadera/efectos adversos , Desviación Ósea/diagnóstico por imagen , Desviación Ósea/etiología , Femenino , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Masculino , Variaciones Dependientes del Observador , Complicaciones Posoperatorias , Reoperación , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: One aspect of the debate over the reconstruction of the anterior cruciate ligament is whether it should be carried out with the single-bundle or double-bundle technique. HYPOTHESIS: The double-bundle technique results in fewer graft failures than the single-bundle technique in anterior cruciate ligament reconstruction. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 153 patients were prospectively randomized into 2 groups of anterior cruciate ligament reconstruction with hamstring autografts using aperture interference screw fixation: single-bundle technique (SB group, n = 78) and double-bundle technique (DB group, n = 75). The evaluation methods were clinical examination, KT-1000 arthrometric measurement, the International Knee Documentation Committee (IKDC) and the Lysholm knee scores, and magnetic resonance imaging (MRI) evaluation. All of the operations were performed by 1 experienced orthopaedic surgeon, and all clinical assessments were made by 2 blinded and independent examiners. A musculoskeletal radiologist blinded to the clinical data made the MRI interpretation. RESULTS: There were no differences between the study groups preoperatively. Ninety percent of patients (n = 138) were available at a minimum 2-year follow-up (range, 24-37 months). Eight patients (7 in the SB group and 1 in the DB group) had graft failure during the follow-up and had anterior cruciate ligament revision surgery (P = .04). In addition, 7 patients (5 in the SB group and 2 in the DB group) had an invisible graft on the MRI assessment at the 2-year follow-up. Also, the anteromedial bundle was partially invisible in 2 patients and the posterolateral bundle in 9 patients. Together, the total number of failures and invisible grafts were significantly higher in the SB group (12 patients, 15%) than the DB group (3 patients, 4%) (P = .024). No significant group differences were found in the knee scores or stability evaluations at the follow-up. CONCLUSION: This 2-year randomized trial showed that the revision rate of the anterior cruciate ligament reconstruction was significantly lower with the double-bundle technique than that with the single-bundle technique. However, additional years of follow-up are needed to reveal the long-term results.
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Reconstrucción del Ligamento Cruzado Anterior/métodos , Adulto , Artrometría Articular , Artroscopía/métodos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Tendones/trasplante , Resultado del Tratamiento , Adulto JovenAsunto(s)
Traumatismos en Atletas/cirugía , Fracturas Óseas/cirugía , Fracturas por Estrés/cirugía , Rótula/lesiones , Rótula/cirugía , Adolescente , Traumatismos en Atletas/diagnóstico , Femenino , Fracturas Óseas/diagnóstico , Fracturas por Estrés/diagnóstico , Humanos , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE. METHODS: A prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high. RESULTS: We found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 vs 9.0 x 10(9)/l, P = 0.001) and urinary protein excretion (2.51 vs 1.68 g/day, P = 0.017), as well as a lower minimum blood platelet count (55 vs 80 x 10(9)/l, P < 0.001), hematocrit (0.34 vs 0.38, P = 0.001), and urinary output (1040 vs 2180 ml/day, P < 0.001). They also stayed longer in hospital than patients with low IL-6 (8 vs 6 days, P < 0.001). In contrast, high CRP did not associate with severe disease. CONCLUSIONS: High plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.
Asunto(s)
Proteína C-Reactiva/análisis , Fiebre Hemorrágica con Síndrome Renal/patología , Fiebre Hemorrágica con Síndrome Renal/virología , Interleucina-6/sangre , Riñón/patología , Virus Puumala/aislamiento & purificación , Adolescente , Adulto , Anciano , Biomarcadores , Recuento de Células Sanguíneas , Creatinina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plasma/química , Estudios Prospectivos , Proteinuria , Índice de Severidad de la Enfermedad , Orina/química , Adulto JovenRESUMEN
OBJECTIVE: The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MATERIALS AND METHODS: MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. RESULTS: In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm(3) and of the patellar bruise 2,832 mm(3). At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm(3) and 1,380 mm(3), respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r = 0.389, P = 0.074) and the follow-up (r = 1.000, P < 0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. CONCLUSION: Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use.
Asunto(s)
Enfermedades Óseas/diagnóstico , Enfermedades Óseas/etiología , Contusiones/diagnóstico , Contusiones/etiología , Imagen por Resonancia Magnética/métodos , Luxación de la Rótula/complicaciones , Luxación de la Rótula/diagnóstico , Enfermedad Aguda , Adulto , Femenino , Estudios de Seguimiento , Humanos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Traumatismos de la Rodilla/complicaciones , Traumatismos de la Rodilla/diagnóstico , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
This study was conducted to determine the frequency, severity and outcome of cardiac findings in patients with acute Puumala hantavirus-induced nephropathia epidemica (NE). 70 consecutive, hospital-treated patients with serologically confirmed NE were prospectively examined using serial electrocardiograms (ECG), plasma troponin I, tumour necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and echocardiography (ECHO). Examinations were repeated after 3 and 12 months. ECG changes were observed in 57% of patients. Plasma troponin I levels remained normal in all. In six patients, ECHO showed left ventricular contraction abnormalities, and 1 patient had mild pericardial effusion. There were no differences in clinical or standard laboratory findings or in plasma TNF-alpha and IL-6 concentrations between patients with and without ECG or ECHO changes. During the follow-up, all acute-phase changes in ECG and ECHO reverted to normal, which probably reflects their benign nature. We conclude that abnormal cardiac findings are surprisingly common during NE.