Association between tears of the posterior root of the medial meniscus and far posterior femoral condyle osteoarthritis

PURPOSEWe aimed to evaluate whether tears of the posterior horn of the medial meniscus root ligament (PHMM RL) are associated with osteoarthritis of the far posterior femoral condyles (FPFC).METHODSRetrospective review of 1158 patients who underwent arthroscopy identified 49 patients with confirmed tears of the medial meniscus posterior root ligament attachment. Preoperative magnetic resonance imaging (MRI) studies were reviewed to identify advanced osteoarthritis involving the medial and lateral FPFC. Control patients (n=48) had no meniscal tears confirmed by arthroscopy. Cases and controls were age- and sex-matched exactly 1:1. One case patient was excluded since there was no age- and sex-matched control available. The International Cartilage Research Society (ICRS) MRI cartilage grade was recorded for the medial and lateral FPFC. Associations were evaluated using univariate and multivariable conditional logistic regression analyses.RESULTSThere were 48 case and 48 control patients (10 men in each group, 20.8%) with median age 53 years (range, 21–67). Medial FPFC ICRS Grade 2 or higher lesions were present in 34 (70.8%) of case patients and 16 (33.3%) of control patients. Lateral FPFC ICRS Grade 2 or higher lesions were present in 24 (50%) of case patients and 14 (28.2%) of control patients. Increased body mass index (BMI) was associated with PHMM RL tears (OR=1.11, 95% CI [1.01, 1.22], P = 0.020). MRI was 81.2% (39/48) sensitive and 91.2% (44/48) specific for detection of PHMM RL tears. PHMM RL tears were associated with Grade 2 or higher medial FPFC osteoarthritis (OR=10.00, 95% CI (2.34, 42.78), P < 0.001). This association remained after adjusting for BMI (OR=11.79, 95% CI [2.46, 56.53], P = 0.002). There was also an association between PHMM RL tears and lateral FPFC osteoarthritis, which persisted after adjusting for BMI (OR =3.00, 95% CI [1.07, 8.37], P = 0.036).CONCLUSIONPHMM RL tears are associated with advanced osteoarthritis of the FPFC. Radiologists identifying FPFC osteoarthritis should look carefully for PHMM RL tears

Survey of Canine Monogenetic Diseases with Established Molecular Bases

The development of a dog breed often involves selection, which intentionally propagates valued genetic traits. Unfortunately, untoward traits can be collaterally propagated during this process. For the purpose of identifying trends in canine genetic diseases, we examined 36 randomly chosen canine pathologies involving single gene mutations. For each disease we provide a brief summary of breed predilection, clinical signs, the underlying genetic mutation, and the availability of a commercial diagnostic test. The following trends were noted in this non-exhaustive list of diseases. First, these genetic diseases primarily involve the ophthalmic (28%) and nervous systems (28%). Second, no single breed was over-represented in these genetic diseases. Third, the majority (89%) of the mutations involve coding regions of the respective genes. Fourth, most (78%) mutations were autosomal recessive. Fifth, nucleotide substitutions were the most common mutation (42%). Finally, genetic testing is available for 89% of these diseases. This review encapsulates canine pathologies associated with single genetic defects, thus providing a resource for practitioners and researchers

Using Crash Outcome Data Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a motor vehicle crash in New York State

Background In New York State (NYS), motor vehicle (MV) injury to child passengers is a leading cause of hospitalization and emergency department (ED) visits in children aged 0–12 years. NYS laws require appropriate child restraints for ages 0–7 years and safety belts for ages 8 and up while traveling in a private passenger vehicle, but do not specify a seating position. Methods Factors associated with injury in front-seated (n = 11,212) compared to rear-seated (n = 93,092) passengers aged 0–12 years were examined by age groups 0–3, 4–7 and 8–12 years using the 2012–2014 NYS Crash Outcome Data Evaluation System (CODES). CODES consists of Department of Motor Vehicle (DMV) crash reports linked to ED visits and hospitalizations. The front seat was row 1 and the rear rows 2–3. Vehicle towed from scene and air bag deployed were proxies for crash severity. Injury was dichotomized based on Maximum Abbreviated Injury Severity (MAIS) scores greater than zero. Multivariable logistic regression (odds ratios (OR) with 95% CI) was used to examine factors predictive of injury for the total population and for each age group. Results Front-seated children had more frequent injury than those rear-seated (8.46% vs. 4.92%, p < 0.0001). Children in child restraints experienced fewer medically-treated injuries compared to seat belted or unrestrained children (3.80, 6.50 and 13.62%, p < 0.0001 respectively). A higher proportion of children traveling with an unrestrained vs. restrained driver experienced injury (14.50% vs 5.26%, p < 0.0001). After controlling for crash severity, multivariable adjusted predictors of injury for children aged 0–12 years included riding in the front seat (1.20, 1.10–1.31), being unrestrained vs. child restraint (2.13, 1.73–2.62), being restrained in a seat belt vs. child restraint (1.20, 1.11–1.31), and traveling in a car vs. other vehicle type (1.21, 1.14–1.28). Similarly, protective factors included traveling with a restrained driver (0.61, 0.50–0.75), a driver aged < 25 years (0.91, 0.82–0.99), being an occupant of a later vehicle model year 2005–2008 (0.68, 0.53–0.89) or 2009–2015 (0.55, 0.42–0.71) compared to older model years (1970–1993). Conclusions Compared to front-seated children, rear-seated children and children in age-appropriate restraints had lower adjusted odds of medically-treated injury

Survey of Canine Monogenetic Diseases with Established Molecular Bases

The development of a dog breed often involves selection, which intentionally propagates valued genetic traits. Unfortunately, untoward traits can be collaterally propagated during this process. For the purpose of identifying trends in canine genetic diseases, we examined 36 randomly chosen canine pathologies involving single gene mutations. For each disease we provide a brief summary of breed predilection, clinical signs, the underlying genetic mutation, and the availability of a commercial diagnostic test. The following trends were noted in this non-exhaustive list of diseases. First, these genetic diseases primarily involve the ophthalmic (28%) and nervous systems (28%). Second, no single breed was over-represented in these genetic diseases. Third, the majority (89%) of the mutations involve coding regions of the respective genes. Fourth, most (78%) mutations were autosomal recessive. Fifth, nucleotide substitutions were the most common mutation (42%). Finally, genetic testing is available for 89% of these diseases. This review encapsulates canine pathologies associated with single genetic defects, thus providing a resource for practitioners and researchers.This article is from Austin J Vet Sci & Anim Husb. 2014;1(1): 7. Posted with permission.</p

Anatomic Relationship and Imaging Relevance of the Perforating Branches of the Peroneal Vessels to the Anterior Talofibular Ligament

Patients frequently present to the emergency department after ankle injuries, and the anterior talofibular ligament (ATFL) is commonly damaged. Musculoskeletal ultrasound (US) can help to make a rapid diagnosis. There is a paucity of literature describing techniques to image the ATFL with US, and the complex ankle anatomy and potential pitfalls make imaging challenging. Our aim was to estimate prevalence of perforating branches (PBs) of the peroneal vessels and determine their most frequent position relative to the ATFL. If these vessels are located in a predictable position at the level of the ATFL, they may serve as a sonographic landmark for the correct imaging plane. Magnetic resonance imaging (MRI) scans of 105 ankles were reviewed to determine the PB prevalence and location at the ATFL. Inter-observer agreement was determined. Additionally, 16 ankles from 8 asymptomatic subjects were scanned using a high-frequency linear transducer and PB prevalence and location were noted. By MRI, PBs were detected in 85% of the ankles and 93% of ankles after consensus. In 73% of cases with agreed PB visualization, vessels assumed a medial position with respect to the ATFL. By US, PBs could be seen in 100% of cases, with the arterial PB seen in 81% of cases and assuming a medial position in 88%. PBs are often present, have a predictable course, and may be useful to help optimize US probe positioning when assessing the ATFL

Clinical prediction rules in practice: review of clinical guidelines and survey of GPs

Background The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas. Aim To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care. Design and setting A review of clinical guidelines and survey of UK GPs. Method Clinical guidelines in eight clinical domains with published CPRs were reviewed for recommendations to use CPRs including primary prevention of cardiovascular disease, transient ischaemic attack (TIA) and stroke, diabetes mellitus, fracture risk assessment in osteoporosis, lower limb fractures, breast cancer, depression, and acute infections in childhood. An online survey of 401 UK GPs was also conducted. Results Guideline review: Of 7637 records screened by title and/or abstract, 243 clinical guidelines met inclusion criteria. CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease (67%) and depression (67%). There was little consensus across various clinical guidelines as to which CPR to use preferentially. Survey: Of 401 responders to the GP survey, most were aware of and applied named CPRs in the clinical areas of cardiovascular disease and depression. The commonest reasons for using CPRs were to guide management and conform to local policy requirements. Conclusion GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs