Anterior Talofibular Ligament Abnormality on Routine Magnetic Resonance Imaging of the Ankle

The anterior talo­fibular ligament (ATFL) extends from the anteroinferior border of the ­fibula to the talar neck. Primary restraint to ankle inversion in plantar‑exion. Injury (acute or chronic) can be diagnosed with physical exam, stress X-Rays, ultrasound or magnetic resonance imaging (MRI). Purpose: MRI abnormalities in asymptomatic individuals known in other areas of orthopaedics (shoulder and spine). Purpose of our study: determine the prevalence of ATFL abnormalities found on MRI in asymptomatic individuals. Asymptomatic individuals - those undergoing MRI for pathology unrelated to lateral ankle trauma, instability, or inversion injuries

Rotator cuff disease: Opinion regarding surgical criteria and likely outcome

Background: Clinical guidelines for the management of rotator cuff disease are not clear. Surgeon surveys in the USA and UK lack agreement regarding surgical indications. Physical examination tests aid surgical decision-making but also lack robust evidence. Study aims were to evaluate: Western Australian orthopaedic surgeons' perceptions about surgical indications; utility of physical examination tests; findings at surgery predictive of outcome and surgeon opinion of a successful surgical outcome. Methods: An anonymous rotator cuff survey, previously reported by the American Academy of Orthopaedic Surgeons, was emailed to all surgeons listed with the Australian Orthopaedic Association in Western Australian. Surgeons who treated patients for rotator cuff disease during the previous 12months were invited to complete the rotator cuff survey and five additional questions were included to capture the above criteria of interest. Results: Within a close community of surgeons based in Western Australia (n=23) considerable heterogeneity exists in surgical decision-making criteria. A successful surgical outcome was considered to include reduced pain levels, restoration of movement and function and gains in muscle strength. Conclusions: Research is required to inform robust clinical practice guidelines for rotator cuff surgery. Identification of prognostic factors for successful surgical outcome is imperative

Spinal Nerve Root Swelling Mimicking Intervertebral Disc Herniation in Magnetic Resonance Imaging -A Case Report-

A herniated intervertebral disc is the most common type of soft tissue mass lesion within the lumbar spinal canal. Magnetic resonance imaging (MRI) is a useful tool for the assessment of patients with lower back pain and radiating pain, especially intervertebral disc herniation. MRI findings of intervertebral disc herniation are typical. However, from time to time, despite an apparently classic history and typical MRI findings suggestive of disc herniation, surgical exploration fails to reveal any lesion of an intervertebral disc. Our patient underwent lumbar disc surgery with the preoperative diagnosis of lumbar disc herniation; however, nothing could be found during the surgical procedure, except a swollen nerve root

Relationship between muscle stress and intramuscular pressure during dynamic muscle contractions

Intramuscular pressure (IMP) has been used to estimate muscle stress indirectly. However, the ability of this technique to estimate muscle stress under dynamic conditions is poorly characterized. Therefore, the purpose of this study was to determine the extent to which IMP is a valid surrogate for muscle stress during dynamic contractions. IMP and muscle stress were compared under steady-state isotonic conditions and during complex dynamic length changes. During concentric contractions the shape of the IMP–velocity curve mimicked the basic shape of the force–velocity curve but with much higher variability. For eccentric contractions, a precipitous drop in IMP was observed despite increased muscle stress. The dissociation between muscle stress and IMP during dynamic contractions was partially explained by sensor movement. When the muscle was not moving, IMP explained 89% ± 5% of the variance in muscle force. However, when transducer movement occurred the linear relationship between IMP and stress was no longer observed. These findings demonstrate the difficulty in interpreting IMP under dynamic conditions when sensor movement occurs. They also illustrate the need to control transducer movement if muscle stress is to be inferred from IMP measurements such as might be desired during clinical gait testing. Muscle Nerve, 2007Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56124/1/20828_ftp.pd

Arthroscopic treatment of a medial meniscal cyst using a posterior trans-septal approach: a case report

Arthroscopic partial menisectomy followed by cyst decompression is currently recommended for treatment of a meniscal cyst. However, it is doubtful whether partial menisectomy should be performed on cysts communicating with the joint in cases without a meniscal tear on its surface since meniscal function will be sacrificed. In this report, a meniscal cyst arising from the posterior horn of the medial meniscus without meniscal tear on its surface was resected using an arthroscopic posterior trans-septal approach. A 59 year-old male presented to our hospital with popliteal pain when standing up after squatting down. Magnetic resonance imaging revealed a multilobulated meniscal cyst arising from the posterior horn of the medial meniscus extending to the posterior septum with a grade 2 meniscal tear by Mink's classification. The medial meniscus was intact on the surface on arthroscopic examination. The meniscal cyst and posterior septum were successfully resected using a posterior trans-septal approach without harming the meniscus. This is the first report on a meniscal cyst being resected using an arthroscopic posterior trans-septal approach with a 9-month follow-up period