Knee MR-arthrography in assessment of meniscal and chondral lesions

SummaryIntroductionNo study, so far in France, has investigated the diagnosis value of knee MR-arthrography since the recent approval of intra-articular gadolinium use, by this country's healthcare authorities. This study objective is to verify the MR-arthrography superiority on conventional knee MRI, in meniscus and cartilage knee lesions diagnosing accuracy both in regard to sensitivity and specificity.HypothesisMR-arthrography, represents in some pathologic situations, a more accurate source of information than conventional MRI.Materials and methodsOver a 27 months period, 25 patients, scheduled to undergo a knee arthroscopy volunteered, after having been fully informed of the possible interest and risk of the MR-arthrography examination, to participate in this study. Twenty-one of them were finally included since in four cases the surgical indication was not confirmed. The group consisted of 15 males and six females with an average age of 35.7 years. All of them consecutively underwent conventional MRI, MR-arthrography finally followed by arthroscopy. The MRI and MR-arthrograms results were compared to the arthroscopy findings using the nonparametric Kappa test.ResultsTo diagnose meniscal tears, statistical agreement measure for MRI with arthroscopy was good (K=0.69) but not as good as the MR-arthrography/arthroscopy agreement which, by itself was excellent (K=0.84). As a diagnosis tool, the sensitivity and specificity of MR-arthrography (respectively 100 and 89.6%) were much higher than the corresponding values observed in conventional MRI (92.3 and 82.8%, respectively) which nonetheless remain satisfactory.The meniscal tears characterization seemed to be better interpreted using MR-arthrography. As far as the chondral lesions in this series, they were predominantly located on the patellar surface and in the medial femorotibial compartment. For diagnosing the latter, the MRI/arthroscopy agreement was good (K=0.70) but not as good as the MR-arthrography/arthroscopy agreement (K=0.805) which can be rated excellent. The detection sensitivity thus increased by 10% with gadolinium intra-articular injection. However, assessment accuracy of the lesions depth was mediocre, with frequent errors for the intermediary stages.DiscussionIntra-articular gadolinium injection improved MRI performances for numerous reasons: filling the joint, reinforcing the synovial fluid signal, and enhancing anatomic structures contrast on the T1-weighted sequences images. In this study, MR-arthrography appeared to be superior to conventional MRI in meniscal and cartilaginous lesions diagnosis, confirming the results previously obtained in other countries. In light of these results and other data from the literature, MR-arthrography can be indicated as an alternative to CT-arthrography in various clinical situations: detection of recurrent tears on operated menisci, search for cartilaginous lesions or foreign bodies in the joint space, and preoperative assessment before chondral repair procedures. However, conventional MRI remains the reference examination for studying cartilage, because the low resolution of MR-arthrography limits its performances in quantitative assessment of lesions depth.Level of evidence: Level III. Non randomized comparative prospective study

Outcomes of talar dome osteochondral defect repair using osteocartilaginous autografts: 37 cases of Mosaicplasty (R)

International audienceBackground: The indications of osteochondral autograft implantation using the Mosaicplasty (R) technique were only recently extended to osteochondral lesions of the talus (OLT), a site for which no medium- or long-term outcome data are available. Our objective here was to evaluate medium-term outcomes in case-series of patients who underwent Mosaicplasty (R) for OLT repair. Hypothesis: Mosaicplasty (R) provides good medium-term outcomes with low morbidity when used for OLT repair. Patients et methods: We retrospectively reviewed cases of Mosaicplasty (R) for OLT repair, performed in combination with malleolar osteotomy on the side of the OLT, at either of two centres, between 1997 and 2013. Pre-operative clinical data were collected from the medical records and all patients were re-evaluated. We studied 37 patients with a mean age of 33 years. Results: Mean follow-up at re-evaluation was 76 months. Mean AOFAS score at re-evaluation was 83( range, 9-100). A work-related cause to the OLT was associated with significantly poorer outcomes( P = 0.01). AOFAS values were significantly better in patients whose OLT size was 0.5 to 1 cm(2). The Ogilvie-Harris score at last follow-up was good or excellent in 78% of patients. No patient experienced morbidity related to the malleolar osteotomy. Persistent patellar syndrome was noted in 6 patients. Discussion: In our case-series, Mosaicplasty (R) for OLT repair provided good medium-term outcomes in 78% of patients. Nevertheless, the donor-site morbidity should be borne in mind. Mosaicplasty (R) deserves to be viewed as a reference standard method for OLT repair. (C) 2014 Elsevier Masson SAS. All rights reserved

Discision ou section du muscle subscapularis dans la butée coracoïdienne. Comparaison clinique et tomodensitométrique à court terme : à propos de 70 cas.

A partir d'une étude radio-clinique, comparaison des résultats d'interventions chirurgicales selon la procédure de Bristow-Latarjet (butée coracoidienne) pour instabilité antérieure chronique de l'épaule, effectuées par section ou discision du muscle subscapularis