The acutely injured acromioclavicular joint – which imaging modalities should be used for accurate diagnosis? A systematic review

Abstract Background The management of acute acromioclavicular (AC) joint injuries depends on the degree of injury diagnosed by the Rockwood classification. Inadequate imaging and not selecting the most helpful imaging protocols can often lead to incorrect diagnosis of the injury. A consensus on a diagnostic imaging protocol for acute AC joint injuries does not currently exist. Therefore we conducted a systematic review of the literature considering three diagnostic parameters for patients with acromioclavicular (AC) joint injuries: 1) Assessment of vertical instability; 2) Assessment of horizontal instability; 3) Benefit of weighted panoramic views. Methods Internet databases were searched in March 2016 using the terms (“AC joint” OR “acromioclavicular joint”) AND (MRI OR MR OR radiograph OR X-ray OR Xray OR ultrasound OR “computer tomography” OR “computed tomography” OR CT). Diagnostic, prospective, retrospective, cohort and cross- sectional studies were included to compare their use of different radiological methods. Case reports, cadaveric studies, and studies concerning chronic AC injuries and clinical outcomes were excluded. Results This search returned 1359 citations of which 1151 were excluded based on title, 116 based on abstract and 75 based on manuscript. 17 studies were included for review and were analyzed for their contributions to the three parameters of interest mentioned above. The inter- and intra-observer reliability for diagnosing vertical instabilities of the clavicle using x-ray alone show a high level of reproducibility while for horizontal instabilities the values were much more variable. In general, digitally measured parameters seem to be more precise and reliable between investigators than visual classification alone. Currently, evidence for the value of weighted views and other additional diagnostic imaging to supplement standard x-rays is controversial. Conclusion To date there is no consensus on a gold standard for diagnostic measures needed to classify acute AC joint injuries. The inter- and intra-observer reliability for diagnosing vertical instabilities of the clavicle using bilateral projections show a high level of reproducibility while for horizontal instabilities the results are much more inconsistent. There is currently no clear consensus on a protocol for image-based diagnosis and classification of acute AC joint injuries, leading to a lack of confidence in reproducibility and reliability

Magnetic resonance image after the large osteochondral autogenous transplantation system technique

Magnetic resonance imaging scan of Patient 23, 59 months after the large osteochondral autogenous transplantation system and cancellous bone grafting.<p><b>Copyright information:</b></p><p>Taken from "The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study"</p><p>http://arthritis-research.com/content/10/3/R68</p><p>Arthritis Research & Therapy 2008;10(3):R68-R68.</p><p>Published online 16 Jun 2008</p><p>PMCID:PMC2483459.</p><p></p

Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity

Purpose!#!Ultrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions.!##!Methods!#!A total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed.!##!Results!#!Thirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p &amp;lt; 0.05). With rising age, a significant increased change of medial joint space width between unloaded and loaded conditions could be demonstrated in 0° (p = 0.032). No significant correlation between BMI and medial joint width in US could be found.!##!Conclusion!#!Mean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee.!##!Level of evidence!#!III

Partial remodelling of the posterior femoral condyle: Patient 17, 82 months postoperatively

One red line marks the prior osteotomy of the posterior femoral condyle according to figure 10, the crossing line marks the Blumensaat's line.<p><b>Copyright information:</b></p><p>Taken from "The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study"</p><p>http://arthritis-research.com/content/10/3/R68</p><p>Arthritis Research & Therapy 2008;10(3):R68-R68.</p><p>Published online 16 Jun 2008</p><p>PMCID:PMC2483459.</p><p></p

Lysholm score for patients with and without osteoarthritis documented presurgery

Box and whisker plot; circles, outliers.<p><b>Copyright information:</b></p><p>Taken from "The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study"</p><p>http://arthritis-research.com/content/10/3/R68</p><p>Arthritis Research & Therapy 2008;10(3):R68-R68.</p><p>Published online 16 Jun 2008</p><p>PMCID:PMC2483459.</p><p></p

Ultrasound-based evaluation revealed reliable postoperative knee stability after combined acute ACL and MCL injuries

Purpose!#!Anterior cruciate ligament (ACL) injuries are often combined with lesions of the medial collateral ligament (MCL). The aim of this study was to evaluate treatment outcome of combined acute ACL and MCL lesions using functional US and clinical examination.!##!Methods!#!Patients aged &amp;gt; 18 years undergoing primary ACL reconstruction with concomitant operative (group 1) or non-operative treatment of the MCL (group 2) between 2014 and 2019 were included after a minimum follow-up of 12 months. Grade II MCL injuries with dislocated tibial or femoral avulsions and grade III MCL ruptures underwent ligament repair whereas grade II injuries without dislocated avulsions were treated non-operatively. Radiological outcome was assessed with functional US examinations. Medial knee joint width was determined in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton) conditions using a fixation device. Clinical examination was performed and patient-reported outcomes were assessed by the use of the subjective knee form (IKDC), Lysholm score, and the Tegner activity scale.!##!Results!#!A total of 40 patients (20 per group) met inclusion criteria. Mean age of group 1 was 40 ± 12 years (60% female) with a mean follow-up of 33 ± 17 months. Group 2 showed a mean age of 33 ± 8 years (20% female) with a mean follow-up of 34 ± 15 months. Side-to-side differences in US examinations were 0.4 ± 1.5 mm (mm) in 0° and 0.4 ± 1.5 mm in 30° knee flexion in group 1, and 0.9 ± 1.1 mm in 0° and 0.5 ± 1.4 mm in 30° knee flexion in group 2, with no statistically significant differences between both groups. MCL repair resulted in lower Lysholm scores (75 ± 19 versus 86 ± 15; p &amp;lt; 0.05). No significant differences could be found for subjective IKDC or Tegner activity scores among the two groups.!##!Conclusion!#!A differentiated treatment concept in combined ACL and MCL injuries based on injury patterns leads to reliable postoperative ligamentous knee stability in US-based and clinical examinations. However, grade II and III MCL lesions with subsequent operative MCL repair (group 1) result in slightly poorer subjective outcome scores.!##!Level of evidence!#!Retrospective cohort study; Level III