Marco Mastantuono

Accelerated rehabilitation after arthroscopic meniscal repair : A clinical and magnetic resonance imaging evaluation

Twenty-two patients who underwent meniscal repair using the outside-in technique combined with anterior cruciate ligament (ACL) reconstruction were submitted to an accelerated rehabilitation protocol that included immediate full range of motion and weightbearing. The patients were reviewed postoperatively by means of clinical assessment and magnetic resonance imaging (MRI) after an average of 28 months. Clinical evaluation was performed according to the International Knee Documentation Committee form, and sagittal knee laxity was measured with a KT-2000 arthrometer (MedMetric Corp, San Diego, CA). The MRI scans were obtained using a 0.2-T high-resolution MRI unit dedicated to the study of limbs, and the meniscal signal was graded according to a modified Crues classification. Overall, 77.3% of patients reported clinically good results. Loss of extension of < 5 degrees was detected in only 2 patients (9.1%). Three out of 22 patients showed clinical signs of meniscal retear. One of these patients had a second operation for a bucket-handle tear. The presence of a full-thickness rim at MRI evaluation, present in 10 patients (45.5%), did not correlate with the presence of clinical symptoms of retear. Instead, the 3 symptomatic patients presented a complete rim with a gap > 1 mm between the meniscal wall and the fragment of the posterior horn. This finding is believed to be a more reliable indicator for retear following meniscal repair. The low failure rate in this series suggests that an aggressive rehabilitation regimen may be prescribed without deleterious effects in subjects undergoing ACL reconstruction and concomitant meniscus repair.

Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients

BACKGROUND The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability in certain patients. However, progression of the transferred coracoid bone graft to osteolysis has been reported in the literature. We propose that the coracoid bone graft osteolysis could be one of the causes of failure of the Latarjet procedure. MATERIALS AND METHODS A computed tomography scan analysis was done of 26 patients prospectively followed-up after the Latarjet procedure to determine the location and the amount of the coracoid graft osteolysis. RESULTS The most relevant osteolysis was represented by the superficial part of the proximal coracoid, whereas the distal region of the coracoid bone graft, especially in the deep portion, was the least involved in osteolysis and had the best bone healing. DISCUSSION To our knowledge, this is the first study to quantify and localize coracoid osteolysis after Latarjet procedure for anteroinferior shoulder instability using CT scan analysis. CONCLUSION Our study suggests that the bone-block effect from the Latarjet procedure may not be the principal effect in its treatment of anteroinferior shoulder instability in patients without significant bony defects.

Osteoid Osteoma: MR-guided Focused Ultrasound for Entirely Noninvasive Treatment

PURPOSE To determine the preliminary feasibility, safety, and clinical efficacy of magnetic resonance (MR)-guided focused ultrasound for the treatment of painful osteoid osteoma. MATERIALS AND METHODS This prospective institutional review board-approved study involved six consecutive patients (five males and one female; mean age, 21 years) with a diagnosis of osteoid osteoma based on clinical and imaging findings. All patients underwent MR-guided focused ultrasound ablation after providing informed consent. Lesions located in the vertebral body were excluded. The number of sonications and the energy deposition were recorded. Treatment success was determined at 1, 3, and 6 months after treatment. A visual analog scale (VAS) score for pain was used to assess changes in symptoms. MR imaging features of osteoid osteoma (edema, hyperemia, and nidus vascularization) were considered at baseline and at imaging follow-up. RESULTS Treatment was performed with a mean of 4 sonications ± 1.8 (standard deviation), with a mean energy deposition of 866 J ± 211. No treatment- or anesthesia-related complications occurred. The pre- and posttreatment mean VAS scores significantly differed (7.9 ± 1.4 and 0.0 ± 0.0, respectively). At imaging, the edema and hyperemia associated with osteoid osteoma gradually disappeared in all lesions. However, nidus vascularization still persisted after treatment in four of six patients. CONCLUSION This limited series demonstrated that MR-guided focused ultrasound treatment of osteoid osteoma can be performed safely with a high rate of success and without apparent treatment-related morbidity.

Cross-Sectional Imaging in a Case of Adventitial Cystic Disease of the Popliteal Artery

Abstract Adventitial cystic disease of the popliteal artery is an unusual condition of uncertain etiology, in which a mucin-containing cyst forms in the wall of the artery and produces lower extremity claudication, typically in young and middle-aged men. A diagnosis of adventitial cystic disease of the popliteal artery was made preoperatively in a 47-year-old man by means of several imaging modalities, including angiography, magnetic resonance imaging, and ultrasound. The pathological findings confirmed the suggested diagnosis.

Coracoid bone graft osteolysis after Latarjet procedure: A comparison study between two screws standard technique vs mini-plate fixation

Aims: One of the reason for Latarjet procedure failure may be coracoid graft osteolysis. In this study, we aimed to understand if a better compression between the coracoid process and the glenoid, using a mini-plate fixation during the Latarjet procedure, could reduce the amount of coracoid graft osteolysis. Materials and Methods: A computed tomography scan analysis of 26 prospectively followed-up patients was conducted after modified Latarjet procedure using mini-plate fixation technique to determine both the location and the amount of coracoid graft osteolysis in them. We then compared our current results with results from that of our previous study without using mini-plate fixation to determine if there is any statistical significant difference in terms of corcacoid bone graft osteolysis between the two surgical techniques. Results: The most relevant osteolysis was represented by the superficial part of the proximal coracoid, whereas the deep part of the proximal coracoid graft is least involved in osteolysis and has best bone healing. The current study showed a significant difference only for the deep part of the distal coracoid with our previous study (P < 0.01). Discussion: To our knowledge, there are no studies in literature that show the causes of coracoid bone graft osteolysis after Latarjet procedure. Conclusion: Our study suggests that there is a significant difference only for the deep part of the distal coracoid in terms of osteolysis. At clinical examination, this difference did not correspond with any clinical findings. Level of Evidence: Level 4. Clinical Relevance: Prospective case series, Treatment study.

Clinical experience of osteoarticular MRI using a dedicated system

Magnetic resonance imaging (MRI) has a significative impact on diagnosis of musculoskeletal diseases. At present, joint diseases are evaluated with total-body systems, this fact representing an obstacle to MR diffusion in the osteoarticular field. The last technological advances have allowed the development of a cost-effective, compact and easy-to-install MR system. The system is constituted by a 0.2-T permanent unit, weighing 800 kg. The unit is used only for limb examination. To verify the diagnostic accuracy of the new system a study based on 1902 lower limb examinations was carried out between October 1992 and February 1994. Of these patients, 301 underwent surgery during which the MR findings were verified. Quite satisfying overall results were obtained, particularly in case of knee trauma, comparable to those provided by total body units with higher magnetic field. It must be noted, however, that in 3% of the investigated knee diseases, the examinations could not be performed due to technical limitations related to the magnet size. The authors believe that the limited field of view (11 cm) does not allows accurate staging of the malignant lesions concerning soft tissue and bone, which require a wider loco-regional staging. They also believe that the particular structure of the magnet allows for a comfortable management of pediatric, elderly, and acute patients.