Lipohemarthrosis of the knee: MR imaging

Two patients with sports-related knee injuries underwent magnetic resonance (MR) imaging, which demonstrated intracapsular fractures and effusions with a signal pattern characteristic of lipohemarthrosis. Four distinct signal bands were identified: superior band representing floating fat, a central band containing serum, an inferior band of dependent red blood cells, and a thin band representing chemical shift artifact at the interface of serum and floating fat.     

Lipohemarthrosis of the knee: MRI as an alternative to the puncture of the knee joint

Joint effusions are common after sports injuries. In a specific form they can be very accurate for the diagnosis of intraarticular fractures; however, assessment can be tricky. Several imaging means are compared which outline the advantages and disadvantages of each technique. Electronic Publication     

The double fat fluid level: Lipohemarthrosis of the knee associated with suprapatellar plica synovialis

Lipohemarthrosis is a frequent occurrence following intrarticular fracture. The contour of the fat and blood interface in the knee joint is dependent upon suprapatellar anatomy. Anatomic variations of the suprapatellar joint space can significantly alter the radiographic appearance of lipohemarthrosis. Three cases are presented in which a double fat-fluid level was identified, due to presence of a well developed suprapatellar plica synovialis. Recognition of the variable appearance of lipohemarthrosis of the knee is important to avoid overlooking this finding in the traumatized patient.     

关节积脂血症的影像诊断

外伤后关节积脂血症并不少见,今报道我们遇到的5例并结合文献加以讨论。1资料与方法1.1临床资料5例患者中,男4例,女1例。年龄23~65岁,平均35.7岁。5例均为外伤后就诊,时间1 h~2 d,其中髋关节1例,膝关节4例。临床症状主要有关节肿痛(5例),活动受限(4例),浮髌试验阳性(4例),合并关节周围骨折4例,关节脱位1例,半月板损伤2例,韧带损伤4例共7条,合并其它部位损伤3例。5例病人外伤后均有相应关节的X线片,其中1例髋关节加做CT扫描,4例膝关节加做MR I扫描。1.2检查设备和方法1.2.1 X线片采用常规卧位投照。1.2.2 CT机为GE ProSpeed SX Advant…     

关节积脂血征的影像学表现

目的：分析外伤所致关节积脂血征的X线、CT和MRI表现,总结其影像学特征表现。方法：回顾性分析46例关节积脂血征的X线、CT和MRI特点,其中膝关节32例、髋关节4例、肩关节4例、踝关节5例及肘关节1例。结果：仅4例在X线上有特征性表现,CT或MRI上46例关节积脂血征患者均有关节内骨折,关节积脂血征CT和MRI表现为关节囊内单液-液平面或双液-液平面,单液-液平面及双液-液平面的不同成份在CT和MRI上密度和信号不同,但上层均为脂肪。结论：关节积脂血征在CT和MRI上具有特征性表现,可做出明确诊断,关节积脂血征均与关节内骨折并存,可作为关节内骨折的可靠间接征象。     

The young athlete's knee: recent advances

The understanding and treatment of the young athlete's knee has improved and continues to do so as arthroscopy and good long-term follow-up studies guide the process. In the management of epiphyseal fractures about the knee the presence of associated ligament injury and the high likelihood of a growth plate injury is now well documented. In the management of ligament injuries and internal derangements, arthroscopy has profoundly changed diagnosis and treatment. Pathology can be precisely identified and the appropriate treatment initiated to preserve an athletic career and possibly prevent degenerative arthritis in adulthood. Lastly, patellofemoral pain continues to be a difficult problem to treat, but a more scientific approach is evolving. This has been facilitated by a better understanding of the varied etiologies for anterior knee pain, and a trend away from classifying all such conditions as chondromalacia.     

Euthanasia in the Netherlands: experiences in a review committee

Since 1999 reported cases of euthanasia in The Netherlands are examined in five regional review committees. In these committees a lawyer, an ethicist and a medical doctor investigate whether the cases reported are in correspondence with the so-called criteria for careful practice. Issues to be investigated include the patient's suffering, the nature of the patient's request, the consultation by another doctor and the way in which the termination of life has been performed. Since April 2002 the judgment of the committees is final. This paper describes the working of the review committees. It also discusses the relevance of experiences in the committee for issues of social and public debate, such as the role of the consulting doctor, the relation between euthanasia and palliative care, and the place of patient autonomy.     

创伤性关节脂血症的影像学特征及其诊断价值

目的：分析创伤性关节脂血症的影像学特征．探讨其对关节囊内骨折的诊断价值。方法：回顾性分析研究100例经手术或穿刺证实的创伤性关节脂血症患者行X线、CT及MRI检查并分析影像学资料。结果：100例患者经3种检查方法印证均存在关节内骨折。X线表现为关节囊肿胀,密度增高与肌肉近似,经特殊体位投照部分可显示脂液平征象。CT全部清晰显示关节囊内有脂液平征．其中单液-液平征72例,双液-液平征25例,气体脂肪血液单或双液-液平征3例。MRI有明确脂液平征89例,位于膝、髋等大关节。脂液平征不明确者11例,位于踝、腕等小而复杂的关节。构成关节囊内单液-液平征的上下2层液体和双液-液平征的上、中、下3层液体有明显不同的CT值和MRI信号强度,其中最上层CT为脂肪密度、MRI为脂肪信号。结论：CT示脂血症清晰而准确,对大部分囊内骨折能明确诊断。MRI对小关节脂血症的诊断不如CT,但对关节囊内骨折及其附属结构损伤的显示明显优于X线片及CT。创伤性关节脂血症可作为关节内骨折可靠的间接征象。     

Determinants of anterior knee pain following total knee replacement: a systematic review

Purpose

Anterior knee pain (AKP) following total knee replacement (TKR) is both prevalent and clinically relevant. The purpose of this study was to systematically review the peer-reviewed literature, and to identify and assess the different modifiable and non-modifiable determinants that may be associated with the development of AKP in patients following primary TKR.

Methods

A systematic computerized database search (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Google Scholar) was performed in January 2012. The quality of the studies was assessed using the GRADE approach.

Results

A total of 54 articles met the inclusion criteria. Variables that have been researched with regard to the prevalence of AKP include patient and knee-specific characteristics, prosthetic design, operative technique, treatment of the patella, and time of assessment. A weak correlation with AKP was found for specific retained presurgery gait patterns. A weak recommendation can be given for the use of femoral components with a posterior centre of rotation, resection of Hoffa’s fat pad, patellar rim electrocautery, and preventing combined component internal rotation. The correlation between postsurgical AKP and the degree of patellar cartilage wear, tibial component bearing strategies, and patellar resurfacing is inconclusive. Due to substantial heterogeneity of the included studies, no meta-analysis was performed.

Conclusions

No single variable is likely to explain the differences in the reported rates of AKP, although variables leading to abnormal patellofemoral joint loading appear to be of special significance.

Level of evidence

III.     

Diagnostic errors in polytrauma: a structured review of the recent literature

Clinically important diagnostic errors are relatively common among polytrauma patients (2–40%). Errors are not random; they are more frequent in the spine and periarticular appendicular skeleton, especially in hemodynamically unstable patients who require resuscitation or operative intervention before completion of secondary or tertiary clinical survey. Misleading history, distracting findings, and misjudgments all contribute to risks of diagnostic errors.     

CT与MRI对创伤性膝关节积脂血症的诊断价值

目的探讨CT与MRI对创伤性膝关节积脂血症(traumaticlipohemarthrosis,TLH)的诊断价值。方法回顾性分析34例TLH的普通X线平片、CT及MRI的影像学表现,并探讨其诊断价值。结果 34例患者中,左膝关节22例,右侧膝关节12例。34例均行普通X线平片检查,提示膝关节骨折32例;16例行CT检查,15例可见明确脂肪、关节液、血液不同成分的分层密度改变。18例行MRI检查,均可见"脂肪-血液接口征"。并拟诊隐性骨折2例。结论 X线平片对骨折的诊断意义大,对积脂血症的诊断帮助不大。CT及MRI均能很好显示创伤性TLH,均有"脂肪-血液接口征"这一特征性表现,尤其MRI除显示积脂血症的典型征象外,对隐性骨折的诊断更有意义。     

Rehabilitation of ligamentous ankle injuries: a review of recent studies

There are many treatment modalities for ankle rehabilitation. These are reviewed, and the most effective training programme for rapid restoration of ankle movement, strength, endurance, and proprioception is selected.     

创伤性"浮膝"骨折37例诊治体会

目的　总结本院 1990～ 1997年收治的 37例、39个“浮膝”骨折损伤的治疗及愈合情况 ,探讨适用受伤初期全身情况和膝关节功能恢复的最佳治疗方法。方法　对病人伤时全身情况、不同治疗方法、合并症、骨折愈合及下肢功能恢复进行统计分析和评定。追踪时间 2～ 10年 ,平均 4 .8年。结果　 2 2个股骨和15个胫骨骨折采用带锁髓内针内固定 ,6个股骨和 5个胫骨骨折用钢板内固定 ,5个股骨和 7个胫骨骨折行单臂支架外固定 ,其它用石膏或牵引外固定治疗。优良率 78.38%。结论　“浮膝”骨折是一种重度不稳定损伤 ,应给予一处骨折内固定或支架外固定 ,使其成为单一骨折。现代带锁髓内针对骨折坚强内固定疗效明显优于其它治疗方法     

Septic knee arthritis following ACL reconstruction: a systematic review

Although postoperative septic arthritis is rare after ACL reconstruction, it carries a high morbidity that results in poor clinical outcome. Despite low incidence, it is important to recognize that infection and treat it without delay because of devastating consequences, such as loss of hyaline cartilage and arthrofibrosis, in order to avoid osteoarthritis development and near full range of motion achieved. Herein we discuss the pathogenesis, risk factors, clinical presentation, diagnostic evaluation, treatment protocols and complications of septic knee arthritis after ACL reconstruction.     

Clinical assessment of antero-medial rotational knee laxity: a systematic review

Purpose

To inventory the examination methods available to assess antero-medial rotational laxity (AMRL) of the knee following medial collateral ligament injury.

Methods

Searches were conducted in accordance with the PRISMA guidelines and using four online databases: WEB OF SCIENCE, MEDLINE, EMBASE, and AMED. The Critical Appraisal Skills Programme guidelines for Diagnostic Test Studies were used for the quality assessment of the articles.

Results

A total of 2241 articles were identified from the database searches. From this, four articles were included in the final review. All were case–control studies, considered a combined ACL/MCL injury and had small study populations. Specialised equipment was required in all studies, and one needed additional imaging support before measurements could be taken. Two employed commercially available measuring equipment as part of the assessment process.

Conclusion

Clinical assessment of AMRL in relation to a MCL injury remains challenging. Although methods have been developed to support clinical examination, they are limited by a number of factors, including the need for additional time in the clinical environment when setting up equipment, the need for specific equipment to produce and measure rotational movement and imaging support. In addition, there are patient safety concerns from the repeated imaging. A reliable and valid clinical examination remains to be found to truly assess antero-medial rotational laxity of the knee.

Level of evidence

IV.

     

Ochronosis, arthroscopy of a black knee: a case report and review of the literature

Ochronotic arthropathy is a rare condition found in patients with alkaptonuria. Due to the accumulation of homogentisic acid, cartilages get a dark discoloration and become brittle and more vulnerable to mechanical stress (Centinus et al. Rheumatol Int 3:127–131, 2004; Hamdi et al. Int Orthop 23:122–125, 1999; Phornphutkul, N Engl J Med 347:2111–2121, 2002; Thacker, Arthroscopy 19:14–17, 2003). This case report is about a patient first diagnosed for ochronosis by arthroscopy of the knee. Her brother was having similar complaints during follow-up. Both patients were prescribed to take glucosamine and chondroitine. Although no report is found in the literature, regarding the success of this therapy in patients with ochronosis, both patients reported a positive effect on articular pain and daily activities.