Suspected testicular torsion and ischemia: evaluation with color Doppler sonography

Color Doppler sonography was performed in 32 patients with a painful scrotum in whom testicular ischemia from torsion or postherniorrhaphy was clinically suspected. Surgical correlation was available in 15 patients, and scintigraphic correlation was available in 17 patients. Seven of the 32 patients were diagnosed as having testicular ischemia from torsion. Color Doppler flow imaging demonstrated a lack of intratesticular flow in six of the seven testes with torsion and relatively normal intratesticular flow in one of the patients with acute torsion. Normal or increased intratesticular flow was demonstrated by color Doppler in all 57 of the nonischemic testes. Using the single criterion of presence or absence of identifiable intratesticular flow, the authors found that color Doppler was 86% sensitive, 100% specific, and 97% accurate in the diagnosis of torsion and ischemia in the painful scrotum. Color Doppler sonography is an accurate, noninvasive means of rapidly assessing perfusion of the testis in the painful scrotum.     

Medial collateral ligament of the knee: anatomy,management and surgical techniques for reconstruction

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. The incidence is reported to be 0.24 per 1000 per year, and twice as high in males. The majority of MCL injuries are isolated, occurring in young sportsmen and women. However, they can occur in association with other injuries of the knee, most commonly the anterior cruciate ligament. Most injuries to the medial supporting structures occur as a result of valgus forces; but in sports, these can be a result of skiing injuries or ‘cutting’ manoeuvres. The majority of MCL injuries heal well with non-operative management and rarely require surgery; but if acute injuries are insufficiently treated or missed, the result can be chronic laxity. This chapter reviews the existing literature on common history and examination findings in MCL injuries. There are a number of classification systems designed to grade the severity of injury, which are based on the amount of laxity and the ability of the assessor to feel an end-point. There has been significant advancement in the understanding of the anatomy and biomechanics of the different components of the MCL. The anatomical landmarks of the superficial and deep MCL as well as the posterior oblique ligament are discussed along with the function of these individual structures. Although most MCL injuries heal well with non-operative management, there are a number of indications for operative intervention. These include open and multi-ligament knee injuries, as well as chronic instability. Broadly these are divide into repair or reconstruction categories. Repair is best performed in acute cases, where surgery is indicated for other reasons such as a meniscal tear; whereas reconstruction is best reserved for chronic instability. The reconstruction techniques including the Lind and LaPrade are described.