Knee Arthrography

2019 ◽  
pp. 158-159
Author(s):  
Matthew DelGiudice
Keyword(s):  
Clinical Practice ◽  
Hyaline Cartilage ◽  
Cruciate Ligament ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Imaging Findings ◽  
Younger Patients ◽  
Osteochondral Injuries ◽  
Knee Arthrography

Chapter 102 describes indications, technique, and imaging findings of knee arthrography. Knee arthrography is selectively performed in clinical practice for MRA, typically in younger patients. Indications include evaluation for meniscal re-tear after prior repair, osteochondral injuries, and therapeutic injections (most commonly steroid). Extension of intraarticular contrast into the meniscal substance indicates a tear or re-tear. Abnormal course of the cruciate ligament fibers indicates a tear. Contrast undermines unstable osteochondral lesions and extends into the hyaline cartilage defects. Complications are rare but include infection and bleeding.

Ankle Arthrography

2019 ◽  
pp. 160-162
Author(s):  
Matthew DelGiudice
Keyword(s):  
Clinical Practice ◽  
Nerve Injury ◽  
Joint Capsule ◽  
Osteochondral Lesions ◽  
Imaging Findings ◽  
Talar Dome ◽  
Younger Patients ◽  
Main Indication

Chapter 103 describes the indications, technique, and imaging findings of ankle arthrography. Ankle arthrography is selectively performed in clinical practice for MRA. It is typically performed in younger patients. The main indication is the evaluation of the talar dome for stability of osteochondral lesions. Contrast undermines the unstable osteochondral lesions. Extravasation of the contrast through the lateral or medial joint capsule is consistent with ligamentous tear. Filling defects within the intraarticular contrast relate to joint bodies or synovitis. Complications are rare but can include infection, bleeding, and nerve injury.

Elbow Arthrography

2019 ◽  
pp. 151-152
Author(s):  
Matthew DelGiudice
Keyword(s):  
Mr Arthrography ◽  
Lateral Radiograph ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Imaging Findings ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Younger Patients ◽  
Radial Collateral Ligament ◽  
Clinical Concern

Chapter 99 describes indications, technique, and imaging findings of elbow arthrography. Elbow arthrography is selectively performed for MR arthrography (MRA), typically in younger patients for evaluation of ligamentous (ulnar or radial collateral ligaments) injuries and osteochondral lesions. Indications also include therapeutic injections. The posterior transtriceps approach is preferred when the clinical concern is for radial collateral ligament injury. Contrast should easily inject and disperse throughout the joint. Contrast opacifies the anterior (coronoid), posterior (olecranon), and periradial (annular) recesses, which are easily depicted on lateral radiograph. Complications are rare but include infection and bleeding.

Hip Arthrography

2019 ◽  
pp. 156-157
Author(s):  
Matthew DelGiudice
Keyword(s):  
Clinical Practice ◽  
Femoral Nerve ◽  
Routine Clinical Practice ◽  
Imaging Findings ◽  
Younger Patients ◽  
Steroid Injections ◽  
Suspected Infection ◽  
Hip Arthrography ◽  
Femoral Nerve Injury ◽  
Labral Injury

Chapter 101 describes the indications, technique, and imaging findings of hip arthrography. Hip arthrography is selectively performed in routine clinical practice for MRA, typically in younger patients. Indications include hip pain thought to be caused by acetabular labral injury, femoroacetabular impingement syndromes, as well as therapeutic steroid injections. Contrast should easily inject and disperse throughout the joint away from the needle, opacifying the femoral head and neck recesses and outlining the zona orbicularis. The technique can also be used for arthrocentesis with suspected infection, but contrast should not be injected. Contrast extension into the acetabular labral substance may be occasionally depicted on the standard arthrography images. However, it is nowadays evaluated by MRA or sometimes CTA. Complications include infection, bleeding (especially if arterial puncture), and femoral nerve injury.

scholarly journals Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110298
Author(s):  
Richard M. Danilkowicz ◽  
Nathan L. Grimm ◽  
Gloria X. Zhang ◽  
Thomas A. Lefebvre ◽  
Brian Lau ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Statistical Significance ◽  
Osteochondral Lesion ◽  
Ankle Arthroscopy ◽  
Categorical Variables ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Bone Marrow Stimulation ◽  
Gold Standard Method ◽  
Marrow Stimulation

Background: Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method. Purpose: To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables. Results: A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort. Conclusion: The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.

scholarly journals Methods of Modification of Mesenchymal Stem Cells and Conditions of Their Culturing for Hyaline Cartilage Tissue Engineering

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1666
Author(s):  
Maria V. Shestovskaya ◽  
Svetlana A. Bozhkova ◽  
Julia V. Sopova ◽  
Mikhail G. Khotin ◽  
Mikhail S. Bozhokin
Keyword(s):  
Tissue Engineering ◽  
Cell Culture ◽  
Clinical Practice ◽  
Regenerative Medicine ◽  
Hyaline Cartilage ◽  
Cartilage Tissue Engineering ◽  
Matrix Proteins ◽  
Cartilage Tissue ◽  
Biodegradable Scaffolds ◽  
Cartilage Extracellular Matrix

The use of mesenchymal stromal cells (MSCs) for tissue engineering of hyaline cartilage is a topical area of regenerative medicine that has already entered clinical practice. The key stage of this procedure is to create conditions for chondrogenic differentiation of MSCs, increase the synthesis of hyaline cartilage extracellular matrix proteins by these cells and activate their proliferation. The first such works consisted in the indirect modification of cells, namely, in changing the conditions in which they are located, including microfracturing of the subchondral bone and the use of 3D biodegradable scaffolds. The most effective methods for modifying the cell culture of MSCs are protein and physical, which have already been partially introduced into clinical practice. Genetic methods for modifying MSCs, despite their effectiveness, have significant limitations. Techniques have not yet been developed that allow studying the effectiveness of their application even in limited groups of patients. The use of MSC modification methods allows precise regulation of cell culture proliferation, and in combination with the use of a 3D biodegradable scaffold, it allows obtaining a hyaline-like regenerate in the damaged area. This review is devoted to the consideration and comparison of various methods used to modify the cell culture of MSCs for their use in regenerative medicine of cartilage tissue.

Diagnostic Value of MRI and Radiographs of the Knee to Identify Osteochondral Lesions in Acute Patellar Instability

2021 ◽  
Author(s):  
Hayden Baker ◽  
Jason Dickherber ◽  
Manoj Reddy ◽  
Andrew Rizzi ◽  
Adam Kahn ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Osteochondral Defect ◽  
Knee Arthroscopy ◽  
Cruciate Ligament ◽  
Diagnostic Value ◽  
Mpfl Reconstruction ◽  
Osteochondral Lesions ◽  
Loose Bodies ◽  
Plain Radiographs ◽  
Diagnostic Arthroscopy

AbstractThe purpose of this study was to define the diagnostic value of magnetic resonance imaging (MRI) and plain radiographs (X-ray [XR]) in identifying an osteochondral defect or loose body in patients undergoing operative treatment for patellar instability. A total of 87 patients treated operatively for patellar instability with medial patellofemoral ligament (MPFL) reconstruction between 2015 and 2019 were identified. Inclusion criteria were evidence of clinical patellar instability, preoperative XR and MRI studies, and concomitant diagnostic knee arthroscopy and MPFL reconstruction performed to address patellar instability. Patients were excluded if they had a history of prior procedure for patellar instability on the surgical knee, underwent MPFL reconstruction without concomitant diagnostic knee arthroscopy, or had an anterior cruciate ligament or posterior cruciate ligament deficient knee. Operative notes and arthroscopic images were reviewed to identify osteochondral or chondral injuries and loose bodies noted during diagnostic arthroscopy. The primary outcome was the identification of intra-articular loose bodies, chondral injury, or osteochondral defect on preoperative plain radiographs and MRI in patients with patellar instability. All MRIs were performed on a 3T MRI. The sensitivity and specificity of identifying loose bodies on MRI were 0.52 and 0.92 and on XR were 0.23 and 0.98, respectively. The sensitivity and specificity of identifying osteochondral lesions on MRI were 0.43 and 0.81 and on XR were 0.08 and 0.97, respectively. Of the 87 available reports, 45 (51%) described performing chondroplasty for Outerbridge grade II/III chondral lesions on diagnostic arthroscopy. In conclusion, MRI and XR are poorly sensitive at identifying loose bodies or osteochondral defects after patellar dislocations. The poor sensitivity of imaging studies must be considered when determining whether or not to recommend operative management to a patient with patellar instability. This is a Level IV, diagnostic study.

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