Absolute Meniscal Extrusion After Lateral Meniscal Allograft Transplantation Does Not Progress During Long-term Follow-up: Average of 10.3 Years’ Follow-up Longitudinal Magnetic Resonance Imaging Study

2019 ◽  
Vol 48 (2) ◽  
pp. 326-333 ◽  
Author(s):  
Sang-Min Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Jun-Gu Park
Keyword(s):  
Sagittal Plane ◽  
Coronal Plane ◽  
Meniscal Extrusion ◽  
Meniscal Allograft ◽  
Long Term Follow Up ◽  
The Mean ◽  
Width Reduction ◽  
Time Point

Background: Long-term outcomes after lateral meniscal allograft transplantation (MAT) are not completely understood. Purpose/Hypothesis: We investigated changes in meniscal extrusion in the coronal and sagittal planes using magnetic resonance imaging (MRI) after lateral MAT through long-term follow-up. We hypothesized that meniscal extrusion would progress during follow-up. Study Design: Case series; Level of evidence, 4. Methods: Patients subjected to lateral MAT were followed up by MRI evaluation in both planes at 1, 4 to 6, and >8 years after MAT. Meniscal extrusion and entire meniscal widths in the coronal plane and anterior (ACMD) and posterior (PCMD) cartilage meniscal distances in the sagittal plane were measured, and values were compared at each time point. Clinical outcomes were evaluated using the Lysholm score. Results: A total of 27 lateral MATs were included with a mean MRI follow-up period of 10.3 years (range, 8.1-15.3 years). The mean absolute meniscal extrusion (coronal plane) was not significantly different at each time point. However, the relative value differed (0.27 ± 0.04 at 1 year; 0.33 ± 0.06 at >8 years after MAT) owing to entire meniscal width reduction. There was no difference in the mean absolute value of the ACMD in the sagittal plane. However, relative values differed (0.21 ± 0.01 at 1 year; 0.27 ± 0.06 at >8 years) owing to entire meniscal width reduction. Absolute and relative values of the PCMD remained unaffected at each time point. The Lysholm score increased after surgery but did not differ postoperatively. Conclusion: During the long-term follow-up of extrusion after lateral MAT using MRI, absolute extrusion remained unchanged across all planes. Relative extrusion in the coronal plane and of the ACMD in the sagittal plane significantly increased, with no differences in the PCMD on follow-up. Clinical outcomes after surgery improved compared with those before surgery and were maintained throughout the long-term follow-up period.

Meniscal Extrusion Does Not Progress During the Midterm Follow-up Period After Lateral Meniscal Transplantation

2016 ◽  
Vol 45 (4) ◽  
pp. 900-908 ◽  
Author(s):  
Nam-Ki Kim ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Chang-Rack Lee ◽  
Jae-Hyan Kim
Keyword(s):  
Sagittal Plane ◽  
Lysholm Score ◽  
Coronal Plane ◽  
Meniscal Extrusion ◽  
Time Points ◽  
Meniscal Allograft ◽  
Significant Difference ◽  
The Mean ◽  
The Absolute

Background: Meniscal extrusion is related to degeneration of the native knee joint. However, the clinical effect of the phenomenon after meniscal allograft transplantation (MAT) has not been clearly identified. Purpose/Hypothesis: The purpose of this study was to evaluate the change in meniscal extrusion in both the coronal and sagittal planes after lateral MAT through the midterm follow-up period. We hypothesized that meniscal extrusion does not progress during the midterm follow-up period. Study Design: Case series; Level of evidence, 4. Methods: A total of 46 patients with a mean follow-up of 51.1 ± 7.1 months were included in the study. The patients underwent lateral MAT using the keyhole technique. Postoperative magnetic resonance imaging (MRI) was performed at 6-week, 1-year, and midterm (3- to 5-year) follow-up. In the coronal plane, the absolute value of meniscal subluxation and the relative percentage of extrusion (RPE) were measured. In the sagittal plane, meniscal subluxation was measured as the absolute and relative anterior cartilage meniscal distance (ACMD) and posterior cartilage meniscal distance (PCMD). The joint-space width (JSW) on weightbearing radiographs with 2 different knee positions was measured preoperatively and at 1-year and midterm follow-up. The Lysholm score was assessed at the same time points. Results: In the coronal plane, the mean absolute meniscal extrusion at 6-week, 1-year, and final follow-up was 2.90 ± 0.94, 2.85 ± 0.97, and 2.83 ± 0.89 mm, respectively, and the mean RPE was 27.0% ± 9.4%, 27.1% ± 10.1%, and 27.8% ± 9.7%, respectively. There were no statistically significant differences in absolute and relative coronal extrusion among the 3 time periods ( P > .05). The percentage of patients with meniscal extrusion (≥3 mm) was 37.0% at 6-week follow-up and 34.8% at 1-year and final follow-up. In the sagittal plane, the mean absolute ACMD was 2.59 ± 1.75, 2.58 ± 1.85, and 2.37 ± 1.60 mm, respectively, and the mean relative ACMD was 20.7% ± 13.1%, 20.6% ± 13.8%, and 19.0% ± 12.2%, respectively, at the 3 follow-up time points. The mean absolute PCMD was −1.23 ± 3.34, −1.28 ± 3.08, and −1.42 ± 2.77 mm, respectively, and the mean relative PCMD was −10.3% ± 25.9%, −11.0% ± 24.6%, and −12.2% ± 23.2%, respectively, at the same time points. Sagittal extrusion was not significantly different between the time points ( P > .05). The mean JSW at 2 days preoperatively, 1 year postoperatively, and midterm follow-up was 5.40 ± 1.07, 5.44 ± 1.04, and 5.43 ± 0.98 mm, respectively, on anterior-posterior radiographs with full extension, and it was 4.90 ± 0.94, 4.94 ± 0.98, and 4.89 ± 0.96 mm, respectively, on posterior-anterior radiographs with 45° of flexion. The mean JSW values were not significantly different between the 3 different time points ( P > .05). The mean preoperative Lysholm score was 58. 9 ± 8.3; the score increased to 90.4 ± 9.7 at 1 year postoperatively and 90.5 ± 10.1 at final follow-up, which is a significant improvement compared with the preoperative status ( P < .05). There was no statistically significant difference between the scores at the 2 postoperative time points ( P > .05). Conclusion: This study demonstrated that extrusion of the meniscal allograft did not significantly progress either in the coronal or sagittal plane after lateral MAT during the midterm follow-up period.

scholarly journals Progression of Allograft Extrusion in Both the Coronal and Sagittal Planes at Midterm Follow-up After Medial Meniscal Allograft Transplant

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097235
Author(s):  
Hanwook Kim ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Bum-Sik Lee ◽  
Dong-Wook Sohn
Keyword(s):  
Sagittal Plane ◽  
Coronal Plane ◽  
Relative Percentage ◽  
Positive Correlation ◽  
Time Points ◽  
Axial Alignment ◽  
Meniscal Allograft ◽  
The Mean ◽  
The Absolute

Background: Although many studies have examined allograft extrusion after medial meniscal allograft transplant (MMAT), it is unclear whether allograft extrusion progresses at midterm follow-up. Hypothesis: After MMAT, allograft extrusion would not progress during the midterm follow-up period. Study Design: Case series; Level of evidence, 4. Methods: A total of 30 patients who underwent MMAT between December 1996 and March 2016 were enrolled. Allograft extrusion was measured on magnetic resonance imaging scans obtained at 6 weeks, 1 year, and 3 to 7 years postoperatively. In the coronal plane, the absolute allograft extrusion and relative percentage of extrusion were measured. In the sagittal plane, the absolute and relative anterior cartilage meniscal distance and posterior cartilage meniscal distance were measured. The joint-space width (JSW) on radiographic Rosenberg view was measured at 3 time points. The axial alignment was measured preoperatively and at the midterm follow-up. Results: In the coronal plane, there were no significant differences in absolute and relative coronal extrusions between 6 weeks and 1 year postoperatively; however, the values were significantly increased at midterm follow-up compared with both of the earlier follow-up periods. Similarly, in the sagittal plane, the mean absolute and relative anterior and posterior cartilage meniscal distances were not significantly different between 6 weeks and 1 year postoperatively but showed significant increases at midterm follow-up compared with both of the earlier follow-up periods. The mean preoperative axial alignment showed a positive correlation with the delta value of relative percentage of extrusion in the coronal plane ( r = 0.378; P = .036). The mean JSW was 4.42 ± 0.88 mm preoperatively, 4.30 ± 0.83 mm at 1-year follow-up, and 3.96 ± 1.06 mm at the midterm follow-up. No significant difference was found between the preoperative and postoperative 1-year values, but the mean JSW was significantly decreased at midterm follow-up compared with both of the other time points ( P = .001 for both). Conclusion: Allograft extrusion did not progress until 1 year after MMAT; however, by midterm follow-up, extrusion had progressed in both the coronal and the sagittal planes. Preoperative axial alignment showed a positive correlation with allograft extrusion in the coronal plane.

scholarly journals Determining transition readiness in Swiss childhood cancer survivors – a feasibility study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maria Otth ◽  
Patrick Wechsler ◽  
Sibylle Denzler ◽  
Henrik Koehler ◽  
Katrin Scheinemann
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Childhood Cancer Survivors ◽  
Self Management ◽  
Transition Readiness ◽  
Long Term Follow Up ◽  
Time Point

Abstract Background The successful transition of childhood cancer survivors (CCSs) from pediatric to adult long-term follow-up care is a critical phase, and determining the right time point can be challenging. We assessed the feasibility of the use of existing transition readiness tools in the context of the Swiss health care system, assessed partly transition readiness in Swiss CCSs, and compared our findings with Canadian CCSs for which these tools were originally developed. Methods We officially translated the Cancer Worry Scale (CWS) and Self-Management Skill Scale (SMSS) into German and integrated them into this cross-sectional study. We included CCSs attending the long-term follow-up (LTFU) clinic in the Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau. We used descriptive statistics to describe transition readiness. Results We randomly recruited 50 CCSs aged ≥18 years at participation. The CCSs had a median CWS score of 62 (interquartile range 55–71), indicating a moderate level of cancer-related worry. Despite high self-management skills, some answers showed a dependency of CCSs on their parents. Our experience shows that the CWS and SMSS are easy for Swiss CCSs to use, understand, and complete. The interpretation of the results must take differences in health care systems between countries into account. Conclusions The translated CWS and SMSS are appropriate additional measures to assess transition readiness in CCSs. These scales can be used longitudinally to find the individual time point for transition and the completion by CCSs enables the health care team to individualize the transition process and to support the CCSs according to their individual needs.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Risk of hemorrhage from de novo cerebral aneurysms

2013 ◽  
Vol 118 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William J. Kemp ◽  
Daniel H. Fulkerson ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Term Follow Up ◽  
De Novo Aneurysm ◽  
The Mean ◽  
Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

scholarly journals Clinical Features of Iris Cysts in Long-Term Follow-Up

2021 ◽  
Vol 10 (2) ◽  
pp. 189
Author(s):  
Joanna Konopińska ◽  
Łukasz Lisowski ◽  
Zofia Mariak ◽  
Iwona Obuchowska
Keyword(s):  
Visual Acuity ◽  
Ultrasound Biomicroscopy ◽  
Anatomical Location ◽  
Long Term Follow Up ◽  
Temporal Quadrant ◽  
The Mean ◽  
Multiple Cysts ◽  
Cyst Growth

This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.

The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

2021 ◽  
Vol 103-B (12) ◽  
pp. 1815-1820
Author(s):  
Stefan Huhnstock ◽  
Ola Wiig ◽  
Else Merckoll ◽  
Svein Svenningsen ◽  
Terje Terjesen
Keyword(s):  
Femoral Head ◽  
Skeletal Maturity ◽  
Strong Predictor ◽  
Perthes Disease ◽  
Radiological Outcome ◽  
Long Term Follow Up ◽  
The Mean ◽  
Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

scholarly journals A New Pre-descemetic Corneal Ring (Neoring) in Deep Anterior Lamellar Keratoplasty for Moderate-Advanced Keratoconus: A Pilot 2-Year Long-Term Follow-Up Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Belén Alfonso-Bartolozzi ◽  
Carlos Lisa ◽  
Luis Fernández-Vega-Cueto ◽  
David Madrid-Costa ◽  
José F. Alfonso
Keyword(s):  
Spherical Aberration ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
Long Term Follow Up ◽  
The Mean ◽  
Corneal Tomography

Purpose: To assess the outcomes of implanting a new polymethylmethacrylate (PMMA) ring (Neoring; AJL Ophthalmic) in pre-descemet deep anterior lamellar keratoplasty (PD-DALK) procedure for moderate-advanced keratoconus.Methods: This prospective study included 10 eyes of 10 patients with moderate-advanced keratoconus who underwent PD-DALK with Neoring implantation. Neoring was implanted in a pre-descemetic pocket. The post-operative examination included refraction, corrected distance visual acuity (CDVA), corneal tomography, and endothelial cell density (ECD). The root mean squares (RMSs) for coma-like aberrations and spherical aberration were evaluated for a pupil size of 4.5 mm. The junctional graft (Tg) and host (Th) thicknesses were measured. The post-operative follow-up was 24 months.Results: Post-operative CDVA was 0.82 ± 0.14 (decimal scale), 100% of the eyes achieved a CDVA of 0.7 (decimal scale). The refractive cylinder was −2.86 ± 1.65 2-years after surgery. No eyes had a post-operative refractive cylinder ≥5.00 D and in five eyes (50%), it was ≤2.50 D. At the last visit, the mean keratometry was 45.64 ± 1.96 D, the RMS for coma-like aberrations was 0.30 ± 0.15 μm and spherical aberration was 0.22 ± 0.09. The mean ECD remains without changes over the follow-up (P = 0.07). At the last visit, Tg and Th were 679.9 ± 39.0 and 634.8 ± 41.2 μm, respectively. The thickness of the complex (host-Neoring) was 740.6 ± 35.6 μm. In all cases, this thickness was thicker than Tg.Conclusion: The results of this study suggest that PD-DALK along Neoring implantation is a viable, effective, and safe option to optimize the post-operative results for moderate-severe keratoconus.

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