Correlation of MRI and arthroscopic findings with clinical outcome in temporomandibular joint disorders: a retrospective cohort study

Background Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage. Methods This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy. Results A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62 and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p = 0.0112 and p = 0.0054), and remained significant at MT in the combined analysis (p = 0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p = 0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p = 0.0474). Conclusion To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.

Radiographic vs. MRI vs. arthroscopic assessment and grading of knee osteoarthritis - are we using appropriate imaging?

Purpose Radiographs and MRI scans are commonly used imaging techniques in the assessment of knee osteoarthritis. However, it currently remains uncertain how good a representation of the actual condition of the knee joint these investigations provide. By comparing them against arthroscopic findings the aim of our study was to conclude how accurate these imaging techniques are at grading knee osteoarthritis. Methods This was a retrospective study looking at knee arthroscopies performed at a tertiary centre over a 5 year period. The Outerbridge grade given at arthroscopy was correlated with pre-operative radiograph and MRI scores, so as to assess the reliability of these imaging techniques at predicting the actual severity of knee osteoarthritis seen. Results Kellgren-Lawrence (KL) grading of radiographs was moderately correlated with Outerbridge grades from arthroscopy for the medial compartment of the knee (Spearman’s rho (SR) 0.483, p < 0.001), with a milder correlation in the lateral compartment (SR 0.218, p = 0.003). MRI reporting of knee osteoarthritis was moderately correlated with Outerbridge grades in the medial compartment (SR 0.451, p < 0.001), mildly correlated for both the lateral (SR 0.299, p < 0.001) and patellofemoral joint compartments (SR 0.142, p = 0.054). KL and MRI grading was moderately correlated for the medial compartment (SR 0.475, p < 0.001) and mildly correlated for the lateral compartment (SR 0.277, p < 0.001). Conclusion The ability of radiographs to represent the actual condition of knee osteoarthritis is underestimated. KL grading especially best represents the disease seen in the medial compartment of the knee joint, with a moderate correlation to Outerbridge scores given on arthroscopic assessment. We suggest that whilst MRI is a useful tool in the investigation of knee symptoms, it is often unnecessarily used in patients with OA, when in fact, radiographs alone would be sufficient. Evidence level III

A Longer Duration from Injury to Surgery is Associated with Preoperative Deterioration of an Isolated Meniscal Tear in Patients Aged 40 Years or Older

Background: It remains unclear what percentage of isolated meniscal tears deteriorates before surgery, especially in older patients. We aimed to evaluate the preoperative deterioration of an isolated meniscal tear in patients aged 40 years or older, and whether time from injury to surgery is associated with worsening of a meniscal tear.Methods: Patients aged 40 years or older who underwent arthroscopic surgery for isolated meniscal tear between 2014 and 2019 were retrospectively reviewed. The diagnostic magnetic resonance imaging (MRI) findings and arthroscopic findings were compared to evaluate the deterioration of meniscal tears. Predictors of the development of meniscal tears; patient demographic factors, duration from injury to surgery (injury to MRI and MRI to surgery), and image findings were assessed. Results: A total of 58 patients (58 knees) were included (mean age, 55.9 ± 8.5 years; male/female, 31/27). An isolated meniscal tear deteriorated in 28 (48.3%). In comparison of patients with and without deteriorated meniscal tear, significant differences were found in the MRI grade of meniscal tear (p = 0.03), duration from injury to MRI (164.2 ± 167.9 vs. 45.2 ± 48.7 days, p < 0.001), and from MRI to surgery (148.8 ± 91.1 vs. 67.6 ± 56.7 days, p < 0.001). A multivariate regression analysis showed that the duration from injury to MRI (odds ratio [OR], 1.03; p < 0.001) and from MRI to surgery (OR, 1.02; p < 0.001) were independent predictors of worsening of a meniscal tear. Conclusions: Approximately 50% of isolated meniscal tears deteriorated preoperatively in patients aged 40 years or older. The duration from injury to MRI and from MRI to surgery were independent predictors of the preoperative worsening of an isolated meniscal tear in this cohort.

Correlation of MRI and Arthroscopic Findings With Clinical Outcome in Temporomandibular Joint Disorders: A Retrospective Cohort Study

Background: Arthroscopy is a minimally invasive diagnostic tool and treatment strategy in patients suffering from temporomandibular disorders (TMD) when conservative treatment fails. This study aimed to find specific variables on pre-operative MRI or during arthroscopy that could predict success of arthroscopic lysis and lavage.Methods: This retrospective analysis compared pre-operative maximum interincisal opening (MIO), pain and main complaint (pain, limited MIO or joint sounds) with results at short-term and medium-term follow-up (ST and MT respectively). Different variables scored on MRI or arthroscopy were used to make a stepwise regression model, subsequently a combined analysis was conducted using variables from both MRI and arthroscopy.Results: A total of 47 patients (50 joints) met the inclusion criteria. The main complaint improved by 62% and 53% at ST and MT respectively. The absolute or probable absence of a crumpled disc scored on MRI predicted success at ST and MT (p=0.0112 and p=0.0054), and remained significant at MT in the combined analysis (p=0.0078). Arthroscopic findings of degenerative joint disease predicted success at ST (p=0.0178), absolute or probable absence of discal reduction scored during arthroscopy significantly predicted success in the combined analysis at ST (p=0.0474).Conclusion: To improve selection criteria for patients undergoing an arthroscopic lysis and lavage of the TMJ, future research might focus on variables visualized on MRI. Although more research is needed, disc shape and in particular the absolute or probable absence of a crumpled disc might be used as predictive variable for success.

Dynadesis for Treatment of Dynamic Scaphoid Instability with 20-Year Results

Background Even though the scapholunate interosseous ligament is the most common wrist ligament injury, its treatment remains a challenge for hand surgeons. We report on a surgical treatment (Dynadesis) for dynamic scaphoid instability (DSI) with a 20-year follow-up period. Description of Technique Dynadesis utilizes antagonist forearm muscles in order to synergistically provide dynamic stabilization to the scaphoid when the wrist is loaded. It is a tendon-to-tendon transfer with the following two components: 1) Dorsal—The extensor carpi radialis longus (ECRL) is passed through a hole in the reduced, distal scaphoid, providing the scaphoid with an independent extension force. 2) Volar—A dynamic checkrein is created by tension-locking the ECRL tendon around the flexor carpi radialis (FCR) tendon. The portion of the FCR distal to the scaphoid tethers and tightens with contracture of the ECRL and FCR muscles. Patients and Methods Twenty patients (21 wrists) were treated with Dynadesis and reevaluated 20 years later (range: 20–27 years). Results Average grip strength improved by 8 kg. The average wrist flexion-extension arc decreased by 3°. Wrist X-rays showed no radiocarpal arthritis. On the Mayo wrist score, 81% reported excellent to good results (average: 89). Pain levels improved by 90%, with 76% of patients reporting no pain. All patients (100%) were satisfied with their results and would recommend the procedure. Conclusions Dynadesis is specifically designed for the treatment of DSI. It avoids the eventual complication of osteoarthritis and does not sacrifice wrist motion. A predictable and satisfactory long-term result is obtainable with correct patient selection based on clinical staging and arthroscopic findings.

Arthroscopic findings and treatment of maisonneuve fracture complex

Background The Maisonneuve fracture complex (MFC) is a well-known lower leg injury. However, the optimal treatment is still not clear and there is limited data on concomitant injuries of cartilage. Therefore, the aim of our study was to report the incidence of incidental cartilage injuries and their management in arthroscopic treatment of MFC. Patients and methods Between February 2018 and February 2021 all patients presenting with MFC in our department were treated with diagnostic ankle arthroscopy and percutaneous syndesmotic screw or suture-endobutton fixation. In case of instable cartilage, it was debrided and according to the International Consensus Meeting on Cartilage Repair of the Ankle, in grade IV lesions < 10 mm or < 100 mm2 area the subchondral bone was microfractured. Results Eighteen patients, 16 male and two female, with a mean age of 48.1 years, were included. In all cases, instability of the distal tibiofibular articulation was confirmed arthroscopically. Injuries of the cartilage were found in 56% of the cases and in 31% of the patients surgical intervention was required. In three talar and one tibial lesion additional arthroscopic bone marrow stimulation with microfracture of the subchondral bone was performed. Conclusions Ankle arthroscopy is a helpful method to guide fibular reduction and to detect and address associated cartilage injuries. Due to the high rate of chondral lesions, addressing these arthroscopically may contribute to better postoperative results. Level of evidence IV

Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

Background: Based on previous studies, it is difficult to discern whether patients who have femoroacetabular impingement (FAI) with borderline developmental dysplasia of the hip (BDDH) would benefit from arthroscopy when compared with patients without BDDH. Purpose: To evaluate the existing comparative literature on arthroscopic findings, procedures, patient-reported outcomes (PROs), and failures in patients who have FAI with BDDH compared with those without BDDH. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Ovid databases were searched for studies published up to August 31, 2019, that reported outcomes after arthroscopy to treat patients who had FAI with BDDH. Included studies were required to have patients diagnosed with FAI and BDDH who were treated arthroscopically and compared with control patients (FAI without BDDH). Arthroscopic findings, PROs, and revision or total hip arthroplasty (THA) conversion rates were compared between groups. Results: Included in the review were 4 articles (933 patients). Patients who had FAI with BDDH were defined as having a lateral center-edge angle (LCEA) of either 18° to 25° or 20° to 25°; for control patients, the maximum LCEA was 40°. Across the studies, there were 224 patients who had FAI with BDDH compared with 709 control patients; the mean follow-up time ranged from 21.6 to 31.3 months among the groups. Improvements were shown across all PROs in each study. Random-effects meta-analysis indicated no statistically significant differences in postoperative PROs, the risk for revision surgery, or conversion to THA between the patients who had FAI with versus without BDDH. Conclusion: The results of the current review indicated that hip arthroscopy produced similar short-term outcomes between patients who had FAI with versus without BDDH.

Responsiveness of five shoulder outcome measures at follow-ups from 3 to 24 months

Background To assess responsiveness of five outcome measures at four different follow-ups in patients with SLAP II lesions of the shoulder. Methods 119 patients with symptoms and signs, MRI arthrography and arthroscopic findings were included. The Western Ontario Shoulder Instability Index (WOSI), Oxford Instability Shoulder Score (OISS), EuroQol (EQ-5D3L), Rowe Score and Constant-Murley Score (CMS) were assessed at baseline, 3, 6, 12 and 24 months. The analysis contains both anchor-based and distribution-based methods, and hypothesis testing. Results Confidence intervals for ROC cut-off values, representing MID, for OISS, CMS and EQ-5D3L crossed zero at 3 months. Cut-off values were stable between 6- and 24-months follow-up. At 24-months ROC cut-off values (95% CI) were: Rowe 18 (13 to 24); WOSI 331 (289 to 442); OISS 9 (5 to 14); CMS 11 (9 to 15) and EQ-5D3L 0.123 (0.035 to 0.222). MID95%limit estimates were substantially higher than ROC cut-off values and MIDMEAN at all follow-ups for all instruments. The reliable change proportion (RCP) values in the improved group were highest for WOSI and the Rowe Score (ranging from 68 to 87%) and significantly lower for CMS. EQ-5D3L had the lowest values (13 to 16%). We found a moderate correlation between mean change scores of the outcome measures and the anchor, except for the EQ-5D3L. Conclusions In patients with SLAP II-lesions the patient reported OISS and WOSI and the clinical Rowe score had best responsiveness. Our results suggest that 3 months follow-up is too early for outcome evaluation.