Adipose Tissue ; pathology ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Joint Diseases ; diagnosis ; pathology ; surgery ; Knee Joint ; pathology ; Male ; Middle Aged

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient's magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.
Anterior Cruciate Ligament/*pathology/radiography ; Arthralgia/etiology ; Humans ; Joint Diseases/diagnosis/*pathology/radiography ; Knee Joint/*pathology/radiography ; Male ; Middle Aged ; Posterior Cruciate Ligament/*pathology/radiography

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a disease of the elderly and extremely rare in young individuals. If young people develop CPPD crystal deposition disease, it may be associated with metabolic diseases such as hemochromatosis, hyperparathyroidism, hypophosphatasia, hypomagnesemia, Wilson's disease, hypothyroidism, gout, acromegaly, and X-linked hypophosphatemic rickets. Therefore, in young-onset polyarticular CPPD crystal deposition disease, investigation for predisposing metabolic conditions is warranted. We report a case of a young male patient with idiopathic CPPD crystal deposition disease, who did not have any evidences of metabolic diseases after thorough evaluations. As far as we know, this is the first report of a young male patient presented with idiopathic CPPD crystal deposition disease.
Adult ; Calcium Pyrophosphate/*metabolism ; Cartilage, Articular/metabolism/pathology ; Diagnosis, Differential ; Human ; Knee Joint/*pathology ; Male ; Metabolic Diseases/metabolism/pathology ; Shoulder Joint/pathology

BACKGROUND: Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. METHODS: Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. RESULTS: Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. CONCLUSIONS: Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.
Ankle Joint/*pathology/*physiopathology ; Arthroscopy/methods ; Chronic Disease ; Female ; Humans ; Joint Diseases/*diagnosis/pathology ; Joint Instability/*diagnosis/pathology ; Lateral Ligament, Ankle/pathology ; Magnetic Resonance Imaging/methods ; Male ; Observer Variation ; Pain Measurement ; Retrospective Studies ; Severity of Illness Index ; Synovitis/pathology

In this study, we reported a case of progressive pseudorheumatoid dysplasia in Peking University Third Hospital. A 56-year-old male patient presented with hip joint pain for more than 40 years and multiple joints pain with limitation of movements of these joints for 28 years. This patient suffered from joint pain and impaired range of motion of the hip, knee, elbow and shoulder gradually, associated with difficulty in walking and inability to take care of himself. He was diagnosed with "femoral head necrosis" or "ankylosing spondylitis" in local hospitals, but the treatment of nonsteroidal antiinflammatory drugs (NSAIDs) and sulfasalazine was not effective. Up to the age of 14, the patient displayed normal physical development, with the highest height was about 158 cm, according to the patient recall. However, his height was 153 cm at present. There was no history of similar illness in any family member. Physical examinations descried limitation of movement of almost all joints. Enlargement and flexion deformity of the proximal interphalangeal (PIP) joints of the hands resulted in the claw hand appearance. Limited abduction and internal and external rotation of the shoulder and hip could be find. He had normal laboratory findings for blood routine test, biochemical indexes and acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Furthermore, HLA-B27 and autoimmune antibodies such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody and antinuclear antibody (ANA) were all negative. X-ray of the hip showed loss of the joint space and irregularities of the femoral head, both femoral head were flattened, it could be see hyperplasia, osteophytes, bilateral femoral neck thicken, neck dry angle turned smaller. The radiological findings of the spinal vertebra indicated kyphosis deformity, narrowing of the intervertebral discs, vertebral syndesmophytes and flattening of the vertebra. However, there was no clues of bone marrow edema in the lumbar MRI. At last, genetic testing for the Wnt1-inducible signaling pathway protein 3 (WISP3) gene was done and indicated compound heterozygous mutations: 756C>G and c.866dupA. These two mutations were derived from the patient's mother and father (the patient's parents each had a heterozygous mutation). Two exons of the WISP3 gene had nucleotide changes leading to amino acid mutations. According to the patient's history, symptoms, physical examinations, radiological findings and genetic testing, the final definitive diagnosis was progressive pseudorheumatic dysplasia.
Cerebral Palsy ; Heterozygote ; Hip/pathology* ; Humans ; Joint Diseases/etiology* ; Male ; Microcephaly ; Middle Aged ; Spondylitis, Ankylosing/diagnosis*

Adult ; Arthritis, Rheumatoid ; epidemiology ; pathology ; surgery ; Female ; Humans ; Joint Diseases ; diagnosis ; pathology ; Male ; Middle Aged ; Shoulder Dislocation ; epidemiology ; pathology ; surgery ; Shoulder Fractures ; epidemiology ; pathology ; surgery ; Shoulder Joint ; pathology ; surgery ; Shoulder Pain ; epidemiology ; pathology ; surgery

OBJECTIVETo evaluate the roles of radiograph, magnetic resonance imaging (MRI), three-dimensional computed tomography (3-D CT) in early diagnosis of femoro-acetabular impingement (FAI) in 17 cases.

METHODSPlain radiographs of the pelvis, 3-D CT, and MRI of the hip were made on 17 patients with groin pain, which was worse with prolonged sitting (i.e. hip flexion). There was no history of trauma or childhood hip disorders in the patients who did not complain of any other joint problems or neurologic symptoms. All patients had positive anterior or posterior impingement test. Plain radiographs included an antero-posterior (AP) view of the hip and a cross table lateral view with slight internal rotation of the hip. CT scan was performed with the Lightspeed 16 row spiral (General Electric Company, USA) at 1.25 mm slice reconstruction. MRI scan was performed on the Siemens Avanto (Siemens Company, Germany)1.5T supraconduction magnetic resonance meter. The CT and MRI scans were taken from 1 cm above the acetabulum to the lesser trochanter in 5 series.

RESULTSThe plain radiographs of the pelvis showed that among the 17 patients, 12 (70.59%) had "Cam" change of the femoral head, 6 (35.29%) had positive "cross-over" sign, and 17 (100%) had positive "pincer" change of the acetabulum. The 16 row spiral CT noncontrast enhanced scan and 3-D reconstruction could discover minus femoral offset and ossification and osteophyte of the acetabulum labrum in all the 17 cases (100%). The MRI noncontrast enhanced scan could discover more fluid in the hip joint in 15 cases (88.33%), subchondral ossification in 3 cases (17.6%), and labrum tears in 3 cases (17.6%).

CONCLUSIONSPlain radiographs can provide the initial mainstay for the diagnosis of FAI, 3-D CT can tell us the femoral offset, while MRI can show labrum tears in the very early stage of FAI. Basically, X-ray examination is enough for the early diagnosis of FAI, but 3-D CT and MRI may be useful for the treatment.

Acetabulum ; pathology ; Adult ; Early Diagnosis ; Femur Head ; pathology ; Hip Joint ; pathology ; Humans ; Imaging, Three-Dimensional ; methods ; Joint Diseases ; diagnosis ; pathology ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

Arthroscopy has become an attractive modality in the diagnosis and treatment of joint diseases in toy breed dogs. However, the application of arthroscopy is limited by small joint space. Our objective was to evaluate the efficacy of a stifle lever for joint distraction during stifle arthroscopy in toy breed dogs. Paired stifles (n = 32 each) collected from 16 cadavers of toy breed dogs were randomly assigned to one of two groups: the stifle lever group or the external manipulation group. All stifles underwent arthroscopic cranial cruciate ligament transection, and the visualization of the medial meniscus was evaluated. Medial meniscal release (MMR) was then performed. Following arthroscopic examination, the success rates of MMR and damages of tibial and femoral cartilages were evaluated. Visualization of the medial meniscus was significantly better, and meniscal probing was significantly easier, in the stifle lever group than in the external manipulation group (p = 0.001). There were no significant differences between groups for MMR success or articular cartilage damage. Using the stifle lever on arthroscopic examination improved visualization and probing on the medial meniscus in toy breed dogs. The stifle lever can be used as a good modality in assessing medial meniscal pathology in toy breed dogs.
Animals ; Anterior Cruciate Ligament ; Arthroscopy ; Cadaver ; Cartilage ; Cartilage, Articular ; Diagnosis ; Dogs ; Joint Diseases ; Joints ; Menisci, Tibial ; Pathology ; Play and Playthings ; Stifle

Arthrography ; Bone Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Bone and Bones ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Immunohistochemistry ; Joint Diseases ; diagnosis ; diagnostic imaging ; pathology ; Joints ; diagnostic imaging ; pathology ; Radionuclide Imaging

OBJECTIVETo observe the diagnosis and treatment of bone marrow edema syndrome and summarize its features, mechanisms and its differences from avascular necrosis of femoral head.

METHODSFrom 2004.1, 19 patients (12 patients were males and 7 patients were females, with a mean age of (46.70 +/- 10.36) years) with bone marrow edema syndrome of hip treated with Ibandronate and physical therapy, as well as scored with Harris system before and after treatment.

RESULTSAverage score before treatment was (43.17 +/- 12.62), and (86.73 +/- 14.29) after treatment, and the difference was significant (P < 0.05).

CONCLUSIONBone marrow edema syndrome of hip is different from avascular necrosis of the hip, it is a distinct clinical entity.

Adult ; Bone Density Conservation Agents ; therapeutic use ; Bone Marrow Diseases ; diagnosis ; drug therapy ; pathology ; therapy ; Diphosphonates ; therapeutic use ; Female ; Femur Head Necrosis ; diagnosis ; pathology ; Hip Joint ; drug effects ; pathology ; Humans ; Male ; Middle Aged