Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.
Adult ; Elbow Joint ; physiopathology ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Shoulder Dislocation ; complications

Adult ; Aged ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Lumbar Vertebrae ; pathology ; physiopathology ; Male ; Middle Aged ; Spinal Canal ; pathology ; physiopathology ; Spinal Stenosis ; complications ; diagnosis ; physiopathology ; surgery

OBJECTIVETo assess the validity of the lateral gutter drive-through (LGDT) test in diagnosing posterolateral rotational instability (PLRI) of the knee joint.

METHODSBetween October 2009 and February 2012, 115 consecutive patients were enrolled into this prospective diagnostic study. The tibia external rotation dial test was used as the gold standard for diagnostic reference. According to the dial test, the patients were divided into a study group (35 patients) and a control group (80 patients). The LGDT test was performed on all patients during arthroscopic surgery. The sensitivity and specificity of the LGDT test were calculated. The statistical difference of sensitivities in patient subgroups defined by injury patterns was tested using χ(2) test. And the correlation between the extent of tibia external rotational instability and the sensitivity of LGDT test was analyzed using logistic regression.

RESULTSThe sensitivity and specificity of the LGDT test were calculated as 91.4% and 93.8%, respectively. The sensitivity of detection for acute PLRI was 9/10 vs. 92.0% in chronic cases (χ(2) = 0.036, P = 0.849). Popliteus femoral "peel off" lesions were detected with a sensitivity of 100% vs. 87.0% in cases of non "peel off" lesions (χ(2) = 1.712, P = 0.536). The sensitivity of detecting isolated external rotational instability vs. combined instability (rotational and varus) was 90.5% and 13/14, respectively (χ(2) = 0.062, P = 0.805). The sensitivity of the LGDT test was correlated with the extent of tibial external rotational instability (r = 1.000, P = 0.011).

CONCLUSIONSThe LGDT test is a reliable method to diagnose PLRI of the knee joint. The highest sensitivity is observed for patients with the femoral "peel off" injury pattern. The sensitivity of the LGDT test is correlated with the extent of tibia external rotational instability.

Adolescent ; Adult ; Aged ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; Knee Joint ; physiopathology ; Male ; Middle Aged ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Young Adult

BACKGROUND: To determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries. METHODS: Between April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30degrees and 90degrees of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons. RESULTS: In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 +/- 3.01degrees at 30degrees of knee flexion and 11.88 +/- 4.03degrees at 90degrees of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 +/- 4.17degrees (p < 0.05) at 30degrees of knee flexion and 16.88 +/- 4.42degrees (p = 0.001) at 90degrees of knee flexion. The mean tibial external rotation was 5.31 +/- 2.86degrees and 6.87 +/- 3.59degrees higher in the reduced position than in the posterior subluxation at both 30degrees and 90degrees of knee flexion. CONCLUSIONS: In the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries.
Adolescent ; Adult ; Biomechanics ; Female ; Humans ; Joint Instability/*diagnosis/physiopathology ; Knee Joint/*physiopathology ; Male ; Middle Aged ; *Physical Examination ; Posterior Cruciate Ligament/*injuries/physiopathology ; Range of Motion, Articular ; Tibia/*physiopathology ; Young Adult

OBJECTIVESTo compare the paravertebral muscle (such as multifidus, erector spinae, psoas muscle) changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles. To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.

METHODSSixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group, meanwhile 60 health persons with no degenerative lumbar instability were selected as control group. No significant differences were found in the gender, age and body mass index between the two groups. The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware. And the lumbar curvature(expressed as lumbar lordosis angle) of all the patients in lumbar X-ray were measured in the two groups. The measured data were analyzed with independent samples t-test.

RESULTSThe difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5, L5-S1 level, compared with the control group, was statistically significant (t = 2.768, t = 6.216, P < 0.05). Between the two groups, the percentage of fatty infiltration in erector spinae showed significant differences (t = 5.862, P < 0.05). The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant. The lumbar lordsis angle in the patients with degenerative lumbar instability was (43.9 ± 15.6)°, which was higher than the (39.3 ± 14.2)° in control group (t = 2.915, P < 0.05).

CONCLUSIONSCompared with the control group, patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration, and erector spinae is more obvious. The degeneration among psoas muscle, erector spinae and multifidus muscle are inconsistent, which may be related to the increasing of the lumbar lordosis angle in the patients with degenerative lumbar instability.

Aged ; Case-Control Studies ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; pathology ; Lumbosacral Region ; physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal ; pathology ; Muscular Atrophy ; complications ; diagnosis ; 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

OBJECTIVETo study the examination,surgical opportunity and surgery methods of lost instability of traumatic dislocation of the knee joint.

METHODSSixty-three patients (48 males and 15 females,ranging in age from 16 to 75 years,with an average of 36.6 years) were checked, treated and followed up from January 2001 to April 2006. According to classification of Wascher for knee dislocation, there was 1 case of KD-I, 13 KD-II, 17 KD-III, 18 KD-IV, 14 KD-V. Stability of the knee was evaluated by physical and radiological examinations, of which 53 patients were treated with open surgery, 4 patients were treated with arthroscope, 4 patients were treated with arthroscope and open surgery, 1 patient was treated with amputation, 1 patient was treated with total knee arthroplasty.

RESULTSThe detection rate of MRI was 100% (39/39), stress radiography was 100% (19/19), arthroscpoe was 93.3% (14/15). According to Lysholm Criteria for knee joint function,the preoperative Lysholm score in old traumatic group was 37.17 +/- 5.33, fresh traumatic group was 37.41 +/- 5.38. The postoperative Lysholm score in old traumatic group was 67.33 +/- 14.72, fresh traumatic group was 82.45 +/- 12.13 (Z = -3.061, P = 0.002).

CONCLUSIONMRI stress radiography and arthroscope do well for the evaluation of stability of the knee. Instable traumatic dislocation of the knee joint must be operated promptly. Fresh instable dislocations of knee prefer repair,old instable dislocations of knee prefer reconstruction.

Adolescent ; Adult ; Aged ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; rehabilitation ; surgery ; therapy ; Knee Dislocation ; diagnosis ; rehabilitation ; surgery ; therapy ; Knee Joint ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Physical Examination ; Radiography

OBJECTIVETo study the performance of MRI and its diagnostic value for ligament injuries of knee joint.

METHODSForm June 2008 to February 2010, the MRI of 74 patients with ligament injuries of knee joint were retrospectively analyzed. There were 47 males and 27 females in the group, which course was from 2 h to 10 d, with an average age of 37.3 years (ranged from 12 to 76). The clinical symptom included knee swelling, pain, joint instability, extension-flexion movement disorder. The physical examination showed valgus test or drawer test positive, and tenderness of medial knee positive.

RESULTSThere were ligament injuies in 74 cases, among them, 19 cases were anterior cruciate ligament (25.7%),18 were posterior cruciate ligament (24.3%), 13 were lateral collateral ligament (17.6%), 24 were medial collateral (32.4%), the ligament of 12 cases were completely broken (included 8 cases cruciate ligament and 4 cases collateral ligament presented as discontinued signals of the ligament, and swelling and thickening of the ligament with medium signal in PDWI and high signal intensity in T2WI and in SPIR). The MRI of 62 patients with partial longitudinal tearing ligaments showed continuity, swelling and thickening of the ligaments with medium signal in PDWI and high signal intensity in T2WI and in SPIR. Forty-four cases were examined with surgery and arthroscopy, 41 ligaments were accorded with MRI, diagnosis rate of MRI was 95%.

CONCLUSIONMRI can accurately diagnose the ligament injuries of knee joint,which is an ideal technique in the diagnosis of ligament injuries of knee joint, and should be used as a routine examining method.

Adolescent ; Adult ; Aged ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; methods ; Child ; Female ; Humans ; Joint Instability ; diagnosis ; Knee Injuries ; diagnosis ; physiopathology ; Knee Joint ; physiopathology ; Ligaments ; physiopathology ; Magnetic Resonance Angiography ; methods ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Posterior Cruciate Ligament ; injuries ; Young Adult