Traumatic rupture of the superior oblique muscle is rare. We report a case of a 54-year-old man injured by the metal hook of a hanger, resulting in a rupture of the superior oblique muscle tendon. He complained of torsional diplopia when in the primary position. The distal margin of the superior oblique muscle was reattached to sclera 5 and 9 mm apart from the medial insertion of the superior rectus muscle. One week after the operation, torsional diplopia disappeared. However, a 4-prism diopter ipsilateral hypertropia was observed. Three months later, hypertropia gradually increased to 20 prism dioptors and the second operation was done to correct vertical diplopia.
Diplopia/etiology/physiopathology/surgery ; Eye Injuries/complications/*diagnosis/surgery ; *Eye Movements ; Humans ; Male ; Middle Aged ; Oculomotor Muscles/*injuries/physiopathology/surgery ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/etiology/physiopathology/surgery ; Tendon Injuries/complications/*diagnosis/surgery

BACKGROUND: Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. METHODS: MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. RESULTS: Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. CONCLUSIONS: MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.
Adolescent ; Adult ; *Ankle Joint/surgery ; Chronic Disease ; Female ; Humans ; Joint Instability/*complications/surgery ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Sensitivity and Specificity ; Tendinopathy/*diagnosis/etiology/surgery ; Tendon Injuries/complications/diagnosis ; Young Adult

BACKGROUND: To evaluate the clinical results and operation technique of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP) lesions, all of which had an anterior-inferior Bankart lesion that continued superiorly to include separation of the biceps anchor in the patients presenting recurrent shoulder dislocations. METHODS: From May 2003 to January 2006, we reviewed 15 cases with combined Bankart and SLAP lesions among 62 patients with recurrent shoulder dislocations who underwent arthroscopic repair. The average age at surgery was 24.2 years (range, 16 to 38 years), with an average follow-up period of 15 months (range, 13 to 28 months). During the operation, we repaired the unstable SLAP lesion first with absorbable suture anchors and then also repaired Bankart lesion from the inferior to superior fashion. We analyzed the preoperative and postoperative results by visual analogue scale (VAS) for pain, the range of motion, American Shoulder and Elbow Surgeon (ASES) and Rowe shoulder scoring systems. We compared the results with the isolated Bankart lesion. RESULTS: VAS for pain was decreased from preoperative 4.9 to postoperative 1.9. Mean ASES and Rowe shoulder scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1, respectively. There were no specific complication and no significant limitation of motion more than 10 degree at final follow-up. We found the range of motions after the arthroscopic repair in combined lesions were gained more slowly than in patients with isolated Bankart lesions. CONCLUSIONS: In recurrent dislocation of the shoulder with combined Bankart and SLAP lesion, arthroscopic repair using absorbable suture anchors produced favorable clinical results. Although it has technical difficulty, the concomitant unstable SLAP lesion should be repaired in a manner that stabilizes the glenohumeral joint, as the Bankart lesion can be repaired if the unstable SLAP lesion is repaired first.
Adolescent ; Adult ; Arthroscopy/*methods ; Humans ; Magnetic Resonance Imaging ; Male ; Orthopedic Procedures/*methods ; Pain Measurement ; Postoperative Care ; Range of Motion, Articular ; Shoulder Dislocation/diagnosis/etiology/physiopathology/*surgery ; Tendon Injuries/complications/diagnosis/physiopathology/*surgery ; Treatment Outcome ; Young Adult

A 38-year-old man presented with right knee pain and swelling following a football injury. Magnetic resonance (MR) imaging showed a complete anterior cruciate ligament (ACL) tear and lateral meniscal tears. The torn ACL was repaired with a graft obtained from the semitendinosus muscle, and the menisci were debrided. The mechanisms of injury to the ACL are varied and may be due to direct or indirect contact with the knee as well as with twisting injuries. Knowledge of the ACL's normal anatomy, together with MR imaging technique and understanding of the appearance of the lesion on MR examination, is crucial to aid in the identification of an ACL tear. Diagnosis of an ACL tear should be based on direct MR imaging signs, although indirect signs may be helpful, particularly in chronic tears. Other associated injuries to be aware of include meniscal and other ligamentous injuries. Normal ACL graft and post-ACL graft reconstruction complications are also briefly discussed.
Adult ; Anterior Cruciate Ligament ; pathology ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; adverse effects ; rehabilitation ; Bone-Patellar Tendon-Bone Grafting ; adverse effects ; rehabilitation ; Football ; injuries ; Humans ; Knee Injuries ; pathology ; rehabilitation ; surgery ; Magnetic Resonance Imaging ; Male ; Postoperative Complications ; diagnosis ; Soccer ; injuries ; Tendons ; transplantation