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The purpose of this study was to evaluate differences in graft orientation between transtibial (TT) and anteromedial (AM) portal technique using magnetic resonance imaging (MRI) in anterior cruciate ligament (ACL) reconstruction. Fifty-six patients who were undergoing ACL reconstruction underwent MRI of their healthy and reconstructed knee. Thirty patients had ACL reconstruction using the TT (group A), while in the remaining 26 the AM (group B) was used. In the femoral part graft orientation was evaluated in the coronal plane using the femoral graft angle (FGA). The FGA was defined as the angle between the axis of the femoral tunnel and the joint line. In the tibial part graft orientation was evaluated in the sagittal plane using the tibial graft angle (TGA). The TGA was defined as the angle between the axis of the tibial tunnel and a line perpendicular to the long axis of the tibia. The ACL angle of the normal knee in the sagittal view was also calculated. The mean FGA for group A was 72 degrees, while for the group B was 53 degrees and this was statistically significant (P < 0.001). The mean TGA for group A was 64 degrees, while for the group B was 63 degrees (P = 0.256). The mean intact ACL angle for group A was 52 degrees, while for the group B was 51 degrees. The difference between TGA and intact ACL angle was statistically significant (P < 0.001) for both groups. Using the AM portal technique, the ACL graft is placed in a more oblique direction in comparison with the TT technique in the femoral part. However, there are no differences between the two techniques in graft orientation in the tibial part. Normal sagittal obliquity is not restored with both techniques. [ABSTRACT FROM AUTHOR]

The aim of this study was to (1) generate quantitative CT (QCT) densitometric data based on routine abdominal multi-detector (MDCT) examinations and (2) investigate whether these data can be used to differentiate osteoporotic from healthy females. Twenty-five female patients (group A) with a history of radiotherapy were examined both with routine abdominal MDCT and standard QCT to generate a MDCT-to-QCT conversion equation. Twenty-one osteoporotic (group B) and 23 healthy female patients (group C) were also recruited in the study. Patients of groups B and C underwent routine abdominal MDCT examination for various clinical indications. Mean bone mineral density (BMD) in patients of group A was 103.4 mg/ml +/- 32.8 with routine abdominal MDCT and 91.0 mg/ml +/- 28.5 with QCT. Quantitative CT BMD(QCT) values for patients in groups B and C were calculated utilizing the BMD(MDCT) values derived from routine abdominal MDCT data sets and the MDCT to QCT conversion equation: BMD(QCT)=0:78 x BMD(MDCT) + 10:13. The calculated QCT densitometric data adequately differentiated osteoporotic from healthy females (area under ROC curve 0.828, p = 0.05). In conclusion, this study showed that in a group of female patients, QCT data derived from routine abdominal MDCT examinations discriminated osteoporotic from healthy subjects. [ABSTRACT FROM AUTHOR]

Background: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears.Methods: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population.Results: The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates.Conclusions: The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods. [ABSTRACT FROM AUTHOR]

Although percutaneous fixation with iliosacral screws has been shown to be a safe and reproducible method for sacroiliac dislocation and sacral fractures, it is a technically demanding technique, and one of its contraindications is sacral anatomical variations and dysmorphism. The incidence and pattern of S1 and S2 anatomical variations were evaluated in 61 patients (35 women and 26 men) using magnetic resonance imaging of the sacrum in an attempt to explore the possible existence of groups of individuals in whom percutaneous sacroiliac fixation is difficult due to local anatomy.S1 and S2 dimensions in both the transverse and coronal planes were recorded and evaluated. In each individual, S1 and S2 dimensions both in the coronal and transverse planes were proportional, with S2 dimensions being 80% of those of S1 on average. Patients were separated into 4 groups based on the S1 and S2 body size and the asymmetry of dimensions in the transverse and coronal planes. In 48 patients (78.6%), dimensions in both planes were symmetrical despite the varying size of the S1 and S2 body. In 2 patients (3.3%) there was a combination of large transverse plane and small coronal plane dimensions, with large S1 and S2 body size. In 9 patients (14.8%), coronal plane dimensions were disproportionately smaller compared to those of the transverse plane, with a varying size of S1 and S2 body making effective sacroiliac screw insertion a difficult task. Thus, a preoperative imaging study, preferably computed tomography scan, of S1 and S2 body size and coronal plane dimensions and an intraoperative fluoroscopic control of S1 and S2 dimensions on the coronal plane are suggested for safe sacroiliac screw fixation. [ABSTRACT FROM AUTHOR]