This study compared the findings of MRI and arthroscopy in diagnosing internal derangements of the knee in 57 patients. The sensitivity of MRI was 100% for all structures studied. The specificity of MRI was 94.1% for ACL tears, 98.1% for PCL tears, 100% for medial meniscal tears, and 97.6% for lateral meniscal tears when compared to arthroscopy. MRI had a 100% negative predictive value but variable positive predictive values ranging from 83.3% to 100% depending on the structure. The study concluded that MRI is highly reliable in excluding ligament tears and determining normal knee anatomy, though arthroscopy remains the gold standard for definitive diagnosis.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study demonstrates that 3D-MRI is able to evaluate the anterolateral ligament fully in all normal knees. The classification system for injury to the ALL described shows high inter- and intra-observer reliability
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study demonstrates that 3D-MRI is able to evaluate the anterolateral ligament fully in all normal knees. The classification system for injury to the ALL described shows high inter- and intra-observer reliability
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Ideal Indications Meniscus Repair KNEE INJURY COMMON SPORTS INJURY
HOW TO DEAL SPORTS INJURY
RETURN TO SPORTS AFTER KNEE INJURY
BEST KNEE SURGEON DOCTOR IN JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
Corrective Surgery for Malunited Tibial Plateau Fractureiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
Periprosthetic fractures are the third most common reason for revision total hip arthroplasty. Surgical treatment of periprosthetic fractures belongs to the most difficult procedures due to the extensive surgery, elderly polymorbid patients and the high frequency of other complications. The aim of this study was to evaluate the results of operatively treated periprosthetic femoral fractures after total hip arthroplasty.
We evaluated 47 periprosthetic fractures in 40 patients (18 men and 22 women) operated on between January 2004 and December 2010. The mean follow-up period was 27 months (within a range of 12-45 months). For the clinical evaluation, we used modified Merle d'Aubigné scoring system.
In group of Vancouver A fractures, 3 patients were treated with a mean score of 15,7 points (good result). We recorded a mean score of 14,2 points (fair result) in 6 patients with Vancouver B1 fractures, 12,4 points (fair result) in 24 patients with Vancouver B2 fractures and 12,8 points (fair result) in 7 patients with Vancouver B3 fractures. In group of Vancouver C fractures, we found a mean score of 16,2 points (good result) in 7 patients.
Therapeutic algorithm based on the Vancouver classification system is, in our opinion, satisfactory. Accurate differentiation of B1 and B2 type of fractures is essential. Preoperative radiographic images may not be reliable and checking the stability of the prosthesis fixation during surgery should be performed.
Ideal Indications Meniscus Repair KNEE INJURY COMMON SPORTS INJURY
HOW TO DEAL SPORTS INJURY
RETURN TO SPORTS AFTER KNEE INJURY
BEST KNEE SURGEON DOCTOR IN JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
Corrective Surgery for Malunited Tibial Plateau Fractureiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Background: Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.
Methods: The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.
Results: Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.
Conclusions: The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.
Keywords: Distal femur, DF-LCP, Lysholm score, Periprosthetic fracture
The role of radiation diagnostic methods in pathological changes of the hip j...SubmissionResearchpa
Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objective was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis replacement. by Janibekov J. J 2020. The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics. International Journal on Integrated Education. 3, 11 (Dec. 2020), 203-205. DOI:https://doi.org/10.31149/ijie.v3i12.918. https://journals.researchparks.org/index.php/IJIE/article/view/918/866 https://journals.researchparks.org/index.php/IJIE/article/view/918
Study of current pattern of Cervical Spondylotic Myelopathy and to evaluate t...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
Ligamentotaxis in the Intraarticular and Juxta Articular Fracture of Wristiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates
Functional outcome of Arthroscopic reconstruction of single bundle anterior c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Similar to A Prospective Comparative Study Correlating Arthroscopic Findings And Magnetic Resonance Imaging In Internal Derangement Of Knee Joint (19)
Treatment of displaced midshaft clavicle fracture with locking compression plate provides better biomechanical stability, good fracture union rates, high post-operative constant score, early pain resolution, early return to activity, high patient satisfaction rates and excellent functional outcome. These benefits of plating overweigh complications when used in specific indications like displaced with or without comminuted middle third clavicle fracture (Robinson Type 2B1, 2B2).
A prospective observational study on comparing the outcome of patellar resurf...Dr.Avinash Rao Gundavarapu
Introduction: Total Knee Arthroplasty (TKA) has been a very successful surgery in relieving pain and restoring function in osteoarthritis. Conflicting evidence in literature exists regarding the merits of patellar resurfacing during TKA over non-resurfacing. Our aim is to evaluate and compare the difference between patellar resurfaced group and non-resurfaced group in primary TKA.
Materials and Methods: This prospective obsevational study was initiated in May 2016 conducted till April 2008 (2 years) in Yashoda Superspeciality Hospital, Hyderabad. At least 14 mm of patella was ensured to be retained after patellar cut. A total of 40 patients were allocated to receive (n=20) or not to receive patellar resurfacing (n=20) during primary TKA. The data was analyzed statistically using the Student t test. Overall patient satisfaction was recorded using the SF-36 score.
Results: Of the 40 patients, 67.5% females and 32.5 % males underwent TKA. Among those who underwent resurfacement, 40% were males. 75% among the non-resurfaced group were females. Right knee was operated on 37.5% of cases. Mean operative time being 103.9 and 122.5 minutes in nonresurfaced and resurfaced cases respectively. Mean patellar thickness was 22.1mm in nonresurfaced and 23.6mm in resurfaced group. The difference in VAS score, modified HSS score, KSS scores between the two groups were statistically insignificant with p-values of 0.230, 0.0214, 0.2513 respectively at the end of two year,
but there was significant reduction of anterior knee pain in the resurfaced with p-value < 0> Conclusion: The functional outcome was not affected by whether the patella was resurfaced or nonresurfaced. There was no significant difference between the two groups with respect to the prevalence of knee-related readmission, or of subsequent patella-related surgery or patients overall satisfaction. We recommend selective patellar resurfacing at the time of primary total knee replacement.
Keywords: TKA, Patellar resurfacement, Non-resurfacement, HSS score, KSS score.
Background
Traditionally, metallic interference screws were considered to have increased resistance to load than bio absorbable screws in anterior cruciate ligament (ACL) reconstruction. We did a comparative evaluation of biodegradable and metallic interference screws for tibial sided ACL reconstruction and also analysed complications, compared clinical outcome, did imaging study of ACL single bundle reconstruction by using titanium & newer poly–L-lactic acid (PLLA) bio absorbable screws to determine as to whether bio absorbable screw which costs double the metallic screw, is functionally better than standard metallic screws.
Methods
This is a prospective comparative study conducted among 50 patients aged between 15 and 55 years with clinical and MRI confirmation of complete ACL tear, treated arthroscopically with ACL reconstruction with either bio absorbable (group 1) or metallic (group 2) interference screw and both the groups were compared on follow up for an average duration of 12 months. Lysholm and Gillquist Knee Scoring Scale were used and outcome scores were divided into excellent, good, fair and poor.
Results
In our study 41 patients were males and 9 were females. Bio screw was used in 24 males and 6 female patients. Metallic screw was used in 17 males and 3 females. Outcome score was excellent in 26 (52 %) cases, good in 18 (36 %) cases, fair in 4 (8 %) cases, poor in 2 (4 %) cases. The mean Lysholm score in bio absorbable group was 93.13 and in metallic group was 89.70. Knee effusion was higher in bio screw group and infection rate was higher in metallic group.
Conclusions
In our study, the difference between bio absorbable screw group and metallic screw group was insignificant with regard to final patient outcome. Final osseointegration was better with bio absorbable screw, but increased cost of implant and almost same results compared to metallic screw does not make the bio absorbable screw superior to its counterpart.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
A Prospective Comparative Study Correlating Arthroscopic Findings And Magnetic Resonance Imaging In Internal Derangement Of Knee Joint
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 10 Ser.9 (October. 2020), PP 34-44
www.iosrjournals.org
DOI: 10.9790/0853-1910093444 www.iosrjournal.org 34 | Page
“ A Prospective Comparative Study Correlating Arthroscopic
Findings And Magnetic Resonance Imaging In Internal
Derangement Of Knee Joint”
Avinash Gundavarapu 1
, Bharat Reddy M 2
, Santhosh Kumar M 3
, Vishal Singh 4
.
1,2,3,4
Department of Orthopedic Surgery, Yashoda Superspeciality Hospital, Rajbhavan Road, Hyderabad,
Telangana, India 500082.
Abstract
Background: The dramatic increase in road traffic accidents and sporting lifestyle makes the knee joint one of
the most commonly injured joints in the body. The accuracy of clinical diagnosis, reported in various series
varies between 64-85 percent. Magnetic resonance imaging (MRI) is a diagnostic method most often used in
diagnosis of internal derangements of the knee. The accuracy rate of MRI scans also varies. Arthroscopy has
been used for many years as a diagnostic and therapeutic tool in knee disorders. It is considered as it allows
direct visualization of the interior of the knee. Although there have been studies in literature comparing MRI
with arthroscopy, the continuing improvement in diagnostic methods now available makes it especially
important to compare the results and recommendations offered in the literature.
Material and Methods: This is a prospective comparative study involving 57 patients who were admitted in
Department of Orthopedics, Yashoda Superspeciality hospital, Somajiguda, Hyderabad, between March 2015 to
May 2016 with the history of injury to the knee. Patients between age group of 18-45 years fulfilling inclusion
and exclusion criteria, who sustained injury to their knee and presented with pain or instability were subjected
to standardized clinical tests and diagnosed clinically as Internal Derangement of Knee. MRI was done in these
patients for the affected knee and diagnosis of injury to menisci or cruciate ligaments were confirmed in MRI.
Subsequent arthroscopic surgery to the injured knee was performed in these patients and findings of MRI were
compared to that of arthroscopy.
Results: The sensitivity of MRI in comparison with Arthroscopy was 100% in all studied lesions. The specificity
of MRI in comparison with Arthroscopy was 94.1%, 98.1%, 100% and 97.6% for ACL, PCL, Medial meniscus
and Lateral meniscus respectively. MRI has 100% negative predictive value with a variable positive predictive
value of 97.6%, 83.3%, 100%, 97.6% for ACL, PCL, Medial meniscus and Lateral meniscus respectively.
Conclusion: MRI is a very good at determining the normal anatomy of the intra-articular structures of the knee
joint and is highly reliable in excluding ligament tears. The treating surgeon has to go through the complete set
of images available in all possible views to come to a definitive conclusion on the pathology. With MRI, in
doubtful cases of IDK unnecessary diagnostic arthroscopy can be avoided, which can significantly bring down
the economic burden among rural population.
Key Words: Internal Derangement of Knee, MRI, Arthroscopy, ACL, PCL.
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Date of Submission: 09-10-2020 Date of Acceptance: 24-10-2020
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I. Introduction
The dramatic increase in road traffic accidents and highly demanding sporting lifestyle
makes the knee joint one of the most commonly injured joints in the body, either as a frequent
component in a polytrauma patient or as isolated injury. Ligament injuries apart from fractures are
more common in the knee joint owing to its complex anatomy. The injury to the intra-articular
structures is generally termed as Internal derangement of knee which was first coined by
William Hey in 1784 [1]
. The clinical evaluation of knee injuries remains a difficult problem even
today. The accuracy of a clinical diagnosis, reported in various series, varies between 64-85
percent, which suggests that even in the most experienced hands, a clinical diagnosis cannot be
ascertained in about 20 percent of cases [2]
. Magnetic resonance imaging (MRI) is a diagnostic
method most often used in diagnosis of internal derangements of the knee, because it is non-
invasive, painless and has no risk of radiation. However it is an expensive investigation and it has
a tendency to be misused and overused, to confirm diagnosis before proceeding with surgical
intervention. The accuracy rate of MRI scans also varies. Arthroscopy has been used for many years
as a diagnostic and therapeutic tool in knee disorders. Arthroscopy allows direct visualization of
the interior of the knee. This study is about comparing knee arthroscopy and MRI in
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diagnosing IDK. All studies were assessed by one reviewer, so there is no inter-observer bias. The
purpose of this study was to find out the diagnostic accuracy of MRI scans and to examine the value
of MRI as a standard pre-operative examination correlating them with the gold standard of
arthroscopy.
Aims: To study the efficacy of Arthroscopy over MRI in diagnosing meniscal and ligament
injuries of the knee joint.
Objectives: To compare the sensitivity and specificity of MRI and knee arthroscopy and to
emphasize the diagnostic accuracy of MRI and Diagnostic knee Arthroscopy.
II. Materials & Methods
This is a prospective comparative study involving 57 patients who were admitted in
Department of Orthopedics, Yashoda Superspeciality hospital, Somajiguda, Hyderabad, between
March 2015 to May 2016 with the history of injury to the knee
Study population: Patients between age group of 18-45 years fulfilling inclusion and exclusion
criteria, who sustained injury to their knee and presented with pain or instability were subjected to
standardized clinical tests and diagnosed clinically as Internal Derangement of Knee. MRI was done
in these patients for the affected knee and diagnosis of injury to menisci or cruciate ligaments
were confirmed in MRI. Subsequent arthroscopic surgery to the injured knee was performed in these
patients and findings of MRI were compared to that of arthroscopy.
Inclusion criteria:-
1. Patients with knee pain with or without instability.
2. Patients with symptoms of locking of knee.
3. Age between 18– 45 years of either sex.
4. MRI images taken in 1.5 Tesla.
Exclusion criteria:-
1. Patients with open fractures of the knee.
2. Patients with bony injuries of the affected limb.
3. Patients who have not consented for study.
4. Patients with pervious surgeries to the knee.
5. Patients with signs of infection.
6. Patients with ankylosed knee joint.
7. Patients unfit for MRI study.
Sample size and sample technique: Statistical analysis done in SPSS 19.0 and Microsoft Excel
(Licensed version) and sample size was estimated to be 57 patients. Images recorded and documented
in capture IT pro (Licensed version).
Tools used - G E MRI 1.5 Tesla machine and Arthrex Arthroscopic system.
MRI was done in 1.5T field strength in our institution and was reported on an objective proforma by a
single senior consultant radiologist. All the arthroscopies were performed by single orthopedic
surgeon. The findings of MRI and arthroscopy were compared and analyzed in detail. Magnetic
resonance imaging can show osseous and soft-tissue structures without the use of ionizing radiation,
and it is non invasive. The knee is the most frequently studied joint and specialized extremity coil is
available for this purpose [5]
. This surface coil allows high-resolution images of the commonly injured
internal structures of the joint [6]
. Sagittal images are best used to evaluate the anterior and posterior
cruciate ligaments. They also provide excellent visualization of the menisci [7]
. Coronal images are
best used to evaluate the collateral ligaments anatomy [7]
.
Sequential Methods Of Assessment: Presenting complaints, History of presenting complaints, Past
history, Personal history, General physical examination, Complete local examination of affected
knee.
Complete inspection of knee - Medial joint line tenderness, Mc Murray‟s test, Apley‟s grinding test,
Lachmann‟s test, Anterior and posterior drawer test, Pivot shift & Mcintosh test.
Radiographs of the involved knee antero-posterior and lateral views to rule out any bony injury.
MRI of the affected knee with the following sequences
1. Localizer sequences in sagittal, coronal and axial planes
2. Fats up pressed T2 axial turbo spin echo.
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3. T1 Spin echo Sagittal.
Pre–operative workup- Routine hemogram, urine routine, biochemical parameters of blood, ECG &
chest radiographs.
Pre–anaesthetic check-up and ASA grading for fitness for surgery.
Surgery: All the arthroscopic procedures were performed under spinal anesthesia after applying
pneumatic tourniquet with patient in supine position and knee in 90 degrees flexion.
30°arthroscope was used in all cases and the operative findings were documented and recorded
simultaneously by the floor assistant in the following order: Anatomical structure viewed and the
presence or absence of tears, its location and additional details wherever possible.
The composite data was tabulated and studied for correlation with MRI findings and grouped into
four categories.
1. True-Positive: If the MRI diagnosis was confirmed by arthroscopic evaluation.
2. True-Negative: When MRI negative for lesion but arthroscopy was negative.
3. False-Positive: When MRI shows lesion but arthroscopy was negative.
4. False-Negative: When arthroscopy showed lesion but MRI was negative.
Statistical analysis was used to calculate the sensitivity, specificity, positive predictive
value (PPV) and the negative predictive value (NPV), in order to assess the reliability of MRI
results. Based on the above categories, five parameters were calculated to assess the reliability of the
MRI results.
Table 1: Interpretation of sensitivity
90%-100% Excellent
80% -90% Very Good
70% -80% Good
70% -60% Average
<60% Poor
Interpretation of Kappa
Poor Slight Fair Moderate Substantial Almost perfect
0.0 0.20 0.40 0.60 0.80 1.0
Kappa Agreement
<0 Less than chance agreement
0.01–0.20 Slight agreement
0.21–0.40 Fair agreement
0.41–0.60 Moderate agreement
0.61–0.80 Substantial agreement
0.81–0.99 Almost perfect agreement
III. Observation And Results
57 patients who were admitted in Department of Orthopedics, Yashoda hospital, with
the history of injury to their knee joint and were diagnosed to have internal derangement of the knee
clinically using standardized clinical tests, MRI of the affected knee joint was done for all these
patients either before or after admission. These patients were then subjected to diagnostic and
therapeutic arthroscopy consecutively and findings in MRI were compared to that of arthroscopy
and results were tabulated.
Sex distribution
The study had 57 patients of which 15 were females and 42 males which accounts to about
26.3% females and 73.7% males respectively.
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Table 2: Sex Distribution
Age distribution
The patients who suffered injury were in the age group ranging from 18 to 45 years. The
mean age was around 33.58. Some of the other interesting observations noted in our study are, as
age increases right side injuries are more compared to that of the left side and frequency of road traffic
accidents are more.
Figure 1: Age distribution
Side involved
The right knee joint was found to be more commonly involved 35 cases (61.4%), than the left knee
joint, 22cases (38.6%) and there were no cases with bilateral knee involvement in our series.
Table 3: Side Involved
Mode of injury
Road traffic accident was the most common mode of injury involving 47 cases (82.46%) followed
by sport injury involving 10 cases (17.54%).
Table 4: Mode of injury
Structures Injured
The total number of anterior cruciate ligament (ACL) tears reported - MRI (ACL tears) : Arthroscopy
(ACL tears) is - 41 : 40.
The total number of posterior cruciate ligament (PCL) tears reported - MRI (PCL tears) : Arthroscopy
(PCL tears) is - 6 : 5
The total number of Medial meniscus tears reported - MRI (MM tears) : Arthroscopy (MM tears) is
32 : 32.
The total number of Lateral meniscus tears reported - MRI (LM tears) : Arthroscopy (LM tears) is 16 :
15
SEX NO OF CASES PERCENTAGE
MALE 42 73.7%
FEMALE 15 26.3%
Side Frequency Percent
Left 22 38.6
Right 35 61.4
Total 57 100
Mode of Injury Frequency Percent
Sports injury 10 17.5
RTA 47 82.5
Total 57 100
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Figure 1 –Structures Injured.
There are several explanations for the misleading results of MRI regarding the menisci and
cruciate ligaments. Firstly, meniscal tears and Meniscus degenerative changes have the same
appearance in MRI, by giving high signal within the meniscus. Diagnosis then depends on the
expansion of the high signal line towards meniscus articular surface. Moreover, one of the most
frequent causes for false positive MRI regarding the lateral meniscus is the misinterpretation of the
signal coming from the inferior knee artery. McKenzie et al summarized the four most common
reasons for false positive diagnosis; wrong diagnosis due to variable anatomic structures, over
estimation of pathology countered as meniscus tear(for example chondral injuries that mimic
meniscus tears) false negative arthroscopic findings and tears with in the meniscus without
expansion to the articular surface.
Figure 2: Graph plotted comparing the true positive, true negative and false positive results.
Statistical Analysis of Tear of Individual Structures:
1. Anterior Cruciate Ligament: Observing the pattern of ACL tears (Table4) revealed a total of 40
cases with torn ACL
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Table 5 : Comparing ACL in MRI vs Arthroscopy.
Table 6: Statistical value for diagnosis pertaining to ACL using various tests.
Graph 1:Scatter Diagram Showing Linear Pattern Suggestive Of Perfect Correlation With Regard To Acl
In our study there was one false positive result in MRI while diagnosing anterior cruciate
ligament tear. The sensitivity and specificity of MRI with respect to Arthroscopy is 100% and
94.1%. The positive predictive value and negative predictive value is 97.6% and 100% respectively.
The inter-observer agreement using Kappa statistics showed almost perfect agreement with value
of 0.95. The accuracy of MRI in diagnosing ACL tear is 98% with significant P value of 0.00
(Table 6). The values when plotted on a scatter diagram showed a linear graph with a Sq linear
value of 0.918 (Graph 1) which is interpreted as strong correlation between the two studied
diagnostic modalities.
2. Posterior Cruciate Ligament: Total number of PCL tears accounted to about 5 cases out of the 57
studied.
Table 7: Table Comparing Pcl In Mri Vs Arthroscopy
SCOPY
MRI TEAR NORMAL TOTAL
TEAR 40 01 41
NORMAL 00 16 16
TOTAL 40 17 57
ACL SENSITIVITY SPECIFICITY PPV NPV KAPPA ACCURACY P
100% 94.1% 97.6% 100% 0.95 98% 0.00
SCOPY
MRI TEAR NORMAL TOTAL
TEAR 05 01 06
NORMAL 00 51 51
TOTAL 05 52 57
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Table 8 : Statistical value for diagnosis pertaining to PCL using various stests.
PCL SENSITIVIY SPECIFICIY PPV NPV KAPPA ACCURACY P
100% 98.1% 83.3% 100% 0.90 98% 0.00
Graph 2: Scatter diagram showing linear pattern suggestive of perfect correlation with regard to PCL
In our study there was one false positive result in MRI while diagnosing posterior cruciate
ligament tear, the loss of signal intensity near the femoral attachment was considered as partial
tear of PCL but on arthroscopic evaluation there was no evidence of tear in PCL. The sensitivity and
specificity of MRI with respect to Arthroscopy is 100% and 98.1%. The positive predictive value
and negative predictive value is 83.3% and 100% respectively. The inter observer agreement using
Kappa statistics showed almost perfect agreement with value of 0.90. The accuracy of MRI in
diagnosing PCL tear is 98% with significant P value of 0.00 (Table 8). The values when plotted
on a scatter diagram showed a linear graph with a Sq linear value of 0.817 (Graph 2) which is
interpreted as strong correlation between the two studied diagnostic modalities.
3. Medial meniscus: Out of the 57 cases, 32 cases had torn medial meniscus and 25 normal medial
meniscus
Table 9: Table Comparing Medial Meniscus In Mri Vs Arthroscopy.
SCOPY
MRI
TEAR NORMAL TOTAL
TEAR 32 00 32
NORMAL 00 25 25
TOTAL 32 25 57
Table 10: Statistical value for diagnosis pertaining to Medial meniscus using various tests.
M.M SENSITIVIY SPECIFICITY PPV NPV KAPPA ACCURACY P
100% 100% 100% 100% 1.0 100% 0.00
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Graph 3:Scatter diagram showing linear pattern suggestive of perfect correlation with regard to Medial
meniscus.
In our study there were no discrepancies in the diagnosis of tears in medial meniscus
between MRI and Arthroscopy. Both these modalities correlated well in the diagnosis of medial
meniscal tears. The sensitivity and specificity of MRI with respect to Arthroscopy is 100% and
100%. The positive predictive value and negative predictive value is 100% and 100% respectively.
The inter observer agreement using Kappa statistic showed almost perfect agreement with value of
1. The accuracy of MRI in diagnosing Medial meniscus tear is 100% with significant P value
of 0.00 (Table 10). The values when plotted on a scatter diagram showed a linear graph with a
Sq linear value of 1 (Graph 3) which is interpreted as very strong correlation between the two
studied diagnostic modalities.
4. Lateral meniscus: Total number of Lateral meniscal tears reported is 15.
Table 11: Comparing Lateral Meniscus In Mri Vs Arthroscopy.
SCOPY
MRI TEAR NORMAL TOTAL
TEAR 15 01 16
NORMAL 00 41 41
TOTAL 15 42 57
Table 12: Statistical value for diagnosis pertaining to Lateral meniscus using various tests.
L.M SENSITIVITY SPECIFICITY PPV NPV KAPPA ACCURACY P
100% 97.6% 93.8 100% 0.95 98% 0.00
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Graph 4: Scatter diagram showing linear pattern suggestive of perfect correlation with regard to Lateral
meniscus.
In our study there were no discrepancies in the diagnosis of tears in medial meniscus
between MRI and Arthroscopy. Both these modalities correlated well in the diagnosis of medial
meniscal tears. The sensitivity and specificity of MRI with respect to Arthroscopy is 100% and
100%. The positive predictive value and negative predictive value is 100% and 97.6% respectively.
The inter observer agreement using Kappa statistic showed perfect agreement with value of 0.95
(Table12). The accuracy of MRI in diagnosing ACL tear is 100% with significant P value of 0.00.
The values when plotted on a scatter diagram showed a linear graph with a Sq linear value of
0.915 (Graph 4) which is interpreted as strong correlation between the two studied diagnostic
modalities.
IV. Discussion
This study was a prospective study done among 57 patients who were admitted with
provisional diagnosis of Internal Derangement of Knee in the Department of Orthopedics
Yashoda hospital, Hyderabad. The current study was done to determine the efficacy of
Arthroscopy over MRI in diagnosing meniscus and ligament injuries of the knee joint. MRI of
the knee joint was done in all these patients and then these patients underwent diagnostic and
therapeutic arthroscopy whenever necessary in the same institution. The main strength of the
study is the use of only one MRI machine GE 1.5 Tesla and interpretation of examination by a
single radiologist, thus making the results more reproducible. This is incongruence with the
analysis done by Runkel et al which showed arthroscopies done could be reduced if the
MRI was reported by an experienced radiologist [ 3 ]
. MRI images were studied for evidence of
injuries to menisci and cruciate ligaments and other associated structures and soft tissues around the
knee joint. Diagnostic arthroscopy was performed on all these patients to confirm the MRI findings
and results were documented. In the present study, of the 57 patients 42 were male and 15 were
female patients. The age groups were ranging from 18 to 45 years with mean age of 33.58. The
youngest patient was 18 years and the oldest was 45 years of age. The youngest male patient was
aged 18 years and the oldest male patient was 45 years old, likewise the youngest female patient
was aged 18 years and the oldest female patient was 45 years old. This showed that the tendency
of being injured and getting operated at an earlier age was common in both male and female
patients. A study by Fritz et al showed males are most likely to suffer knee injuries since they are
active in sports and the right knee was more frequently injured than the leftknee.[4]
As mentioned
earlier in our study also males comprise the predominant number of patients who suffered knee
injuries owing to their highly active social and sporting lifestyle. Sports injuries were more common
in male patients than in females, out of the 10 cases who suffered injuries in this mode there was
only 1 female patient in this category. The overall percentage of sports injuries were 17.5%
(10cases) when compared to 82.5% (47cases) who sustained injury through road traffic accident.
Meniscal injuries, anterior cruciate ligament and posterior cruciate ligaments injuries were classed as
either torn or not torn. Anterior cruciate ligament injures occurred in about 40 patients (70.2%).
Posterior cruciate ligament injuries occurred in 5 patients (8.8%). The frequencies of injuries to
medial meniscus (56.1%), in 32 patients were almost one fold higher than that of injuries to
lateral meniscus (26.3%), in 15 patients.
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Studies in the literature have shown a range of 61–97% in the sensitivity of MRI in detecting
ACL tears and a specificity of 82–97%[8,9,10,11,12]
..
William„s et al. suggested that MRI results in fast
and accurate diagnosis and it allows the surgeon to plan the surgical procedure [13]
. Results of various
studies demonstrate that meniscal and cruciate ligament injuries of the knee can be accurately
diagnosed by MRI and they support the findings of other studies [14]
. Vaz et al. concluded that MRI
has high accuracy for diagnosing knee meniscal and cruciate ligament lesions [15]
. In 2012
Lokannavar HS, Yang X, Guduru H. examined MR imaging study of 146 patients showed high
accuracy (98.08%) and negative predictive value (98.62%) for MRI in comparison with arthroscopy
[16]
. In 2013 Justin W. Griffin, Mark D. Miller concluded that MRI have remarkable correlation with
arthroscopic findings [17]
. In 2014 Kostov H, Stojmenski S, Kostova E concluded that MRI is an
appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in
most patients [18]
.
Yaqoob J, Alam MS, Khalid in their study conducted in 2015 concluded that the sensitivity,
specificity and accuracy of MR imaging for menisci and ACL injury were labeled to be 100%
sensitivity, 88.4% specificity, 90% positive predictive value, 100% negative predictive value, and
94.4% accuracy were noted for medial meniscal injury. Similarly, MR had sensitivity of 85.7%,
specificity of 95%, positive predictive value of 85.7%, negative predictive value of 95%, and
accuracy of 92.5% for lateral meniscal injuries. Likewise, anterior cruciate ligament had 91.6%
sensitivity, 95.2% specificity, 84.6% positive predictive value, 97.5% negative predictive value, and
94.4% accuracy [19]
.
False positive and false negative results:
MRI studies have higher false positives than false negative results confirmed by literature
and it was the same finding in our study too, even though the false positive results were very
minimal which accounts to only 3 cases out of the 57 cases evaluated. Each of the false positive
results were encountered in ACL, PCL and Lateral meniscus respectively where as there was no
discrepancies in Medial meniscal lesions.
The false positive results in our study are described below:
1. The reported degenerative tear of the lateral meniscus in case 10 was not visualized in
arthroscopic examination.
2. The reported right side ACL tear in MRI in case 12 showed mild laxity and increased
signal intensity of ACL near its tibial attachment which was interpreted as partial ACL tear, but in
arthroscopic examination here was no evidence of tear at the given location.
3. Posterior Cruciate ligament of the right knee in case 51 showed a intra substance cyst/tear
in MRI, was not revealed in arthroscopic examination.
Sensitivity and specificity:
The sensitivity of MRI in comparison with Arthroscopy was 100% in all studied lesions.
The specificity of MRI in comparison with Arthroscopy was 94.1%, 98.1%, 100% and 97.6% for ACL,
PCL, Medial meniscus and Lateral meniscus respectively.
Positive and Negative predictive value:
Statistics revealed MRI has 100% negative predictive value with a variable positive predictive
value of 97.6%, 83.3%, 100%, 97.6% for ACL, PCL, Medial meniscus and Lateral meniscus
respectively. Thus according to our study MRI is a very good at determining the normal
anatomy of the intra-articular structures of the knee joint and is highly reliable in excluding
pathology, in our case tear in ligaments. Hence were commend MRI in doubtful cases of internal
derangement of the knee joint where by unnecessary diagnostic arthroscopy can be avoided
which can significantly bring down the economic burden among rural population.
V. Conclusion
The use of MRI and arthroscopy of the knee has evolved substantially over the last
several decades and the advancement in surgical treatment of traumatic ligament injuries of the
knee has been improved because of both technologies. The astute orthopedic surgeon must be able
to associate the findings on MRI in the decision making before and during arthroscopy. Moreover
for abetter correlation of findings the surgeon has to go through the complete set of images
available in all possible views to come to a definitive conclusion on the pathology. An accurate
understanding of the surgical anatomy and pathology found on both clinical examination and pre-
operative imaging will help the surgeon to improve the surgical technique at the time of
arthroscopy and ultimately improve patient outcomes.
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Acknowledgement
It is with glorious veneration and intense gratitude that I would like to thank my esteemed guide Dr.
Sunil dachepalli, Consultant Orthopedic Surgeon, Yashoda hospital, Somajiguda, Hyderabad, who has been
source of sustained illumination to me during my course, whose valuable guidance and generous support
facilitate me to accomplish this dissertation. I would like to thank Dr. T. Dasaratha Rama Reddy, Senior
Consultant Orthopedic surgeon and HOD, Yashoda Hospital, Somajiguda for his constant guidance and fatherly
support during making of this dissertation. I am very much grateful to Dr. M. Uma Maheshwar, Dr . P. Manoj
Chakravorthy for their valuable support and constant encouragement which made this dissertation possible. I
express my thank to Dr. G. S. Rao and Dr. A. Lingaiah, for supporting me to coordinate this thesis using the
hospital facilities. My Heartful thanks to my parents my family and my dear friend Dr Bharat Reddy and Dr
Santhosh Kumar for their unconditional support and inspiration that keep me going on the path of success. I
would also like to thank the almighty and all the patients without whom, this study would not have been
possible.
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