scholarly journals New secondary sign of ACL tear – The medial femoral notch sign (Gupta-Botchu sign)

2020 ◽  
Vol 0 ◽  
pp. 1-3
Author(s):  
Ahmed Saad ◽  
Ghassan Almeer ◽  
Christine Azzopardi ◽  
Harun Gupta ◽  
Rajesh Botchu
Keyword(s):  
Acl Tear ◽  
Femoral Notch ◽  
Secondary Signs

ACL is the most common injured ligament of the knee. The diagnosis on MRI is by primary and secondary signs. We describe a new secondary sign of ACL tear – The medial femoral notch sign. (xxxxxx sign).

Magnetic Resonance Signal Abnormalities within the Pericruciate Fat Pad: A Possible Secondary Sign for Acute Anterior Cruciate Ligament Tears

2017 ◽  
Vol 68 (4) ◽  
pp. 438-444 ◽  
Author(s):  
Ferdinando Draghi ◽  
Mario Torresi ◽  
Luigi Urciuoli ◽  
Salvatore Gitto
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Diagnostic Value ◽  
Fat Pad ◽  
Acl Tear ◽  
Arthroscopic Findings ◽  
Anterior Cruciate ◽  
Cruciate Ligament Tears ◽  
Secondary Signs

Purpose The study sought to investigate the presence of magnetic resonance (MR) signal alterations within the pericruciate fat pad in patients with an acute anterior cruciate ligament (ACL) tear as well as evaluate its diagnostic value in comparison with the main secondary signs of ACL tears. Methods Two musculoskeletal radiologists retrospectively reviewed knee MR examinations performed from May to October 2015. The ACL was considered as torn or intact based on either previous arthroscopic findings or unequivocal MR imaging interpretation if arthroscopic correlation was unavailable. Abnormalities of the pericruciate fat pad were evaluated as increased signal on the fluid-sensitive sequences; the main secondary signs of ACL tears were identified. Sensitivity and specificity were calculated for each sign. Results A total of 182 patients entered this study: 22 with an acute ACL tear, 160 with intact ACL. Signal hyperintensity of the pericruciate fat pad was demonstrated in all patients with an acutely torn ACL, resulting significantly different between individuals with intact ACL and those with ligament tear ( P < .0001). This sign was much more sensitive (100%) but less specific (72.5%-75%) than other secondary signs. Conclusions Signal hyperintensity of the pericruciate fat pad on the fluid-sensitive sequences is associated with acute ACL tears and could be considered as a possible indicator of these injuries.

scholarly journals Lateral femoral notch sign and posterolateral tibial plateau fractures and their associated injuries in the setting of an anterior cruciate ligament rupture

2021 ◽  
Author(s):  
Alexander Korthaus ◽  
Malte Warncke ◽  
Geert Pagenstert ◽  
Matthias Krause ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Ligament Injury ◽  
Ligament Rupture ◽  
Impression Fracture ◽  
Anterior Cruciate ◽  
Lateral Femoral Notch ◽  
Femoral Notch

Abstract Introduction ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated. Materials and methods One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al. Results In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039). Conclusion In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.

scholarly journals Increased Total Cost and Lack of Diagnostic Utility for Emergency Department Visits After ACL Injury

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110067
Author(s):  
Lambert T. Li ◽  
Carlin Chuck ◽  
Steven L. Bokshan ◽  
Brett D. Owens
Keyword(s):  
Emergency Department ◽  
Socioeconomic Status ◽  
Low Socioeconomic Status ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Emergency Department Visits ◽  
Level Of Evidence ◽  
Total Cost ◽  
Acl Tear ◽  
Chi Square Analysis

Background: Patients are commonly evaluated at the emergency department (ED) with acute anterior cruciate ligament (ACL) tears, but providers without orthopaedics training may struggle to correctly diagnose these injuries. Hypothesis: It was hypothesized that few patients would be diagnosed with an ACL tear while in the ED and that these patients would be of lower socioeconomic status and more likely to have public insurance. Study Design: Cohort study; Level of evidence, 3. Methods: The 2017 State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) from the state of Florida were utilized in this study. Cases with Current Procedural Terminology code 29888 (arthroscopically aided ACL reconstruction [ACLR]) were selected from the SASD, and data from the SEDD were matched to patients who had an ED visit for a knee injury within 120 days before ACLR. Chi-square analysis was used to test for differences in patient and surgical variables between the ED visit and nonvisit patient groups. A generalized linear model was created to model the effect of ED visit on total cost for an ACL injury. Results: While controlling for differences in patient characteristics and concomitant procedure usage, a visit to the ED added $4587 in total cost ( P < .001). The ED visit cohort contained a greater proportion of patients with Medicaid (20.2% vs 9.1%), patients who were Black (18.4% vs 10.3%), and patients in the lowest income quartile (34.4% vs 25.0%) ( P < .001 for all). In the ED visit cohort, 14.4% of patients received an allograft versus 10.1% in the non-ED visit cohort ( P = .001) despite having a similar mean age. An ACL sprain was diagnosed in only 29 of the 645 (4.5%) patients who visited the ED. Conclusion: Utilizing the ED for care after an ACL injury was expensive, averaging a $4587 increase in total cost associated with ACLR. However, patients rarely left with a definitive diagnosis, with only 4.5% of patients who underwent ACLR being correctly diagnosed with an ACL tear in the ED. This additional cost was levied disproportionately on patients of low socioeconomic status and patients with Medicaid.

scholarly journals Improvement of the Diagnosis of Isoattenuating Pancreatic Carcinomas by Defining their Characteristics on Contrast Enhanced Computed Tomography and Endosonography with Fine-Needle Aspiration (EUS-FNA)

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 776
Author(s):  
Robert Psar ◽  
Ondrej Urban ◽  
Marie Cerna ◽  
Tomas Rohan ◽  
Martin Hill
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Pancreatic Duct ◽  
Fine Needle Aspiration ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Characteristic Analysis ◽  
Fine Needle ◽  
Contrast Enhanced ◽  
Secondary Signs

(1) Background. The aim was to define typical features of isoattenuating pancreatic carcinomas on computed tomography (CT) and endosonography and determine the yield of fine-needle aspiration endosonography (EUS-FNA) in their diagnosis. (2) Methods. One hundred and seventy-three patients with pancreatic carcinomas underwent multiphase contrast-enhanced CT followed by EUS-FNA at the time of diagnosis. Secondary signs on CT, size and location on EUS, and the yield of EUS-FNA in isoattenuating and hypoattenuating pancreatic cancer, were evaluated. (3) Results. Isoattenuating pancreatic carcinomas occurred in 12.1% of patients. Secondary signs of isoattenuating pancreatic carcinomas on CT were present in 95.2% cases and included dilatation of the pancreatic duct and/or the common bile duct (85.7%), interruption of the pancreatic duct (76.2%), abnormal pancreatic contour (33.3%), and atrophy of the distal parenchyma (9.5%) Compared to hypoattenuating pancreatic carcinomas, isoattenuating carcinomas were more often localized in the pancreatic head (100% vs. 59.2%; p < 0.001). In ROC (receiver operating characteristic) analysis, the optimal cut-off value for the size of isoattenuating carcinomas on EUS was ≤ 25 mm (AUC = 0.898). The sensitivity of EUS-FNA in confirmation of isoattenuating and hypoattenuating pancreatic cancer were 90.5% and 92.8% (p = 0.886). (4) Conclusions. Isoattenuating pancreatic head carcinoma can be revealed by indirect signs on CT and confirmed with high sensitivity by EUS-FNA.

Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis

2017 ◽  
Vol 26 (5) ◽  
pp. 1399-1405 ◽  
Author(s):  
Ajay C. Kanakamedala ◽  
Jeremy M. Burnham ◽  
Thomas R. Pfeiffer ◽  
Elmar Herbst ◽  
Marcin Kowalczuk ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Notch Depth ◽  
Rotatory Instability ◽  
Shift Analysis ◽  
Quantitative Pivot Shift ◽  
Lateral Femoral Notch ◽  
Femoral Notch

scholarly journals Pharmacological Inhibition of Myostatin Protects Against Atrophy and Weakness after ACL Tear

2016 ◽  
Vol 4 (7_suppl4) ◽  
pp. 2325967116S0013
Author(s):  
Caroline Nicole Wolfe ◽  
Jonathan P. Gumucio ◽  
Jeremy Grekin ◽  
Roger Karl Khouri ◽  
Asheesh Bedi ◽  
...  
Keyword(s):  
Acl Tear ◽  
Pharmacological Inhibition

Is Treatment of Segond Fracture Necessary With Combined Anterior Cruciate Ligament Reconstruction?

2017 ◽  
Vol 46 (4) ◽  
pp. 832-838 ◽  
Author(s):  
Heath P. Melugin ◽  
Nick R. Johnson ◽  
Isabella T. Wu ◽  
Bruce A. Levy ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Control Group ◽  
Study Group ◽  
Activity Levels ◽  
Segond Fracture ◽  
Acl Tear ◽  
Significant Difference ◽  
Ikdc Score ◽  
Grade 3

Background: There is a paucity of clinical information to guide the treatment of a combined anterior cruciate ligament (ACL) tear and Segond fracture. Purpose: To compare clinical outcomes, graft failure rates, and activity levels between patients undergoing ACL reconstruction (ACLR) with and without an untreated Segond fracture at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: This study included a group of patients with a combined ACL tear/untreated Segond fracture that was matched based on age, sex, body mass index, and graft type to a control group of patients with an ACL tear and no Segond fracture. All patients were treated with ACLR alone between the years of 2000 and 2015. The diagnosis of a Segond fracture, or bony avulsion of the anterolateral complex, was made by radiographic analysis. Data regarding the initial injury, surgical intervention, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination results, International Knee Documentation Committee (IKDC) subjective scores, and Tegner activity levels. Results: Twenty patients (16 male, 4 female) with a combined ACL tear/untreated Segond fracture with a mean age of 26.3 years (range, 13-44 years) were matched to a control group of 40 patients (32 male, 8 female) with an ACL tear and no Segond fracture with a mean age of 26.4 years (range, 13-47 years). The study group was followed for a mean of 59.1 months (range, 24-180 months) and the control group for a mean of 55.5 months (range, 24-120 months). The mean IKDC score was 86.5 (range, 54-100) for the study group compared with 93.0 (range, 54-100) for the control group ( P = .03). The graft rupture rate was 10% for both groups ( P = .97). The mean time to rupture was 33.0 months (range, 21-45 months) in the study group and 63.5 months (range, 39-88 months) in the control group ( P = .24). Patients in the study group had significantly more anteroposterior instability by preoperative Lachman testing than those in the control group (control group: 0 normal, 3 grade 1+, 37 grade 2+, 0 grade 3+; study group: 0 normal, 1 grade 1+, 10 grade 2+, 9 grade 3+; P = .0001). There was no significant difference between the 2 groups in regard to postoperative Lachman testing (control group: 35 normal, 3 grade 1+, 2 grade 2+, 0 grade 3+; study group: 17 normal, 3 grade 1+, 0 grade 2+, 0 grade 3+; P = .31). Patients in the study group had significantly more instability by preoperative pivot-shift testing than those in the control group (control group: 0 normal, 7 grade 1+, 33 grade 2+, 0 grade 3+; study group: 1 normal, 1 grade 1+, 11 grade 2+, 7 grade 3+; P = .0003). No significant difference was found between the 2 groups for postoperative pivot-shift testing (control group: 36 normal, 2 grade 1+, 2 grade 2+, 0 grade 3+; study group: 18 normal, 1 grade 1+, 1 grade 2+, 0 grade 3+; P = .61) or final Tegner activity level (median, 6). Conclusion: At midterm follow-up, patients undergoing ACLR with and without a Segond fracture had similar pivot-shift test results, graft failure rates, and activity levels. The IKDC score was statistically worse in the patients with a combined ACL tear/untreated Segond fracture, but the difference was less than the minimal clinically important difference for the IKDC score. These findings suggest that patients with a combined ACL tear/untreated Segond fracture can have comparable outcomes to patients with an ACL tear and no Segond fracture when treated with ACLR alone.

scholarly journals Secondary Signs Related to Pancreatic Adenocarcinomas on CT: Are They Really Specific Findings for Malignancies?

2021 ◽  
Author(s):  
Kanki A ◽  
Ito K ◽  
Yamamoto A ◽  
Yasokawa K ◽  
Kido A ◽  
...  
Keyword(s):  
Secondary Signs
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