Non-invasive evaluation of Achilles tendon and its enthesis using ultrashort echo time adiabatic T (UTE-Adiab-T) magnetic resonance imaging (MRI) in psoriatic arthritis.

Purpose: This cross-sectional study investigates the utility of the quantitative ultrashort echo time (UTE) adiabatic T (UTE-Adiab-T) magnetic resonance imaging (MRI) in detecting potential differences in Achilles tendons and entheses of patients with psoriatic arthritis disease (PsA) compared with asymptomatic volunteers.

Material And Method: The Achilles tendons of forty-four PsA patients (59 ± 15 years old, 38 % female) and thirty-seven asymptomatic volunteers (32 ± 10 years old, 51 % female) were scanned on a 3 T clinical scanner in the sagittal plane using a 3-inch surface coil. The 3D UTE-Adiab-T sequences with fat saturation (FS) were used to measure UTE-Adiab-T.

Deep Convolutional Neural Network for Dedicated Regions-of-Interest Based Multi-Parameter Quantitative Ultrashort Echo Time (UTE) Magnetic Resonance Imaging of the Knee Joint.

We proposed an end-to-end deep learning convolutional neural network (DCNN) for region-of-interest based multi-parameter quantification (RMQ-Net) to accelerate quantitative ultrashort echo time (UTE) MRI of the knee joint with automatic multi-tissue segmentation and relaxometry mapping. The study involved UTE-based T1 (UTE-T1) and Adiabatic T1ρ (UTE-AdiabT1ρ) mapping of the knee joint of 65 human subjects, including 20 normal controls, 29 with doubtful-minimal osteoarthritis (OA), and 16 with moderate-severe OA. Comparison studies were performed on UTE-T1 and UTE-AdiabT1ρ measurements using 100%, 43%, 26%, and 18% UTE MRI data as the inputs and the effects on the prediction quality of the RMQ-Net.

Periarticular blast wounds without fracture a prospective case series.

Background: During the wars in Afghanistan and Iraq most injuries to service members involved the musculoskeletal system. These wounds often occurred around joints, and in some cases result in traumatic arthrotomy-a diagnosis that is not always clear, especially when there is no concomitant articular fracture. The aim of the present study is to evaluate the diagnosis and treatment of peri-articular blast injuries without fracture.

Decreasing lower extremity junctional and perineal injury from explosive blast with a pelvic protection system.

Objective: Lower extremity junctional injuries due to explosive blasts are among the most lethal sustained on the battlefield. To help reduce the effects of junctional and perineal trauma from this injury mechanism, a tiered Pelvic Protection System (PPS) was fielded during the war in Afghanistan.

Methods: Thirty-six patients with known PPS status who sustained traumatic above knee amputations, with and without perineal injuries, were identified from an operative amputation registry in Helmand Province, Afghanistan, spanning a 12-month period.

Ultrashort echo time adiabatic T (UTE-Adiab-T) is sensitive to human cadaveric knee joint deformation induced by mechanical loading and unloading.

Purpose: The development of ultrashort echo time (UTE) MRI sequences has led to improved imaging of tissues with short T relaxation times, such as the deep layer cartilage and meniscus. UTE combined with adiabatic T preparation (UTE-Adiab-T) is an MRI measure with low sensitivity to the magic angle effect. This study aimed to investigate the sensitivity of UTE-Adiab-T to mechanical load-induced deformations in the tibiofemoral cartilage and meniscus of human cadaveric knee joints.

Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the suprascapular nerve and brachial plexus for postoperative analgesia following ambulatory rotator cuff repair. A proof-of-concept study.

Background And Objectives: Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain following knee and foot surgery. However, it remains unknown if this analgesic technique may be used in ambulatory patients following upper extremity surgery.

Contrast-Enhanced MRI Evaluation of Bone-Patellar Tendon-Bone and Hamstring ACL Autograft Healing in Humans: A Prospective Randomized Study.

Background: Gadopentetate dimeglumine-enhanced magnetic resonance imaging (MRI), or gadolinium-enhanced MRI, was used to prospectively study the postoperative course of bone-patellar tendon-bone (BPTB) and combined semitendinosus and gracilis (STG) tendon autografts following arthroscopically assisted reconstruction of the anterior cruciate ligament (ACL) in humans. Gadopentetate dimeglumine is a contrast agent that has been shown to enhance the signal of vascularized tissue when examined by MRI.

Purpose: To prospectively determine and compare the pattern and timing of autograft revascularization following arthroscopically assisted ACL reconstruction by BPTB or STG autografts.

Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: Neuromodulation of the Femoral Nerve for Postoperative Analgesia Following Ambulatory Anterior Cruciate Ligament Reconstruction: A Proof of Concept Study.

Objectives: The purpose of this prospective proof of concept study was to investigate the feasibility of using percutaneous peripheral nerve stimulation of the femoral nerve to treat pain in the immediate postoperative period following ambulatory anterior cruciate ligament reconstruction with a patellar autograft.

Materials And Methods: Preoperatively, an electrical lead (SPRINT, SPR Therapeutics, Inc., Cleveland, OH, USA) was percutaneously implanted with ultrasound guidance anterior to the femoral nerve caudad to the inguinal crease.

An Unusual Case of an Intra-Articular Osseous Fragment Associated with a Medial Collateral Ligament Femoral Avulsion Fracture in an Adult: A Case Report.

Case: The medial collateral ligament (MCL) is the most commonly injured ligament of the knee; however, to our knowledge, avulsion fractures of the MCL resulting in an intra-articular fragment have not been reported. We present the case of a 55-year-old woman with a posterior cruciate ligament avulsion fracture and an MCL avulsion fracture with an intra-articular bony fragment.

Conclusion: Patients who sustain trauma to the knee should be carefully evaluated for ligamentous avulsion injuries.

Fusobacterium nucleatum Osteomyelitis of the Femur in a Patient with Hereditary Hemorrhagic Telangiectasia: A Case Report.

Case: Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is an often overlooked cause of orthopaedic-related infections despite a well-accepted association in the literature. We present the case of a forty-seven-year-old man with HHT who developed femoral osteomyelitis and a subsequent pathologic femoral fracture from a rare bacterial species associated with HHT.

Conclusion: Patients with HHT and extremity pain should be carefully evaluated for orthopaedic infections.

Incidence of knee sepsis after ACL reconstruction at one institution: the impact of a clinical pathway.

Background: After experiencing an unusually high incidence of knee sepsis after anterior cruciate ligament (ACL) reconstruction, we sought to (1) describe how we resolved this problem through temporary discontinuation of the procedure, formation of a multidisciplinary ACL Task Force, systematic investigation of clinical data and institutional care practices, and development and implementation of an evidence-based ACL Clinical Pathway (the Pathway); and (2) report our findings and results.

Methods: From 1999 through 2008, thirty-seven cases of knee sepsis after ACL reconstruction were recorded at our institution. In 2008 (yearly incidence, 4.

The traumatic lower extremity amputee: surgical challenges and advances in prosthetics.

The mangled lower extremity is a challenging injury to treat. Orthopaedic surgeons treating patients with these severe injuries must have a clear understanding of contemporary advantages and disadvantages of limb salvage versus amputation. It is helpful to review the acute management of mangled extremity injuries in the civilian and military populations, to be familiar with current postoperative protocols, and to recognize recent advances in prosthetic devices.

Advances in the care of battlefield orthopaedic injuries.

Musculoskeletal wounds are the most common type of injury among survivors of combat trauma. The treatment of these wounds entails many challenges. Although methods of care are evolving, significant gaps remain as knowledge of civilian trauma is extrapolated to combat injuries.

Blast injuries: mechanics and wounding patterns.

Blast and fragment injuries are the most frequently encountered wounds in modern warfare. Explosive devices have become the preferred weapon of domestic and foreign terrorists because they are relatively inexpensive to manufacture and can cause substantial casualties. Although blast injuries have traditionally been associated with the battlefield, this type of trauma is being seen more commonly today among noncombatants due to increasing worldwide terrorism.

War wounds of the foot and ankle: causes, characteristics, and initial management.

Foot and ankle trauma sustained in the Global War on Terror have unique causes and characteristics. At least one-quarter of all battle injuries involve the lower extremity. These severe lower extremity wounds require specialized early treatment.

Case report: Bowel perforation presenting as subcutaneous emphysema of the thigh.

Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical débridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema.

Orthopaedic war injuries: recent developments in treatment and research.

Musculoskeletal injury is the most common type of injury among survivors of combat trauma, and combat-related trauma is challenging for an orthopaedic surgeon to treat. Methods of treatment are evolving, but significant gaps remain as knowledge of civilian trauma is extrapolated to combat trauma.

Orthopaedic war injuries: from combat casualty care to definitive treatment: a current review of clinical advances, basic science, and research opportunities.

Musculoskeletal war wounds often involve massive injury to bone and soft tissue that differ markedly in character and extent compared with most injuries seen in civilian practice. These complex injuries have challenged orthopaedic surgeons to the limits of their treatment abilities on the battlefield, during medical evacuation, and in subsequent definitive or reconstructive treatment. Newer methodologies are being used in the treatment of these wounds to prevent so-called second hit complications, decrease complications associated with prolonged medical evacuation, reduce the incidence of infection, and restore optimal function.

Levels of medical care in the global war on terrorism.

Trauma care for military personnel injured in Iraq has become increasingly sophisticated. There are five levels, or echelons, of care, each progressively more advanced. Level I care provides immediate first aid at the front line.

Combat orthopaedics: a view from the trenches.

Approximately 70% of war wounds involve the musculoskeletal system, and military orthopaedic surgeons have assumed a pivotal role in the frontline treatment of these injuries in Iraq. Providing battlefield orthopaedic care poses special challenges; not only are many wounds unlike those encountered in civilian practice, but patients also must be triaged and treated in an austere and dangerous environment, undergo staged resuscitation and definitive surgery, and endure prolonged medical evacuation, often involving ground, helicopter, and fixed-wing transport across continents. Most orthopaedic wounds in Iraq are caused by exploding ordnance--frequently, improvised explosive devices, or IEDs.

The effects of varied joint motion and loading conditions on posterior cruciate ligament fiber length behavior.

Background: The posterior cruciate ligament has been described as being composed of 2 bands that reciprocally tighten and loosen with knee flexion, but the fiber anatomy and behavior may be more complex.

Hypothesis: The mechanical effects of defined loading conditions at discrete knee joint angles can vary significantly within the substance of the posterior cruciate ligament depending on the fiber region tested.

Study Design: Controlled laboratory study.

Musculoskeletal war wounds during Operation BRAVA in Sri Lanka.

Operation BRAVA (Blast Resuscitation and Victim Assistance) was conceived as a means of conducting humanitarian assistance, education, and training in the acute surgical management of land mine and other blast injuries. The first Operation BRAVA mission was carried out in Sri Lanka during 1998 at a time of civil war between government forces and Tamil separatists. Thirty-seven patients with orthopedic war wounds were seen during this mission because of the fighting.

Ambulatory surgery in a navy fleet hospital training set.

A series of 51 active duty patients who elected to undergo ambulatory surgery in a Navy Fleet Hospital Training Set (a modified field hospital) over a 2-year period were followed prospectively for perioperative complications. All patients were active duty personnel, ranging in grade from E1 to O5, who voluntarily gave specific informed consent to have their surgery performed in the training set. Patients were offered surgery in the training set only if attending surgeons were confident that the surgery could be done safely and with the same expected outcome as if performed in the hospital.

Blast and fragment injuries of the musculoskeletal system.

Blast and fragment injuries of the musculoskeletal system are the most frequently encountered wounds in modern warfare. Most injuries to the musculoskeletal system involve so-called secondary blast injuries in which casing fragments and other debris become flying projectiles. Nonoperative treatment of selected wounds caused by small-fragment debris has been successful but remains controversial.