Ambiguous Nomenclature in Musculoskeletal Magnetic Resonance Imaging.

Introduction: Medical vocabulary that conveys different meanings to different groups of readers can lead to confusion and potential misinterpretation of diagnoses. This article reviews words used by radiologists that convey information to the orthopedic surgeon and patient that is different from what the radiologist intended. These terms include meniscal tears, ligament sprains, partial tendon tears, bone bruises, bone contusions, articular cartilage injury, disc bulges, disc herniations, and joint subluxation.

Approach to the Patient with Disproportionate Pain.

Faced with a patient who presents with unexplained disproportionate pain, a surgeon may be tempted to diagnose a low pain threshold, malingering, poor coping, anxiety, or other emotional condition. However, a variety of conditions must be ruled out before the orthopedist can prescribe watchful waiting. Computed tomography and magnetic resonance imaging can detect occult fractures, acute spinal conditions or vascular occlusions, but early on are inadequate to diagnose a compartment syndrome, necrotizing fasciitis, or reflex sympathetic dystrophy (RSD).

Lawsuits After Primary and Revision Total Knee Arthroplasty: A Malpractice Claims Analysis.

Introduction: As the number of total knee arthroplasties (TKAs) increases, the number of associated complications will also increase. Our goal with this study was to identify common causes of and financial trends relating to malpractice claims filed after TKA.

Methods: We analyzed malpractice claims filed for alleged neglectful primary and revision TKA surgeries performed between 1982 and 2012 by orthopaedic surgeons insured by a large New York state malpractice carrier.

Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis.

Background: As the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs.

Methods: Analysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011.

The Contribution of Different Femur Segments to Overall Femoral Torsion.

Background: Femoral torsion is a critical parameter in hip and knee disorders. The unproven assumption is that the femoral neck exclusively contributes to the overall torsion of the femur.

Purpose/hypothesis: The aim of this study was to measure femoral torsion at different levels in patients with abnormally high or low femoral torsion and to compare the results with healthy volunteers.

Acid ceramidase treatment enhances the outcome of autologous chondrocyte implantation in a rat osteochondral defect model.

Objective: The overall aim of this study was to evaluate how supplementation of chondrocyte media with recombinant acid ceramidase (rhAC) influenced cartilage repair in a rat osteochondral defect model.

Methods: Primary chondrocytes were grown as monolayers in polystyrene culture dishes with and without rhAC (added once at the time of cell plating) for 7 days, and then seeded onto Bio-Gide® collagen scaffolds and grown for an additional 3 days. The scaffolds were then introduced into osteochondral defects created in Sprague-Dawley rat trochlea by a microdrilling procedure.

Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital.

Surgical site infections after hip and knee arthroplasty can be devastating if they lead to periprosthetic joint infection. We examined the prevalence of the modifiable risk factors for surgical site infection described by the American Academy of Orthopaedic Surgery Patient Safety Committee. Our study of 300 cases revealed that only 20% of all cases and 7% of revision cases for infection had no modifiable risk factors.

Congruous versus incongruous patellar tilt--a preliminary study.

Unlabelled: Although the presence of patellar tilt usually implies a tight lateral retinaculum and unhealthy pressure distributions within the patellar cartilage, it is possible for the bony portion of the patella to appear tilted while the articular cartilage is in fact fully congruous in a medial-lateral direction. We call this "congruous tilt." In such cases, a patient may not suffer from an excessive lateral pressure phenomenon, despite the presence of tilt.

The intra- and inter-observer reliability of the physical examination methods used to assess patients with patellofemoral joint instability.

Background: An accurate physical examination of patients with patellar instability is an important aspect of the diagnosis and treatment. While previous studies have assessed the diagnostic accuracy of such physical examination tests, little has been undertaken to assess the inter- and intra-tester reliability of such techniques. The purpose of this study was to determine the inter- and intra-tester reliability of the physical examination tests used for patients with patellar instability.

The female knee: anatomic variations and the female-specific total knee design.

Unlabelled: The concept and need for a gender-specific or female-specific total knee prosthesis have generated interest and discussion in the orthopaedic community and the general public. This concept relies on the assumption of a need for such a design and the opinion that there are major anatomic differences between male and female knees. Most of the information regarding this subject has been disseminated through print and Internet advertisements, and through direct-to-patient television and magazine promotions.

The pathophysiology of patellofemoral arthritis.

Faced with a patient suffering from patellofemoral arthritis, the surgeon must determine the pathophysiology of the condition, because different causes demand different treatments. Possible causes include malalignment, patellofemoral dysplasia, patellofemoral instability, patellofemoral trauma, obesity, osteoarthritis, inflammatory arthritis, and a genetic predisposition. Arthritis secondary to malalignment, dysplasia, instability, or trauma is less likely than arthritis secondary to the other causes to progress to femorotibial arthritis.

Patellar tilt: the physical examination correlates with MR imaging.

Patella malalignment is a recognized cause of knee pain, tilt being one of its more common forms. Although patellar tilt has been described both on the physical examination and on computerized imaging, to date the correlation between the two has not been established. A strong correlation would strengthen the value of each.

Men and women have similar Q angles: a clinical and trigonometric evaluation.

The Q angle is an important determinant of patellar tracking, though its clinical relevance is debatable. One controversy centres around any possible differences in its value between men and women. The accepted, though unproven explanation, for the greater Q angle in women is that a woman has a wider pelvis.

Patellar nomenclature: the Tower of Babel revisited.

Because we communicate mainly through words, it is important that terms be understood in the same manner by all readers. Unfortunately, the study of the patellofemoral joint is complicated by the use of expressions that hold different meanings for different readers. Ideally, the community of musculoskeletal physicians should agree on a single definition of terms, but until then, authors and speakers should define their terms clearly.