ObjectiveTo compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy.MethodsA clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups (P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups.ResultsThe operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference (t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones (P<0.05), and there was no significant difference in the differences before and after operation between the two groups (P>0.05). No Popeye sign appeared during the follow-up.ConclusionThe arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.
Objective To evaluate the clinical diagnostic value of MRI at 90°at 90° flexed knee position for meniscal Ramp lesions. Methods A total of 228 patients with knee pain as the main complaint who were admitted between September 2021 and September 2023 were selected as the research subjects, of which 51 patients met the selection criteria and were enrolled in the study. There were 31 males and 20 females with an average age of 38.6 years (range, 15-67 years). Body mass index was 17.2-28.7kg/m2 (mean, 23.9 kg/m2). There were 25 cases of left knee and 36 cases of right knee. The time from injury to admission was 0.1-14.3 weeks (mean, 2.1 weeks). Preoperative MRI at fully extended (knee extension position) and 90° flexed knee positions (knee flexion position) were performed to determine the presence of irregular signs at the posterior edge of the medial meniscus, and complete fluid filling between the posterior horn of the medial meniscus (PHMM) and the capsule margin (i.e. PHMM fluid high signal). Findings obtained under arthroscopy served as the gold standard to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of MRI at knee extension and flexion positions for the two specific signs of Ramp lesions. Results Twenty-one patients (41%) were diagnosed with Ramp lesions by using arthroscopy, including 1 case of Thaunat type Ⅰ, 2 cases of type Ⅱ, 6 cases of type Ⅲ, 7 cases of type Ⅳ, and 5 cases of type Ⅴ. The positive rates of irregular signs at the posterior edge of the medial meniscus on MRI at knee extension and knee flexion positions were significantly different from the diagnosis of Ramp injury under arthroscopy (P<0.05). The sensitivity, specificity, accuracy, PPV, and NPV of MRI in the diagnosis of irregular signs were 76.1%, 60.0%, 66.7%, 57.1%, and 78.3% respectively at knee extension position, and 85.7%, 73.3%, 78.4%, 69.2%, and 88.0% respectively at knee flexion position. The positive rates of PHMM fluid high signal on MRI at knee extension and knee flexion positions were significantly different from the diagnosis of Ramp injury under arthroscopy (P<0.05). The sensitivity, specificity, accuracy, PPV, and NPV of MRI in diagnosing PHMM fluid high signal were 38.1%, 100%, 74.5%,100%, and 69.8% respectively at knee extension position, and 85.7%, 100%, 94.1%, 100%, and 90.9% respectively at knee flexion position. ConclusionMRI at 90° flexed knee position improves the diagnostic performance of the detection of medial meniscal Ramp lesions compared with MRI at fully extended position.