Skeletal Radiology (2018) 47:1313 https://doi.org/10.1007/s00256-018-2990-9 Published online: 7 June 2018 ISS 2018 Bursal-sided rotator cuff tears: simple versus everted type. thickened tendon on preoperative imaging studies may prepare the surgeon for potential challenges at surgery. Kim HJ, et al. Detection of the tram track lesion in the ankle joint: com- Am J Sports Med. (2018); 46(2):441–8 paring 3.0-Tesla magnetic resonance imaging and arthroscopy. Rarely, the torn portion of a bursal-sided partial thickness rotator cuff tear (PTRCT) may become displaced medially and superi- Shim DW, et al. orly, i.e. “everted.” More common is the non-displaced “simple” bursal-sided tear. A retrospective review of 1722 arthroscopic Arthroscopy. (2018); 34(3):866–71 cuff repair surgeries identified 31 (1.8%) everted and 359 simple (20.8%) bursal-sided PTRCTs. Clinical and MR imaging follow The tram track lesion is a characteristic longitudinal trough-like up was available for 25 patients (mean age 60.8 years, 16 wom- talar cartilage defect that is caused by impingement of anterior en) with everted bursal-sided PTRCTs. These patients and 25 rim distal tibial osteophytes/spurs on the talar articular surface. A patients with simple bursal-sided PTRCTs matched for age, gen- retrospective review of 335 ankle arthroscopies found 175 pa- der, tear size, and fatty infiltration of the cuff musculature com- tients with anterior distal tibial osteophytes and correlative ankle prised the study group were studied. Visual analog scale (VAS) MRs, but no “typical” talar osteochondral lesions. The ankle pain scores, range of motion (ROM), and the UCLA and MRs were reviewed by 2 independent “musculoskeletal special- Constant shoulder scores were recorded preoperatively and at a ists” blinded to arthroscopic findings. On MR imaging, a tram mean follow up of 2.5 years and 2.8 years for everted and simple track lesion was defined as a longitudinal, fluid-filled talar carti- tears, respectively. Preoperative radiographs, pre- and postoper- lage defect visible on at least 2 consecutive images. The presence ative MR images, and operative findings were compared. of associated edema-like marrow signal, cysts, and subchondral Preoperatively, the everted PTRCTs had worse pain, worse sclerosis was also reported. In this study, as in the literature, this UCLA and Constant clinical scores along with diminished range is an uncommon injury; at arthroscopy, 16 patients (mean age of motion compared to simple tears. Radiographs showed 38.3 years, range 15–67 years; 13 men) had tram track lesions of acromial spurs for all shoulders with an everted tear, but only the talar cartilage, a 9.1% prevalence in ankles with anterior tibial 14 (56%) of those with simple tears. A “hat-shaped” acromial plafond osteophytes. Independent MR review correctly identi- spur, i.e. a spur with medial and lateral extension similar to the fied 88% (14/16), of the tram track lesions that were found at brim of a hat, was seen only with everted type tears (52%). For arthroscopy with no false positive readings. On coronal images, the everted tears, preoperative MR images showed the medially 80% (14) of lesions were in the lateral talar dome, 3 were medial everted tendon flap as a fold causing a significantly thicker ten- and 1 central. None of the lesions showed associated bone le- don stump (mean 8.1 mm) than seen with simple tears (mean sions, i.e. no marrow edema, cysts or sclerosis. The interobserver thickness 5.5 mm). At arthroscopy, 64% of the everted tears agreement for MR imaging was perfect. The tibial spurs were required more sutures than expected to repair the tendon com- radiographically apparent for all ankles. Most (10/16, 62%) had pared to 16% of the simple tears. Despite the more involved grade 3 spurs, however, there was no correlation between the size surgery for everted tears, all repaired shoulders showed similar, of the spurs and the severity of tram track cartilage damage at favorable results with significant postoperative improvement in arthroscopy. The study is limited by the small patient cohort. all measures and intact tendons by MR imaging. While everted type bursal-sided PTRCTs are unusual, recognition of the hat- Abstracted by C. S. Winalski, M.D. shaped acromial spur and the displaced tendon flap with a September 2018.
Skeletal Radiology – Springer Journals
Published: Jun 7, 2018
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