European Journal of Molecular & Clinical Medicine

The purpose of this study is to Correlate the characteristic pattern of lesions
affecting posterior horn of medial meniscus in MRI with Arthroscopic findings and calculate sensitivity, specificity and accuracy in diagnosis of ramp lesions.
Methodology:It is a 2-year prospective study conducted in department of orthopedics, Rajarajeswari Medical college and Hospital, Banglore. Patients who were diagnosed with meniscal injuries were posted for arthroscopy surgery after obtaining the informed consent.
In this study we compared MRI findings with arthroscopic findings of medial meniscal ramp lesions of knee. The data is prepared and sensitivity, specificity, accuracy of MRI were calculated.
Results:A total of 112 patients of knee injuries were evaluated in which the Medial
meniscus was injured in 64.96% of cases. The MM tear with ramp lesion was present in 26(65%) cases, of which 5 (12.5%) cases had grade I tear, 8 (20%) cases had grade II tear and 13 (32.5%) cases had grade III tear. The sensitivity, specificity, PPV and NPV were calculated and we found Sensitivity 88.89%, Specificity 84.62%, Positive predictive value 92.31%, Negative predictive value 78.57%, Accuracy 87.50%.
Conclusions:The Meniscal Ramp lesions need to evaluation of the knee injuries accurately
is very crucial for the proper management and outcome. MRI shows moderate sensitivity, specificity and accuracy in the diagnosis of ramp lesions in posterior horn of medial meniscus with more false positives and false negative values. Common causes of false positive findings in MRI is due to misinterpretation of intra meniscal signal changes (grade II signal changes) or normal anatomy as tears. The arthroscopic evaluation of ramp lesions was done using a postero-medial and trans-notch view and other accessory portals.

Background: Complete evaluation of knee injury includes a detailed history, thorough clinical examination, radiological evaluation, and arthroscopic examination.  Present study was aimed to study correlation between MRI and arthroscopic findings in anterior cruciate ligament and meniscal injuries of the knee joint at a tertiary hospital.
Material and Methods: Present study was hospital based, prospective, comparative, observational study, conducted in ppatients admitted to the hospital with traumatic knee injury, underwent MRI knee followed by arthroscopy.
Results: During study period 60 patients of knee injury underwent MRI knee followed by arthroscopy considered for study. Majority were male (86.67 %), from 20-29 years age group (60 %), had injury dure to motor vehicle accident (43.33 %) & sports related activity (35 %). We compared injuries to ACL, PCL medial meniscus & lateral meniscus mentioned during MRI study with respect to knee arthroscopy using knee arthroscopy as diagnostic gold standard. In cases of ACL tear, MRI had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) & accuracy values as 86.66 %, 73.33 %, 90.69 %, 64.70 % & 83.33 % respectively. In cases of PCL tear, MRI had sensitivity, specificity, PPV, NPV & accuracy values as 86.36 %, 89.47 %, 82.60 %, 91.89 % & 88.33 % respectively. In cases of Medial meniscus tear, MRI had sensitivity, specificity, PPV, NPV & accuracy values as 86.11 %, 87.5 %, 91.17 %, 80.76 % & 86.66 % respectively. In cases of lateral meniscus tear, MRI had sensitivity, specificity, PPV, NPV & accuracy values as 83.33 %, 88.09 % & 75 %, 92.5 % & 86.66 % respectively.
Conclusion: MRI is an excellent, non-invasive, radiation free imaging modality with multiplanar capabilities and excellent soft tissue delineation

Background: The knee joint is the most commonly injured of all joints and the anterior cruciate ligament (ACL) is the most commonly injured ligament. Anatomical graft placement is one of the major challenges in ACL reconstruction. Three-dimensional (3D) reconstruction of computed tomography (CT) images is currently the best method to determine whether the ACL tunnel and graft is positioned correctly. This study was done to calculate parameters of femoral tunnel in terms of femoral tunnel diameter, femoral tunnel length, femoral tunnel position based on Bernard and Hertel grid (Quadrant method) and the angle between a line drawn along the femur diaphysis and the femoral tunnel (femoral tunnel-femur diaphyseal angle/coronal angle/coronal obliquity) and to compare the results of femoral tunnel parameters measured with current literature.
Aims and Objectives: To Evaluate the Femoral Tunnel After Arthroscopic Anterior Cruciate Ligament Reconstruction.
Materials and Methods: This is an observational cross-sectional study conducted in the Department of Orthopaedics, H.B.T. medical college and Dr. R.N. Cooper municipal general hospital, Mumbai, on 39 patients of age group of 19-52 year who underwent arthroscopic ACL reconstruction over a period of 1 year.
Results: Most of patients had femoral tunnel diameter between 7.5-8.5 mm and length of 3-4 cm and femoral tunnel-femur diaphyseal angle of 30-40 degree. Most patients had position of femoral tunnel along high to low axis of 28-34% and position of femoral tunnel along deep to shallow axis of >27%. Femoral tunnel position along high to low axis and deep to shallow axis warren anatomical.
Conclusion: Low percent of ACL reconstruction were in recommended anatomical position. CT scan is a very good tool to analyse tunnel position after ACL reconstruction.

Background: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia for arthroscopic knee surgeries. Hyperbaric bupivacaine, the local anaesthetic most commonly used, don’t have the advantage of prolonged analgesia. Due to the early arising post-operative pain the role of various adjuvants has been proposed and evaluated. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries. Patients and Methods: A total of 68 patients were randomly taken for this study and categorized into Group Ⅰ (nalbuphine) and Group II (fentanyl). Each group received 12.5mg of 0.5% heavy bupivacaine with 1 mg nalbuphine or 25μg fentanyl diluting it to 3 ml total volume. Sensory and motor block characteristics and time to first rescue analgesia were recorded as the primary end points. Drug‑related side effects of hypotension, bradycardia, respiratory depression, nausea, vomiting, shivering, urinary retention and pruritus were recorded as the secondary outcomes.
Results: Sensory and motor blockade and time for peak sensory level was earlier in group I as compared to group II. Mean time for 2 segments regression in Group I was prolonged as compared to group Ⅱ. Duration of motor block in Group I [241.471± 12.464 min]was significantly prolonged compared to Group II [179.265± 6.868 min] with (p=0.000). Sensory level at L4 in Group I was 406.618± 17.953 min and in Group II was 228.235± 8.694 min with (p=0.000). Rescue analgesia time in Group I [401.471±16.946 min] was significantly prolonged as compared to Group II [220.000±11.282 min] with (p=0.000). The adverse events in group I are lesser as compared to group II and was statistically significant.
Conclusion: Nalbuphine is a better adjuvant than fentanyl in spinal anesthesia for prolonging post-operative analgesia.

Background: MR examination, a non-invasive modality, is now routinely used to assess
a wide spectrum of internal knee derangements and articular disorders. The present
study was conducted to assessed the efficacy of MRI in evaluation of knee joint
pathologies.
Materials & Methods: 70 patients with painful knee joint of both gendersunderwent
MRI of knee joint with 1.5 Tesla high gradient MRI scanner. T1 and T2 weighted
sequences in sagittal planes, PD weighted sequences in axial, coronal and sagittal planes
and fat suppressed T2 or STIR sequences were recorded.
Results: Out of 70 patients, males were 45 and females were 25. Common knee
pathologies were anterior cruciate ligament tear in 12, posterior cruciate ligament tear
in 8, chondromalacia patellae in 5, rheumatoid arthritis in 7, medial collateral ligament
tears in 10, lateral collateral ligament tears in 8, medial meniscal tears in 5, lateral
meniscal tears in 5, osteochondritis dissecans in 6 and infection in 4 patients. The
difference was significant (P< 0.05).
Conclusion: MRI is an accurate and cost- effective radiographic aid useful in diagnosis
of painful knee. Common knee pathologies were anterior cruciate ligament tear,
posterior cruciate ligament tear, chondromalacia patellae, rheumatoid arthritis, medial
collateral ligament tears, lateral collateral ligament tears, medial meniscal tears, lateral
meniscal tears, osteochondritis dissecans and infection.

Background: Ligamentous injuries to the ligaments and menisci of the knee can lead to significant morbidity and may precipitate osteoarthritis.Arthroscopic diagnosis though invasive is considered as the gold standard. Various imaging modalities like CT scan and MRI have alsobeen used in the diagnosis of these injuries and the quest for the best technique goes on.
Aim: The aim of this study is to assess the diagnostic accuracy of 1.5 T MRI in cases of ligamentous injuries of the knee joint and compare its efficacy with arthroscopy.
Materials & Methods: This is a comparative observational study which included 50 patientswho were clinically suspected to be having ligamentous injuries of the knee. MRI was done for all these patients and all of them laterunderwent arthroscopy in the Department of Orthopaedics-IMCHRC.Statistical analysis was done to derive the sensitivity, specificity, positive predictive value (PPV) and the negative predictive value (NPV) and for this the findings at arthroscopy were taken to be the true diagnosis.
Results: The patients were commonly in the age group of 21-30 years and males with RTA being the commonest mode of injury and duration of injury commonly between 6weeks to 6 months.ACL tear was the commonest injury found in 76% followed by PCL tear in 38% , MM tear in 36%, LM tear in 32%. Regarding the efficacy of 1.5T MRI for ACL tears the sensitivity was 94.6%, specificity 76.9%, PPV 92.1%, NPV 83.3% and accuracy 90%. For PCL it was 94.4%, 93.8%, 89.5%,96.8%,94% respectively. For MM it was 94.7%,100%,100%,96.9%,98% respectively and for LM 83.3%,96.9%.93.9%,91.2%,92% respectively.
Conclusion: MRI is of proven diagnostic value in the evaluation of internal ligamentous injuries of the knee joint. It has a fairly good PPV and its routine use in all clinically suspicious ligamentous injuries of the knee may be recommended. Further since MRI has a high NPV, a normal MRI scan may be used to exclude any pathology and thus avoid an expensive and invasive procedure like arthroscopy.

Background: The shoulder arthroscopy is the gold standard of reference in most of the shoulder pathologies including Rotator cuff tears. However, it is an invasive surgical procedure with associated risks of surgery and anaesthesia. The objective of the present study is to find out how accurately the rotator cuff pathologies can be diagnosed by these imaging tests.
Aims and Objectives: To compare the Ultrasonography, MRI findings with the Arthroscopic findings of Rotator cuff pathology of the shoulder.
Materials and Methods: All patients in whom the history and clinical examination is suggestive of Rotator cuff pathology were included in the study. Patients were evaluated using high resolution Ultrasound (HRUS) Philips HD-11, Germany and 1.5-Tesla MRI [1.5 Tesla, GE, Excite HD and USA]. Ultrasonographic and MRI examination is performed by a single radiologist experienced in musculoskeletal ultrasonography and MR Imaging. A Real time high resolution USG imaging and MRI of the shoulder was performed in a standardized fashion and subsequently with therapeutic or diagnostic arthroscopy on the symptomatic shoulder. Results were analyzed.
Results: Considering arthroscopy as the final gold standard of investigation, out of the 24 patients studied, five (20.8%) had rotator cuff tendinosis/tendinopathy, four (16.6%) had PT RCT, twelve (50%) had FT RCT while the remaining three (12.6%) had normal rotator cuff. The average delay between the MRI examination and arthroscopic surgery was 6 days (range 0-27 days) but in one case, it was as long as 117 days. A total of five (20.8%) patients were in the age group < 40 years while another five (20.8%) were between 40-50 years age group. A majority of eleven (45.8%) patients were between 50-60 years old while three (12.6%) were above 60 years.
Conclusion: It should be noted that following USG of the shoulder performed by a dedicated radiologist, MRI offers little additional value, with regard to the detection of rotator cuff tears.

Background: Degenerative joint disease is a common cause of knee symptoms and
disability. The purpose of the present study is to address the role of arthroscopic surgery in
patients who have degenerative joint disease in the knee.
Methods: The present study included 40 patients from August 2019 to August 2021 who
complained with knee pain in the department of Orthopaedics, IGIMS, Patna. Intra operative
grading of articular cartilage degeneration was done by method described by Noyes – Stabler.
Patient called for follow - up on 1 month, 3 months and 6 months of post-operative day in
OPD, and pain severity score was measured according to knee society pain score8 routine
physical examination of knee was done for other physical signs.
Results: Out of 40 patients in the present study, 15 were females and 25 were males.
The patients showed 65% improvement in grade 2 after 6 months, 30% patients showed
improvement in grade 3 and 5% showed improvement in grade 4 patients after 6 months.
Conclusion: Although Arthroscopy is valuable for the treatment of many knee disorders. The
efficacy of arthroscopic treatment for osteoarthritis of the knee is limited by poor natural
history of osteoarthritis.

Background: The shoulder joint is a ball and socket variety of joint with wide range of movements in multiple planes where stability is compromised for mobility. The muscles and tendons are subjected to severe strain resulting in tears. Rotator cuff disease is one of the most common causes of shoulder pain. In addition to history and physical examination, several radiological techniques have been used to detect tears of the rotator cuff. Each has limitations and no clear consensus on the optimum diagnostic study has emerged. The radiological diagnosis of rotator cuff tears has traditionally been performed with arthrography and more recently with non-invasive techniques like ultrasonography and MRI.
Aims and objectives: Evaluation of role of MRI in rotator cuff injuries, evaluation of role of high resolution ultrasound in rotator cuff injuries. Correlation of clinical and high resolution ultrasound findings with MRI findings.
Materials and Methods: In our study we took over the analysis of 32 patients with clinically suspected rotator cuff injuries were subjected to undergo USG and MRI after thorough history taking and clinical examination. USG was carried out on IU22 Philips machine using a high frequency transducer of 5-17 MHz. The rotator cuff tendons, muscles, ACJ, joint cavity and bursae were examined in various positions. Dynamic examination of shoulder were also carried out for impingement. MRI was performed on 1.5 Tesla MRI scanner, using a dedicated surface coil for shoulder.

The analysis of literature data, which made it possible to characterize the main modern stages
in the development and establishment of diagnosis and treatment of shoulder joint instability,
was carried out. The purpose of this review was to highlight the main directions in the
treatment of chronic instability of the shoulder joint and identify problematic issues requiring
further scientific research. The main results of observation of patients undergoing various
types of arthroscopic treatment are presented. The modern level of diagnostics makes it
possible to accurately determine the indications for surgical treatment. Isolation of all possible
links of pathogenesis and individual preoperative planning are the main tasks of preventing
recurrence of instability.

Purpose of current investigation was to improve the arthroscopy technique of patients with osteoarthritis of knee, by introduction of complex clinic and diagnostic algorithm. Materials and methods. The investigation was carried out on the basis of 218 patients data of the clinic of Sport traumatology department of Republican Scientific and practical medical Centre of Traumatology and Orthopedics during 2014-2018 yy. with osteoarthritis of knee of different degree (0-IV st.) by Kellgren and Lawrence classification. All patients were carried out 5 types arthroscopic operations depending on the stage o morphologic alteration, that based to development of clinic and diagnostic algorithm. Results were studied at nearest (3-6 months) and long term (6 months - year) periods. At postoperative period to patientsmedications, early rehabilitations and physiotherapy were recommended. In our data, in 96,5% were positive results. Conclusion. Arthroscopy with using of clinic and diagnostic algorithm is allowed to rise of share good results, to activate of patients and to begin of early rehabilitations at postoperative periods.