| 1. |
- Askenberger, M, et al.
(författare)
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Medial Patellofemoral Ligament Injuries in Children With First-Time Lateral Patellar Dislocations: A Magnetic Resonance Imaging and Arthroscopic Study
- 2016
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 44:1, s. 152-158
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Tidskriftsartikel (refereegranskat)abstract
- A lateral patellar dislocation (LPD) is the most common knee injury in children with traumatic knee hemarthrosis. The medial patellofemoral ligament (MPFL), the important passive stabilizer against LPDs, is injured in more than 90% of cases. The MPFL injury pattern is most often defined in adults or in mixed-age populations. The injury pattern in the skeletally immature patient may be different. Purpose: To describe MPFL injuries in the skeletally immature patient by magnetic resonance imaging (MRI), and to compare the results with the injury pattern found at arthroscopic surgery. Study Design: Case series; Level of evidence, 4. Methods: This was a prospective series of patients aged 9 to 14 years with acute, first-time traumatic LPDs in whom clinical examinations, radiographs, MRI, and arthroscopic surgery were performed within 2 weeks from the index injury. The MPFL injury was divided into 3 different groups according to the location: patellar site, femoral site, or multifocal. The MPFL injury site was confirmed on MRI by soft tissue edema. The length of the MPFL injury at the patellar site was measured at arthroscopic surgery, and those ≥2 cm were defined as total ruptures. Results: A total of 74 patients (40 girls and 34 boys; mean age, 13.1 years) were included; 73 patients (99%) had an MPFL injury according to MRI and arthroscopic surgery. The MRI scans showed an isolated MPFL injury at the patellar attachment site in 44 of 74 patients (60%), a multifocal injury in 26 patients (35%), an injury at the femoral site in 3 patients (4%), and no injury in 1 patient (1%). Arthroscopic surgery disclosed an isolated MPFL injury at the patellar site in 60 of 74 patients (81%) and a multifocal injury in 13 patients (18%); the MPFL injury at the patellar site was a total rupture in 49 patients (66%). Edema at the patellar attachment site on MRI was proven to be an MPFL rupture at the same site at arthroscopic surgery in 99% of the patients. A patellar-based injury, isolated or as part of a multifocal injury, was present on MRI in 95% (n = 70) of the patients, with a false-negative rate of 5% (n = 4) of patients compared with arthroscopic surgery. Conclusion: Skeletally immature children are more prone to sustaining an MPFL injury at the patellar attachment site. Arthroscopic surgery and MRI complement each other in the investigation of MPFL injuries.
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| 2. |
- Askenberger, M, et al.
(författare)
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Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children
- 2017
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 45:1, s. 50-58
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of primary lateral patellar dislocation (LPD) in children aged 9 to 14 years is 0.6 to 1.2 per 1000. Causation is assumed to be multifactorial, including anatomic variants of the patellofemoral (PF) joint that result in a higher risk of LPD. No publication has compared the morphology of the PF joint and anatomic patellar instability risk factors (APIFs) in a primary LPD population versus controls, defining children by skeletal maturity. Purpose: To characterize the PF morphology and APIFs (trochlear dysplasia, abnormal lateral patellar tilt, elevated tibial tubercle–trochlear groove [TT-TG] distance, patella alta) through magnetic resonance imaging (MRI) measurements in skeletally immature children with and without a primary LPD and to identify (potential) distinctive differences between these 2 groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective series of 103 skeletally immature children aged 9 to 14 years with an MRI-confirmed primary LPD were matched with a control group of 69 children. The PF morphology and APIFs were assessed during a 2.5-year period with standardized MRI using sagittal and axial views. Results: In the LPD group, 79% had 2 to 4 APIFs compared with 7% in the control group. All major measurements of trochlear dysplasia were significantly different between the 2 groups. The mean central condylar height was significantly higher in the LPD group compared with the control group, resulting in a lower trochlear depth (2.3 vs 4.5 mm, respectively) and higher sulcus angle (156.7° vs 141.1°, respectively). The LPD group had significantly higher values of patellar height, Caton-Deschamps index (1.33 vs 1.15, respectively), lateral patellar tilt (21.1° vs 8.5°, respectively), and TT-TG distance (13.9 vs 9.8 mm, respectively) compared with the control group. The main divergent APIF was trochlear dysplasia (defined as trochlear depth <3 mm), seen in 74% of the LPD group compared with 4% of the control group. Elevated TT-TG distance as a single APIF was never present in the LPD group; patellar tilt was only seen in the LPD group. The most common APIF in the control group was patella alta (36%). Conclusion: There was a significant difference in mean values of all established APIFs between the children with a first-time LPD and the controls. Trochlear dysplasia was the main APIF, and together with lateral patellar tilt (≥20°), they had the strongest association with LPD.
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| 3. |
- Askenberger, M, et al.
(författare)
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Occult Intra-articular Knee Injuries in Children With Hemarthrosis
- 2014
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 42:7, s. 1600-1606
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Tidskriftsartikel (refereegranskat)abstract
- Hemarthrosis after acute knee trauma is a sign of a potentially serious knee injury. Few studies have described the epidemiology and detailed injury spectrum of acute knee injuries in a general pediatric population. Purpose: To document the current injury spectrum of acute knee injuries with hemarthrosis in children aged 9 to 14 years and to describe the distribution of sex, age at injury, type of activity, and activity frequency in this population. Study Design: Descriptive epidemiology study. Methods: All patients in the Stockholm County area aged 9 to 14 years who suffered acute knee trauma with hemarthrosis were referred to Astrid Lindgren Children’s Hospital, Karolinska University Hospital, from September 2011 to April 2012. The patients underwent clinical examination, radiography, and magnetic resonance imaging (MRI). The type of activity when injured, regular sports activity/frequency, and patient sex and age were registered. The diagnoses were classified into minor and serious injuries. Results: The study included 117 patients (47 girls and 70 boys; mean age, 13.2 years). Seventy percent had a serious knee injury. Lateral patellar dislocations, anterior cruciate ligament ruptures, and anterior tibial spine fractures were the most common injuries, with an incidence of 0.6, 0.2, and 0.1 per 1000 children, respectively. The sex distribution was equal up to age 13 years; twice as many boys were seen at the age of 14 years. The majority of injuries occurred during sports. Forty-six patients (39%) had radiographs without a bony injury but with a serious injury confirmed on MRI. Conclusion: Seventy percent of the patients aged 9 to 14 years with traumatic knee hemarthrosis had a serious intra-articular injury that needed specific medical attention. Fifty-six percent of these patients had no visible injury on plain radiographs. Physicians who treat this group of patients should consider MRI to establish the diagnosis when there is no or minimal radiographic findings. The most common serious knee injury was a lateral patellar dislocation. This should be taken into consideration to improve prevention strategies and treatment algorithms in pediatric knee injuries.
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| 4. |
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| 5. |
- Finnbogason, T., et al.
(författare)
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Anterior dynamic ultrasound and Graf's examination in neonatal hip instability
- 2008
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 49:2, s. 204-11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Discrepancy between neonatal hip morphology and stability has been reported in the literature. Comparative ultrasound studies on this issue are limited. PURPOSE: To compare neonatal hip instability, as assessed by dynamic ultrasound and clinical examination, with acetabular morphology, as assessed by Graf's method. MATERIAL AND METHODS: 536 newborn infants with clinical signs of hip instability, ambiguous findings at clinical hip examination, or positive risk factors for DDH were investigated with two ultrasound methods, the Graf method and anterior dynamic ultrasound, at an average age of 12 days. The hips were allocated to three groups according to the Graf result: A, normal (type Ia and b); B, borderline or immature (type IIa); and C, pathologic (type IIc and worse). Graf examination was compared with two diagnostic tests for instability, namely clinical examination by senior pediatric orthopedists and anterior dynamic ultrasound. RESULTS: According to Graf's method, 77% of the hips were normal, 20% borderline/immature, and 3% pathologic. On clinical hip examination, 82% were stable, 14% unstable, and 4% dislocatable. The dynamic ultrasound outcome was 88% stable hips, 10% unstable, and 2% dislocatable. Of the hips considered unstable or dislocatable on dynamic ultrasound, 21% had normal (type I) and 66% immature acetabular morphology according to the Graf method. Of the hips that were stable on dynamic ultrasound, only one (0.1%) was dysplastic according to the Graf method. Graf's examination showed the smallest number of normal hips, but also the fewest pathologic hips, with many indeterminate results that needed follow-up. CONCLUSION: Acetabular morphology correlated better to stability as assessed by dynamic ultrasound than to the clinical examination results, with fair to moderate agreement. Graf's examination resulted in a large number of indeterminate results that needed follow-up, but when used as the sole criterion for deciding treatment did not lead to a higher treatment rate than when the decision was based on clinical hip examination.
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| 6. |
- Finnbogason, T, et al.
(författare)
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Dynamic ultrasonography of the infant hip with suspected instability. A new technique
- 1997
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 38:2, s. 206-209
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: the combining of clinical examination of the infant hip with dynamic ultrasound (US) into one examination, performed by one examiner, should result in a sensitive test for hip instability. in this study a new method of dynamic US examination of the hip in newborn and very young children, that combined US with stress testing (Barlow method) was tested. Material and Methods: A specially designed examination table, with a US probeholder, enabled the radiologist to perform a stress test of the hip according to Barlow(using both hands), and simultaneously monitor it on US. Fifty-seven infants and young children were examined by this method, and compared with the Graf'method and clinical stress test. Results: Our method allowed clear visualisation of the movement of the femoral head during the stress test, and was performed easily in patients under 3–4 months of age. Conclusion: the described method is easily adapted for one examiner with experience in US and in the clinical examination of the infant hip.
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| 7. |
- Finnbogason, T., et al.
(författare)
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Neonatal hip instability : a prospective comparison of clinical examination and anterior dynamic ultrasound
- 2008
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 49:2, s. 212-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ultrasound is increasingly being used to complement the clinical examination in assessing neonatal hip instability. The clinical examination, although highly sensitive in detecting hip instability, can lead to considerable overtreatment. PURPOSE: To compare anterior dynamic ultrasound and clinical examination in the assessment of neonatal hip instability and regarding treatment rates. MATERIAL AND METHODS: 536 newborn infants (out of a population of 18,031) were selected, on the basis of a combination of risk factors, clinical signs of hip instability or ambiguous clinical findings, to undergo an anterior dynamic ultrasound examination of the hip, by a method developed by our group. This examination, performed by one out of seven experienced examiners, was compared with the standard clinical hip examination conducted by one of four pediatric orthopedic surgeons. The clinical examination was carried out both prior to and within a few hours after the ultrasound examination. RESULTS: The clinical examination diagnosed 81.7% of the hips as normal, 14.5% as unstable, and 3.8% as dislocatable or dislocated. With the dynamic ultrasound method, the corresponding figures were 87.8%, 10.4%, and 1.8%, respectively. Use of the criteria of the clinical examination resulted in treatment of 147 infants. Using the dynamic ultrasound examination as a criterion meant that 87 infants would receive treatment. The calculated treatment rate was 0.85% when based on the clinical stress test and 0.49% when based on the dynamic ultrasound. CONCLUSION: The dynamic ultrasound results reduced the treatment rate by over 40% when used as a basis for the decision regarding treatment.
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