Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
MỘT SỐ PHÂN ĐỘ TỔN THƯƠNG
CƠ XƯƠNG KHỚP
CHI TRÊN VÀ CHI DƯỚI
Dr Le Duy Chung
• Shoulder
• Elbow
• Wrist and Hand
Upper extremity
Type I Type II
Type III Type IV
Type 1: flat undersurface
Type 2: curved undersurface
Type 3: hooked
Type 4: upward or sup...
flat lateral tilt low-lying
Acromion Slope
Os Acromiale
Os Acromiale
Crescentic U-shaped L-shaped
Supraspinatus Tear Shape
Partial-Thickness Tear
Bursal surface
Partial-thickness tear with
tendon thinning
Articular surface Intrasubstance
Ellman’s grade
– Grade 1: < 3mm
– Grade 2: 3-6mm, < 50% of cuff thickness
– Grade 3: > 6mm, > 50% of cuff thickness
Clin O...
Greatest dimension of tear
• Small : < 1 cm
• Medium : 1~3 cm
• Large : 3~5 cm
• Massive : > 5 cm
Full-Thickness Tear
Small: < 1cm Medium: 1-3 cm
Large: 3-5 cm Massive : >5cm
Tendon Retraction
Stage 1 Stage 2 Stage 3
Irreparable if retracted tendon edge is
medial to glenoid fossa !
Full-Thickness...
Grade 0
normal
Pfirrmann CWA et al .
Radiology 1999; 213: 709-714
Subscapularis
Tendon Tears
Grading Grade 1
cranial lesio...
Impingement : Classification
• Type 1
– Presence of subacromial bursitis
• Type 2
– Tendinosis (type 2a),
– Partial tear (...
Impingement : Classification
Goutallier classification is used for
the assessment muscle degeneration:
Grade 0: No intramuscular fat
Grade 1: Some fatt...
I II
IV
III
V
Goutallier Classification
normal atrophy
Tangent Sign
Muscle Atrophy
Oblique sagittal at medial coracoid process
Scapular Ratio
< 50%, atrophy
Current SLAP Lesion Classification with Associated
Clinical Findings and Mechanisms of Injury
I Fraying Could be incidenta...
I Fraying
II Tear
III Bucket handle tear
IV Biceps tendon
V Bankart Fraying
VI Flap
VII MGHL
VIII Posterior
IX AnteriorPos...
SLAP lesion
Smith et al. Radiology 201:251–256
Eur Radiol. 2006 Feb;16(2):451-8
Superior sublabral recess : Types
Superior sublabral recess.
Drawings representing a coronal
section through the labral-
bicipital complex illustrate type I...
Zlatkin MB, et al. AJR;1988: 150: 151-158
From glenoid labrum From glenoid neck, < 1cm
From glenoid neck, > 1cm
Capsular i...
Type IIType I Type III
Zlatkin MB, et al. AJR;1988: 150: 151-158
Capsular insertion : Types
Habermyer classification of biceps
pulley lesions
J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):5-12.
Group 1
Group 4Group 3
G...
• Formation phase
• Resting phase
– No enlargement of deposit
• Resorptive phase
– Inflammation with cells resolving calci...
• Shoulder
• Elbow
• Wrist and Hand
Upper extremity
• Stage 1
– PLRI of ulna and radius
– Disruption of LUCL ± RCL & post-lat capsule
• Stage 2
– Incomplete dislocation
– Cor...
Clin Orthop Relat Res 2000(370):34-43
Elbow instability : Stages
• Shoulder
• Elbow
• Wrist and Hand
Upper extremity
Distal radioulnar joint dislocation
TFCC lesions by Palmer
I: traumatic injury
– A: central perforation
– B: ulnar avulsion ± distal ulnar fracture
– C: distal avulsion (carpal atta...
I
A
I
B
TFCC lesions by Palmer
B: ulnar avulsion ± distal ulnar
fracture
A: central perforation
I
D
I
C
TFCC lesions by Palmer
C: distal avulsion
(carpal attachment)
D: radial avulsion
± sigmoid notch fracture
• II; degenerative injury
– A: TFC complex wear
– B: A + chondromalacia (lunate or ulnar)
– C: TFCC perforation + chondrom...
IIA IIB
TFCC lesions by Palmer
A: TFC complex wear B: A + chondromalacia
(lunate or ulnar)
IIEIIDIIC
TFCC lesions by Palmer
C: TFCC perforation
+ chondromalacia
D: C + lunotriquetral
ligament perforation
E: D + ul...
extensor carpi ulnaris tendon
• Hip
• Knee
• Ankle and Foot
Lower extremity
Ficat RP, JBJS(B) 1985: 67:3-9
Stage Radiographic Appearance RN uptake
0 Normal Normal
I Normal Decrease
II Increased scle...
Osteonecrosis Staging
Association Research Circulation Osseous (ARCO)
0 Normal
I Medullar edema, joint effusion
II Necrosi...
Criteria for staging AVN
______________________________________________________________________________________
Stage
____...
Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone
Joint Surg Br 1995;77(...
% of necrotic lesion =
(A/180)x(B/180)x100
Mitchell Staging System
Acetabular labral lesions
Czerny classification
Stage 0
Homogeneous low SI, triangular shape, continuous attachment
to lat...
• Hip
• Knee
• Ankle and Foot
Lower extremity
Medial patellar plica
Sakakibara Arthroscopic Classification
Type A: cordlike elevation
in synovial wall
Type B: shelflike...
Suprapatellar plica
Zidorn classification
Type I (septum completum)
suprapatellar bursa and
knee joint are
completely sepa...
Outerbridge Classification
Grade 0: intact cartilage with normal signal and uniform
thickness
Grade 1 : thickening with ab...
Cartilage lesions
Outerbridge and Yulish Classification
Yulish BS, Montanez J, Goodfellow DB, Bryan PJ, Mulopulos GP, Modi...
Grade I inhomogeneous signal intensity on
high-spatial-resolution GRE images
grade IIa cartilage defects: less than half o...
Classification of ACL
according to Barry et al.
Type 0: an intact ligament.
Type I to type V describe different ligamentou...
Copyright ©Radiological Society of North America, 2000
Recondo, J. A. et al. Radiographics 2000;20:S91-S102
Lateral collat...
Stage I stable lesion in continuity with the host
bone, covered by intact cartilage
Stage II partial discontinuity of the ...
• Grade I: minimal disruption at M-T junction
• Grade II: partial tear with intact M-T fibers present
• Grade IIIA: comple...
Types of tibial spine avulsions
Mayer and Mc Keevers classification
Types of tibial tuberosity avulsions
Christie MJ, Dvonch VM. Tibial tuberosity avulsion fracture in adolescents. J Pediatr...
Tibial tuberosity fractures
Watson-Jones classification
Type I
A small fragment, displaced superiorly
Type II
A larger fra...
• Hip
• Knee
• Ankle and Foot
Lower extremity
Osteochondral Lesion of the Talus
MRI Classification
Stage I Subchondral trabecular compression.
Plain raidiograph normal,...
Stage IIA Formation of subchondral cyst.
Stage I Subchondral trabecular compression. Marrow edema on MRI
Stage IIB
Incomplete
separation of
fragment.
Stage III Unattached, undisplaced
fragment with presence of synovial fluid
around fragment.
Stage IV
Displaced fragment
Achilles tendon ruptures
A four-stage classification system has been developed to grade
Achilles tendon ruptures
• Type 1:...
Focal complete tear of Achilles tendon
with less than 3cm of retraction
Partial Achilles tendon tear
Type 3: complete rupture of Achilles
tendon with a tendinous gap of 3 to 6cm
Type 4: complete rupture of Achilles tendon with a defect greater than 6cm
Partial overlap
of torn Achilles
tendon ends
Symptomatic Type II
Accessory Navicular Bone
• Type I : Os tibiale externum
Sesamoid bone
No cartilage connection with
nav...
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Phân độ tổn thương cơ xương khớp các chi
Nächste SlideShare
Wird geladen in …5
×

Phân độ tổn thương cơ xương khớp các chi

5.885 Aufrufe

Veröffentlicht am

Veröffentlicht in: Gesundheit & Medizin, Technologie
  • Hi there! I just wanted to share a list of sites that helped me a lot during my studies: .................................................................................................................................... www.EssayWrite.best - Write an essay .................................................................................................................................... www.LitReview.xyz - Summary of books .................................................................................................................................... www.Coursework.best - Online coursework .................................................................................................................................... www.Dissertations.me - proquest dissertations .................................................................................................................................... www.ReMovie.club - Movies reviews .................................................................................................................................... www.WebSlides.vip - Best powerpoint presentations .................................................................................................................................... www.WritePaper.info - Write a research paper .................................................................................................................................... www.EddyHelp.com - Homework help online .................................................................................................................................... www.MyResumeHelp.net - Professional resume writing service .................................................................................................................................. www.HelpWriting.net - Help with writing any papers ......................................................................................................................................... Save so as not to lose
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Follow the link, new dating source: ❤❤❤ http://bit.ly/2F7hN3u ❤❤❤
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • Dating for everyone is here: ❤❤❤ http://bit.ly/2F7hN3u ❤❤❤
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Phân độ tổn thương cơ xương khớp các chi

  1. 1. MỘT SỐ PHÂN ĐỘ TỔN THƯƠNG CƠ XƯƠNG KHỚP CHI TRÊN VÀ CHI DƯỚI Dr Le Duy Chung
  2. 2. • Shoulder • Elbow • Wrist and Hand Upper extremity
  3. 3. Type I Type II Type III Type IV Type 1: flat undersurface Type 2: curved undersurface Type 3: hooked Type 4: upward or superior convexity of inferior border Contemp Orthop. 1995 Mar;30(3):227-9. Acromion Shape
  4. 4. flat lateral tilt low-lying Acromion Slope
  5. 5. Os Acromiale
  6. 6. Os Acromiale
  7. 7. Crescentic U-shaped L-shaped Supraspinatus Tear Shape
  8. 8. Partial-Thickness Tear Bursal surface Partial-thickness tear with tendon thinning Articular surface Intrasubstance
  9. 9. Ellman’s grade – Grade 1: < 3mm – Grade 2: 3-6mm, < 50% of cuff thickness – Grade 3: > 6mm, > 50% of cuff thickness Clin Orthop Relat Res. 1990 May;(254):64-74. Partial-Thickness Tear : Depth
  10. 10. Greatest dimension of tear • Small : < 1 cm • Medium : 1~3 cm • Large : 3~5 cm • Massive : > 5 cm Full-Thickness Tear
  11. 11. Small: < 1cm Medium: 1-3 cm Large: 3-5 cm Massive : >5cm
  12. 12. Tendon Retraction Stage 1 Stage 2 Stage 3 Irreparable if retracted tendon edge is medial to glenoid fossa ! Full-Thickness Tear
  13. 13. Grade 0 normal Pfirrmann CWA et al . Radiology 1999; 213: 709-714 Subscapularis Tendon Tears Grading Grade 1 cranial lesion Grade 2 cranial three- quarters tears Grade 3 complete tear
  14. 14. Impingement : Classification • Type 1 – Presence of subacromial bursitis • Type 2 – Tendinosis (type 2a), – Partial tear (type 2b) • Type 3 – Complete tear of RC AJR Am J Roentgenol. 1988 Feb;150(2):343-7.
  15. 15. Impingement : Classification
  16. 16. Goutallier classification is used for the assessment muscle degeneration: Grade 0: No intramuscular fat Grade 1: Some fatty streaks Grade 2: Fat is evident but less fat than muscle tissue Grade 3: Fat equals muscle tissue Grade 4: More fat is present than muscle tissue References Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;78-83 Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999; 8(6):599-605 Goutallier Classification
  17. 17. I II IV III V Goutallier Classification
  18. 18. normal atrophy Tangent Sign Muscle Atrophy Oblique sagittal at medial coracoid process Scapular Ratio < 50%, atrophy
  19. 19. Current SLAP Lesion Classification with Associated Clinical Findings and Mechanisms of Injury I Fraying Could be incidental finding; more significant in young people involved in overhead activities II Tear with biceps extension Most common type; association with acute traction, repetitive overhead motion, and microinstability; could be associated with type IV III Bucket-handle tear with intact biceps Less severe than type IV; association with fall on outstretched arm IV Bucket-handle tear with biceps extension More severe than type III because of biceps extension; could be associated with type II; association with fall on outstretched arm. V Not specified Either a Bankart lesion with superior extension or a SLAP lesion with anterior inferior extension VI Anterior or posterior flap tear Probably represents type IV or less likely type III with tear of the bucket-handle component VII Not specified Type of middle glenohumeral ligament extension (avulsion or split) not specified; association with acute trauma with anterior dislocation VIII Not specified Similar to type IIB but with more extensive abnormalities; association with acute trauma with posterior dislocation IX Not specified Global labrum abnormality; probably traumatic event X Not specified +Rotator interval extension; articular side abnormalities
  20. 20. I Fraying II Tear III Bucket handle tear IV Biceps tendon V Bankart Fraying VI Flap VII MGHL VIII Posterior IX AnteriorPosterior X RCI SLAP lesion
  21. 21. SLAP lesion
  22. 22. Smith et al. Radiology 201:251–256 Eur Radiol. 2006 Feb;16(2):451-8 Superior sublabral recess : Types
  23. 23. Superior sublabral recess. Drawings representing a coronal section through the labral- bicipital complex illustrate type I (1), type II (2), and type III (3) labral attachments. In type I, the labrum (L) is tightly attached to the glenoid, whereas in types II and III, a recess is present between the labrum and glenoid (arrow). B = biceps tendon, C = cartilage. De Maeseneer, M. et al. Radiographics 2000;20:67-81S Superior sublabral recess : Types
  24. 24. Zlatkin MB, et al. AJR;1988: 150: 151-158 From glenoid labrum From glenoid neck, < 1cm From glenoid neck, > 1cm Capsular insertion : Types
  25. 25. Type IIType I Type III Zlatkin MB, et al. AJR;1988: 150: 151-158 Capsular insertion : Types
  26. 26. Habermyer classification of biceps pulley lesions J Shoulder Elbow Surg. 2004 Jan-Feb;13(1):5-12. Group 1 Group 4Group 3 Group 2
  27. 27. • Formation phase • Resting phase – No enlargement of deposit • Resorptive phase – Inflammation with cells resolving calcium • Post-calcific phase – Reconstruction of tendon integrity Calcific tendinitis : Stages
  28. 28. • Shoulder • Elbow • Wrist and Hand Upper extremity
  29. 29. • Stage 1 – PLRI of ulna and radius – Disruption of LUCL ± RCL & post-lat capsule • Stage 2 – Incomplete dislocation – Coronoid appears perched on the trochlea – Lateral ligaments and capsular disruption • Stage 3 – complete posterior dislocation – 3A: only posterior bundle of MCL disruption – 3B: anterior bundle of MCL disruption Clin Orthop Relat Res 2000(370):34-43 Elbow instability : Stages (posterolateral rotatory instability PLRI)
  30. 30. Clin Orthop Relat Res 2000(370):34-43 Elbow instability : Stages
  31. 31. • Shoulder • Elbow • Wrist and Hand Upper extremity
  32. 32. Distal radioulnar joint dislocation
  33. 33. TFCC lesions by Palmer
  34. 34. I: traumatic injury – A: central perforation – B: ulnar avulsion ± distal ulnar fracture – C: distal avulsion (carpal attachment) – D: radial avulsion ± sigmoid notch fracture TFCC lesions by Palmer
  35. 35. I A I B TFCC lesions by Palmer B: ulnar avulsion ± distal ulnar fracture A: central perforation
  36. 36. I D I C TFCC lesions by Palmer C: distal avulsion (carpal attachment) D: radial avulsion ± sigmoid notch fracture
  37. 37. • II; degenerative injury – A: TFC complex wear – B: A + chondromalacia (lunate or ulnar) – C: TFCC perforation + chondromalacia – D: C + lunotriquetral ligament perforation – E: D + ulnocarpal osteoarthritis TFCC lesions by Palmer
  38. 38. IIA IIB TFCC lesions by Palmer A: TFC complex wear B: A + chondromalacia (lunate or ulnar)
  39. 39. IIEIIDIIC TFCC lesions by Palmer C: TFCC perforation + chondromalacia D: C + lunotriquetral ligament perforation E: D + ulnocarpal osteoarthritis
  40. 40. extensor carpi ulnaris tendon
  41. 41. • Hip • Knee • Ankle and Foot Lower extremity
  42. 42. Ficat RP, JBJS(B) 1985: 67:3-9 Stage Radiographic Appearance RN uptake 0 Normal Normal I Normal Decrease II Increased sclerosis Increased IIIa Increased sclerosis, subchondral fracture without collapse Increased IIIb Increased sclerosis, subchondral fracture with collapse Increased IV Increased sclerosis, subchondral fracture with collapse and secondary osteoarthritis Increased Osteonecrosis Staging Ficat stages
  43. 43. Osteonecrosis Staging Association Research Circulation Osseous (ARCO) 0 Normal I Medullar edema, joint effusion II Necrosis, demarcation III Microfracture IV Flattening head V Joint space narrowing, acetabular VI Joint destruction
  44. 44. Criteria for staging AVN ______________________________________________________________________________________ Stage ______________________________________________________________________________________ 0 Normal or non-diagnostic radiograph, bone scan and MRI I* Normal radiograph, abnormal bone scan and/or MRI II* Abnormal radiograph showing `cystic' and sclerotic changes in the femoral head III* Subchondral collapse producing a crescent sign IV* Flattening of the femoral head V* Joint narrowing with or without acetabular involvement VI Advanced degenerative changes ______________________________________________________________________________________  Quantification of extent of involvement by AVN __________________________________________________________________________________________ Stage Grade __________________________________________________________________________________________ I and II A, mild <15% of head involvement as seen on radiograph or MRI B, moderate 15% to 30% C, severe >30% III A, mild subchondral collapse (crescent) beneath <15% of articular surface B, moderate crescent beneath 15% to 30% C, severe crescent beneath >30% IV A, mild <15% of surface has collapsed and depression is <2 mm B, moderate 15% to 30% collapsed or 2 to 4 mm depression C, severe >30% collapsed or >4 mm depression V A, B or C average of femoral head involvement, as determined in stage IV, and estimated acetabular involvement __________________________________________________________________________________________ Steinberg ME et al. JBJS(B) 1995: 77 (1);34-41 Steinberg Staging
  45. 45. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1995;77(1):34–41 RadioGraphics 2007;27:1005-1021 Osteonecrosis staging University of Pennsylvania System for Staging Avascular Necrosis of the Hip Stage Imaging Criteria 0 Normal or nondiagnostic radiographs, bone scans, and MR images I Normal radiographs, abnormal bone scans and MR images II Abnormal radiograph showing cystic and sclerotic changes in the femoral head III Subchondral collapse producing a crescent sign IV Flattening of the femoral head V Join narrowing with or without acetabular involvement VI Advanced degenerative changes
  46. 46. % of necrotic lesion = (A/180)x(B/180)x100
  47. 47. Mitchell Staging System
  48. 48. Acetabular labral lesions Czerny classification Stage 0 Homogeneous low SI, triangular shape, continuous attachment to lateral margin of acetabulum without notch or sulcus (normal) 1A Area of increased SI within the center of triangular shaped labrum 1B 1A + thickened labrum, no labral recess 2A Extension of contrast material into labrum without detachment from acetabulum. Triangular shape and labral recess is present 2B 2A + thickened labrum, no labral recess 3A Detached labrum from acetabulum. Triangular shape and labral recess is present 3B 3A + thickened labrum, no labral recess Czerny C, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996;200:225-230
  49. 49. • Hip • Knee • Ankle and Foot Lower extremity
  50. 50. Medial patellar plica Sakakibara Arthroscopic Classification Type A: cordlike elevation in synovial wall Type B: shelflike appearance but not cover anterior surface of medial femoral condyle Type C: large with shelflike appearance and cover anterior surface of medial femoral condyle Type D: central defect (fenestrated plica) Basis of size AJR 2001; 177:221-227 Sakakibara J. Arthroscopic study on Iino's band. Nippon Seikeigeka Gakkai Zasshi 1976;50:513 -522
  51. 51. Suprapatellar plica Zidorn classification Type I (septum completum) suprapatellar bursa and knee joint are completely separated by septum Type II (septum perforatum) one or more openings of varying size in septum Type III (septum residuale) remaining fold, usually in medial location Type IV (septum extinctum) completely involuted septum
  52. 52. Outerbridge Classification Grade 0: intact cartilage with normal signal and uniform thickness Grade 1 : thickening with abnormal signal Grade 2 : superficial ulceration or fissuring Grade 3 : deep ulceration or fissuring Grade 4 : full-thickness chondral injury with bruising of subchondral bone Grade 5 : osteochondral injury with separation of osteochondral fragment
  53. 53. Cartilage lesions Outerbridge and Yulish Classification Yulish BS, Montanez J, Goodfellow DB, Bryan PJ, Mulopulos GP, Modic T. Chondromalacia patellae: assessment with MR imaging. Radiology 1987;156:763-766 Arthroscopic (Outerbridge) classification MR (Yulish) classification Grade 0 Normal Grade 0 Normal Grade 1 Softening, without morphologic defect Grade 1 Normal contour ± abnormal signal Grade 2 Superficial blistering or fraying: erosion or ulceration of <50% Grade 2 Superficial fraying: erosion or ulceration of < 50% Grade 3 Partial-thickness defect of > 50%, but <100% Grade 3 Partial-thickness defect of > 50%, but <100% Grade 4 Ulceration and bone exposure Grade 4 Full-thckness cartilage loss
  54. 54. Grade I inhomogeneous signal intensity on high-spatial-resolution GRE images grade IIa cartilage defects: less than half of articular cartilage thickness grade IIb cartilage defects: more than half of cartilage but less than full thickness grade III cartilage defects exposing bone Cartilage Lesions Noyes and Stabler Classification (Modified for MR imaging by Recht et al)
  55. 55. Classification of ACL according to Barry et al. Type 0: an intact ligament. Type I to type V describe different ligamentous ruptures. Type I: a swollen ligament with increased signal in T2, an intraligamentous rupture Type II: a horizontally orientated ligament Type III: non visualization of a ligament Type IV: interruption of a ligament Type V: a vertically orientated ligament. M. Munshi, M. Davidson, P.B. MacDonald, W. Froese and K. Sutherland, The efficacy of magnetic resonance imaging in acute knee injuries, Clin J Sport Med 2000;10:34-39
  56. 56. Copyright ©Radiological Society of North America, 2000 Recondo, J. A. et al. Radiographics 2000;20:S91-S102 Lateral collateral ligament tears Avulsion fracture Complete tear Partial tear
  57. 57. Stage I stable lesion in continuity with the host bone, covered by intact cartilage Stage II partial discontinuity of the lesion, stable on probing Stage III complete discontinuity of the "dead in situ" lesion, but fragment not dislocated Stage IV dislocated fragment AJR 2003; 180:641-645 International Cartilage Repair Society. ICRS cartilage injury evaluation package. Available at: http://www.cartilage.org/evaluation_package/ICRS_evaluation.pdf. Accessed December 23, 2002 Osteochondritis dissecans International Cartilage Repair Society classification at surgery
  58. 58. • Grade I: minimal disruption at M-T junction • Grade II: partial tear with intact M-T fibers present • Grade IIIA: complete rupture of M-T unit • Grade IIIB: avulsion fracture at tendon origin or insertion Tuit MJ, DeSmet AA. MRI of selected ports injuries: muscle tears, groin pain, and osteochondritis dissecans. Semin Ultrasound CT MR 1994;15:318-340 Muscle strain
  59. 59. Types of tibial spine avulsions Mayer and Mc Keevers classification
  60. 60. Types of tibial tuberosity avulsions Christie MJ, Dvonch VM. Tibial tuberosity avulsion fracture in adolescents. J Pediatr Orthop 1981; 1:391-394 Radiographics. 1999;19:655-672
  61. 61. Tibial tuberosity fractures Watson-Jones classification Type I A small fragment, displaced superiorly Type II A larger fragment involving the secondary center of ossification and proximal tibial epiphysis Type III A fracture that passes proximally and posteriorly across the epiphyseal plate and proximal articular surface of tibia (S-H type III) Type I Type II Type III
  62. 62. • Hip • Knee • Ankle and Foot Lower extremity
  63. 63. Osteochondral Lesion of the Talus MRI Classification Stage I Subchondral trabecular compression. Plain raidiograph normal, positive bone scan Marrow edema on MRI Stage IIA Formation of subchondral cyst. Stage IIB Incomplete separation of fragment. Stage III Unattached, undisplaced fragment with presence of synovial fluid around fragment. Stage IV Displaced fragment. Anderson IF et al. JBJS(A) 1989; 71:1143
  64. 64. Stage IIA Formation of subchondral cyst. Stage I Subchondral trabecular compression. Marrow edema on MRI
  65. 65. Stage IIB Incomplete separation of fragment.
  66. 66. Stage III Unattached, undisplaced fragment with presence of synovial fluid around fragment.
  67. 67. Stage IV Displaced fragment
  68. 68. Achilles tendon ruptures A four-stage classification system has been developed to grade Achilles tendon ruptures • Type 1: Partial ruptures affecting 50% or less of the tendon • Type 2: Complete ruptures with a tendinous gap of 3cm or less • Type 3: Complete ruptures with a tendinous gap of 3 to 6cm • Type 4: Complete tendon ruptures with a defect greater than 6cm Type 4 is associated with neglected ruptures.
  69. 69. Focal complete tear of Achilles tendon with less than 3cm of retraction Partial Achilles tendon tear
  70. 70. Type 3: complete rupture of Achilles tendon with a tendinous gap of 3 to 6cm
  71. 71. Type 4: complete rupture of Achilles tendon with a defect greater than 6cm Partial overlap of torn Achilles tendon ends
  72. 72. Symptomatic Type II Accessory Navicular Bone • Type I : Os tibiale externum Sesamoid bone No cartilage connection with navicular tuberosity • Type II accessory navicular Triangular or heart-shaped accessory ossification center of navicular tuberosity Connected to navicular by 1-2 mm fibrocartilage or hyaline cartilage Most commonly symptomatic • Type III : cornuated navicular Osseous fusion of accessory navicular Australasian Radiol 2004; 48:267

×