Browsing by Author "Luderowski, Eva"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
Item A new, MRI-based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and Mckeever(2019) Green, Daniel; Tuca, María; Luderowski, Eva; Gausden, Elizabeth; Goodbody, Christine; Konin, GabriellePurpose Tibial spine fractures (TSFs) are graded according to the Meyers and McKever (MM) classification system, which is based on a qualitative evaluation of plain radiographs. However, although MRI images can provide important information about these fractures, there is no MRI-based classification system. This study aims to (1) establish the intra- and inter-rater reliability of the MM system for use with radiographs, (2) propose a quantitative, MRI-based system and compare its reliability to the MM system, and (3) assess how often using the MRI-based system changes the classification and potential treatment plan as previously determined using MM. Methods The MRI-based system was designed with three grades based on quantitative displacement patterns of the fractured fragment and tissue entrapment. Four raters from a tertiary care center evaluated 20 fractures according to the MM and MRIbased systems. Observers graded images at two time points at least 2 weeks apart, after which we compared the intra- and inter-rater reliability of each system (using Fleiss’ kappa and weighted kappa, respectively) and assessed how often using the MRI-based system changed the fracture grade. Results Both the MM and MRI-based systems exhibit fair to moderate intra- and inter-rater reliability (average kappa values ranged from 0.38 to 0.66). Use of the MRI-based system changed the fracture grade and as a result modified the treatment recommendations in 32.5% of cases: 6.9% were previously unnoticed fractures, 13.1% underwent a raise in grade, and 12.5% were graded as lower than before. Conclusion The MRI-based system is as reliable as the MM system and provides specific, quantitative criteria for classifying fractures according to fragment displacement and tissue entrapment. The new MRI-based system potentially clarifies treatment indications for TSFs. Level of evidence Diagnostic Study, Level II.Item Juvenile Osteochondritis Dissecans of the Trochlea: A Cohort Study of 34 Trochlear Lesions Associated With Sporting Activities that Load the Patellofemoral Joint(2018) Price, Meghan J.; Tuca, María; Nguyen, Joseph; Silberman, Jason; Luderowski, Eva; Uppstrom, Tyler J.; Green, Daniel W.Background: Juvenile osteochondritis dissecans (JOCD) lesions are rarely located in the trochlea and few studies have focused on the causes and outcomes of JOCD lesions in this part of the knee. The purpose of this study is to (1) evaluate the clinical characteristics and outcomes of patients who undergo surgery for JOCD in this unusual location as well as (2) assess the association between trochlear JOCD and participation in sporting activities that load the patellofemoral joint. Methods: We conducted a retrospective cohort study of 34 trochlear JOCD lesions in 30 patients. Cases that involved traumatic cartilage shear or patella instability were excluded. Preoperative and postoperative magnetic resonance images and x-rays were evaluated and demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from medical records. A case-control cohort of 102 femoral condyle lesions was used to assess the correlation between sports played and lesion location. Results: The cohort comprised 34 consecutive trochlear JOCD lesions in 30 patients (26 males, 4 females). Average age at surgery was 13.8 years (9.3 to 18.0 y). In total, 27 (90%) patients were active, and of these active patients, soccer and basketball were the most common sports played. In the case-control comparison, the correlation between playing either basketball or soccer and the presence of a trochlear JOCD lesion was statistically significant (P= 0.017). In total, 21 knees (62%) received operative treatment. Sixteen of the surgical patients underwent repair and fixation with bioabsorbable nails. The average length of clinical and radiographic follow-up was 21.1 months. All patients who underwent fixation showed radiographic and/or clinical indications of healing at most recent follow-up. Thirteen of the patients who underwent fixation were active, and all of these patients reported successful return to sports. Thirteen knees underwent nonoperative treatment, and the majority of these patients had limited follow-up. Conclusions: We report a significant association between pediatric athletes who play basketball and soccer and the development of trochlear JOCD, suggesting that repetitive loading of the patellofemoral joint may play a role in the development of JOCD lesions. Patients with trochlear JOCD lesions were likely to undergo surgery, and repair and fixation of the lesions produced good outcomes at short-term follow-up. Level of Evidence: Level III—case-control studyItem Meniscal transplant in children(Lippincott Williams & Wilkins, 2016) Tuca, María; Luderowski, Eva; Rodeo, ScottPURPOSE OF REVIEW: The purpose is to review and discuss the fundamentals, indications, surgical technique, controversies, and outcomes regarding meniscal transplantation, focusing on available evidence in pediatric populations. RECENT FINDINGS: Recent studies have confirmed meniscal allograft transplantation as an effective procedure to improve symptoms, knee function, and quality of life following meniscectomy, particularly in symptomatic young patients. Associated procedures, such as osteotomies and cartilage-related surgeries, have expanded the indications for transplantation. Most patients return to sports following meniscal transplantation, and the procedure does not preclude the potential return to high-level athletic competition. The chondroprotective effect of transplantation has not been proven and as a result the role of prophylactic transplantation remains unclear. SUMMARY: Meniscal allograft transplantation is indicated following symptomatic meniscal loss in young, active patients to relieve pain and improve knee function. The quality of the available evidence regarding meniscal transplantation is limited, and no published series to date has focused exclusively on a pediatric population. Further high-quality studies are needed to establish improved indications, timing, and outcomes in a pediatric population.Item Tibial tubercle avulsion fractures in children(2020) Franz, Pia; Luderowski, Eva; Tuca, MaríaTTAFs tend to occur in adolescents nearing skeletal maturity who engage in sports with repetitive jumping. The most popular classification system was proposed by Ogden, which defines five fracture types based on the fracture pattern and extent of fragment displacement. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Arthroscopic approaches can reveal associated soft tissue injuries, such as meniscal tears, and confirm articular reduction. The most common postoperative complication is irritation because of hardware. With proper treatment, both nonsurgical and surgical outcomes are excellent. TTAFs have high rates of union and patients typically return to sports.