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Biomedical subjects

J Hodler

Publications and source records attributed to J Hodler.

At least 37 records · Page 2Linked to original sources
PubMed2000

Functional MR imaging of the craniocervical junction. Correlation with alar ligaments and occipito-atlantoaxial joint morphology: a study in 50 asymptomatic subjects.

PURPOSE: Whiplash injuries are frequent in industrialized countries. The acute and chronic symptoms following such injuries are incompletely understood and objective clinical or imaging findings are rare. Several authors have suspected that rear end collisions occurring when the head is rotated may result in tears of the alar ligaments. There has been experimental proof that a torn alar ligament increases the rotation of the C0/C1 and C1/C2 segments to the contralateral side. Functional cross sectional imaging has therefore been proposed to diagnose injuries of the alar ligaments. So far, published data on normal ranges of rotation in an asymptomatic population have been sparse. The aim of this study was to determine by MR imaging the normal range of rotation in the first three cervical segments and their relation to the morphology of the alar ligaments and the occipito-atlantoaxial joints. MATERIAL AND METHODS: Functional MR imaging of the craniocervical junction in maximum active left and right head rotation was performed in 50 healthy volunteers with a mean age of 29.8 years (31 men, 19 women, range 19-47 years). Measurements were independently performed by two musculoskeletal radiologists to assess interobserver error. The results were correlated with gender and age, with morphological findings in the occipito-atlantoaxial joints (i.e. joint symmetry, joint effusions, dens position), and with the form, course and symmetry of the alar ligaments. RESULTS: The mean range of rotation for the C0/C1 joint was 2.7 degrees (standard deviation [SD] 3.3 degrees)/3.3 degrees (SD 3.6 degrees) (right/left) and at the C1/C2 level 38 degrees (SD 6.5 degrees)/37.8 degrees (SD 6.4 degrees). The mean differences in left/right rotation were: C0/C1 3.5 degrees (SD 2.8 degrees) and C1/C2 6.3 degrees (SD 4.4 degrees). No correlation was found between segmental rotation and morphological characteristics of the craniocervical joints or ligament structures. CONCLUSION: There is wide variation of segmental motion in the upper cervical spine. Differences in right-to-left rotation are frequently encountered in an asymptomatic population. Therefore, these measurements are unsuitable for indirect diagnosis of soft tissue lesions after whiplash injury and should not be used as a basis for treatment guidelines.

Adult↗
PubMed2000

MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects.

OBJECTIVE: To determine the prevalence and extent of residual defects or retears and bursitis-like subacromial abnormalities on MR images after rotator cuff repair in asymptomatic subjects, and to define the clinical relevance of these findings. DESIGN AND PATIENTS: Fourteen completely asymptomatic patients and 32 patients with residual symptoms were investigated 27-53 months (mean 39 months) after open transosseous reinsertion of the rotator cuff. Coronal T2-weighted turbo spin-echo and turbo STIR or T2-weighted fat-suppressed MR images were obtained. The prevalence and extent of residual defects or retears of the rotator cuff and bursitis-like subacromial abnormalities were determined. RESULTS: Residual defects or retears were detected in three (21%) and bursitis-like abnormalities in 14 (100%) of the 14 asymptomatic patients. Fifteen (47%) residual defects or retears and 31 (97%) bursitis-like abnormalities were diagnosed in the 32 patients with residual symptoms. The size of the residual defects/retears was significantly smaller in the asymptomatic group (mean 8 mm, range 6-11 mm) than in the symptomatic group (mean 32 mm, range 7-50 mm) (t-test, P = 0.001). The extent of the bursitis-like subacromial abnormalities did not significantly differ (t-test, P > 0.05) between asymptomatic (mean 28 x 3 mm) and symptomatic patients (mean 32 x 3 mm). CONCLUSION: Small residual defects or retears (< 1 cm) of the rotator cuff are not necessarily associated with clinical symptoms. Subacromial bursitis-like MR abnormalities are almost always seen after rotator cuff repair even in patients without residual complaints. They may persist for several years after rotator cuff repair and appear to be clinically irrelevant.

Adult↗
PubMed2000

Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability.

OBJECTIVE: To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability. DESIGN AND PATIENTS: CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available. RESULTS: Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01). CONCLUSION: Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm.

Adolescent↗
PubMed2000

Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound.

This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician's degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair.

Diagnosis, Differential↗
PubMed2000

Precision of distance determination using 3D to 2D projections: the error of migration measurement using X-ray images.

The goal of this study has been to objectively and reliably estimate the precision of measuring 2D migration of hip prostheses. This is the distance change over time between the implant and the bone observable in X-ray images. To reach this goal, a generally valid scheme for determining the standard deviation of distance measurements in 3D to 2D projections has been worked out. The scheme was applied to four previously published methods for measuring the migration of the prosthetic cup using standard radiographs. Applying the scheme yields measures for the sensitivity of the migration measurement towards the relevant sources of error. Inserting previously published data for the amounts of the entering errors, the standard deviation of the migration measurement has been calculated numerically resulting in values up to several millimeters.

Hip Joint↗
PubMed2000

Patient-controlled interscalene analgesia with ropivacaine 0.2% versus patient-controlled intravenous analgesia after major shoulder surgery: effects on diaphragmatic and respiratory function.

BACKGROUND: The authors compared the effects of patient-controlled interscalene analgesia (PCIA) with ropivacaine 0.2% and patient-controlled intravenous analgesia (PCIVA) with opioids on hemidiaphragmatic excursion and respiratory function after major shoulder surgery. METHODS: Thirty-five patients scheduled for elective major shoulder surgery were prospectively randomized to receive either PCIA or PCIVA. All patients received an interscalene block before surgery. In the PCIA group, a catheter was introduced between the anterior and middle scalene muscles. Six hours after the initial block, patients received for 48 h either a continuous infusion of 0.2% ropivacaine through the interscalene catheter at a rate of 5 ml/h plus a bolus dose of 3 or 4 ml with a lockout time of 20 min (PCIA group) or a continuous intravenous infusion of nicomorphine at a rate or 0.5 mg/h plus a bolus dose of 2 or 3 mg with a lockout time of 20 min (PCIVA group). Hemidiaphragmatic excursion and respiratory function were assessed with the patient in a 45 degrees semirecumbent position the day before the operation and 20 min (in the operating room), 24 h, and 48 h after the initial block by means of ultrasonography and spirometry, respectively. Pain relief was regularly assessed, side effects were noted, and patient satisfaction was rated 6 h after the end of the study. RESULTS: Hemidiaphragmatic excursion was similar in the two groups 20 min after interscalene block. Hemidiaphragmatic excursion was increased in the PCIA group on the nonoperated side 24 and 48 h after the interscalene block (P < 0.05). Pulmonary function was similar in the two groups at each time. Pain was better controlled in the PCIA group at 12 and 24 h (P < 0.05). The incidence of nausea and vomiting were 5.5% versus 60% for the PCIA and PCIVA groups, respectively (P < 0.05). Patient satisfaction was greater in the PCIA group (P < 0.05). CONCLUSIONS: The use of PCIA or PCIVA techniques to provide analgesia after major shoulder surgery is associated with similar effects on respiratory function. In the PCIA group, hemidiaphragmatic excursion showed a significantly greater amplitude 24 and 48 h after the initial block on the nonoperated side. The PCIA technique provided better pain control, a lower incidence of side effects, and a higher degree of patient satisfaction.

Adult↗
PubMed2000

Positional MR imaging of the lumbar spine: does it demonstrate nerve root compromise not visible at conventional MR imaging?

PURPOSE: To evaluate whether positional magnetic resonance (MR) images of the lumbar spine demonstrate nerve root compromise not visible on MR images obtained with the patient in a supine position (conventional MR images). MATERIALS AND METHODS: Thirty patients with chronic low back pain unresponsive to nonsurgical treatment and with disk abnormalities but without compression of neural structures were included. Positional MR images were obtained by using an open-configuration, 0.5-T MR imager with the patients seated and with flexion and extension of their backs. The disk and nerve root were related to the body position. Nerve root compression and foraminal size were correlated with the patient's symptoms, as assessed with a visual analogue scale. RESULTS: Nerve root contact without deviation was present in 34 of 152 instances in the supine position, in 62 instances in the seated flexion position, and in 45 instances in the seated extension position. As compared with the supine position, in the seated flexion position nerve root deviation decreased from 10 to eight instances; in the seated extension position, it increased from 10 to 13 instances. Nerve root compression was seen in one patient in the seated extension position. Positional pain score differences were significantly related to changes in foraminal size (P =.046) but not to differences in nerve root compromise. CONCLUSION: Positional MR imaging more frequently demonstrates minor neural compromise than does conventional MR imaging. Positional pain differences are related to position-dependent changes in foraminal size.

Adult↗
PubMed2000

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings.

PURPOSE: To correlate magnetic resonance (MR) images of a bone marrow edema pattern with histologic findings in osteoarthritic knees. MATERIALS AND METHODS: Sixteen consecutive patients (age range, 43-79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1-4 days before surgery. Tibial plateau abnormalities on MR images were compared quantitatively with those on histologic maps. RESULTS: The bone marrow edema pattern zone (ill-defined and hyperintense on STIR images and hypointense on T1-weighted MR images) mainly consisted of normal tissue (53% of the area was fatty marrow, 16% was intact trabeculae, and 2% was blood vessels) and a smaller proportion of several abnormalities (bone marrow necrosis [11% of area], abnormal [necrotic or remodeled] trabeculae [8%], bone marrow fibrosis [4%], bone marrow edema [4%], and bone marrow bleeding [2%]). The bone marrow edema pattern zone and the zone with a normal MR imaging appearance differed significantly in the presence of bone marrow necrosis (P =.021), bone marrow fibrosis (P =.014), and abnormal trabeculae (P =.011) but not in the prevalence of bone marrow edema (P =.069). Bone marrow edema also was found in zones with an unremarkable MR appearance (perifocal zone, 5% edema; control zone, 2% edema). CONCLUSION: A bone marrow edema pattern in osteoarthritic knees represents a number of noncharacteristic histologic abnormalities. Edema is not a major constituent of MR imaging signal intensity abnormalities in such knees.

Adult↗
PubMed2000

Characteristics of triangular fibrocartilage defects in symptomatic and contralateral asymptomatic wrists.

PURPOSE: To characterize triangular fibrocartilage (TFC) defects in symptomatic and contralateral asymptomatic wrists. MATERIALS AND METHODS: Communicating and noncommunicating defects of the TFC were depicted on bilateral wrist arthrograms in 56 patients with unilateral wrist pain and without associated lesions of the scapholunate or lunotriquetral ligaments. The exact location of each TFC lesion was noted. RESULTS: Communicating defects were noted in 36 (64%) of 56 symptomatic and in 26 (46%) of 56 asymptomatic wrists. Twenty-five (69%) of 36 communicating defects were bilateral. Except for one defect in each group of symptomatic and asymptomatic wrists, all communicating defects were noted radially. Noncommunicating defects were noted in 28 (50%) of 56 symptomatic wrists and in 15 (27%) of 56 asymptomatic wrists. Eleven (39%) of 28 noncommunicating defects were bilateral. On the symptomatic side, 28 of 36 noncommunicating defects (including eight multiple defects) were located proximally at the ulnar side. On the asymptomatic side, 11 of 17 noncommunicating defects (including two multiple defects) were at or near the ulna. CONCLUSION: Noncommunicating TFC defects, which typically are located on the proximal side of the TFC near its ulnar attachment, have a more reliable association with symptomatic wrists than do communicating defects. Radial-sided communicating defects described in the literature (Palmer type 1A and 1D) as posttraumatic commonly are seen bilaterally and in asymptomatic wrists.

Adolescent↗
PubMed2000

Femoral trochlear dysplasia: MR findings.

PURPOSE: To establish quantitative and qualitative magnetic resonance (MR) criteria for the diagnosis of trochlear dysplasia. MATERIALS AND METHODS: MR images were analyzed in 16 consecutive patients with and 23 without trochlear dysplasia. The standard of reference was a true lateral radiograph of the knee. Quantitative and qualitative MR criteria were assessed. RESULTS: In patients with trochlear dysplasia, the trochlear groove was significantly less deep than that in control subjects. The most accurate measurement was 3 cm above the femorotibial joint space (P: <.001), where a trochlear depth of 3 mm or less had a sensitivity of 100% and a specificity of 96%. The ventral trochlear prominence between the supratrochlear femoral cortex and the most ventral point of the trochlear floor (midsagittal section) was always larger than 6.9 mm in dysplastic trochleae. A facet ratio of less than 2:5 (medial to lateral) 3 cm above joint space level had a sensitivity of 100% and a specificity of 96%. A nipplelike anterior prominence at the superior end of the femoral trochlea on midsagittal images was a specific (91%) qualitative criterion. CONCLUSION: Dysplasia of the femoral trochlea can be diagnosed reliably by using quantitative or qualitative criteria on midsagittal or transverse MR images obtained 3 cm above the femorotibial joint space.

Adolescent↗
PubMed2000

The results of repair of massive tears of the rotator cuff.

BACKGROUND: Massive tears of the tendons of the rotator cuff cause atrophy and fatty degeneration of the rotator cuff muscles and painful loss of function of the shoulder. Repair of massive rotator cuff tears is often followed by retears of the tendons, additional muscular degeneration, and a poor clinical outcome. The purposes of this study were to determine whether a new method of repair of rotator cuff tendons can yield a lower retear rate and a better clinical outcome than previously reported methods, to assess the muscular changes following repair of massive tears of the musculotendinous units, and to correlate findings on magnetic resonance imaging with the clinical results. METHODS: Twenty-nine massive rotator cuff tears involving complete detachment of at least two tendons were repaired operatively with use of a new laboratory-tested technique in a prospective study. At least two years (average, thirty-seven months; range, twenty-four to sixty-one months) postoperatively, twenty-seven patients were evaluated clinically and with magnetic resonance imaging to determine the clinical outcome, the integrity of the repair, and the condition of the rotator cuff muscles. RESULTS: The age and gender-adjusted Constant score improved from an average of 49 percent preoperatively to an average of 85 percent postoperatively, corresponding to a subjective shoulder value of 78 percent of that of a normal shoulder. Pain-free flexion improved from an average of 92 degrees to an average of 142 degrees, and abduction improved from an average of 82 degrees to an average of 137 degrees. Pain decreased and performance of activities of daily living improved significantly (p < 0.05). The seventeen patients who had a structurally successful repair all had an excellent clinical outcome. Muscle atrophy could not be reversed except in successfully repaired supraspinatus musculotendinous units. Fatty degeneration increased in all muscles. CONCLUSIONS: The method of repair of massive rotator cuff tears that was used in this study yielded a comparatively low retear rate and good-to-excellent clinical results; however, the repair did not result in substantial reversal of muscular atrophy and fatty degeneration. Retears occurred more often in patients who had had a shorter interval between the onset of the symptoms and the operation (p < 0.05). Patients who had a retear had improvement of the shoulder compared with the preoperative state, but they had less improvement than did those who had a successful repair.

Activities of Daily Living↗
PubMed1999

[Osteofibrous dysplasia and its differential diagnosis].

We present a case of a 13 year old girl with swelling and pain of the right lower leg persisting for four months. The radiological and histological diagnosis is osteofibrous dysplasia. Osteofibrous dysplasia is a rare bone lesion predominantly affecting the cortex of the tibia. Almost all patients are younger than ten years at presentation. Swelling is a typical clinical manifestation. Radiologically and even histologically the distinction between the osteofibrous dysplasia and the more aggressive adamantinoma can be difficult. Other bone lesions potentially mimicking osteofibrous dysplasia include: fibrous dysplasia, osteoid osteoma, osteosarcoma, osteoblastoma and intracortical Brodie's abcess. The natural course of the disease is unpredictable. Lesions with typical radiological appearance are considered to be "no touch lesions". In equivocal cases block resection (with both a diagnostic and therapeutic purpose) should be performed.

Adolescent↗
PubMed1999

[Diagnostic assessment in lumbar back pain. II. Imaging and image-guided infiltrations].

The diagnostic assessment of low back pain should predominantly be based on history and clinical examination rather than on imaging studies. The problem of diagnostic imaging in low back pain is related to the high rate of asymptomatic morphological alterations in the lumbar spine. The diagnosis should therefore not be guided by findings in imaging. The imaging studies (standard radiographs and MRI) should verify the clinically suspected diagnosis and further lead to imaging guided injection studies (e.g. nerve root block, facet joint block, sacro-iliac joint block, provocative discography) to differentiate between symptomatic and asymptomatic morphological alterations. With longlasting local anaesthetics and steroids it is possible to achieve a diagnostic as well as a therapeutic effect.

Diagnosis, Differential↗
PubMed1999

Virtual MR arthroscopy: new insights into joint morphology.

Evaluation of the feasibility of virtual magnetic resonance (MR) arthroscopy was performed on 10 patients referred for MR arthrography of the shoulder, the elbow, or the knee. A fast spoiled contrast-enhanced three-dimensional gradient-echo sequence was combined with image postprocessing to render arthroscopic views. Virtual MR arthroscopy was successfully demonstrated in all 10 joints. Determination of added diagnostic benefit will require further study.

Adult↗
PubMed1999

MR imaging and CT in osteoarthritis of the lumbar facet joints.

OBJECTIVE: To test the agreement between MR imaging and CT in the assessment of osteoarthritis of the lumbar facet joints, and thus to provide data about the need for an additional CT scan in the presence of an MR examination. DESIGN AND PATIENTS: Using a four-point scale, two musculoskeletal radiologists independently graded the severity of osteoarthritis of 308 lumbar facet joints on axial T2-weighted and on sagittal T1- and T2-weighted turbo-spin-echo images and separately on the corresponding axial CT scans. Kappa statistics and percentage agreement were calculated. RESULTS: The weighted kappa coefficients for MR imaging versus CT were 0.61 and 0.49 for readers 1 and 2, respectively. The weighted kappa coefficients for interobserver agreement were 0.41 for MR imaging and 0.60 for CT, respectively. There was agreement within one grade between MR and CT images in 95% of cases for reader 1, and in 97% of cases for reader 2. CONCLUSION: With regard to osteoarthritis of the lumbar facet joints there is moderate to good agreement between MR imaging and CT. When differences of one grade are disregarded agreement is even excellent. Therefore, in the presence of an MR examination CT is not required for the assessment of facet joint degeneration.

Adult↗
PubMed1999

Posteromedial corner of the knee: MR imaging with gross anatomic correlation.

OBJECTIVE: The objective of this study was to illustrate the magnetic resonance (MR) image appearance of the structures of the posteromedial "corner" of the knee with particular emphasis on the anatomy and differentiation between the medial collateral ligament and the posterior oblique ligament. DESIGN: Six cadaveric knee specimens underwent MR imaging, before and following instillation of intra-articular contrast material. The knees were sectioned in the axial, coronal, and coronal oblique planes and the gross morphology of the posteromedial corner and surrounding structures was studied and correlated with the MR images. PATIENTS: The human cadaveric specimens were from two female and four male patients (age at death, 72-86 years; average, 78 years). RESULTS AND CONCLUSIONS: The contrast-enhanced sequences and the coronal oblique images allowed for improved visualization of the structures.

Aged↗