Dai Li

Objective: This study aimed to investigate the relationship between magnetic resonance imaging (MRI) findings and intraoperative findings of Grade III medial collateral ligament (MCL) injuries to validating the diagnostic accuracy of MRI in localizing the tear and exploring the distribution of tear locations in these injuries. Methods: We reviewed 226 patients with MCL repair surgery and introduced a novel MRI-based classification system. MCL tears were classified into types 1a, 1b, 2a, 2b, 3, 4a, and 4b based on their location relative to the seven attachments. We then recorded tear locations and calculated the incidence of each type. The Kappa statistic was used to assess both the agreement between MRI and intraoperative classifications and inter-observer reliability. The sensitivity, specificity and accuracy (95% CIs) of MRI for localizing tears were calculated against intraoperative findings. Results: There was good inter-observer ( k = 0.63, P < 0.001) and substantial intraoperative ( k = 0.92, P < 0.001) agreement for the MRI classifications. MRI demonstrated high diagnostic performance across all locations. Sensitivity ranged from 81.8% (95% CI: 47.8%–96.8%) for location S2 to 100% for locations P1 (95% CI: 97.0%–100.0%) and P2 (95% CI: 75.9%–100.0%). Specificity was consistently high, ranging from 90.8% (95% CI: 80.3%–96.2%) for D1 to 100.0% (95% CI: 97.8%–100%) for S2. Accuracy ranged from 95.6% (95% CI: 92.1%–97.6%) for D1 to 99.6% (95% CI: 97.5%–99.9%) for P1 and P2. Type 1b tears were the most common (63.3%), followed by types 4b and 3. The posterior oblique ligament (POL) tears were present in 77.0% of the cohort. Conclusion: The MRI classification system provides high diagnostic accuracy in locating MCL tears, particularly POL tears, for which the adductor tubercle serves as a reliable reference. Thus, this system confirms that the presence of a POL tear is a key factor guiding acute MCL repair.

Traumatic brain injury, cardiac arrest, intracerebral hemorrhage, and ischemic stroke may cause disorders of consciousness (DoC). Repetitive transcranial magnetic stimulation (rTMS) has been used to promote the recovery of disorders of consciousness (DoC) patients. In this meta-analysis, we examined whether rTMS can relieve DoC patient symptoms. We searched through journal articles indexed in PubMed, the Web of Science, Embase, Scopus, and the Cochrane Library until 20 April 2023. We assessed whether studies used rTMS as an intervention and reported the pre- and post-rTMS coma recovery scale-revised (CRS-R) scores. A total of 207 patients from seven trials were included. rTMS significantly improved the recovery degree of patients; the weighted mean difference (WMD) of the change in the CRS-R score was 1.89 (95% confidence interval (CI): 1.39–2.39; p < 0.00001) in comparison with controls. The subgroup analysis showed a significant improvement in CRS-R scores in rTMS over the dorsolateral prefrontal cortex (WMD = 2.24; 95% CI: 1.55–2.92; p < 0.00001; I² = 31%) and the primary motor cortex (WMD = 1.63; 95% CI: 0.69–2.57; p = 0.0007; I² = 14%). Twenty-hertz rTMS significantly improved CRS-R scores in patients with DoC (WMD = 1.61; 95% CI: 0.39–2.83; p = 0.010; I² = 31%). Furthermore, CRS-R scores in rTMS over 20 sessions significantly improved (WMD = 1.75; 95% CI: 0.95–2.55; p < 0.0001; I² = 12%). rTMS improved the symptoms of DoC patients; however, the available evidence remains limited and inadequate.