scholarly journals Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774391 ◽  
Author(s):  
Michael Jernick ◽  
Edward Walker Gallego ◽  
Michael Nuzzo
Keyword(s):  
Body Mass Index ◽  
Magnetic Resonance ◽  
Case Series ◽  
Ultrasound Guided ◽  
Level Of Evidence ◽  
Office Setting ◽  
Radiology Reports ◽  
Magnetic Resonance Arthrogram ◽  
Patient Variables ◽  
Age And Sex

Background: Ultrasound (US)–guided intra-articular hip injections have been proposed in the literature to be accurate, reliable, and safe alternatives to fluoroscopy-guided injections. Purpose: To evaluate the accuracy of US-guided magnetic resonance (MR) arthrogram injections of the hip performed in the office setting by a single orthopaedic surgeon and elucidate the potential effects that patient age, sex, and body mass index (BMI) have on contrast placement. Study Design: Case series; Level of evidence, 4. Methods: From a review of the senior author’s office database, 89 patients (101 hips) who had US-guided MR arthrogram injections performed between December 2014 and June 2016 were identified. Official radiology reports were evaluated to determine whether extra-articular contrast was noted. Patient variables, including BMI, age, and sex, were evaluated between patients who had inappropriately placed contrast and those who did not. Results: Of the 101 hip injections, there were 6 cases that demonstrated inadequate contrast placement within the joint, likely secondary to extravasation or incorrect placement; however, an MR arthrogram was adequately interpreted in all cases. There were no significant differences noted between those with appropriate versus inappropriate contrast placement when evaluating BMI ( P = .57), age ( P = .33), or sex ( P = .67), and neither group had an adverse event. Conclusion: US-guided injections are safe and accurate alternatives to fluoroscopy-guided injections in the office setting, with 94% accuracy. Furthermore, BMI, age, and sex did not play a statistically significant role among patients with inappropriately placed contrast.

Comparing Tendinous and Ligamentous Ankle Pathology in Atraumatic Overweight and Nonoverweight Patients

2014 ◽  
Vol 7 (6) ◽  
pp. 449-456 ◽  
Author(s):  
Melissa M. Galli ◽  
Nicole M. Protzman ◽  
Eiran M. Mandelker ◽  
Amit Malhotra ◽  
Edward Schwartz ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Magnetic Resonance ◽  
Present Report ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Prevalence Of Obesity ◽  
Prospective Longitudinal ◽  
Prospective Longitudinal Cohort

With the increased prevalence of obesity, there has been a parallel rise in musculoskeletal disorders. However, the effect of body mass index (BMI) on pathology of the hindfoot and ankle is scarcely understood. The purpose of the present report was to compare the number of tendinous and ligamentous pathologies within the hindfoot and ankle between overweight (BMI ≥ 25.00 kg/m2) and nonoverweight (BMI < 25.00 kg/m2) atraumatic patients. We hypothesized that overweight patients would demonstrate more tendinous and ligamentous pathologies compared with their nonoverweight counterparts. Five hundred consecutive magnetic resonance images were reviewed. One hundred eight patients met the inclusion and exclusion criteria. Sixty-six patients were overweight and 42 patients were nonoverweight. Ninety-eight percent of overweight patients demonstrated pathology of a tendinous or ligamentous nature, whereas 62% of nonoverweight patients demonstrated pathology of a tendinous or ligamentous nature. Thus, the prevalence of pathology was 1.59 times higher among overweight patients compared with nonoverweight patients. Moreover, controlling for age, overweight patients demonstrated approximately twice as many tendinous and ligamentous pathologies compared with nonoverweight patients (adjusted mean ± SD = 4.44 ± 2.14 vs 1.98 ± 2.07, respectively), which was statistically significantly different ( P < .001). To definitively assess causation and the clinical evolution of hindfoot and ankle pathology, prospective, longitudinal cohort studies are warranted. Level of Evidence: Diagnostic, Level III: Case series

All-Arthroscopic Autologous Matrix-Induced Chondrogenesis-Aided Repair of a Patellar Cartilage Defect Using Dry Arthroscopy and a Retraction System

2017 ◽  
Vol 30 (09) ◽  
pp. 925-929 ◽  
Author(s):  
Mariusz Puszkarz ◽  
Lidia Kosmalska ◽  
Martin Wiewiorski ◽  
Boguslaw Sadlik
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Case Series ◽  
Collagen Matrix ◽  
International Knee Documentation Committee ◽  
Level Of Evidence ◽  
Patellar Cartilage ◽  
Radiological Data ◽  
Implantation Techniques

AbstractThe technique of all-arthroscopic autologous matrix-induced chondrogenesis (AMIC)-aided repair of patellar cartilage lesions using a retraction system and dry arthroscopy has been recently described. We report the first clinical and radiological data at a short-term follow-up. Twelve patients underwent AMIC-aided cartilage repair for a patellar lesion. All steps of the procedure were performed arthroscopically, which include the use of an intra-articularly placed retraction plate for distraction of the patellofemoral joint and evacuation of saline solution for collagen matrix insertion and fixation. Clinical assessment performed before surgery and at a mean follow-up time of 38 months (range: 24–70) included the following scores: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and visual analog scale (VAS). Magnetic resonance imaging was performed at the follow-up examination, including the magnetic resonance observation of cartilage repair tissue (MOCART) score. The mean KOOS and IKDC scores increased significantly (p < 0.01) from 50.3 and 37.4 points preoperatively to 90.1 and 79.4 postoperatively. The VAS score decreased from 7.8 to 2.3 points. Mean MOCART score at follow-up was 58.3 points. Cartilage repair of patellar lesions aided by a retraction system in a dry arthroscopy setup is a promising approach. Further studies are needed to evaluate this procedure and compare it to existing matrix implantation techniques. The level of evidence for the study is 4 (case series).

Autologous Osteochondral Mosaicplasty for Centrally and Laterally Located, Advanced Capitellar Osteochondritis Dissecans in Teenage Athletes: Clinical Outcomes, Radiography, and Magnetic Resonance Imaging Findings

2018 ◽  
Vol 46 (8) ◽  
pp. 1943-1951 ◽  
Author(s):  
Tadanao Funakoshi ◽  
Daisuke Momma ◽  
Yuki Matsui ◽  
Tamotsu Kamishima ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Osteochondritis Dissecans ◽  
Case Series ◽  
Return To Play ◽  
Joint Surface ◽  
Resonance Imaging ◽  
Level Of Evidence

Background: Autologous osteochondral mosaicplasty (ie, mosaicplasty) results in satisfactory clinical outcomes and reliable return to play for patients with large or unstable lesions due to osteochondritis dissecans (OCD) of the humeral capitellum. However, the association between the healing of the reconstructed cartilage and clinical outcomes remains unclear. Purpose: To evaluate the efficacy of mosaicplasty in teenage athletes through use of clinical scores and imaging. The secondary purpose was to compare the clinical outcomes with images of centrally and laterally located lesions. Study Design: Case series; Level of evidence, 4. Methods: This study analyzed 22 elbows (all male patients; mean age, 13.5 ± 1.2 years) with capitellar OCD managed with mosaicplasty. Patients were divided into 2 groups according to the location of the lesions: central (10 patients) and lateral (12 patients). Evaluation was performed through use of the clinical rating system of Timmerman and Andrews, plain radiographs, and magnetic resonance imaging (MRI; the cartilage repair monitoring system of Roberts). The mean follow-up period was 27.5 months (range, 24-48 months). Results: Lateral lesions were significantly larger than central lesions (147.1 ± 51.9 mm2 vs 95.5 ± 27.4 mm2, P = .01). No other significant differences were found between central and lateral lesions. Timmerman and Andrews scores for both central and lateral lesions improved significantly from 125.0 ± 30.1 points and 138.3 ± 34.5 points preoperatively to 193.5 ± 11.3 points and 186.7 ± 18.1 points, respectively, at final follow-up ( P < .0001, P < .0001). Radiography identified complete graft incorporation in all cases and the absence of severe osteoarthritic changes or displaced osteochondral fragments. In the lateral group, the radial head ratio at final follow-up (1.83 ± 0.23) was significantly larger than the preoperative findings (1.75 ± 0.14, P = .049). The quality of joint surface reconstruction was found to be acceptable for central and lateral lesions on MRI evaluation. Conclusion: Mosaicplasty resulted in satisfactory clinical outcomes and smooth cartilage surface integrity in teenage athletes with OCD on their return to competition-level sports activities irrespective of lesion location.

scholarly journals Inferior Glenohumeral Ligament (IGHL) Injuries: A Case Series of Magnetic Resonance (MR) Imaging Findings and Arthroscopic Correlation

2020 ◽  
Vol 13 ◽  
pp. 275-279
Author(s):  
Michael Glass ◽  
Vafa Behzadpour ◽  
Jessica Peterson ◽  
Lauren Clark ◽  
Shelby Bell-Glenn ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Case Series ◽  
Inclusion Criteria ◽  
Glenohumeral Ligament ◽  
Radiology Reports ◽  
Labral Tears ◽  
Tissue Edema ◽  
Cortical Irregularity ◽  
Inferior Glenohumeral Ligament ◽  
Magnetic Resonance Imaging Mri

The inferior glenohumeral ligament (IGHL) complex is commonly assessed by both magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrogram. Our study aimed to compare the accuracy of MR arthrogram compared to MRI using arthroscopic correlation as the gold standard. A retrospective review of cases reporting an IGHL injury was performed. 77 cases met inclusion criteria, while 5 had arthroscopic reports that directly confirmed or refuted the presence of IGHL injury. Two arthroscopic reports confirmed concordant IGHL injuries, while 3 arthroscopic reports mentioned discordant findings compared to MR. Interestingly, all three discordant cases involved MR arthrogram. Findings included soft tissue edema, fraying of the axillary pouch fibers, and cortical irregularity of the humeral neck. Of the two concordant cases, one was diagnosed by MRI, revealing an avulsion of the anterior band, while the second was diagnosed by MR arthrogram showing ill-defined anterior band fibers. Many cases involved rotator cuff or labral tears, which may have been the focus of care for providers, given their importance for shoulder stability. Additionally, a lack of diagnostic confidence in MR reports may have influenced surgeons in the degree to which they assessed the IGHL complex during arthroscopy. In conclusion, radiologists seemed more likely to make note of IGHL injuries when MR arthrograms were performed; meanwhile, all three discordant cases involved MR arthrogram reads. Therefore, additional larger studies are needed with arthroscopic correlation to better elucidate MR findings that confidently suggest injury to the IGHL complex, in order to avoid false positive radiology reports.

scholarly journals Ultrasound-Guided Percutaneous Tenotomy for Gluteal Tendinopathy

2020 ◽  
Vol 8 (3) ◽  
pp. 232596712090786 ◽  
Author(s):  
Champ L. Baker ◽  
J. Ryan Mahoney
Keyword(s):  
Short Form ◽  
Tendon Repair ◽  
Case Series ◽  
Outpatient Setting ◽  
Harris Hip Score ◽  
Ultrasound Guided ◽  
Level Of Evidence ◽  
Nonsurgical Management ◽  
Gluteal Tendinopathy

Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described. Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months). Results: The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 ( P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 ( P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) ( P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures. Conclusion: PUT is an effective treatment, with good results for patients with gluteal tendinopathy.

Ultrasound-Guided Hyaluronic Acid Injection for the Management of Morton’s Neuroma

2017 ◽  
Vol 39 (2) ◽  
pp. 201-204 ◽  
Author(s):  
Kang Lee ◽  
Il-Yeong Hwang ◽  
Chang Hyun Ryu ◽  
Jae Woo Lee ◽  
Seung Woo Kang
Keyword(s):  
Hyaluronic Acid ◽  
Case Series ◽  
Functional Improvement ◽  
X Rays ◽  
Ultrasound Guided ◽  
Morton’S Neuroma ◽  
Level Of Evidence ◽  
Hyaluronic Acid Injection ◽  
Acid Injection ◽  
Morton's Neuroma

Background: Morton’s neuroma is one of the common causes of forefoot pain. In the present study, hyaluronic acid injection was performed on patients to determine the efficacy and adverse effects of hyaluronic acid in management of Morton’s neuroma. Methods: Eighty-three patients with Morton’s neuroma in their third intermetatarsal space with definite Mulder’s click were included in the study. Those with severe forefoot deformities such as forefoot cavus or hallux valgus on plain X-rays were excluded. Ultrasound-guided hyaluronic acid injections were performed on all patients weekly for 3 weeks. Pain during walking using visual analogue scale (VAS) and AOFAS Forefoot Scale were prospectively evaluated preinjection, and at 2, 4, 6, 12 months postinjection. Results: Significant improvement in VAS and AOFAS Forefoot Scale were seen overall at 2 months after hyaluronic acid injections ( P < .05). Then, there were almost no changes after 4 months, continuing until 12 months. The mean VAS was decreased from 73.1 initially to 23.0 at 12 months and AOFAS Forefoot Scale was increased from 32.2 to 86.5. There were no complications which occurred. Conclusion: In the present study, ultrasound-guided hyaluronic injection was clinically effective for pain relief and functional improvement for at least 12 months in patients with Morton’s neuroma. However, numbness associated with Morton’s neuroma should be addressed more cautiously since it may persist without much improvement. Level of Evidence: Level IV, retrospective case series.

Osteochondral Transplantation in the Elbow Leads to Good Clinical and Radiologic Long-term Results

2011 ◽  
Vol 39 (12) ◽  
pp. 2619-2625 ◽  
Author(s):  
Stephan Vogt ◽  
Sebastian Siebenlist ◽  
Daniel Hensler ◽  
Lizzy Weigelt ◽  
Patrick Ansah ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Weight Lifting ◽  
Long Term Results ◽  
Osteochondral Lesions ◽  
Osteochondral Transplantation ◽  
Level Of Evidence

Background: In the long-term follow-up after debridement, microfracture, or drilling of osteochondral lesions in the elbow, subsequent osteoarthritis is a problem. Osteochondral transplantation for these defects has become a more common procedure. However, long-term results are unknown. Purpose: This study was undertaken to evaluate long-term clinical and radiologic outcomes of advanced osteochondral lesions in the elbow treated with osteochondral transplantation. Study Design: Case series; Level of evidence, 4. Methods: The study included 8 patients with osteochondral lesions in the elbow who were treated by autologous osteochondral transplantation between 1996 and 2002. Patients (average age, 17 years) were evaluated pre- and postoperatively by Broberg-Morrey score to assess elbow function and by American Shoulder and Elbow Surgeons (ASES) score for pain analysis. In addition, radiographs (at the first postoperative day, and at 5-year and 10-year follow-up) and magnetic resonance images (8 to 12 weeks postoperatively, and at 5-year and 10-year follow-up) were made to evaluate the joint status. At last follow-up (range, 8-14 years postoperatively), 7 of 8 patients were seen for clinical examination and radiologic analysis. Results: The Broberg-Morrey score increased from an average of 75.9 ± 13.1 to 96.4 ± 2.4 and ASES score significantly improved as follows: worst pain, 7.9 ± 1.1 to 1.6 ± 1.9; rest pain, 3.14 ± 2.7 to 0.6 ± 1.5; weight-lifting pain, 7.6 ± 0.8 to 3.1 ± 1.6; and repetitive movement pain, 5.3 ± 2.4 to 1.6 ± 1.5. Compared with the contralateral side, there was a mean preoperative flexion lag of 12.5° ± 11.6°. At the final follow-up, flexion was free. The mean extension lag was reduced from average 5.4° ± 5.7° to 0°. Radiographs of 2 patients made at final follow-up showed mild signs of osteoarthritis (Kellgren and Lawrence grade I). Postoperative magnetic resonance images showed graft viability in all and a congruent chondral surface in 6 of 7 patients. Conclusion: Clinical long-term results after osteochondral transplantation in the elbow are good to excellent and comparable with midterm results in the literature. Therefore, this technique is a reliable option for satisfactory long-term results regarding treatment of advanced osteochondral lesions in the elbow.

Midfoot Arthrodesis following Multi-Joint Stabilization with a Novel Hybrid Plating System

2012 ◽  
Vol 33 (3) ◽  
pp. 220-225 ◽  
Author(s):  
Jorge Filippi ◽  
Mark S. Myerson ◽  
Mark W. Scioli ◽  
Bryan Dale Den Hartog ◽  
David B. Kay ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Body Mass Index ◽  
Healing Rate ◽  
Case Series ◽  
The Other ◽  
Joint Disease ◽  
Retrospective Case ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Joint Gap

Background: Several methods for fixation have been described for midfoot arthrodesis. Multi-joint arthrodesis at this level can be challenging because of bone loss and deformity, making it difficult to obtain a stable construct. We present the results of a novel hybrid plating system that incorporates locked and non-locked compression screws for multi-joint arthrodesis of the midfoot. Method: A retrospective multicenter review of patients undergoing multi-joint arthrodesis with hybrid plating of the midfoot was performed to evaluate the time to radiographic arthrodesis. Hybrid plating was defined as a construct that incorporates locked and non-locked compression screws. Neuropathy was the only exclusion criteria. Radiographic arthrodesis was defined as bridging bone on one of the three standard foot radiographs in the absence of a joint gap on the other views, or by 50% or greater bridging bone on computed tomography. Etiology of the arthritis, presurgical comorbidities, body mass index, functional level and postoperative complications were evaluated. Results: Seventy-two patients were evaluated, and arthrodesis was obtained in 67 patients at 6 weeks in 27 patients, 9 weeks in 26, 12 weeks in 11, and at 16 weeks in three. In five patients at least one of the joints were not fused at 16 weeks and were considered a nonunion. Complications were present in 12 patients (17%). Conclusions: The healing rate and time to arthrodesis compared favorably to similar published studies. Based on these results, hybrid plating was a reliable and consistent alternative for fixation in midfoot arthrodesis, especially in multi-joint disease. Level of Evidence: IV; Retrospective Case Series

scholarly journals EVALUATION OF DISTAL FOREARM FRACTURES USING THE AO 2018 CLASSIFICATION

2019 ◽  
Vol 27 (4) ◽  
pp. 220-222
Author(s):  
Alysson Figueiredo Nogueira ◽  
Lucas Moratelli ◽  
Marcela dos Santos Martins ◽  
Ricardo Torres Iupi ◽  
Marcos Felipe Marcatto de Abreu ◽  
...  
Keyword(s):  
Case Series ◽  
Tertiary Hospital ◽  
Common Type ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Level Of Evidence ◽  
Ulnar Fracture ◽  
Limb Fractures ◽  
Distal Forearm Fractures ◽  
Age And Sex

ABSTRACT Objective: Distal forearm fractures are among the most common upper limb fractures in all ages, and many classifications have been proposed to describe them. Recently, a new version of AO/OTA classification was proposed. The aim of this study is to use the AO/OTA 2018 classification to report the epidemiology of distal forearm fractures in adults treated at a single center. Methods: A retrospective analysis of the initial radiographs obtained from cases of distal forearm fractures in an orthopedic emergency room at a single tertiary hospital. Results: Three hundred twenty-two cases were studied, aged 50.35 ± 18.98 years, 55.3% were female and 44.7% were right-sided. Type 2R3A, 2R3B and 2R3C fractures corresponded to 32.3%, 18.0% and 48.4% of the cases, respectively. Distal ulnar fracture was present in 41.9%. There was a correlation between age and sex: 78.3% of the subjects aged under 30 years were male, and 80.6% of those aged over 60 years were female (p<0.001). Conclusion: The most common type of radial fractures was 2R3C, and the most common type of ulna fracture was 2U3A1.1. There was a correlation between age and sex. Level of evidence IV, Case-series.

scholarly journals When the Wave Breaks You: Magnetic Resonance Imaging Findings After Surfing Injuries

2019 ◽  
Vol 12 (1) ◽  
pp. 88-93
Author(s):  
Bhumin J. Patel ◽  
Madison R. Heath ◽  
Christian S. Geannette ◽  
Peter D. Fabricant ◽  
Harry G. Greditzer
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tertiary Care ◽  
Case Series ◽  
Final Analysis ◽  
Body Part ◽  
The United States ◽  
Resonance Imaging ◽  
Level Of Evidence ◽  
Picture Archiving And Communication

Background: There are approximately 2.1 million recreational surfers in the United States. However, little has been reported on surfing-related injuries and, to date, no study has utilized magnetic resonance imaging (MRI) to characterize injury patterns. Objective: To use MRI to perform a descriptive analysis of surfing injuries in patients who presented to an urban tertiary care musculoskeletal hospital. This was not a hypothesis-driven study. Study Design: Case series. Level of Evidence: Level 4. Methods: A retrospective review of the picture archiving and communication system as well as the electronic medical record was performed to identify patients with surfing-related injuries who presented to a tertiary care musculoskeletal hospital for treatment. The search included participants over a 10-year period who presented between January 1, 2009, and August 1, 2018. Descriptive data analyses were performed to determine frequency of body part injured, diagnosis, and operative versus nonoperative treatment. Results: The search yielded 109 patients with surfing-related injuries and MRIs. A total of 90 patients presented within 6 months of their surfing injury and were included in the final analysis. The median age was 36 years (range, 12-66 years). A majority of the patients included were male (74%; n = 67). Acute surfing injuries were diagnosed via imaging in 72% (n = 65) of patients. The joints injured most commonly were the shoulder (46%; n = 30) and the knee (28%; n = 18). Only 17% (n = 11) of acute surfing injuries required surgery, while 83% (n = 54) were treated nonoperatively. Conclusion: The most common surfing-related injuries occurred in the shoulder and knee. Clinical Relevance: This study helps characterize the risk of injury for surfers and informs healthcare providers on common surfing injuries.

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