Normal appearance and complications of double-bundle and selective-bundle anterior cruciate ligament reconstructions using optimal MRI techniques.

OBJECTIVE: Double-bundle and selective-bundle anterior cruciate ligament (ACL) reconstructions are increasingly performed to better reproduce the double-bundle anatomy of the native ACL and to improve knee stability and surgical outcomes. This article illustrates how to optimize visualization of the ACL bundle anatomy and the appearances of graft components and postoperative complications. CONCLUSION: It is important for the radiologist to be familiar with the appearance of double-bundle and selective-bundle ACL reconstructions and associated complications.

MRI findings of prepatellar Morel-Lavallée effusions.

OBJECTIVE: To describe MR imaging characteristics and treatment options for prepatellar closed degloving injuries or Morel-Lavallée effusions. Imaging features are discussed that may aid in the distinguishing of this entity from "housemaid's knee" or prepatellar bursitis. MATERIALS AND METHODS: MR images of four young wrestlers were reviewed by two attending radiologists and one fellow, and correlative clinical data were collected using the electronic medical database. RESULTS: MR images in all cases showed a unilocular, T2 hyperintense prepatellar collection extending beyond the normal boundaries of the prepatellar bursa. No necrotic fat or blood products were identified in the collections. Surgical pathology proving the absence of synovial tissue was available for one case, and differentiation of the collection from the adjacent bursa was confirmed visually by the surgeon in a second case. CONCLUSION: Although prepatellar hemorrhagic bursitis and Morel-Lavallée effusions share many imaging features, making a specific diagnosis in most cases is not necessary, as treatment is often similar for both entities.

Spontaneous ocular prolapse as an unusual late presentation of acrocephalosyndactyly.

A 38-year-old man presented with an unusual complaint of spontaneous left ocular prolapse, which had occurred while scratching his lower eyelid. He was noted to have an atypical facial appearance with frontal bossing and maxillary hypoplasia. Examination of the hands revealed bilateral syndactyly, suggesting a diagnosis of acrocephalosyndactyly. While it is common for eyes to prolapse in childhood in Crouzon or Apert syndrome, it is unusual for them to present in this way in middle age. It may be that age-related loss of tissue elasticity and consequent lower eyelid laxity decreased the inferior support of the globe, explaining the late presentation.

Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study.

OBJECTIVE: Chronic tendinosis of the Achilles tendon is a common overuse injury that is difficult to manage. We report on a new injection treatment for this condition. SUBJECTS AND METHODS: Thirty-six consecutive patients (25 men, 11 women; mean age, 52.6 years) with symptoms for more than 3 months (mean, 28.6 months) underwent sonography-guided intratendinous injection of 25% hyperosmolar dextrose every 6 weeks until symptoms resolved or no improvement was shown. At baseline and before each injection, clinical assessment was performed using a visual analogue scale (VAS) for pain at rest (VAS1), pain during normal daily activity (VAS2), and pain during or after sporting or other physical activity (VAS3). Sonographic parameters including tendon thickness, echogenicity, and neovascularity were also recorded. Posttreatment clinical follow-up was performed via telephone interview. RESULTS: Thirty-three tendons in 32 patients were successfully treated. The mean number of treatment sessions was 4.0 (range, 2-11). There was a mean percentage reduction for VAS1 of 88.2% (p < 0.0001), for VAS2 of 84.0% (p < 0.0001), and for VAS3 of 78.1% (p < 0.0001). The mean tendon thickness decreased from 11.7 to 11.1 mm (p < 0.007). The number of tendons with anechoic clefts or foci was reduced by 78%. Echogenicity improved in six tendons (18%) but was unchanged in 27 tendons (82%). Neovascularity was unchanged in 11 tendons (33%) but decreased in 18 tendons (55%); no neovascularity was present before or after treatment in the four remaining tendons. Follow-up telephone interviews of the 30 available patients a mean of 12 months after treatment revealed that 20 patients were still asymptomatic, nine patients had only mild symptoms, and one patient had moderate symptoms. CONCLUSION: Intratendinous injections of hyperosmolar dextrose yielded a good clinical response--that is, a significant reduction in pain at rest and during tendon-loading activities--in patients with chronic tendinosis of the Achilles tendon.