Imaging of postoperative shoulder instability.

Postoperative imaging in shoulder instability is still a challenge for radiologists due to various postsurgical anatomical findings that could be considered pathologic in treated shoulder. For this reason is very important a deep knowledge about surgical procedures, anatomical changes after surgery and the appropriate diagnostic imaging modalities to work up the symptomatic postoperative shoulder. Postoperative imaging options include use conventional radiography, magnetic resonance imaging (MRI), MRI arthrography, computed tomography (CT) and CT arthrography. The purpose of our review is to explain the different surgical procedures and to describe postoperative changes detected with radiological imaging.

Surgical treatment of anterior iliac spines fractures: our experience.

INTRODUCTION: Iliac spines fractures represent 4% of all pelvic ring fractures and affect more frequently young people with open growth physis. These lesions are usually the consequence of an indirect avulsion trauma due to a sudden and forceful contraction of the muscles that take their origin on these structures. The treatment can be conservative or surgical according to the size and the amount of the dislocation of the fragment. The aim of this study is to evaluate the outcomes of surgical approach of these fractures. MATERIALS AND METHODS: Between 2002 and 2010, 9 patients with fractures of anterior iliac spines were surgically treated. All patients, after an average follow up of 48 months, were evaluated clinically with the Non-arthritic Hip Score (NAHS) and radiographically in order to detect their consolidation. Complications related to the fracture and its treatment were analyzed. Time between trauma and return to sport performance (RSP) was recorded. RESULTS: Mean NAHS was 98 points and RSP averaged 82 days. In 2 cases a transient meralgia paresthetica was observed. In 2 other cases follow-up radiographs showed asymptomatic hyperostosis around the iliac spines. CONCLUSION: The treatment of iliac spines fractures is mainly conservative. When fragment size is bigger than 2 cm and is dislocated of more than 2 cm surgical treatment is indicated. We recommend a fixation with metallic screws in order to obtain a more stable fixation and an earlier recovery especially in high demanding patients.

Mini-invasive anterior approach in total hip arthroplasty: short-term follow-up.

PURPOSE: To evaluate short-term follow-up of patients treated with total hip arthroplasty through minimally invasive anterior approach. METHODS: Twenty-four patients, surgically treated with this approach from January 2010 to December 2010. We measured the blood loss, the number of transfusions, the time of surgery, the length of hospital stay and intra and postoperative complications. All patients were clinically evaluated by Womac and Harris Hip Score 12 months after surgery. Radiographic views were performed postoperatively and at 1, 3 and 12 months after surgery in order to evaluate component positioning. RESULTS: The mean value of total blood loss was 1050 ml, the number of transfusions after surgery was on average 0.85. The mean time of surgery was 111 minutes. The mean hospital stay was 6.5 days. The radiographic views showed a correct component placement. We didn't encounter any complication and the mean score of Womac and Harris Hip Score was satisfactory in all cases. CONCLUSIONS: Minimally invasive anterior approach provides good short-term results. However, long-term studies are needed to confirm this evaluation.

High tibial osteotomy: our experience with hemicallotasis method.

Despite the many progresses and ever better outcomes in knee arthroplasty, surgical osteotomy in this area of the body is still commonly used. Valgus high tibial osteotomy (HTO) through external fixator progressive distraction (hemicallotasis) has given good results in the treatment of varus knee deformities. Such surgical techinque, once all controindications and favorable factors have been identified, allows to progressively correct the deformity with extreme precision without using internal fixation devices or bone grafts. The positive outcomes in all 24 subjects included in our study affected with varus knees and initial medial osteoarthritis confirm the validity of this osteotomy technique.

The prosthetic implant of MBA Optetrak in the treatment of knee osteoarthritis: 5 years of experience.

In this study the authors report their experience in treating knee osteoarthritis with MBA Optetrak prosthetic implant, designed to minimize the stress of high density polyethylene. In all patients, we implanted two different Optetrak prosthesis according to the validity or not of the posterior cruciate ligament. At follow-up visit, which was performed after an average follow-up of 3.6 years, we analyzed 53 patients radiographically and clinically using the Knee Society Score (KSS). Depending on our experience, we consider mandatory to have a precise selection of the patients as well as to perform an accurate capsular and ligamentous balance during operation. Furthermore, the use of prosthesis models which are similar to the normal knee allows to obtain good and durable results.

Multidetector computed tomography arthrography of the shoulder: diagnostic accuracy and indications.

BACKGROUND: The presence of subcutaneous implants, such as permanent defibrillators, is an absolute contraindication to the use of magnetic resonance imaging (MRI). Moreover, MRI is unadvisable in subjects with metallic hardware near the area of study, as artifacts generated by such materials distort image quality. PURPOSE: To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography arthrography (arthro-MDCT) of the shoulder in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. MATERIAL AND METHODS: After intraarticular injection of iodixanol and volumetric acquisition, 70 shoulders in 70 patients (30 females, 40 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI because of absolute contraindications (subcutaneous electronic implants), surgical metal implants, or claustrophobia. In 28 of the 70 patients who had had previous shoulder surgery, the arthro-CT examination was preceded by an MRI on the same day. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. RESULTS: In the 42 non-operated patients, the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 87% and 100%. In the 28 operated shoulders, arthro-MDCT had an accuracy of 94% compared with 25% with MRI. Interobserver agreement was almost perfect (kappa=0.95) in the evaluation of all types of lesions, both on MDCT and MRI. When arthro-MDCT was compared with MRI in the postoperative patients by a McNemar test, a significant difference (P<0.05) was found between these two techniques. CONCLUSION: Arthro-MDCT of the shoulder is a safe technique that provides accurate diagnosis in identifying chondral, fibrocartilaginous, and intraarticular ligamentous lesions in patients who cannot be evaluated by MRI, and in patients after surgery.

Magnetic resonance imaging comparison of intra-articular cavernous synovial hemangioma and cystic synovial hyperplasia of the knee.

PURPOSE: To identify and compare magnetic resonance imaging (MRI) characteristics, with and without intravenous contrast medium, of cavernous synovial hemangiomas and cystic synovial hyperplasia. MATERIAL AND METHODS: Four cases of cavernous synovial hemangioma and five of cystic synovial hyperplasia of the knee were studied retrospectively. The patients (5 F and 4 M; 15-25 years of age) all had long-standing knee pain. At clinical examination we observed elastic swelling and pain without significant joint effusion. The patients underwent conventional radiography and MRI without and following intravenous contrast medium before arthroscopic biopsy. RESULTS: The radiographs were interpreted as negative in all patients. MRI examination without contrast medium revealed a similar multicystic appearance for both lesions. Following intravenous contrast agent administration, cavernous synovial hemangiomas demonstrated avid, rather homogenous enhancement, whereas cystic synovial hyperplasia demonstrated less intense, peripheral enhancement only. Arthroscopy with histological examination of the lesions confirmed the MRI diagnosis in every case. CONCLUSION: In our experience, cavernous synovial hemangioma and cystic synovial hyperplasia have a similar appearance on unenhanced MRI, but can be reliably differentiated on the basis of enhancement characteristics following intravenous contrast administration.

[Isolated atrophy of the infraspinatus muscle in baseball players]. / Atrofia isolata del muscolo sottospinoso nel giocatore di baseball.

Atrophy of infraspinatus muscle caused by suprascapular nerve entrapment is a typical disease of overhead sports such as volleyball, baseball and javelin. The chronic distress of suprascapular nerve infraspinatus branch may derive from nerve kinking and friction caused by an entrapment at the spino-glenoid notch, often repeated during external-rotation and abduction of shoulder. From 1999 to 2000 4 athletes, out of 143 professional baseball players, were found suffering from this disease. The diagnosis was confirmed by MNR and EMG, while a isokinetic test quantified a loss of strength in external-rotation and allowed a standard parameter for the treatment result evaluation. The 4 athletes were submitted to a non-invasive rehabilitation protocol, thanks to electrostimulation and isokinetic exercises, aiming at strengthening the extrarotator muscles and restoring a suited musclar balance. A subjective improvement was verified and confirmed by isokinetic test in all the players; moreover no surgery was needed.