Meniscal ramp lesions: an illustrated review.

The purpose of this review is to describe the anatomy and lesions affecting the peripheral portion of posterior horn of medial menisci (ramp lesions), along with illustrations and MRI cases. We will correlate imaging features with arthroscopic classification of ramp lesions. Also, postoperative and chronic changes related to meniscocapsular tears will be presented, as well as biomechanical consequences and treatment approach.

The use of bioactive glass S53P4 in the treatment of an infected Charcot foot: a case report.

OBJECTIVE:: To report a case of successful limb-salvage staged treatment in the treatment of an infected diabetic Charcot foot. CASE SUMMARY:: A 45-year-old male with long-term, uncontrolled type 2 diabetes, six months' history of progressive deformity on the right foot and 45 days of purulent drainage in the lateral aspect of the foot. Patient was diagnosed with an infected Charcot foot with extensive midfoot bone involvement as shown by radiographic and MRI images. We used a multidisciplinary approach to treatment with early antibiotic therapy, tight glycaemic control and staged surgical treatment. Initial treatment was adequate irrigation and debridement, bone-void filling with bioactive glass, external fixation and provisional negative pressure wound therapy (NPWT). Later progressed to total contact casting and progressive protect weight bearing. At final follow-up, patient was full weight-bearing in stiff soled footwear, with no clinical signs of infection, no gross alteration of gait pattern and demonstrating complete bone healing and integration of the bioactive glass. CONCLUSION:: The bioactive glass S53P4 was successfully used in the limb-salvage staged treatment of a patient with an infected Charcot foot. Here, full integration with the surrounding bone and its supportive action in the combat of bone infection was demonstrated.

Demystifying MR Neurography of the Lumbosacral Plexus: From Protocols to Pathologies.

Magnetic resonance neurography is a high-resolution imaging technique that allows evaluating different neurological pathologies in correlation to clinical and the electrophysiological data. The aim of this article is to present a review on the anatomy of the lumbosacral plexus nerves, along with imaging protocols, interpretation pitfalls, and most common pathologies that should be recognized by the radiologist: traumatic, iatrogenic, entrapment, tumoral, infectious, and inflammatory conditions. An extensive series of clinical and imaging cases is presented to illustrate key-points throughout the article.

Evaluation of Posterior Cruciate Ligament and Intercondylar Notch in Subjects With Anterior Cruciate Ligament Tear: A Comparative Flexed-Knee 3D Magnetic Resonance Imaging Study.

PURPOSE: To determine if posterior cruciate ligament (PCL) and intercondylar notch (IN) morphometries and volumetrics act as risk factors for anterior cruciate ligament (ACL) tears. METHODS: A prospective case-controlled magnetic resonance imaging (MRI) study was conducted with subjects presenting noncontact knee injuries. Exclusion criteria were previous surgery, PCL tear, osteoarthritis, tumors, or infectious and inflammatory conditions. All participants underwent a flexed-knee 3-dimensional (3D) magnetic resonance imaging (MRI) to uniformly straighten PCL. MR images were independently reviewed by 2 radiologists and assessed for 2D and 3D measurements (bicondylar width; IN angle, depth, width, and cross-sectional area; PCL width, thickness, and cross-sectional area; and IN and PCL volumes). Clinical profiles were tabulated and subjects were divided into cases (ACL tear) and controls (without ACL tear). RESULTS: The study was composed of 50 cases versus 52 controls (N = 102), with a mean age of 36.8 years. There was no difference between groups (P > .05) regarding age, gender, body mass index, time from injury, Tegner score, flexion angle, limb side, intensity of injury, or familial or opposite limb history of tear. Agreement between readers ranged from substantial to almost perfect. Subjects with ACL tear presented with lower IN width, lower IN minus PCL widths, lower Notch Width Index, higher PCL/IN width proportion, higher PCL thickness, lower IN depth minus PCL thickness, and higher PCL thickness/IN depth proportion (P < .05). Moreover, higher PCL/IN cross-sectional area proportion, higher PCL volumes (OR = 9.01), and higher PCL/IN volume proportion were also found in cases. CONCLUSIONS: Our study shows that subjects with ACL tears present not only reduced IN but also larger PCL dimensions. These findings, isolated and combined, and especially PCL volume, might be suggestive as risk factors for ACL tears owing to the reduction of its space inside the IN. LEVEL OF EVIDENCE: Level III, comparative group.

Subclinical Propionibacterium acnes infection estimation in the intervertebral disc (SPInE-ID): protocol for a prospective cohort.

INTRODUCTION: Low back pain and vertebral endplate abnormalities are common conditions within the population. Subclinical infection caused by indolent pathogens can potentially lead to these findings, with differentiation between them notably challenging from a clinical perspective. Progressive infection of the intervertebral disc has been extensively associated with increasing low back pain, with Propionibacterium acnes specifically implicated with in relation to sciatica. The main purpose of this study is to identify if the presence of an infective pathogen within the intervertebral disc is primary or is a result of intraoperative contamination, and whether this correlates to low back pain. METHODS AND ANALYSIS: An open prospective cohort study will be performed. Subjects included within the study will be between the ages of 18 and 65 years and have a diagnosis of lumbar disc herniation requiring open decompression surgery. Excised herniated disc fragments, muscle and ligamentum flavum samples will be collected during surgery and sent to microbiology for tissue culture and pathogen identification. Score questionnaires for pain, functionality and quality of life will be given preoperatively and at 1, 3, 6 and 12 months postoperatively. A MRI will be performed 12 months after surgery for analysis of Modic changes and baseline comparison. The primary endpoint is the rate of disc infection in patients with symptomatic degenerative disc disease. The secondary endpoints will be performance scores, Modic incidence and volume. ETHICS AND DISSEMINATION: This study was approved by our Institutional Review Board and was only initiated after it (CAAE 65102617.2.0000.0071). Patients agreeing to participate will sign an informed consent form before entering the study. Results will be published in a peer reviewed medical journal irrespective of study findings. If shown to be the case, this would have profound effects on the way physicians treat chronic low back pain, even impacting health costs. TRIALS REGISTRATION NUMBER: NCT0315876; Pre-results.

MRI features of the anterolateral ligament of the knee.

OBJECTIVE: Evaluate the visibility and describe the anatomical features of the anterolateral ligament of the knee using MRI. MATERIALS AND METHODS: Magnetic resonance imaging examinations of the knee were independently reviewed by two musculoskeletal radiologists and assessed for the visibility of the anterolateral ligament under direct cross-referencing of axial and coronal images as complete, partial, or non-visible. Distal insertion site (tibial, meniscal), distance to lateral tibial plateau, measurements (length, width, thickness), and associated imaging findings were also tabulated. Clinical and surgical records were also reviewed. RESULTS: Seventy MRI scans from 60 consecutive subjects were included in the study. Mean age was 40 years, body mass 74.9 kg, and height 1.72 m. The subject population was 53% male, most of the knees were from the left side (51%), and chronic pain was the main clinical symptom (40%). Nine knees (13 %) had undergone previous surgery. The anterolateral ligament was identified in 51% of the knees: completely visible in 11% and partially visible in 40%. In all visible cases, the distal insertion site was identified on the tibia, with a mean distance of 5.7 mm to the plateau. A completely visible ligament had a mean length of 33.2 mm, width of 5.6 mm, and thickness of 1.9 mm [corrected]. Inter-observer agreement for ligament presence was significant (κ = 0.7). Statistical analyses showed a trend to be more visible in men, with a longer length compared with women. CONCLUSIONS: Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized.

Apofisites dos membros inferiores: aspectos de imagem / Apophysitis of the lower limbs: imaging findings

As apófises são núcleos de ossificação secundários que se desenvolvem com o crescimento. Estão sujeitas a forças de tração porque servem para inserção de músculos e ligamentos. Se a força de tração torna-se maior em magnitude e freqüência, pode ocorrer irritação da fase, resultando na apofisite. As lesões apofisárias ocorrem em adolescentes, geralmente presentes com dor articu-lar, associadas com o crescimento, imaturidade esquelética, microtraumas repetidos e imaturidade músculo-tendínea. As apofisites e as suas localizações principais são: doença de Osgood-Schlatter (tuberosidade tibial), apofisites do quadril (crista ilíaca e tuberosidade isquiática), doença de Sever (calcâneo posterior), apofisite do navicular, síndrome de Sindig-Larsen-Johans-son (patela inferior) e doença de lselin (tuberosidade da base do quinto metatarsal). 0 principal objetivo será demonstrar os principais achados de imagem destas afecções pela ressonância magnética e raios-X, bem como discutir os principais diagnósticos diferenciais.

Importância da ressonância magnética na avaliaçäo das lesöes traumáticas da placa de crescimento epifisária / Magnetic ressonance imaging importance in evaluation of the traumatic lesions of the epiphyseal growth plate

Estudo retrospectivo de nove pacientes que sofreram lesao traumática da placa de crescimento foi realizado através da análise de seus prontuários, com o objetivo de determinar o valor da ressonância magnética no diagnóstico precoce das lesoes pós-traumáticas da placa de crescimento e também na capacidade de identificar o tipo, localizaçao e extensao da lesao, para melhor planejar o tratamento. As ressonâncias magnéticas foram realizadas com séries pesadas em T1, T2 e T2* (gradiente eco), nos planos coronais e sagitais. Em dois casos de lesao traumática aguda sem desvio da placa de crescimento, foi possível sua identificaçao. Nos casos em que havia ponte através da placa de crescimento, foi possível identificar sua localizaçao, sua extensao e ainda diferenciar entre ponte óssea ou fibrosa, com exceçao de um caso. Os resultados mostraram que a RM é um eficiente método na detecçao precoce das alteraçoes pós-traumáticas da placa de crescimento, assim como na determinaçao da localizaçao e extensao dessas, contribuindo muito para o planejamento terapêutico.

Dor nas costa em crianças e adolescentes / Back pain in chindren and adolescents

Os autores analisam as várias causas de dor em um paciente em crescimento. Chamam a atençäo para os aspectos clínicos, do diagnóstico e do tratamento das afecçöes mais comuns que causam dor na coluna nesse grupo etário.

Herniaton of the lumbar disk in adolescents

The authors review eight cases of lumbar intervertebral disk herniation in adolescents aged less than 16 years, with a minimun follow-up treatment of 2 years, during an 18-year period. All patients presented lower back and sciatic pain, antalgic scoliosis, and a positive Lasègue sign. Nerve compression signs present in 25+ of the cases. Seventy-five percent of the cases underwent myelography and 25% underwent computerized axial tomography. Results were good in all cases

Diagnóstico por imagem nas lombalgias / Diagnostic imaging in backaches

Os autores avaliam as várias modalidades de diagnóstico empregadas nas lombalgias. Analisam as modalidades de diagnóstico em relaçäo ao quadro clínico. Apresentam um algoritmo baseado na idade dos pacientes

Ressonancia magnetica do osteoma osteoide vertebral / Magnetic resonance of spinal osteoid osteoma

Os autores apresentarm um caso de osteoma osteoide vertebral, localizado na coluna toracica, no qual foi feita ressonancia magnetica. Abordam os aspectos de imagem da ressonancia magnetica da lesao. Chamam atencao para a necessidade da precisa localizacao do osteoma osteoide vertebral, para seu correto tratamento cirurgico.