Magnetic Resonance Imaging-Defined Osteophyte Presence and Concomitant Cartilage Damage in Knees With Incident Tibiofemoral Osteoarthritis: Data From the Pivotal Osteoarthritis Initiative Magnetic Resonance Imaging Analyses Study.

OBJECTIVE: To describe compartmental frequencies of magnetic resonance image (MRI)-defined osteophytes and co-localized cartilage damage and evaluate the associations of osteophyte size with any ipsicompartmental cartilage damage in knees with incident tibiofemoral radiographic knee osteoarthritis (OA). METHODS: We evaluated knees from the Osteoarthritis Initiative without radiographic knee OA at baseline that developed radiographic knee OA during a 4-year interval. Semiquantitative MRI scoring of osteophytes and cartilage damage was performed at the time point when radiographic knee OA was diagnosed, defined as Kellgren/Lawrence grade of ≥2, using the MRI Osteoarthritis Knee Score instrument. The frequencies of maximum osteophyte size and maximum grade of ipsicompartmental (i.e., patellofemoral, medial tibiofemoral, lateral tibiofemoral, posterior femur) cartilage damage were assessed. Generalized estimating equations were used to determine the association of MRI-defined maximum osteophyte size with presence of any (excluding focal superficial defects) ipsicompartmental cartilage damage. RESULTS: A total of 296 knees that did not have tibiofemoral radiographic knee OA at the baseline visit but developed radiographic knee OA during the 48-month observational period were included. In the patellofemoral, medial tibiofemoral, and lateral tibiofemoral compartments, the most frequent osteophyte grade was 1 (67.6%, 59.1%, and 51.7%, respectively) and was 0 (51.7%) in the posterior femur. For all compartments except the posterior femur, a linear trend was found between increasing maximum osteophyte size and the presence of any concomitant cartilage damage. CONCLUSION: In this sample of knees with incident tibiofemoral radiographic knee OA, the patellofemoral joint showed more severe cartilage damage than other compartments regardless of concomitant osteophyte size. In the posterior femur, cartilage damage was rare despite the presence or size of concomitant osteophytes.

Unusual case of lipoma arborescens in the subacromial-subdeltoid bursa.

A 38-year-old female presented with a 10-month history of right shoulder pain with impingement symptoms. She was diagnosed on magnetic resonance (MR) imaging to have supraspinatus tendon tear and degenerative changes contributing to subacromial impingement. She also had lipoma arborescens of the subacromial-subdeltoid bursa, an uncommon condition in a particularly rare location. Lipoma arborescens is a benign intra-articular condition characterized by lipomatous proliferation of synovium with replacement of subsynovial tissue by mature adipocytes. It is typically a monoarticular process affecting the knee. Due to the presence of pathognomonic fat, diagnosis is usually straightforward with MR as the preferred imaging modality.

You can never have too many accessories - a case of two accessory muscles of the ankle.

Accessory muscles are relatively rare anatomic duplications of muscles that may appear anywhere in the muscular system. Though a wide array of accessory and supernumery muscles involving the ankle have been described in the literature, this is the first reported case we are aware of that features two accessory muscles. Accessory muscles are typically asymptomatic and often picked up as incidental findings but are important to be identified in the presence of chronic persistent ankle pain and the absence of other more common aetiologies.

Costs, charges and revenues of elective coronary angioplasty and stenting: the public versus the private system.

OBJECTIVE: To calculate the costs of elective coronary angioplasty and stenting (CAS) in the public and private healthcare systems and to compare these costs with the charges levied and the revenues obtained. DESIGN: A prospective health economics study. SETTING: A tertiary care public hospital and a co-located tertiary care private hospital in the 12 months from February 1998. STUDY POPULATION: 186 consecutive patients (124 public, 62 private) undergoing elective CAS. MAIN OUTCOME MEASURES: Outcome of CAS; exact costs of CAS in the two hospitals; exact charges to private patients; estimated charges in a typical, not co-located, "industry standard private hospital"; estimated costs to the Federal Government of CAS in the public and private system. RESULTS: The immediate and six-month outcomes in the two groups were similar. The average cost of CAS in public patients was $5,516, compared with $5,844 in private patients. The length of stay, number of stents per case and use of nonstent consumables was similar for both groups. Average charges for CAS in patients in the co-located private hospital were $13,347, and estimated average charges for CAS in an industry standard private hospital were $14,978. Estimated current costs to the government for CAS in a public hospital, a co-located private hospital, and an industry standard private hospital were $5664, $5,394 and $6,201, respectively. CONCLUSIONS: Despite similar treatments and similar treatment costs, CAS in the private system, as a consequence of the charges levied, is more than twice as expensive as in the public system, with government costs similar for both systems. These data (together with data from other studies showing that CAS is performed more frequently in private patients) suggest that encouraging more people to take out private health insurance will, paradoxically, increase government costs for CAS as well as increasing overall health expenditure.