Evaluation of a newly designed deep learning-based algorithm for automated assessment of scapholunate distance in wrist radiography as a surrogate parameter for scapholunate ligament rupture and the correlation with arthroscopy.

PURPOSE: Not diagnosed or mistreated scapholunate ligament (SL) tears represent a frequent cause of degenerative wrist arthritis. A newly developed deep learning (DL)-based automated assessment of the SL distance on radiographs may support clinicians in initial image interpretation. MATERIALS AND METHODS: A pre-trained DL algorithm was specifically fine-tuned on static and dynamic dorsopalmar wrist radiography (training data set n = 201) for the automated assessment of the SL distance. Afterwards the DL algorithm was evaluated (evaluation data set n = 364 patients with n = 1604 radiographs) and correlated with results of an experienced human reader and with arthroscopic findings. RESULTS: The evaluation data set comprised arthroscopically diagnosed SL insufficiency according to Geissler's stages 0-4 (56.5%, 2.5%, 5.5%, 7.5%, 28.0%). Diagnostic accuracy of the DL algorithm on dorsopalmar radiography regarding SL integrity was close to that of the human reader (e.g. differentiation of Geissler's stages ≤ 2 versus > 2 with a sensitivity of 74% and a specificity of 78% compared to 77% and 80%) with a correlation coefficient of 0.81 (P < 0.01). CONCLUSION: A DL algorithm like this might become a valuable tool supporting clinicians' initial decision making on radiography regarding SL integrity and consequential triage for further patient management.

MRI-based torsion measurement of the lower limb is a reliable and valid alternative for CT measurement: a prospective study.

PURPOSE: The aim of this study was to compare MRI-based torsion measurements of the lower limb to a well-established CT-based assessment in a prospective inter- and intraindividual approach. METHODS: A total of 26 patients (age 28.8 years ± 11.0) were enrolled beginning in January 2021 until August 2022. Inclusion criteria were the clinical indication for torsion measurement of the lower limb. CT and MRI imaging were performed with a standard operating procedure, to ensure that all patients were examined in a standardized position. The examinations were planned on a coronal scout view based on prominent anatomical landmarks. Femoral and tibial torsion were measured individually. Torsion measurements were analysed twice: immediately after examination and after 3 weeks. Subsequently, intra-rater and parallel test reliability was calculated accordingly. RESULTS: High significant results for CT and MRI measurements for both tibia (MRI: r = 0.961; p ≤ 0.001; CT: r = 0.963; p ≤ 0.001) and femur (MRI: r = 0.980; p ≤ 0.001; CT: r = 0.979; p ≤ 0.001) were obtained by calculated intra-rater reliability, showing that measurements were highly consistent for MRI and CT, respectively. Parallel test reliability for time point 1 as well as time point 2 was also highly significant and ranged from r = 0.947 to r = 0.972 (all with p ≤ 0.001, respectively) for both tibia and femur, showing a high concordance between the two measurements. CONCLUSION: Measurement of tibial as well as femoral torsion was comparable for CT and MRI measurement. Therefore, this study supports MRI measurement as an equivalent alternative for CT measurement concerning torsional malalignment to reduce exposure to radiation. LEVEL OF EVIDENCE: Level II.

A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2).

INTRODUCTION: The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. PATIENTS AND METHODS: This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. RESULTS: Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. CONCLUSION: The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

Diagnostic Accuracy of 128-Slice Single-Source CT for the Detection of Dislocated Bucket Handle Meniscal Tears in the Setting of an Acute Knee Trauma-Correlation with MRI and Arthroscopy.

(1) Background: Meniscal tears are amongst the most common knee injuries. Dislocated bucket handle meniscal tears in particular should receive early intervention. The purpose of this study was to evaluate the diagnostic performance of CT in detecting dislocated bucket handle meniscal tears compared with the gold-standard MRI and arthroscopy. (2) Methods: Retrospectively, 96 consecutive patients underwent clinically indicated CT of the knee for suspected acute traumatic knee injuries (standard study protocol, 120 kV, 90 mAs). Inclusion criteria were the absence of an acute fracture on CT and a timely MRI (<6 months). Corresponding arthroscopy was assessed. Two experienced musculoskeletal radiologists analyzed the images for dislocated bucket handle meniscal tears, associated signs thereof (double posterior cruciate ligament sign, double delta sign, disproportional posterior horn sign), and subjective diagnostic confidence on a 5-point-Likert scale (1 = 'non-diagnostic image quality', 5 = 'very confident'). (3) Results: Dislocated bucket handle meniscal tears were detected on CT by standard three-plane bone kernel reconstructions with a sensitivity of 90.7% and a specificity of 99.3% by transferring the knowledge of established MRI signs. The additional use of soft-tissue kernel reconstructions in three planes increased the sensitivity by 4.0% to 94.7%, specificity to 100%, inter-rater agreement to 1.0, and the diagnostic confidence of both readers improved to a median 4/5 ('confident') in both readers. (4) Conclusions: Trauma CT scan of the knee with three-plane soft-tissue reconstructions delivers the potential for the detection of dislocated bucket handle meniscal tears with very high diagnostic accuracy.

Prospective intraindividual comparison of a standard 2D TSE MRI protocol for ankle imaging and a deep learning-based 2D TSE MRI protocol with a scan time reduction of 48.

PURPOSE: Magnetic resonance imaging (MRI) scan time remains a limited and valuable resource. This study evaluates the diagnostic performance of a deep learning (DL)-based accelerated TSE study protocol compared to a standard TSE study protocol in ankle MRI. MATERIAL AND METHODS: Between October 2020 and July 2021 forty-seven patients were enrolled in this study for an intraindividual comparison of a standard TSE study protocol and a DL TSE study protocol either on a 1.5 T or a 3 T scanner. Two radiologists evaluated the examinations regarding structural pathologies and image quality categories (5-point-Likert-scale; 1 = "non diagnostic", 5 = "excellent"). RESULTS: Both readers showed almost perfect/perfect agreement of DL TSE with standard TSE in all analyzed structural pathologies (0.81-1.00) with a median "good" or "excellent" rating (4-5/5) in all image quality categories in both 1.5 T and 3 T MRI. The reduction of total acquisition time of DL TSE compared to standard TSE was 49% in 1.5 T and 48% in 3 T MRI to a total acquisition time of 5 min 41 s and 5 min 46 s. CONCLUSION: In ankle MRI the new DL-based accelerated TSE study protocol delivers high agreement with standard TSE and high image quality, while reducing the acquisition time by 48%.

Deep Learning MRI Reconstruction for Accelerating Turbo Spin Echo Hand and Wrist Imaging: A Comparison of Image Quality, Visualization of Anatomy, and Detection of Common Pathologies with Standard Imaging.

RATIONALE AND OBJECTIVES: Magnetic resonance imaging (MRI) of the hand and wrist is a routine MRI examination and takes about 15-20 minutes, which can lead to problems resulting from the relatively long scan time, such as decreased image quality due to motion artifacts and lower patient throughput. The objective of this study was to evaluate a deep learning (DL) reconstruction for turbo spin echo (TSE) sequences of the hand and wrist regarding image quality, visualization of anatomy, and diagnostic performance concerning common pathologies. MATERIALS AND METHODS: Twenty-one patients (mean age: 43 ± 19 [19-85] years, 10 men, 11 female) were prospectively enrolled in this study between October 2020 and June 2021. Each participant underwent two MRI protocols: first, standard fully sampled TSE sequences reconstructed with a standard GRAPPA reconstruction (TSES) and second, prospectively undersampled TSE sequences using a conventional parallel imaging undersampling pattern reconstructed with a DL reconstruction (TSEDL). Both protocols were acquired consecutively in one examination. Two experienced MSK-imaging radiologists qualitatively evaluated the images concerning image quality, noise, edge sharpness, artifacts, and diagnostic confidence, as well as the delineation of anatomical structures (triangular fibrocartilage complex, tendon of the extensor carpi ulnaris muscle, extrinsic and intrinsic ligaments, median nerve, cartilage) using a five-point Likert scale and assessed common pathologies. Wilcoxon signed-rank test and kappa statistics were performed to compare the sequences. RESULTS: Overall image quality, artifacts, delineation of anatomical structures, and diagnostic confidence of TSEDL were rated to be comparable to TSES (p > 0.05). Additionally, TSEDL showed decreased image noise (4.90, median 5, IQR 5-5) compared to TSES (4.52, median 5, IQR 4-5, p < 0.05) and improved edge sharpness (TSEDL: 4.10, median 4, IQR 3.5-5; TSES: 3.57, median 4, IQR 3-4; p < 0.05). Inter- and intrareader agreement was substantial to almost perfect (κ = 0.632-1.000) for the detection of common pathologies. Time of acquisition could be reduced by more than 60% with the protocol using TSEDL. CONCLUSION: Compared to TSES, TSEDL provided decreased noise and increased edge sharpness, equal image quality, delineation of anatomical structures, detection of pathologies, and diagnostic confidence. Therefore, TSEDL may be clinically relevant for hand and wrist imaging, as it reduces examination time by more than 60%, thus increasing patient comfort and patient throughput.

Ultra-low-dose CT is feasible for torsion measurement of the lower limb in patients with metal implants.

OBJECTIVES: Patients who need torsion measurement of the lower limb often have metal implants hindering e.g. MRI. A new ultra-low-dose (ULD-)CT protocol might be feasible for torsion measurement at cost of relatively low radiation exposure. METHODS: We retrospectively included all patients with clinically indicated torsion measurement in the period July 2019 to June 2021 and metal implants in the scanning field. The ULD-CT protocol comprised automated tube current time product and automated tube voltage with reference settings of 100kV/20mAs (hip), 80kV/20mAs (knee) and 80kV/10mAs (ankle). Femoral neck anteversion, tibial, intra-articular knee and overall leg torsion measurements were performed by two radiologists independently. Diagnostic confidence regarding the delineation of the relevant cortical bone was rated on a 5-point Likert scale (1 = non-diagnostic, 5 = excellent). RESULTS: 102 consecutive patients could be included (BMI 27.38 ± 5.85) with 154 metal implants. Median total dose length product of the ULD-CT-torsion measurement was 16.5mGycm [11-39]. Both readers showed high agreement with a maximum torsional difference of 4.1°. Diagnostic confidence was rated best (5/5) in 92.2% (reader 1) and 93.1% (reader 2) with a worst rating of 3/5. CONCLUSION: The new ULD-CT protocol is feasible for torsion measurement of the lower limb - even in patients with metal implants. ADVANCES IN KNOWLEDGE: Metal implants are not an obstacle for ULD-CT torsion measurements of the lower limb.

A brazilian nationwide multicenter study on deficiency of deaminase-2 (DADA2)

Abstract Introduction The deficiency of ADA2 (DADA2) is a rare autoinflammatory disease provoked by mutations in the ADA2 gene inherited in a recessive fashion. Up to this moment there is no consensus for the treatment of DADA2 and anti-TNF is the therapy of choice for chronic management whereas bone marrow transplantation is considered for refractory or severe phenotypes. Data from Brazil is scarce and this multicentric study reports 18 patients with DADA2 from Brazil. Patients and methods This is a multicentric study proposed by the Center for Rare and Immunological Disorders of the Hospital 9 de Julho - DASA, São Paulo - Brazil. Patients of any age with a confirmed diagnosis of DADA2 were eligible for this project and data on clinical, laboratory, genetics and treatment were collected. Results Eighteen patients from 10 different centers are reported here. All patients had disease onset at the pediatric age (median of 5 years) and most of them from the state of São Paulo. Vasculopathy with recurrent stroke was the most common phenotype but atypical phenotypes compatible with ALPS-like and Common Variable Immunodeficiency (CVID) was also found. All patients carried pathogenic mutations in the ADA2 gene. Acute management of vasculitis was not satisfactory with steroids in many patients and all those who used anti-TNF had favorable responses. Conclusion The low number of patients diagnosed with DADA2 in Brazil reinforces the need for disease awareness for this condition. Moreover, the absence of guidelines for diagnosis and management is also necessary (t).

Application of a Deep Learning Algorithm for Combined Super-Resolution and Partial Fourier Reconstruction Including Time Reduction in T1-Weighted Precontrast and Postcontrast Gradient Echo Imaging of Abdominopelvic MR Imaging.

Purpose: The purpose of this study was to test the technical feasibility and the impact on the image quality of a deep learning-based super-resolution reconstruction algorithm in 1.5 T abdominopelvic MR imaging. Methods: 44 patients who underwent abdominopelvic MRI were retrospectively included, of which 4 had to be subsequently excluded. After the acquisition of the conventional volume interpolated breath-hold examination (VIBEStd), images underwent postprocessing, using a deep learning-based iterative denoising super-resolution reconstruction algorithm for partial Fourier acquisitions (VIBESR). Image analysis of 40 patients with a mean age of 56 years (range 18−84 years) was performed qualitatively by two radiologists independently using a Likert scale ranging from 1 to 5, where 5 was considered the best rating. Results: Image analysis showed an improvement of image quality, noise, sharpness of the organs and lymph nodes, and sharpness of the intestine for pre- and postcontrast images in VIBESR compared to VIBEStd (each p < 0.001). Lesion detectability was better for VIBESR (p < 0.001), while there were no differences concerning the number of lesions. Average acquisition time was 16 s (±1) for the upper abdomen and 15 s (±1) for the pelvis for VIBEStd, and 15 s (±1) for the upper abdomen and 14 s (±1) for the pelvis for VIBESR. Conclusion: This study demonstrated the technical feasibility of a deep learning-based super-resolution algorithm including partial Fourier technique in abdominopelvic MR images and illustrated a significant improvement of image quality, noise, and sharpness while reducing TA.

Ultra-low dose CT for scaphoid fracture detection-a simulational approach to quantify the capability of radiation exposure reduction without diagnostic limitation.

Background: Modern CT might deliver higher image quality than necessary for fracture imaging, which would mean non-essential effective radiation exposure for patients. We simulated ultra-low dose (ULD)-CT at different dose levels and analyzed their diagnostic performance for scaphoid fracture detection. Methods: 30 consecutive high quality CT with clinically suspected scaphoid fractures were assessed. ULD-simulations were made at 20%, 10% and 5% of original dose. Three readers at different levels of experience (expert, moderate, inexperienced) expressed their diagnostic confidence (DC; 5-point-Likert-scale) and analyzed the presence and classification of scaphoid fractures within Krimmer's and Herbert's classifications. Effective radiation exposure of the original data sets and ULD-CT were calculated. Results: At 20% and 10% dose the more experienced readers reached perfect sensitivity (100%) and specificity (100%), showing perfect agreement regarding fracture classification (1.00). Diagnostic performance decreased at 5% dose (92.86% sensitivity, 100% specificity; expert reader). The inexperienced reader showed reduced sensitivity and specificity at all dose levels. At 10% dose minimal DC of all readers was 3/5 and mean calculated effective radiation exposure was 1.11 [±0.36] µSv. Conclusions: The results suggest that ULD-CT at 10% dose compared to high quality CT might offer sufficient image quality to precisely detect and classify scaphoid fractures, if moderate experience of the radiologist is granted.

Feasibility of an accelerated 2D-multi-contrast knee MRI protocol using deep-learning image reconstruction: a prospective intraindividual comparison with a standard MRI protocol.

OBJECTIVES: The aim of this study was to evaluate the image quality and diagnostic performance of a deep-learning (DL)-accelerated two-dimensional (2D) turbo spin echo (TSE) MRI of the knee at 1.5 and 3 T in clinical routine in comparison to standard MRI. MATERIAL AND METHODS: Sixty participants, who underwent knee MRI at 1.5 and 3 T between October/2020 and March/2021 with a protocol using standard 2D-TSE (TSES) and DL-accelerated 2D-TSE sequences (TSEDL), were enrolled in this prospective institutional review board-approved study. Three radiologists assessed the sequences regarding structural abnormalities and evaluated the images concerning overall image quality, artifacts, noise, sharpness, subjective signal-to-noise ratio, and diagnostic confidence using a Likert scale (1-5, 5 = best). RESULTS: Overall image quality for TSEDL was rated to be excellent (median 5, IQR 4-5), significantly higher compared to TSES (median 5, IQR 4 - 5, p < 0.05), showing significantly lower extents of noise and improved sharpness (p < 0.001). Inter- and intra-reader agreement was almost perfect (κ = 0.92-1.00) for the detection of internal derangement and substantial to almost perfect (κ = 0.58-0.98) for the assessment of cartilage defects. No difference was found concerning the detection of bone marrow edema and fractures. The diagnostic confidence of TSEDL was rated to be comparable to that of TSES (median 5, IQR 5-5, p > 0.05). Time of acquisition could be reduced to 6:11 min using TSEDL compared to 11:56 min for a protocol using TSES. CONCLUSION: TSEDL of the knee is clinically feasible, showing excellent image quality and equivalent diagnostic performance compared to TSES, reducing the acquisition time about 50%. KEY POINTS: • Deep-learning reconstructed TSE imaging is able to almost halve the acquisition time of a three-plane knee MRI with proton density and T1-weighted images, from 11:56 min to 6:11 min at 3 T. • Deep-learning reconstructed TSE imaging of the knee provided significant improvement of noise levels (p < 0.001), providing higher image quality (p < 0.05) compared to conventional TSE imaging. • Deep-learning reconstructed TSE imaging of the knee had similar diagnostic performance for internal derangement of the knee compared to standard TSE.

Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing.

PURPOSE: Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. METHODS: Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. RESULTS: Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38-11.03], LTI (6.6 [0.6-68.1]), TT-TG (2.9 [0.9-9.2]), and patellar height according to ISI (2.3 [0.7-7.5]) and CDI (2.3 [0.7-7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42-100) points and an IKDC score of 90.6 ± 11.7 (55.2-100) points. CONCLUSION: Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. LEVEL OF EVIDENCE: Level IV.

Radiation Dose Reduction in CT Torsion Measurement of the Lower Limb: Introduction of a New Ultra-Low Dose Protocol.

This study analyzed the radiation exposure of a new ultra-low dose (ULD) protocol compared to a high-quality (HQ) protocol for CT-torsion measurement of the lower limb. The analyzed patients (n = 60) were examined in the period March to October 2019. In total, 30 consecutive patients were examined with the HQ and 30 consecutive patients with the new ULD protocol comprising automatic tube voltage selection, automatic exposure control, and iterative image reconstruction algorithms. Radiation dose parameters as well as the contrast-to-noise ratio (CNR) and diagnostic confidence (DC; rated by two radiologists) were analyzed and potential predictor variables, such as body mass index and body volume, were assessed. The new ULD protocol resulted in significantly lower radiation dose parameters, with a reduction of the median total dose equivalent to 0.17 mSv in the ULD protocol compared to 4.37 mSv in the HQ protocol (p < 0.001). Both groups showed no significant differences in regard to other parameters (p = 0.344-0.923). CNR was 12.2% lower using the new ULD protocol (p = 0.033). DC was rated best by both readers in every HQ CT and in every ULD CT. The new ULD protocol for CT-torsion measurement of the lower limb resulted in a 96% decrease of radiation exposure down to the level of a single pelvic radiograph while maintaining good image quality.

1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 1.

ABSTRACT: Whole-body magnetic resonance imaging (MRI) systems with a field strength of 3 T have been offered by all leading manufacturers for approximately 2 decades and are increasingly used in clinical diagnostics despite higher costs. Technologically, MRI systems operating at 3 T have reached a high standard in recent years, as well as the 1.5-T devices that have been in use for a longer time. For modern MRI systems with 3 T, more complexity is required, especially for the magnet and the radiofrequency (RF) system (with multichannel transmission). Many clinical applications benefit greatly from the higher field strength due to the higher signal yield (eg, imaging of the brain or extremities), but there are also applications where the disadvantages of 3 T might outweigh the advantages (eg, lung imaging or examinations in the presence of implants). This review describes some technical features of modern 1.5-T and 3-T whole-body MRI systems, and reports on the experience of using both types of devices in different clinical settings, with all sections written by specialist radiologists in the respective fields.This first part of the review includes an overview of the general physicotechnical aspects of both field strengths and elaborates the special conditions of diffusion imaging. Many relevant aspects in the application areas of musculoskeletal imaging, abdominal imaging, and prostate diagnostics are discussed.

Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years.

BACKGROUND: This study presents patient-reported outcome measures after combined matrix-associated autologous chondrocyte implantation and autologous bone grafting in high-stage osteochondral lesions of the talus in adolescents. METHODS: A total of 12 adolescent patients (13 ankles) received matrix-associated autologous chondrocyte implantation and autologous bone grafting for a solitary osteochondral lesion of the talus at a single centre. The Foot and Ankle Outcome Score and Foot and Ankle Ability Measure were defined as outcome measures (median follow-up 80 months [range 22-107 months]). Pre- and postoperative ankle radiographs were evaluated according to the van Dijk ankle osteoarthritis scale. RESULTS: The study population consisted of four male and nine female cases (mean age at the time of surgery, 17.7 ± 2.1 years). Eight lesions were classified as traumatic and five as idiopathic. Twelve lesions were located medial vs one lateral in the coronal plane and all central in the sagittal plane. The median lesion size and depth were 1.3 cm2 (range 0.9-3.2 cm2) and 5 mm (range 5-9 mm), respectively. There were no perioperative complications in any of the cases. In 9 cases patient-reported outcome measures were available. The results of the Foot and Ankle Outcome Score subscales were symptoms, 70 ± 14; pain, 83 ± 10; activities of daily living, 89 ± 12; sports/recreational activities, 66 ± 26; and quality of life, 51 ± 17. The mean overall Foot and Ankle Outcome Score was 78 ± 13. The results of the Foot and Ankle Ability Measure subscales were activities of daily living, 81 ± 20; function/activities of daily living, 84 ± 13; sports, 65 ± 29; and function/sports, 73 ± 27. According to the function overall subscale of the Foot and Ankle Ability Measure, in two cases, the patients assessed the ankle function as normal, in three as nearly normal, and in three as abnormal (missing data, n = 1). Preoperative van Dijk scale: stage 0 in five cases and stage I in eight cases; postoperative van Dijk scale: stage 0 in four cases, stage I in 9 cases CONCLUSIONS: Patient-reported outcome measures following matrix-associated autologous chondrocyte implantation and autologous bone grafting for high-stage osteochondral lesions of the talus in adolescents show heterogeneous results. Long-term limitations mainly affect sports and recreational activities. Osteochondral lesions of the talus are associated with osteoarthritis, even preoperatively. However, we did not find significant osteoarthritis progression after matrix-associated autologous chondrocyte implantation and autologous bone grafting in the long term.

Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients.

BACKGROUND: The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. METHODS: Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. 'Re-operation' as the outcome measure was evaluated after a median follow-up of 42 months (range 6-117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. RESULTS: Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13-61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). CONCLUSIONS: We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.

Improving the accuracy of patient positioning for long-leg radiographs using a Taylor Spatial Frame mounted rotation rod.

INTRODUCTION: Long-leg radiographs are used to plan and supervise the correction of bone deformity in patients treated with the Taylor Spatial Frame (TSF). Often radiographs are performed with malpositioning of the limb leading to wrong alignment measurements. The aim of this retrospective study was to show the usefulness of a simple device which might enhance the reproducibility of limb rotation on long-leg radiographs. MATERIALS AND METHODS: We included 20 consecutive patients with TSF treatment and at least three long-leg radiographs (4.9 ± 1.3). Eight out of 20 patients received radiographs with the help of a rotation rod (device with two clamps and a carbon tube). It is placed at the most frontal tab of the reference ring while conducting the radiograph. By this means, limb rotation can be controlled. To show the usefulness of this device, two observers measured the relation of the distances between the middle of the reference ring to the medial and lateral fourth hole on the reference ring (TSF-RR). The standard deviation and range of the TSF-RR of all radiographs for each patient was calculated and compared between patients without and with the rotation rod. RESULTS: The standard deviations of TSF-RR in patients without the rotation rod was significantly higher compared to patients with rotation rod (observer 1: p = 0.0228, observer 2: p = 0.0038). Also, the range of the TSF-RR within one patient is significant higher (observer 1: p = 0.0279, observer 2: p = 0.0038) in patients without the rotation rod compared to patients with the rotation rod. CONCLUSIONS: The variability of rotation on radiographs was lower with the rotation rod. Therefore, more reproducible and better comparable radiographs can be conducted. Radiologic exposure might be reduced as repetition of wrongly positioned limbs on radiographs are less frequent.