Inter- and Intra-Observer Variability of the AMADEUS Tool for Osteochondral Lesions of the Talus.

BACKGROUND: Managing osteochondral cartilage defects (OCDs) of the talus is a common daily challenge in orthopaedics as they predispose patients to further cartilage damage and progression to osteoarthritis. Therefore, the implementation of a reliable tool to quantify the amount of cartilage damage that is present is of the essence. METHODS: We retrospectively identified 15 adult patients diagnosed with uncontained OCDs of the talus measuring <150 mm2, which were treated arthroscopically with bone marrow stimulation. Five independent assessors evaluated the pre-operative MRI scans with the AMADEUS scoring system (i.e., MR-based pre-operative assessment system) and the intra-/inter-observer variability was then calculated by means of the intraclass correlation coefficients (ICC) and Kappa (κ) statistics, respectively. In addition, the correlation between the mean AMADEUS scores and pre-operative self-reported outcomes as measured by the Manchester-Oxford foot questionnaire (MOxFQ) was assessed. RESULTS: The mean ICC and the κ statistic were 0.82 (95% CI [0.71, 0.94]) and 0.42 (95% CI [0.25, 0.59]). The Pearson correlation coefficient was found to be r = -0.618 (p = 0.014). CONCLUSIONS: The AMADEUS tool, which was originally designed to quantify knee osteochondral defect severity prior to cartilage repair surgery, demonstrated good reliability and moderate inter-observer variability for small OCDs of the talar shoulder. Given the strong negative correlation between the AMADEUS tool and pre-operative clinical scores, this tool could be implemented in clinical practise to reliably quantify the extent of the osteochondral defects of the talus.

Stress Injuries of the Spine in Sports.

Spine sports stress injuries account for a significant amount of time loss at play in athletes, particularly if left unrecognized and allowed to progress. Spondylolysis makes up most of these stress injuries. This article focuses on spondylolysis, bringing together discussion from the literature on its pathomechanics and the different imaging modalities used in its diagnosis. Radiologists should be aware of the limitations and more importantly the roles of different imaging modalities in guiding and dictating the management of spondylolysis. Other stress-related injuries in the spine are also discussed including but not limited to pedicle fracture and apophyseal ring injury.

Split and partially entwined sciatic nerve following closed reduction of a dislocated hip prosthesis.

We present a case of split and partially entwined sciatic nerve by a femoral prosthesis following closed reduction of a dislocated hip replacement. This complication is very rare and there are only few cases reported in the literature, with even less accompanied by supporting MRI. We present MRI features of a split and partially entwined sciatic nerve around a hip prosthesis.

Plicae: Where Do They Come from and When Are They Relevant?

Synovial plicae are vestigial folds of synovium in a joint, most widely recognized in the knee and also in the elbow and hip joints. The most commonly shared theory on the origin of plicae is that they are the remnants of the membranes that divide the synovial cavitations during normal joint development. Synovial folds do not generally cause any symptoms. However, they can become inflamed, thickened, fibrosed, and also impinged in the joint, leading to mechanical symptoms and chondral damage. This article presents an overview of the embryological origin of plicae, their anatomy, pathologies, and appearances on imaging. We also discuss the lesser known plicae in various other areas.