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Oca Pernas R, Fernández Cantón G. Direct MR arthrography without image guidance: a practical guide, joint-by-joint. Skeletal Radiol 2024:10.1007/s00256-024-04709-0. [PMID: 38801542 DOI: 10.1007/s00256-024-04709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
Direct MR arthrography (dMRA) is a fundamental technique in diagnosing pathology in major peripheral joints, allowing for precise evaluation of intra-articular structures. Although injection guidance is typically performed using imaging techniques such as ultrasound or fluoroscopy, puncture via anatomical landmarks may be useful in certain circumstances where it has been proven to be a safe and effective procedure. This paper describes the indications and injection technique of dMRA, joint by joint, focusing on the different technical details, from the most common locations, like the shoulder or hip, to those with more restricted clinical indications, such as the wrist, knee, elbow, or ankle. The most relevant anatomical landmarks are detailed for each joint, aiding in the intra-articular introduction of diluted contrast, highlighting the most accessible trajectories and structures to avoid when inserting the needle. Additionally, tips are provided to facilitate proper joint distension. With all this information, this paper aims to serve as a suitable reference guide for performing dMRA without image guidance if needed.
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Affiliation(s)
- Roque Oca Pernas
- Osakidetza - Basque Health Service, MRI Department, OSATEK, Osatek Deusto, Luis Power, 18, 48014, Bilbao, Spain.
- Department of Radiology, Mutualia, Bilbao, Spain.
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2
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Khan I, Ranjit S, Welck M, Saifuddin A. The role of imaging in the diagnosis, staging, and management of the osteochondral lesions of the talus. Br J Radiol 2024; 97:716-725. [PMID: 38321227 PMCID: PMC11027257 DOI: 10.1093/bjr/tqae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
Osteochondral lesions of the talus (OLT) represent an abnormality of the articular cartilage and sub-chondral bone. The abnormality is typically associated with trauma though the exact aetiology remains unknown. Multiple staging systems have been developed to classify the abnormality and management can vary from conservative treatment to different surgical options. Early diagnosis is essential for optimal outcome and all imaging modalities have a role to play in patient management. The aim of this article is to review the pathology, classification, multimodality imaging appearances of OLT, and how the imaging affects patient management.
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Affiliation(s)
- Imran Khan
- Department of Radiology, University Hospitals of Leicester NHS Trust, LE5 4PW, Leicester, United Kingdom
| | - Srinath Ranjit
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Matt Welck
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Foti G, Booz C, Buculo GM, Oliboni E, Longo C, Avanzi P, Campacci A, Zorzi C. Dual-Energy CT Arthrography: Advanced Muscolo-Skelatal Applications in Clinical Practice. Tomography 2023; 9:1471-1484. [PMID: 37624110 PMCID: PMC10458814 DOI: 10.3390/tomography9040117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected contrast medium is subtracted from the articular cavity in order to better analyze 2D and 3D images of the bone. Moreover, virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non-calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore, the role of iodine maps in enhancing the contrast between soft tissues, optimizing the visualization of contrast material, and distinguishing contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high-spatial-resolution dual-energy CT reconstructed images.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany;
| | | | - Eugenio Oliboni
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Chiara Longo
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Paolo Avanzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
| | - Antonio Campacci
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
| | - Claudio Zorzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
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Ormeci T, Tekin B, Altintas H, Durur Subasi I, Cacan M. Comparison of conventional MRI, MR arthrography, MR arthrography with traction, MR arthrography with pressure in the evaluation of articular distension. J Orthop 2022; 30:12-17. [PMID: 35210720 PMCID: PMC8844734 DOI: 10.1016/j.jor.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- T. Ormeci
- Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey,Corresponding author. Medipol University, Faculty of Medicine, Department of Radiology, Medipol Mega Hastaneler Kompleksi, Radyoloji Department, TEM Avrupa Otoyolu Göztepe çıkışı No:1 Bağcılar, 34214, İstanbul, Turkey.
| | - B. Tekin
- Department of Anatomy, School of Medicine, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - H.M. Altintas
- Department of Anatomy, School of Medicine, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey,Department of Anatomy, School of Medicine, Ankara Medipol University, Ankara, Turkey
| | - I. Durur Subasi
- Department of Radiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - M.A. Cacan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Abstract
Groin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem.
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Affiliation(s)
- Vijay D Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital Hillside Avenue, Hiranandani Gardens Powai, Mumbai 400076 India
| | - Nikhil S Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital Hillside Avenue, Hiranandani Gardens Powai, Mumbai 400076 India
| | - Amith P Shetty
- Hiranandani Orthopaedic Medical Education (HOME), Dr. L. H. Hiranandani Hospital Hillside Avenue, Hiranandani Gardens Powai, Mumbai 400076 India
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Abstract
Our understanding of labral tears in young patients has evolved significantly in recent years. Successful outcome depends on addressing all bony impingement to improve the intra-articular environment, and prevent further damage to the labrum and articular cartilage. Improved clinical outcomes are associated with labral repair; in cases of a deficient labrum, arthroscopic reconstruction techniques have been developed, with promising clinical outcomes. This article reviews the anatomy of the acetabular labrum, and discusses the pathogenesis of labral tears as well as various treatment options, including arthroscopic labral repair and reconstruction.
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Affiliation(s)
- Jack G Skendzel
- The Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA
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Skendzel JG, Weber AE, Ross JR, Larson CM, Leunig M, Kelly BT, Bedi A. The approach to the evaluation and surgical treatment of mechanical hip pain in the young patient: AAOS exhibit selection. J Bone Joint Surg Am 2013; 95:e133. [PMID: 24048564 DOI: 10.2106/jbjs.l.01611] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The mechanical causes of hip pain in a young athlete often reflect a complex combination of static and dynamic factors. A comprehensive diagnostic approach is paramount to the development of a rational treatment strategy that will address all underlying pathologic factors. The goals of this paper are to highlight the pertinent biomechanical factors of the hip joint in femoroacetabular impingement and to discuss the clinical history, physical examination, and radiographic findings that are essential to formulating a proper diagnosis and an effective treatment plan. In addition, the current literature and reported outcomes of femoroacetabular impingement surgery in athletic patients are reviewed.
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Affiliation(s)
- Jack G Skendzel
- Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106. E-mail address for A. Bedi:
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Abstract
Hip arthroscopy is one of the fastest growing surgical procedures performed by orthopaedic surgeons, with the number of hip arthroscopies expected to double in 2013. The increase in surgical prevalence is at least in part due to an increased awareness of prearthritic hip pathology. The diagnoses of prearthritic hip conditions are made through a comprehensive history, physical examination, and selection of appropriate diagnostic imaging modalities. The purpose of this review article is to provide the practicing orthopaedic surgeon with an overview of the imaging modalities available for the diagnosis of prearthritic hip pathology, with a focus on literature supporting advancements in imaging techniques and new applications of existing modalities.
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Affiliation(s)
- Alexander E. Weber
- />Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
| | - Jon A. Jacobson
- />Department of Radiology, University of Michigan, 2910G Taubman Center, SPC 5326, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Asheesh Bedi
- />Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
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Poultsides LA, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J 2012; 8:213-24. [PMID: 24082863 PMCID: PMC3470663 DOI: 10.1007/s11420-012-9304-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging. QUESTIONS/PURPOSES The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis? METHODS An unrestricted computerized search of MEDLINE was conducted. Different terms were used in various combinations. RESULTS An algorithmic approach to physical examination of a painful nonarthritic hip, including history, physical examination (specific tests), and advanced imaging allow for better interpretation of debilitating intra- and extra-articular disorders and their effect on core performance. Additionally, it improves our understanding as to how underlying abnormal joint mechanics may predispose the hip joint and the associated hemipelvis to asymmetric loads. These abnormal joint kinematics (layer I) can lead to cartilage and labral injury (layer II), as well as resultant injury to the musculotendinous (layer III) and neural structures (layer IV) about the hip joint and the hemipelvis. The layer concept is a systematic means of determining which structures about the hip are the source of hip pathology and how to best implement treatment. CONCLUSIONS A clear understanding of the differential diagnosis of hip pain through a detailed and systematic physical examination, diagnostic imaging assessment, and the interpretation of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip can facilitate the diagnosis and treatment recommendations.
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Affiliation(s)
- Lazaros A. Poultsides
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Asheesh Bedi
- Sports Medicine and Shoulder Surgery, MedSport, University of Michigan Health System, Ann Arbor, MI 48109 USA
| | - Bryan T. Kelly
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
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Perdikakis E, Karachalios T, Katonis P, Karantanas A. Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology. Skeletal Radiol 2011; 40:1441-7. [PMID: 21298428 DOI: 10.1007/s00256-011-1111-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/18/2010] [Accepted: 01/19/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the diagnostic ability of MR arthrography (MRa) and MDCT arthrography (CTa) in depicting surgically proven hip labral tears and articular cartilage degradation. MATERIALS AND METHODS Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 10 patients. The findings were evaluated by two independent observers (a musculoskeletal fellow and one senior musculoskeletal radiologist). Sensitivity, specificity, accuracy, and positive predictive value were determined using arthroscopic and open surgery findings as the standard of reference. Interobserver agreement was recorded. All images were assessed for the presence of a labral tear (according to Czerny classification) and for cartilage erosion using a 3 point scale for both methods: 1 = complete visualization-sharp edges, 2 = blurred edges fissuring-partial defects, 3 = exposed bone. The same classification was applied surgically. RESULTS Disagreement between the senior observer and the fellow observer was recorded in three cases of labral tearing with MRa and six with CTa. Disagreement was also found in four cases of cartilage erosion with both MRa and CTa. The percent sensitivity, specificity, accuracy, and positive predictive value for correctly assessing the labral tear were as follows for MRa/CTa, respectively: 100/15, 50/13, 90/14, and 90/13 (P < 0.05). The same values for cartilage assessment were 63/66, 33/40, 50/57 and 55/66 (P > 0.05). CONCLUSION Interobserver reproducibility with MRa is very good for labral tearing assessment. MRa is better for assessing labral tears. CTa shows better, but not statistically significant, demonstration of the articular cartilage.
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Affiliation(s)
- Evangelos Perdikakis
- Department of Radiology, University Hospital, University of Crete, Stavrakia, Heraklion, Greece.
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12
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Sprunggelenk. ARTHROSKOPIE 2011. [DOI: 10.1007/s00142-011-0643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Genovese E, Ronga M, Angeretti MG, Novario R, Leonardi A, Albrizio M, Callegari L, Fugazzola C. Matrix-induced autologous chondrocyte implantation of the knee: mid-term and long-term follow-up by MR arthrography. Skeletal Radiol 2011; 40:47-56. [PMID: 20446086 DOI: 10.1007/s00256-010-0939-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 03/18/2010] [Accepted: 04/12/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To define magnetic resonance (MR) arthrography imaging findings of matrix-induced autologous chondrocyte implantation (MACI) grafts of the knee in order to describe implant behaviour and to compare findings with validated clinical scores 30 and 60 months after MACI implant. MATERIALS AND METHODS Thirteen patients were recruited (10 male, 3 female) with a total number of 15 chondral lesions. Each patient underwent an MACI procedure and MR arthrography 30 and 60 months after surgery. MR arthrography was performed using a dedicated coil with a 1.5-Tesla unit. The status of the chondral implant was evaluated with the modified MOCART scoring scale. The lining of the implant, the integration to the border zone, the surface and structure of the repaired tissue were assessed, and the presence of bone marrow oedema and effusion was evaluated. For clinical assessment, the Cincinnati score was used. RESULTS At 60 months, the abnormality showed worsening in 1 out of 15 cases. Integration showed improvement in 3 out of 15 cases, and worsening in 3 out of 15 cases. Two surfaces of the implant showed further deterioration at 60 months, and 1 afflicted implant fully recovered after the same time interval. Implant contrast enhancement at 30 months was seen in 2 out of 15 cases, 1 of which recovered at 60 months. According to the MOCART score, 4 cases were rated 68.4 out of 75 at 30 months and 65 out of 75 at 60 months. The mean clinical score decreased from 8.6 out of 10 at 30 months to 8.1 out of 10 at 60 months. CONCLUSION Magnetic resonance arthrography improved the evaluation of implants and facilitated the characterisation of MACI integration with contiguous tissues. The follow-up showed significant changes in MACI, even at 60 months, allowing for useful long-term MR evaluations.
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Affiliation(s)
- Eugenio Genovese
- Department of Radiology, Insubria University, Via Guicciardini, 21100, Varese, Italy.
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Aubry S, Bélanger D, Giguère C, Lavigne M. Magnetic resonance arthrography of the hip: technique and spectrum of findings in younger patients. Insights Imaging 2010; 1:72-82. [PMID: 22347907 PMCID: PMC3259340 DOI: 10.1007/s13244-010-0023-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/26/2010] [Accepted: 04/28/2010] [Indexed: 11/26/2022] Open
Abstract
Magnetic resonance(MR) imaging is the reference imaging technique in the evaluation of hip abnormalities. However, in some pathological conditions-such as lesions of the labrum, cartilaginous lesions, femoroacetabular impingement, intra-articular foreign bodies, or in the pre-operative work-up of developmental dysplasia of the hip-intra-articular injection of a contrast medium is required to obtain a precise diagnosis. This article reviews the technical aspects, contraindications, normal appearance and potential pitfalls of MR arthrography, and illustrates the radiological appearance of commonly encountered conditions.
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Affiliation(s)
- Sébastien Aubry
- Service de Radiologie A., CHU Jean Minjoz, Boulevard Flemming, 25000 Besançon Cedex, France
- Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Danny Bélanger
- Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Caroline Giguère
- Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Martin Lavigne
- Département d’Orthopédie, Hôpital Maisonneuve Rosemont, Montréal, QC Canada
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Abstract
Soccer is the most common sport activity worldwide. Over the last two decades the increase in soccer players has mainly been due to increased interest by females. In general, soccer is a relatively safe sport activity, especially if minor injuries resulting in short periods of absence from playing or training are neglected. However, due to the high number of soccer players severe injuries are also frequent. These are a problem not only for the injured player and the team but may also become problematic for the socio-economic system. In up to 80-90% structures of the lower extremities are injured. For sufficient radiological diagnosis knowledge of the biomechanics of the soccer game and some details about the history of the injury may be of help. To prevent soccer injuries or keep the degree of injury low, special programs had been developed.
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Affiliation(s)
- J Kramer
- Röntgeninstitut am Schillerpark, Rainerstr. 6-8, A-4020, Linz, Osterreich.
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Abstract
MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography permits more sensitive imaging of suspected intra-articular pathology in cases in which conventional MR imaging is either insufficient or inadequate for diagnosis or treatment planning. The main indications for MR arthrography are the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography can be a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in those cases in which an invasive procedure is contraindicated or image guidance is not available.
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Shindle MK, Voos JE, Heyworth BE, Mintz DN, Moya LE, Buly RL, Kelly BT. Hip arthroscopy in the athletic patient: current techniques and spectrum of disease. J Bone Joint Surg Am 2007; 89 Suppl 3:29-43. [PMID: 17908869 DOI: 10.2106/jbjs.g.00603] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Ho YY, Stanley AJ, Hui JHP, Wang SC. Postoperative Evaluation of the Knee after Autologous Chondrocyte Implantation: What Radiologists Need to Know. Radiographics 2007; 27:207-20; discussion 221-2. [PMID: 17235008 DOI: 10.1148/rg.271065064] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Articular cartilage lesions occur commonly. Cartilage is relatively avascular and is unable to self-repair. A chondral lesion may become symptomatic. It may lead to osteoarthritis and increased morbidity. The aim of cartilage repair is to restore hyaline cartilage. There are many types of cartilage repair surgery, most of which result in fibrocartilage repair tissue that is suboptimal. Autologous chondrocyte implantation has been shown to produce hyaline-type repair tissue. Magnetic resonance (MR) imaging is performed preoperatively to define the ulcer and postoperatively to evaluate the technical success of implantation and the state of cartilage healing and to identify potential complications. Features of the autologous chondrocyte implantation graft that are assessed include the degree of filling by repair tissue, its integration with native cartilage and subchondral bone, the character of the graft substance and surface, and the underlying bone. MR arthrography is superior to unenhanced MR imaging because intraarticular contrast material allows the recipient site to be physically separated from adjacent structures so that it can be characterized more accurately. MR imaging and arthroscopy are complementary investigations in the follow-up of an autologous chondrocyte implantation in the knee. The appearance of the knee after autologous chondrocyte implantation varies among individuals and according to the time-course of healing. Familiarity with the surgical procedure and imaging appearance is essential for an accurate postsurgical assessment.
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Affiliation(s)
- Yvonne Yiwan Ho
- Department of Diagnostic Imaging, National University Hospital of Singapore, 5 Lower Kent Ridge Rd, Singapore 119074.
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Cerezal L, García-Valtuille R, Canga A, Rolón A, Abascal F. Técnica e indicaciones de la resonancia magnética artrografía. Extremidad superior (I). RADIOLOGIA 2006; 48:341-56. [PMID: 17323892 DOI: 10.1016/s0033-8338(06)75150-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance (MR) is the most effective imaging technique in the diagnosis of articular pathology. MR arthrography (MRA), with intra-articular injection of diluted gadolinium or physiological saline solution has become more common in recent years. The intra-articular fluid facilitates the detection of articular pathology by delineating the articular structures, separating adjacent anatomic structures, and filling potential spaces that originate in or communicate with the joint. MRA provides additional information about the integrity of the articular structures, especially cartilage, fibrocartilage, and ligaments. MRA has proven especially useful in the shoulder, where most of the studies have been centered. The detection of subtle lesions of the capsule/labrum complex is fundamental for presurgical evaluation. MRA can be used to complement conventional MR imaging in some cases and in others it is the initial technique of choice. Indirect MRA with intravenous gadolinium administration is based on the enhancement of articular fluid caused by diffusion from the synovial space to the articular space. This technique offers better results in articulations with less capacity for distension, such as the wrist, ankle, hand, and foot. This first part of two-part article reviews the current role of MRA in the upper limb. Special emphasis is placed on the shoulder joint, where its usefulness has been most clearly established. The usefulness of this technique in other joints is also described, reviewing the most important anatomic aspects, techniques and applications.
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Affiliation(s)
- L Cerezal
- Instituto Radiológico Cántabro, Clínica Mompía, Santander, España.
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Shindle MK, Foo LF, Kelly BT, Khanna AJ, Domb BG, Farber A, Wanich T, Potter HG. Magnetic resonance imaging of cartilage in the athlete: current techniques and spectrum of disease. J Bone Joint Surg Am 2006; 88 Suppl 4:27-46. [PMID: 17142433 DOI: 10.2106/jbjs.f.00614] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michael K Shindle
- Department of Radiology and Imaging, MRI Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Mustonen AOT, Tielinen L, Lindahl J, Hirvensalo E, Kiuru M, Koskinen SK. MRI of menisci repaired with bioabsorbable arrows. Skeletal Radiol 2006; 35:515-21. [PMID: 16547748 DOI: 10.1007/s00256-006-0080-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Revised: 12/08/2005] [Accepted: 01/04/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze with conventional magnetic resonance imaging (MRI) the signal appearance of menisci repaired with bioabsorbable arrows. DESIGN AND PATIENTS Forty-four patients with 47 meniscal tears treated with bioabsorbable arrows underwent follow-up conventional MRI examination. The time interval between the surgery and MRI varied from 5 to 67 months (mean 26 months). Twenty-six patients also had concurrent repair of torn anterior cruciate ligament. The following grades were used to classify meniscal signal intensity: (a) G0; low signal intensity on all sequences and regular configuration in every plane, (b) G1; increased signal intensity within the meniscus, not extending to the meniscal surface, (c) G2; increased signal intensity linear in shape, which may or may not communicate with the capsular margin of the meniscus, without extending to the meniscal surface, and (d) G3; increased signal intensity extending to the meniscal surface. RESULTS Thirteen menisci (27.5%) had normal signal intensity, 13 menisci (27.5%) Grade 1 signal intensity, 9 menisci (19%) Grade 2 signal intensity and 12 menisci (26%) Grade 3 signal intensity. The time difference between operation and MRI was statistically significant between the G0 (36 months) and G3 groups (14 months; P = 0.0288). There was no statistical significance in different grades between medial and lateral meniscus or between patients with operated or intact ACL. On physical examination sixteen patients reported slight symptoms, seen evenly in each group. CONCLUSION No difference was seen in different grades between patients with operated or intact ACL. The highest incidence of menisci with a Grade 3 signal was seen in patients where surgery was within the last 18 months.
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Affiliation(s)
- Antti O T Mustonen
- Helsinki University Hospital-Radiology, Topeliuksenkatu 5, Helsinki, 00260, Finland
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Abstract
For decades, fluoroscopic arthrography was the only method available to image a joint with contrast enhancement. Advances in CT led to the natural development of CT arthrography. Development of MRI and its capability for multiplanar imaging led to direct magnetic resonance arthrography (MRA). This technique has been performed since 1987 and has surpassed CT arthrography in popularity in the United States. Indirect MRA developed subsequently to offer a less invasive alternative. This article presents an overview of direct MRA and addresses joint-specific issues regarding direct MRA. An overview of indirect MRA also is provided.
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Affiliation(s)
- Todd Osinski
- Department of Radiology, University of California San Francisco, 505 Parnassus, Suite M392, San Francisco, CA 94143-0628, USA
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Diulus CA, Krebs VE, Hanna G, Barsoum WK. Hip arthroscopy technique and indications. J Arthroplasty 2006; 21:68-73. [PMID: 16781433 DOI: 10.1016/j.arth.2006.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 01/15/2006] [Indexed: 02/01/2023] Open
Abstract
The recent advances in hip arthroscopy have made it a useful minimally invasive approach to the diagnosis and treatment of intra-articular hip pathology. It offers the benefits of being an outpatient procedure with short rehabilitation and few reported complications and does not hinder opportunities for future surgical interventions. The lateral approach has been widely accepted, and technical details are discussed. Patients typically present with mechanical symptoms and persistent pain resistant to a reasonable trial of conservative treatment and are without significant joint space narrowing. Indications include debridement of labral lesions and loose bodies as well as treatment of impingement syndrome and avascular necrosis. Arthroscopy has also proven a useful tool in evaluation components in symptomatic patients after hip arthroplasty and in the treatment of native and replacement joint infections.
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Affiliation(s)
- Carrie A Diulus
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Sundberg TP, Toomayan GA, Major NM. Evaluation of the Acetabular Labrum at 3.0-T MR Imaging Compared with 1.5-T MR Arthrography: Preliminary Experience. Radiology 2006; 238:706-11. [PMID: 16436825 DOI: 10.1148/radiol.2382050165] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. The purpose of this study was to prospectively compare imaging of the acetabular labrum with 3.0-T magnetic resonance (MR) imaging and 1.5-T MR arthrography. Eight patients (four male, four female; mean age, 38 years) with hip pain suspicious for labral disease were examined at both MR arthrography and MR imaging. Presence of labral lesions, paralabral cysts, articular cartilage lesions, subchondral cysts, osteophytes, and synovial herniation pits was recorded. There was arthroscopic correlation of findings in five patients. MR imaging depicted four surgically confirmed labral tears that were identified at MR arthrography, as well as one that was not visualized at MR arthrography. MR imaging helped identify all other pathologic conditions that were diagnosed at MR arthrography and helped identify one additional surgically confirmed focal articular cartilage lesion. These results provide encouraging support for evaluation with 3.0-T MR imaging over 1.5-T MR arthrography.
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Affiliation(s)
- Thorsten P Sundberg
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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Yang C, Zhang SY, Wang XD, Fan XD. Magnetic resonance arthrography applied to the diagnosis of intraarticular adhesions of the temporomandibular joint. Int J Oral Maxillofac Surg 2005; 34:733-8. [PMID: 15979852 DOI: 10.1016/j.ijom.2005.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Revised: 11/11/2004] [Accepted: 02/04/2005] [Indexed: 11/17/2022]
Abstract
The purpose of this study is to investigate the diagnostic accuracy of magnetic resonance arthrography (MRAr) on the diagnosis of intraarticular adhesions of the temporomandibular joint (TMJ). Twenty-four patients (31 joints) diagnosed as internal disorders of TMJ were examined to establish the presence, suspicion or absence of intraarticular adhesions through MRAr according to the MRAr radiographic criteria in a blind fashion, subsequent arthroscopy were performed on all 31 joints. The findings were compared to MRAr with those of arthroscopy. The comparison data were assessed by generating receiver operating characteristic curve (ROC curve) and analyzing the area (Az) under the curve with SPSS11.0 software. The area under the ROC curve was 0.91 (0.86, 0.95), P<0.05. MRAr proves to be an excellent modality to diagnose intraarticular adhesions of TMJ.
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Affiliation(s)
- C Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Second Medical University, 200011 Shanghai, PR China.
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Cerezal L, Abascal F, García-Valtuille R, Canga A. Ankle MR Arthrography: How, Why, When. Radiol Clin North Am 2005; 43:693-707, viii. [PMID: 15893532 DOI: 10.1016/j.rcl.2005.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography may facilitate the evaluation of patients with suspected intra-articular pathology in whom conventional MR imaging is not sufficient for an adequate diagnosis and be useful for therapy planning. MR arthrography is valuable in the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography is a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in cases in which an invasive procedure is contraindicated or when fluoroscopy is not available.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Instituto Radiológico Cántabro, Clínica Mompía, Mompía, 39109 Cantabria, Spain.
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Dinauer PA, Murphy KP, Carroll JF. Sublabral Sulcus at the Posteroinferior Acetabulum:A Potential Pitfall in MR Arthrography Diagnosis of Acetabular Labral Tears. AJR Am J Roentgenol 2004; 183:1745-53. [PMID: 15547222 DOI: 10.2214/ajr.183.6.01831745] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our study correlated findings on hip MRI and MR arthrography with hip arthroscopy to assess the location, prevalence, and potential pitfall of a normal acetabular sublabral sulcus. MATERIALS AND METHODS We retrospectively collected 58 hip MRI studies along with surgical reports in 58 patients who underwent hip arthroscopy over a 5-year period. Intraoperative photography (n = 23), radiography (n = 56), unenhanced MRI (n = 13), and MR arthrography (n = 54) studies were available for review. Two radiologists described hip anatomy on radiology studies with agreement by consensus. RESULTS A normal posteroinferior sublabral groove was confirmed on available arthroscopy photographs in four (17.4%) of 23 hips. In each of these four patients, the anatomic sublabral groove correlated with apparent partial labral detachment on MR arthrography. On review of all studies, 13 hips (22.4%) without a posterior labral tear at surgery had imaging findings of a sublabral sulcus. The sulcus was not associated with acetabular dysplasia, which was radiographically noted in 12 cases (21.4%). Preoperatively, the sulcus was misdiagnosed as a tear in two cases. Labral tears were anterior or anterosuperior in 51 patients. CONCLUSION A posteroinferior sublabral groove is a relatively common normal anatomic hip variation. If not recognized as normal, the sulcus may serve as a diagnostic pitfall on MR arthrography. Its location is distinct from most labral tears. We did not discover a sublabral sulcus at the anterior or anterosuperior acetabulum, the most common sites of labral injury.
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Affiliation(s)
- Philip A Dinauer
- Department of Radiology, Walter Reed Army Medical Center, 6900 Georgia Ave., NW, Washington, DC 20307-5001, USA.
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Elentuck D, Palmer WE. Direct magnetic resonance arthrography. Eur Radiol 2004; 14:1956-67. [PMID: 15351900 DOI: 10.1007/s00330-004-2449-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Revised: 07/07/2004] [Accepted: 07/12/2004] [Indexed: 10/26/2022]
Abstract
Magnetic resonance (MR) arthrography has gained increasing popularity as a diagnostic tool in the assessment of intra-articular derangements. Its role has been studied extensively in the shoulder, but it also has been explored in the hip, elbow, knee, wrist and ankle. This article reviews the current role of direct MR arthrography in several major joints, with consideration of pertinent anatomy, techniques and applications.
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Affiliation(s)
- Dmitry Elentuck
- Musculoskeletal Imaging, Massachusetts General Hospital, 15 Parkman Street, WACC 515, Boston, MA 02114, USA
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Abstract
Malunion of an ankle fracture can lead to considerable pain and loss of function. Restoration of the normal anatomical alignments can restore function and minimize the onset of degeneration that will lead to severe arthrosis requiring an arthrodesis. This article outlines common causes of ankle malunion and treatment options.
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Affiliation(s)
- Toby Branfoot
- St. James's University Teaching Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Abstract
Directed injections of the foot and ankle performed under fluoroscopic guidance have both considerable diagnostic value and the potential for targeted therapy by accurately delivering corticosteroid and/or anesthetic to the source of pain. Both large and small joints in the foot and ankle are readily accessed, offering precise information to the foot and ankle surgeon who may be contemplating arthrodesis or other intervention. In addition to its role in pain management, ankle arthrography may be performed in conjunction with MRI or CT, with improved evaluation of articular cartilage and capsular abnormalities.
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Affiliation(s)
- Joel S Newman
- Department of Rediology, New England Baptist Bone and Joint Institute, 125 Parker Hill Avenue, Boston, MA 02120 USA
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