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Li M, Dai X. Editorial for "Age and Gender-Dependence of Single- and Bi-Exponential T1ρ MR Parameters in Knee Ligaments". J Magn Reson Imaging 2024; 60:713-714. [PMID: 37885130 DOI: 10.1002/jmri.29087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Affiliation(s)
- Man Li
- The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Xu Dai
- The School of Sport and Exercise Rehabilitation, Jinzhou Medical University, Jinzhou, China
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Sarblah SR, Rachman P, Antwi WK, Anudjo MNK, Botwe BO, Akudjedu TN. Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review. Radiography (Lond) 2024; 30:1001-1013. [PMID: 38692168 DOI: 10.1016/j.radi.2024.04.017] [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: 12/19/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients. METHODS A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis. RESULTS The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI. DISCUSSION Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate. IMPLICATIONS FOR PRACTICE MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI.
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Affiliation(s)
- S R Sarblah
- Radiology Department, Hereford County Hospital, Wye Valley NHS Foundation Trust, Hereford, UK; Department of Health Sciences, Faculty of Environmental & Life Sciences, Southampton University, UK
| | - P Rachman
- Department of Health Sciences, Faculty of Environmental & Life Sciences, Southampton University, UK
| | - W K Antwi
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, Ghana
| | - M N K Anudjo
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK; School of Radiology, AECC University College, Bournemouth, UK
| | - B O Botwe
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, Ghana; Department of Midwifery and Radiography Division School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.
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Socha DE, Pownder SL, Kayano M, Koff MF, Hayashi K. Ultrashort Echo Time Quantitative Magnetic Resonance Imaging of the Cruciate Ligaments in Normal Beagles. Vet Comp Orthop Traumatol 2024; 37:145-150. [PMID: 38290532 DOI: 10.1055/s-0043-1778684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim of this study was to provide normative ultrashort echo time magnetic resonance imaging (UTE MRI) data of the patellar ligament (PL), cranial cruciate ligament (CrCL) and caudal cruciate ligament (CdCL) in non-lame Beagles. STUDY DESIGN Eight stifles from four subjects obtained immediately postmortem were imaged using UTE MRI in the true sagittal plane. Regions of interest were drawn manually and the total (T2*), short T2* (T2*S) and long T2* (T2*L) values of the signal decay were calculated to evaluate the bound and free water components of the tendon. The T2*S, T2*L and T2* values were compared between the PL, CrCL and CdCL RESULTS: The mean and standard deviation of T2*S, T2*L and T2* were as follows: 0.54 ± 0.13, 4.65 ± 1.08 and 8.35 ± 0.82 ms for the PL; 0.46 ± 0.14, 5.99 ± 0.52 and 8.88 ± 0.4 ms for the CrCL and 0.41 ± 0.13, 7.06 ± 0.57 and 9.26 ± 0.18 ms for the CdCL. Significant differences were found between the T2*L component of the PL and each CrCL/CdCL and a smaller difference was noted between the T2*L of the CrCL and CdCL (p = 0.05). No difference of the T2*S value was found between any of the ligaments. CONCLUSION Establishing normative UTE data of the canine stifle is valuable for comparison in future studies in which normal and damaged ligaments may be evaluated, particularly in those affected limbs in which no instability is identified on physical examination in which normal and damaged ligaments may be evaluated.
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Affiliation(s)
- Dennis E Socha
- VCA Colonial Animal Hospital, Ithaca, New York, United States
| | - Sarah L Pownder
- Hospital for Special Surgery, New York, New York, United States
| | - Mitsunori Kayano
- Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
| | - Matthew F Koff
- Hospital for Special Surgery, New York, New York, United States
| | - Kei Hayashi
- Cornell University College of Veterinary Medicine, Ithaca, New York, United States
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Hamdan R, Chapelon B, Kisterman JP, Baldassini AL, Falchero C, Chrétien N, Marx P, Van Der Bol Murat D. Severe ischemia due to popliteal artery occlusion in a young patient: Evidence of type 3 popliteal artery entrapment syndrome on Doppler ultrasound. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:112-114. [PMID: 38697707 DOI: 10.1016/j.jdmv.2024.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/17/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Rémy Hamdan
- Explorations fonctionnelles de médecine vasculaire, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France.
| | - Benoît Chapelon
- Service d'angiologie, centre hospitalier du Pays Charolais Brionnais, Paray-le-Monial, France
| | | | - Anne-Laure Baldassini
- Explorations fonctionnelles de médecine vasculaire, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
| | - Catherine Falchero
- Explorations fonctionnelles de médecine vasculaire, centre hospitalier de Mâcon, 350, boulevard Louis-Escande, 71000 Mâcon, France
| | - Nicolas Chrétien
- Service de chirurgie vasculaire, centre hospitalier de Mâcon, Mâcon, France
| | - Pierre Marx
- Service d'imagerie médicale, centre hospitalier de Mâcon, Mâcon, France
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Akatsuka Y, Teramoto A, Murahashi Y, Takahashi K, Imamura R, Takashima H, Watanabe K, Yamashita T. Quantitative assessment of anterior talofibular ligament quality in chronic lateral ankle instability using magnetic resonance imaging T2* value. Skeletal Radiol 2024; 53:733-739. [PMID: 37857750 DOI: 10.1007/s00256-023-04480-8] [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: 08/13/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To determine T2* normal reference values for anterior talofibular ligament (ATFL) and to investigate the feasibility of the quantitative ATFL quality evaluation in chronic lateral ankle instability (CLAI) using T2* values. MATERIALS AND METHODS This study enrolled 15 patients with CLAI and 30 healthy volunteers. The entire ATFL T2* values from the MRI T2* mapping were measured. The prediction equation (variables: age, height, and weight) in a multiple linear regression model was used to calculate the T2* normal reference value in the healthy group. T2* ratio was defined as the ratio of the actual T2* value of the patient's ATFL to the normal reference value for each patient. A Telos device was used to measure the talar tilt angle (TTA) from the stress radiograph. RESULTS T2* values of ATFL in the healthy and CLAI groups were 10.82 ± 1.84 ms and 14.36 ± 4.30 ms, respectively, which are significantly higher in the CLAI group (P < 0.05). The prediction equation of the normal reference T2* value was [14.9 + 0.14 × age (years) - 4.7 × height (m) - 0.03 × weight (kg)] (R2 = 0.65, P < 0.0001). A significant positive correlation was found between the T2* ratio and TTA (r = 0.66, P = 0.007). CONCLUSION MRI T2* values in patients with CLAI were higher than those in healthy participants, and the T2* ratio correlated with TTA, suggesting that T2* values are promising for quantitative assessment of ATFL quality preoperatively.
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Affiliation(s)
- Yoshihiro Akatsuka
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Rui Imamura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroyuki Takashima
- Faculty of Health Sciences, Hokkaido University, North-12, West-15, Kita-ku, Sapporo, 060-0812, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Hanna AJ, Popper HR, Sonnier JH, Erickson BJ, Jack RA, Cohen SB. The Utility of Stress Ultrasound in Identifying Risk Factors for Elbow Ulnar Collateral Ligament Tear: A Longitudinal Study of 203 Professional Baseball Players. Am J Sports Med 2024; 52:1060-1067. [PMID: 38406885 DOI: 10.1177/03635465241230049] [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] [Indexed: 02/27/2024]
Abstract
BACKGROUND Injuries to the medial ulnar collateral ligament (UCL) are common among baseball pitchers due to repetitive stress on the soft tissue stabilizers of the elbow during pitching. Dynamic stress ultrasound (SUS) can be used to evaluate the UCL and ulnohumeral joint to identify anatomic risk factors of those who will require UCL reconstruction (UCLR). PURPOSE To determine whether any adaptive or morphological changes detectable on SUS can predict injury to the UCL in professional baseball pitchers. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 203 professional baseball pitchers who underwent SUS at preseason training sessions over the course of 18 years were categorized into 1 of 2 groups: those without a history of shoulder, arm, elbow, or forearm surgery or injuries (healthy cohort; n = 184) and those who underwent UCLR the same season as SUS (UCLR cohort; n = 19). Ligament thickness, joint spacing, and laxity were compared. An additional matched cohort analysis was conducted using 10 players from each group to detect differences in the progression of UCL and ulnohumeral joint measures in the year before injury. RESULTS The UCLR cohort, when compared with the healthy cohort, had higher relative (ie, nondominant-side measurements subtracted from dominant-side measurements) resting ulnohumeral joint space (median, 0.50 vs 0.20 mm, respectively; P = .006) and higher rates of hypoechoic foci (57.9% vs 30.4%, respectively; P = .030). Players of both groups had similar dominant UCL thickness (P = .161), ulnohumeral joint space at rest (P = .321), space under stress (P = .498), and laxity (P = .796). Groups did not differ in terms of relative UCL thickness, ulnohumeral joint space under stress, or relative laxity. In the year before UCL injury, the UCLR cohort, compared with the matched healthy cohort, had a greater increase in mean dominant UCL thickness (0.94 vs -0.60 mm, respectively; P = .038) and a greater increase in relative median UCL thickness (1.35 vs -0.35 mm, respectively; P = .045). Players in the healthy cohort were statistically older than those in the UCLR cohort (23 vs 22 years, respectively; P = .004). No differences in ulnohumeral stress spacing or laxity were detected. CONCLUSION SUS of players who underwent UCLR demonstrated a progressive increase in UCL thickness over 1 year, higher rates of hypoechoic foci, and increased ulnohumeral rest space compared with SUS of uninjured players.
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Affiliation(s)
- Adeeb Jacob Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Hannah R Popper
- Department of Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - John Hayden Sonnier
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
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Vidal L, Lopez-Garzon M, Venegas V, Vila I, Domínguez D, Rodas G, Marotta M. A Novel Tendon Injury Model, Induced by Collagenase Administration Combined with a Thermo-Responsive Hydrogel in Rats, Reproduces the Pathogenesis of Human Degenerative Tendinopathy. Int J Mol Sci 2024; 25:1868. [PMID: 38339145 PMCID: PMC10855568 DOI: 10.3390/ijms25031868] [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: 12/22/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Patellar tendinopathy is a common clinical problem, but its underlying pathophysiology remains poorly understood, primarily due to the absence of a representative experimental model. The most widely used method to generate such a model is collagenase injection, although this method possesses limitations. We developed an optimized rat model of patellar tendinopathy via the ultrasound-guided injection of collagenase mixed with a thermo-responsive Pluronic hydrogel into the patellar tendon of sixty male Wistar rats. All analyses were carried out at 3, 7, 14, 30, and 60 days post-injury. We confirmed that our rat model reproduced the pathophysiology observed in human patients through analyses of ultrasonography, histology, immunofluorescence, and biomechanical parameters. Tendons that were injured by the injection of the collagenase-Pluronic mixture exhibited a significant increase in the cross-sectional area (p < 0.01), a high degree of tissue disorganization and hypercellularity, significantly strong neovascularization (p < 0.01), important changes in the levels of types I and III collagen expression, and the organization and presence of intra-tendinous calcifications. Decreases in the maximum rupture force and stiffness were also observed. These results demonstrate that our model replicates the key features observed in human patellar tendinopathy. Collagenase is evenly distributed, as the Pluronic hydrogel prevents its leakage and thus, damage to surrounding tissues. Therefore, this model is valuable for testing new treatments for patellar tendinopathy.
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Affiliation(s)
- Laura Vidal
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Maria Lopez-Garzon
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Vanesa Venegas
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - Ingrid Vila
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
| | - David Domínguez
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation, 08970 Sant Joan Despí, Spain
| | - Gil Rodas
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Medical Department of Futbol Club Barcelona (FIFA Medical Center of Excellence) and Barça Innovation, 08970 Sant Joan Despí, Spain
- Sports Medicine Unit, Hospital Clínic and Sant Joan de Déu, 08950 Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Mario Marotta
- Leitat Technological Center, Carrer de la Innovació 2, 08225 Terrassa, Spain
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations Laboratory, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona (UAB), 08035 Barcelona, Spain
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Scott I, Connell D, Moulton D, Waters S, Namburete A, Arnab A, Malliaras P. An automated method for tendon image segmentation on ultrasound using grey-level co-occurrence matrix features and hidden Gaussian Markov random fields. Comput Biol Med 2024; 169:107872. [PMID: 38160500 DOI: 10.1016/j.compbiomed.2023.107872] [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: 04/10/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Despite knowledge of qualitative changes that occur on ultrasound in tendinopathy, there is currently no objective and reliable means to quantify the severity or prognosis of tendinopathy on ultrasound. OBJECTIVE The primary objective of this study is to produce a quantitative and automated means of inferring potential structural changes in tendinopathy by developing and implementing an algorithm which performs a texture based segmentation of tendon ultrasound (US) images. METHOD A model-based segmentation approach is used which combines Gaussian mixture models, Markov random field theory and grey-level co-occurrence (GLCM) features. The algorithm is trained and tested on 49 longitudinal B-mode ultrasound images of the Achilles tendons which are labelled as tendinopathic (24) or healthy (25). Hyperparameters are tuned, using a training set of 25 images, to optimise a decision tree based classification of the images from texture class proportions. We segment and classify the remaining test images using the decision tree. RESULTS Our approach successfully detects a difference in the texture profiles of tendinopathic and healthy tendons, with 22/24 of the test images accurately classified based on a simple texture proportion cut-off threshold. Results for the tendinopathic images are also collated to gain insight into the topology of structural changes that occur with tendinopathy. It is evident that distinct textures, which are predominantly present in tendinopathic tendons, appear most commonly near the transverse boundary of the tendon, though there was a large variability among diseased tendons. CONCLUSION The GLCM based segmentation of tendons under ultrasound resulted in distinct segmentations between healthy and tendinopathic tendons and provides a potential tool to objectively quantify damage in tendinopathy.
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Affiliation(s)
- Isabelle Scott
- Mathematical Institute, University of Oxford, Oxford, United Kingdom; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.
| | | | - Derek Moulton
- Mathematical Institute, University of Oxford, Oxford, United Kingdom
| | - Sarah Waters
- Mathematical Institute, University of Oxford, Oxford, United Kingdom
| | - Ana Namburete
- Oxford Machine Learning in Neuroimaging laboratory, OMNI, Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | | | - Peter Malliaras
- Imaging at Olympic Park, Melbourne, Australia; Department of Physiotherapy, Monash University, Melbourne, Australia
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Kamona N, Jones BC, Lee H, Song HK, Rajapakse CS, Wagner CS, Bartlett SP, Wehrli FW. Cranial bone imaging using ultrashort echo-time bone-selective MRI as an alternative to gradient-echo based "black-bone" techniques. MAGMA (NEW YORK, N.Y.) 2024; 37:83-92. [PMID: 37934295 PMCID: PMC10923077 DOI: 10.1007/s10334-023-01125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES CT is the clinical standard for surgical planning of craniofacial abnormalities in pediatric patients. This study evaluated three MRI cranial bone imaging techniques for their strengths and limitations as a radiation-free alternative to CT. METHODS Ten healthy adults were scanned at 3 T with three MRI sequences: dual-radiofrequency and dual-echo ultrashort echo time sequence (DURANDE), zero echo time (ZTE), and gradient-echo (GRE). DURANDE bright-bone images were generated by exploiting bone signal intensity dependence on RF pulse duration and echo time, while ZTE bright-bone images were obtained via logarithmic inversion. Three skull segmentations were derived, and the overlap of the binary masks was quantified using dice similarity coefficient. Craniometric distances were measured, and their agreement was quantified. RESULTS There was good overlap of the three masks and excellent agreement among craniometric distances. DURANDE and ZTE showed superior air-bone contrast (i.e., sinuses) and soft-tissue suppression compared to GRE. DISCUSSIONS ZTE has low levels of acoustic noise, however, ZTE images had lower contrast near facial bones (e.g., zygomatic) and require effective bias-field correction to separate bone from air and soft-tissue. DURANDE utilizes a dual-echo subtraction post-processing approach to yield bone-specific images, but the sequence is not currently manufacturer-supported and requires scanner-specific gradient-delay corrections.
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Affiliation(s)
- Nada Kamona
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Brandon C Jones
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Hyunyeol Lee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Electronics Engineering, Kyungpook National University, Daegu, South Korea
| | - Hee Kwon Song
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith S Rajapakse
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Felix W Wehrli
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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10
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Hanna AJ, Sonnier JH, Fliegel BE, Sherman MB, Ciccotti MG, Jack RA, Cohen SB. Association Between Draft Order and Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers: An 18-Year Study. Am J Sports Med 2024; 52:224-231. [PMID: 38164663 DOI: 10.1177/03635465231210292] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND The Major League Baseball (MLB) draft is a common route for players to enter professional baseball in the United States. Players taken in earlier rounds are typically higher-performing players. When looking at pitchers specifically, higher performance at the amateur level may be associated with an increased frequency of adaptive change in the throwing elbow. PURPOSE To determine whether pitchers taken in earlier rounds of the MLB draft have a greater frequency or extent of pathological change in the elbow, as measured by dynamic stress ultrasound. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Dynamic stress ultrasounds (SUSs) were performed over 18 years on the dominant and nondominant arms of 651 professional pitchers. The 383 drafted players were grouped according to the round in which they were drafted (rounds 1-5, 6-10, 11-20, 21+). Groups were compared with respect to "relative" ulnar collateral ligament (UCL) thickness (dominant-nondominant), relative ulnohumeral joint laxity (joint space distance under stress minus joint space at rest), and the presence of pathology (calcifications, tears, hypoechoic foci, osteophytes). In addition, a subgroup analysis was done to compare the progression of SUS findings over 3 years in players for which data were available. RESULTS Draft round groups did not differ by age, number of previous spring training, or handedness. Comparing baseline measurements, there was no significant relationship between draft round and relative UCL thickness (P = .932), relative laxity (P = .996), or presence of pathology detectable on SUS (P = .642). However, increased relative UCL thickness was significantly associated with the presence of pathology on SUS (odds ratio, 1.45; 95% CI, 1.26-1.69; P < .001). Longitudinally, there was no significant relationship between draft round and 3-year progression of relative laxity, relative UCL thickness, or clinical progression of pathology. CONCLUSION Higher-performing pitchers are drafted earlier in the MLB draft. This may be attributable to peak pitch velocity, in-game performance, visibility gained during player showcases, or any number of other sport-specific variables. However, despite this, there was no significant relationship between draft round and adaptive changes to the elbow or specific properties of the UCL on stress ultrasound.
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Affiliation(s)
- Adeeb J Hanna
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
- Rowan-Virtua School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - John H Sonnier
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Brian E Fliegel
- Department of Orthopaedic Surgery, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - Matthew B Sherman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Michael G Ciccotti
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - Steven B Cohen
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania, USA
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11
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Xue Z, Wen B. Bioanalytical evaluation of wound depth and musculoskeletal injuries: Synergizing focused assessment with sonography for trauma with computed tomography/magnetic resonance imaging in orthopaedic trauma care. Int Wound J 2024; 21:e14647. [PMID: 38272795 PMCID: PMC10805531 DOI: 10.1111/iwj.14647] [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: 12/09/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Orthopaedic trauma care frequently necessitates prompt and precise assessment of musculoskeletal injuries and wound depth. The potential for improved diagnostic accuracy and patient outcomes exists with the integration of sophisticated imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) with focused assessment with sonography for trauma (FAST). The purpose of this research was to examine the benefits and drawbacks of this integrative method in the clinical environment. From June 2022 to September 2023, 250 patients who were admitted to Ningbo University Affiliated People's Hospital, participated in this cross-sectional observational study. Following the administration of FAST, CT and MRI were utilized to evaluate orthopaedic injuries and skin wounds in patients. Analyses of data centred on the precision of diagnoses, the influence of treatment decisions and patient outcomes. Aged and gendered differently, the study participants sustained the variety of injuries and superficial wounds that were predominantly the result of traffic accidents. The FAST assay exhibited sensitivity of 65%, specificity of 80% and 72% overall accuracy. MRI demonstrated the finest diagnostic performance (85% sensitivity, 95% specificity and 89% accuracy), whereas CT scans offered improved diagnostic efficacy (80% sensitivity, 90% specificity and 84% accuracy). Treatment decisions were substantially impacted by integration of these imaging modalities, resulting in modifications in 20%-35% of cases, depending on the specific modality employed. Specifically, MRI played a pivotal role in informing treatment approaches, influencing non-surgical as well as surgical procedures. This study substantiates the significant advantages of integrating FAST with CT and MRI in orthopaedic trauma care, particularly in the accurate assessment of wound depth. The synergistic use of these imaging techniques not only enhances diagnostic precision but also positively impacts treatment strategies and patient outcomes, emphasizing the need for a comprehensive diagnostic approach in trauma care settings.
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Affiliation(s)
- Zujun Xue
- OrthopedicsNingbo University Affiliated People's HospitalNingboChina
| | - Bi Wen
- Infection DepartmentNingbo University Affiliated People's HospitalNingboChina
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12
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Nunna B, Parihar P, Wanjari M, Shetty N, Bora N. High-Resolution Imaging Insights into Shoulder Joint Pain: A Comprehensive Review of Ultrasound and Magnetic Resonance Imaging (MRI). Cureus 2023; 15:e48974. [PMID: 38111406 PMCID: PMC10725840 DOI: 10.7759/cureus.48974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Shoulder joint pain is a complex and prevalent clinical concern affecting individuals across various ages and lifestyles. This review delves into the pivotal role of high-resolution imaging techniques, namely ultrasound and magnetic resonance imaging (MRI), in the comprehensive assessment and management of shoulder joint pain. We explore the anatomical foundations of the shoulder, common etiologies of pain, and the significance of precise diagnosis. High-resolution imaging facilitates the identification of various shoulder pathologies and is crucial in treatment planning, surgical interventions, and long-term prognosis assessment. We examine emerging technologies, discuss challenges and limitations, and chart potential future developments, emphasizing the ongoing evolution of imaging in this critical healthcare domain. In conclusion, high-resolution imaging is an indispensable tool, continually advancing to meet the diagnostic and therapeutic needs of individuals grappling with shoulder joint pain.
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Affiliation(s)
- Bhagyasri Nunna
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratap Parihar
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Shetty
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Bora
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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13
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Jerban S, Afsahi AM, Ma Y, Moazamian D, Statum S, Lombardi AF, Kakos L, Dorthe E, Dlima D, Du J, Chung CB, Chang EY. Correlations between elastic modulus and ultrashort echo time (UTE) adiabatic T1ρ relaxation time (UTE-Adiab-T1ρ) in Achilles tendons and entheses. J Biomech 2023; 160:111825. [PMID: 37856976 PMCID: PMC10991081 DOI: 10.1016/j.jbiomech.2023.111825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
Patients with psoriatic arthritis commonly have abnormalities of their entheses, which are the connections between tendons and bone. There are shortcomings with the use of conventional magnetic resonance imaging (MRI) sequences for the evaluation of entheses and tendons, whereas ultrashort echo time (UTE) sequences are superior for the detection of high signals, and can also be used for non-invasive quantitative assessments of these structures. The combination of UTE-MRI with an adiabatic-T1ρ preparation (UTE-Adiab-T1ρ) allows for reliable assessment of entheses and tendons with decreased susceptibility to detrimental magic angle effects. This study aimed to investigate the relationship between quantitative UTE-MRI measures and the biomechanical properties of Achilles tendons and entheses. In total, 28 tendon-enthesis sections were harvested from 11 fresh-frozen human cadaveric foot-ankle specimens (52 ± years old). Tendon-enthesis sections were scanned using the UTE-Adiab-T1ρ and UTE-T1 sequences on a clinical 3 T scanner. MRI-based measures and indentation tests were performed on the enthesis, transitional, and tensile tendon zones of the specimens. Hayes' elastic modulus showed significant inverse correlations (Spearman's) with UTE-Adiab-T1ρ in all zones (R= - 0.46, - 0.54, and - 0.61 in enthesis, transition, and tensile tendon zones, respectively). Oliver-Pharr's elastic modulus showed significant inverse correlations with UTE-Adiab-T1ρ in transition (R= - 0.52) and tensile tendon zone (R=- 0.60). UTE-T1 did not show significant correlations with the elastic modulus. UTE-MRI and elastic modulus were significantly lower in the tensile tendon compared with the enthesis regions This study highlights the potential of the UTE-Adiab-T1ρ technique for the non-invasive evaluation of tendons and enthuses.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA; Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA.
| | - Amir Masoud Afsahi
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Alecio F Lombardi
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Lena Kakos
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Erik Dorthe
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Daryll Dlima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA; Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA, USA.
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14
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Holmgren JG, Kottapalli V, Ngo T, Tran A, Roberts T, Johnson T, Gao J. Anisotropy and reproducibility of ultrasound shear wave elastography in patella tendons with and without tendinopathy. Clin Imaging 2023; 102:71-77. [PMID: 37633230 DOI: 10.1016/j.clinimag.2023.08.002] [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: 01/25/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Ultrasound shear wave elastography (SWE) is a tool that can be utilized to assess biomechanical properties of tendons. Anisotropy, an ultrasound imaging artifact has been commonly cited as a potential source of error in the accuracy and reproducibility of SWE. The aim of the study was to assess reproducibility in performing SWE of patella tendons and differences in SWE and anisotropy between normal patella tendons and patellar tendinopathy. METHODS After obtaining the Institutional Review Board approval and written informed consent, we prospectively measured the shear wave velocity (SWV) of patella tendons with and without tendinopathy in 25 volunteers. SWVs were measured in three anatomic planes: longitudinal, perpendicular transverse, and tilted transverse with the probe tilted 15-30° from the perpendicular transverse plane by three operators with varied levels of experience. Anisotropy coefficient (A) was calculated by formula of A = (SWVLongitudinal - SWVTransverse) / SWVTransverse. RESULTS Differences in SWV and anisotropy coefficient between normal tendons and tendons with tendinopathy were significant (p < 0.05). The intra- and inter-observer reproducibility in performing SWE were moderate to good (intraclass correlation coefficient: 0.81-0.95). The mean difference of 95% Bland-Altman limits of agreement for measuring tendon SWV ranged -0.08 to 0.41 (upper 0.08 to 1.14, lower -1.22 to -0.22) between senior and junior operators. CONCLUSION The results of this study suggest that SWE and anisotropy coefficient are feasible tools to differentiate patellar tendinopathy from normal patella tendons. The reproducibility of performing SWE of patella tendons is moderate to good.
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Affiliation(s)
| | | | - Thien Ngo
- Rocky Vista University, Ivins, UT, USA
| | | | | | | | - Jing Gao
- Rocky Vista University, Ivins, UT, USA.
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15
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Walton J, Kozina E, Woo F, Jadidi S. A Review of Patellar Tendinopathy in Athletes Involved in Jumping Sports. Cureus 2023; 15:e47459. [PMID: 38022235 PMCID: PMC10661584 DOI: 10.7759/cureus.47459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
This review article discusses the anatomy and histopathology of the patellar tendon, as well as the risk factors and common interventions for patellar tendinopathy (PT) with a view to guide clinicians in treating athletes with patellar tendon pain. PT, or jumper's knee, refers to a chronic injury to the patellar tendon that affects athletes who engage in jumping and explosive movements. The condition is characterized by degeneration and disorganization of the collagen fibers in the tendon, an increase in mucoid ground substance, and fibroblast proliferation. Risk factors for patellar tendinopathy include participation in jumping sports, a greater counter-movement jump height, and training on hard surfaces. Nonoperative treatments for patellar tendinopathy include relative rest, stretching and strengthening exercises, and correction of biomechanical abnormalities. Surgery and other procedures, such as extracorporeal shockwave therapy (ESWT) and injection therapies, may be considered for patients who do not respond to conservative measures.
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Affiliation(s)
- John Walton
- Family and Community Medicine, McGaw Medical Center of Northwestern University, Chicago, USA
| | - Erik Kozina
- Orthopedics, University of Illinois at Chicago, Chicago, USA
| | - Frank Woo
- Internal Medicine and Pediatrics, Loyola University Medical Center, Chicago, USA
| | - Shaheen Jadidi
- Sports Medicine, Loyola University Medical Center, Chicago, USA
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16
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Rodríguez-Sanz D, Losa-Iglesias ME, de Bengoa-Vallejo RB, Sánchez-Milá Z, Dorgham HAA, Elerian AE, Yu T, Calvo-Lobo C, Velázquez-Saornil J, Martínez Jimene EM. A New Test for Achilles Tendinopathy Based on Kager's Fat Pad Clinical Assessment Predictive Values. J Clin Med 2023; 12:5183. [PMID: 37629225 PMCID: PMC10455944 DOI: 10.3390/jcm12165183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy. STUDY DESIGN Observational study. METHODS Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David's test. RESULTS Most (86%) subjects demonstrated Kager's fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David's sign). No healthy tendons had David's sign. CONCLUSIONS The presence of asymmetry in Kager's fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David's test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.
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Affiliation(s)
- David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Marta Elena Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (M.E.L.-I.); (J.V.-S.)
| | - Ricardo Becerro de Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Zacarías Sánchez-Milá
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain;
| | | | - Ahmed Ebrahim Elerian
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Al Salam University, Tanta 31511, Egypt;
| | - Tian Yu
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Jorge Velázquez-Saornil
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (M.E.L.-I.); (J.V.-S.)
| | - Eva María Martínez Jimene
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
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17
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Lim S, Liem B. First Metatarsophalangeal Joint Pain in Athletes: Diagnosis, Management, and Return to Play Considerations. Curr Sports Med Rep 2023; 22:217-223. [PMID: 37294197 DOI: 10.1249/jsr.0000000000001076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
ABSTRACT The first metatarsal-phalangeal joint plays a key role for athletes of various disciplines. When an athlete presents for evaluation of pain at this joint, there are several causes that should be considered. The purpose of this article is to review common injuries including turf toe, sand toe, extensor and flexor hallucis longus tendinopathy, sesamoiditis, and metatarsalgia and provide current evidence-based recommendations for diagnosis, management, and return to play considerations. Conditions not specific to athletes like gout and hallux rigidus also are discussed. Mechanism of injury, physical examination, and imaging such as weight-bearing radiographs and point-of-care ultrasound can help with diagnosis. Treatment of many of these injuries begins with nonsurgical management strategies including footwear or activity modification, physical therapy, and select interventions.
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Affiliation(s)
- Sara Lim
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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18
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Gao J, Rosander A, Rubin JM. Quantitative Assessment of Tendon Backscatter Anisotropy in B-Mode Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1408-1414. [PMID: 36878827 DOI: 10.1016/j.ultrasmedbio.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 05/11/2023]
Abstract
To test the anisotropy of human tendons in conventional B-mode ultrasound, we prospectively performed ultrasound scans of 40 normal patella tendons and 24 patella tendons with chronic tendinopathy in adults. We scanned all tendons in longitudinal orientation (parallel to tendon fibers) using a linear array transducer (8.5 MHz) with beam steering at 0°, 5°, 10°, 15° and 20°. We used ImageJ histogram analysis to process B-mode images offline for assessing backscatter as a function of angle, known as backscatter anisotropy, between normal tendons and the subcutaneous tissues and between normal tendons and tendons with tendinopathy. We compared the results using the slopes of linear regression lines drawn through the angle-dependent data, and we concluded that the tissue anisotropy was significantly different if the 95% confidence intervals of the line slopes for different tissues did not overlap. We observed significant differences between normal tendons and both the adjacent subcutaneous tissues and tendons with tendinopathy. However, the difference in the regression slopes between tendons with tendinopathy and the adjacent subcutaneous soft tissues was not significant. It appears that changes in anisotropic backscatter could be used to detect tendon abnormalities and in assessing the significance of disease and the effectiveness of therapy.
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Affiliation(s)
- Jing Gao
- Rocky Vista University, Ivins, UT, USA; Weill Cornell Medicine, Department of Radiology, Cornell University, New York, NY, USA.
| | | | - Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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19
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Jenner F, Wagner A, Gerner I, Ludewig E, Trujanovic R, Rohde E, von Rechenberg B, Gimona M, Traweger A. Evaluation of the Potential of Umbilical Cord Mesenchymal Stromal Cell-Derived Small Extracellular Vesicles to Improve Rotator Cuff Healing: A Pilot Ovine Study. Am J Sports Med 2023; 51:331-342. [PMID: 36645050 DOI: 10.1177/03635465221145958] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite significant advancements in surgical techniques to repair rotator cuff (RC) injuries, failure rates remain high and novel approaches to adequately overcome the natural biological limits of tendon and enthesis regeneration of the RC are required. Small extracellular vesicles (sEVs) derived from the secretome of human multipotent mesenchymal stromal cells (MSCs) have been demonstrated to modulate inflammation and reduce fibrotic adhesions, and therefore their local application could improve outcomes after RC repair. PURPOSE In this pilot study, we evaluated the efficacy of clinical-grade human umbilical cord (hUC) MSC-derived sEVs (hUC-MSC-sEVs) loaded onto a type 1 collagen scaffold in an ovine model of acute infraspinatus tendon injury to improve RC healing. STUDY DESIGN Controlled laboratory study. METHODS sEVs were enriched from hUC-MSC culture media and were characterized by surface marker profiling. The immunomodulatory capacity was evaluated in vitro by T-cell proliferation assays, and particle count was determined by nanoparticle tracking analysis. Twelve skeletally mature sheep were subjected to partial infraspinatus tenotomy and enthesis debridement. The defects of 6 animals were treated with 2 × 1010 hUC-MSC-sEVs loaded onto a type 1 collagen sponge, whereas 6 animals received only a collagen sponge, serving as controls. Six weeks postoperatively, the healing of the infraspinatus tendon and the enthesis was evaluated by magnetic resonance imaging (MRI) and hard tissue histology. RESULTS CD3/CD28-stimulated T-cell proliferation was significantly inhibited by hUC-MSC-sEVs (P = .015) that displayed the typical surface marker profile, including the presence of the MSC marker proteins CD44 and melanoma-associated chondroitin sulfate proteoglycan. The local application of hUC-MSC-sEVs did not result in any marked systemic adverse events. Histologically, significantly improved Watkins scores (P = .031) indicated improved tendon and tendon-to-bone insertion repair after sEV treatment and lower postcontrast signal of the tendon and adjacent structures on MRI suggested less residual inflammation at the defect area. Furthermore, the formation of osteophytes at the injury site was significantly attenuated (P = .037). CONCLUSION A local, single-dose application of hUC-MSC-sEVs promoted tendon and enthesis healing in an ovine model of acute RC injury. CLINICAL RELEVANCE Surgical repair of RC tears generally results in a clinical benefit for the patient; however, considerable rerupture rates have been reported. sEVs have potential as a cell-free biotherapeutic to improve healing outcomes after RC injury.
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Affiliation(s)
- Florien Jenner
- VETERM, Equine Surgery Unit, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Iris Gerner
- VETERM, Equine Surgery Unit, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Eberhard Ludewig
- Diagnostic Imaging Unit, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Robert Trujanovic
- Clinical Unit of Anaesthesiology and Perioperative Intensive Care, Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Eva Rohde
- Department of Transfusion Medicine, Salzburger Landeskliniken GesmbH, Paracelsus Medical University, Salzburg, Austria.,GMP Unit, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Mario Gimona
- GMP Unit, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria.,Research Program "Nanovesicular Therapies," Paracelsus Medical University, Salzburg, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Centre Salzburg, Paracelsus Medical University, Salzburg, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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20
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Fritz B, Fritz J. MR Imaging–Ultrasonography Correlation of Acute and Chronic Foot and Ankle Conditions. Magn Reson Imaging Clin N Am 2023; 31:321-335. [PMID: 37019553 DOI: 10.1016/j.mric.2023.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Foot and ankle injuries are common musculoskeletal disorders. In the acute setting, ligamentous injuries are most common, whereas fractures, osseous avulsion injuries, tendon and retinaculum tears, and osteochondral injuries are less common. The most common chronic and overuse injuries include osteochondral and articular cartilage defects, tendinopathies, stress fractures, impingement syndromes, and neuropathies. Common forefoot conditions include traumatic and stress fractures, metatarsophalangeal and plantar plate injuries and degenerations, intermittent bursitis, and perineural fibrosis. Ultrasonography is well-suited for evaluating superficial tendons, ligaments, and muscles. MR imaging is best for deeper-located soft tissue structures, articular cartilage, and cancellous bone.
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21
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Nelson MS, Liu Y, Wilson HM, Li B, Rosado-Mendez IM, Rogers JD, Block WF, Eliceiri KW. Multiscale Label-Free Imaging of Fibrillar Collagen in the Tumor Microenvironment. Methods Mol Biol 2023; 2614:187-235. [PMID: 36587127 DOI: 10.1007/978-1-0716-2914-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
With recent advances in cancer therapeutics, there is a great need for improved imaging methods for characterizing cancer onset and progression in a quantitative and actionable way. Collagen, the most abundant extracellular matrix protein in the tumor microenvironment (and the body in general), plays a multifaceted role, both hindering and promoting cancer invasion and progression. Collagen deposition can defend the tumor with immunosuppressive effects, while aligned collagen fiber structures can enable tumor cell migration, aiding invasion and metastasis. Given the complex role of collagen fiber organization and topology, imaging has been a tool of choice to characterize these changes on multiple spatial scales, from the organ and tumor scale to cellular and subcellular level. Macroscale density already aids in the detection and diagnosis of solid cancers, but progress is being made to integrate finer microscale features into the process. Here we review imaging modalities ranging from optical methods of second harmonic generation (SHG), polarized light microscopy (PLM), and optical coherence tomography (OCT) to the medical imaging approaches of ultrasound and magnetic resonance imaging (MRI). These methods have enabled scientists and clinicians to better understand the impact collagen structure has on the tumor environment, at both the bulk scale (density) and microscale (fibrillar structure) levels. We focus on imaging methods with the potential to both examine the collagen structure in as natural a state as possible and still be clinically amenable, with an emphasis on label-free strategies, exploiting intrinsic optical properties of collagen fibers.
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Affiliation(s)
- Michael S Nelson
- Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuming Liu
- Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA
| | - Helen M Wilson
- Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Bin Li
- Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,Morgridge Institute for Research, Madison, WI, USA
| | - Ivan M Rosado-Mendez
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeremy D Rogers
- Morgridge Institute for Research, Madison, WI, USA.,McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - Walter F Block
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin W Eliceiri
- Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA. .,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA. .,Morgridge Institute for Research, Madison, WI, USA. .,Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA. .,McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA.
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22
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Pre-procedural Imaging. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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23
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Singh K, Hosseini N, Pooyan A, Zadeh FS, Chalian M. Imaging Tendon Disorders in Athletes. Clin Podiatr Med Surg 2023; 40:223-238. [PMID: 36368845 DOI: 10.1016/j.cpm.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Imaging plays a critical role in evaluating pathology affecting athletes from various fields. Tendon pathology manifests in terms of mechanical, degenerative, enthesitis, neoplastic, and overuse diseases. Tendon pathologies in athletes usually involve injuries to commonly injured tendons such as the tendons involving the ankle, elbow, rotator cuff, hip abductors, patellar tendon, and Achilles tendon. For the purposes of this article, the focus will be on the tendons involving the ankle such as the tibialis posterior and peroneal tendons. The 2 most common imaging modalities used for the evaluation of tendons are ultrasound (US) and magnetic resonance imaging (MRI). There are several emerging imaging techniques such as T2 mapping, ultra-short echo time MRI, and sonoelastography. These novel imaging techniques are all in research phase and have not been adapted to routine clinical practice.
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Affiliation(s)
- Kanwardeep Singh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA
| | - Nastaran Hosseini
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/Nas_Hosseini
| | - Atefe Pooyan
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/AtefePooyan
| | - Firoozeh Shomal Zadeh
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA. https://twitter.com/FiroozehShomal
| | - Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, 4245 Roosevelt Way Northeast, Box 354755, Seattle, WA 98105, USA.
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Diagnostic Ultrasound: Recognizing Musculoskeletal Pathology. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fleischhacker E, Siebenbürger G, Gleich J, Böcker W, Gilbert F, Helfen T. The Accuracy of Distal Clavicle Fracture Classifications-Do We Need an Amendment to Imaging Modalities or Fracture Typing? J Clin Med 2022; 11:jcm11195638. [PMID: 36233506 PMCID: PMC9572249 DOI: 10.3390/jcm11195638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Despite its fair-to-moderate reliability, the “modified Neer classification” is widely accepted and used. The purpose of this study was to reevaluate its applicability. Methods: Of n = 59 patients with distal clavicle fractures, fractures were classified on standard radiographs. Afterwards, an MRI examination was performed, and fractures reclassified. The primary outcome parameter was quantifying the rate of misclassification. The secondary outcome parameters were the evaluation of the ligamentous injury constellations. Results: In all cases, the fracture course and ligamental integrity could be assigned to the fracture type. Correction of the classification was necessary in n = 5 (8.5%) cases. In n = 3 (5%) cases, a correction was necessary from Neer I to Craig IIc and thus from conservative to operative treatment. Mean coracoclavicular distance (CCD) in Neer I was 10.2 ± 2.1 mm versus 14.2 ± 3.9 mm in Craig IIc (p = 0.02). The mean fracture angle in Neer I was 25.1 ± 3.3° versus 36.8 ± 4.4° in Craig IIc (p = 0.02). Conclusion: Cross-sectional imaging resulted in higher precision. Nevertheless, recommendations remain for standard radiographs. The CCD and fracture angle should be considered. An angle of >30° can be assumed as a parameter of instability. A previously undescribed fracture type does not seem to exist. The modified Neer classification is an appropriate and complete fracture classification.
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Hunter CW, Deer TR, Jones MR, Chang Chien GC, D'Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15:2683-2745. [PMID: 36132996 PMCID: PMC9484571 DOI: 10.2147/jpr.s370469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from – unfortunately, there is no consensus on which treatments are “better” and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.
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Affiliation(s)
- Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA.,Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | | | - Ryan S D'Souza
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Erica R Eldon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lissa Hewan-Lowe
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jillian A Maloney
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anthony J Mazzola
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Jeanmarie Tari
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Chris Wie
- Interventional Spine and Pain, Dallas, TX, USA
| | - Douglas Beall
- Comprehensive Specialty Care, Oklahoma City, OK, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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27
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Malta LMDA, Lugon JR, Santos AASMDD, Machado LM. Morphometric magnetic resonance imaging study of the quadriceps tendon in hemodialysis patients: comparison with non-dialyzed controls. Radiol Bras 2022; 55:293-298. [PMID: 36320376 PMCID: PMC9620849 DOI: 10.1590/0100-3984.2021.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the knees of individuals with renal failure who are on
hemodialysis, using magnetic resonance imaging (MRI), comparing them with
those of a group of individuals with normal renal function. Materials and Methods This was a cross-sectional, observational, controlled study conducted between
August 2018 and February 2020. The cases consisted of 15 patients who had
been on hemodialysis for ≥ 5 years and did not have a quadriceps
tendon rupture. The controls consisted of 15 individuals with normal renal
function who were matched (1:1) to the cases for sex, age, and physical
activity level. The subjects in both groups underwent MRI of the right knee
only. Results The mean ages of the cases and controls were 50 ± 15 years and 49
± 14 years, respectively. The median time on hemodialysis was 11
years (range, 10-14 years). Serum levels of parathyroid hormone, ferritin,
alkaline phosphatase, phosphorus, and creatinine were higher among the cases
than among the controls, whereas serum albumin and hemoglobin were lower
(p < 0.05 for all). The MRI study showed a
hyperintense signal in the quadriceps tendon in 11 of the cases and in three
of the controls (p = 0.009). Knee joint effusion was
observed in nine of the cases and in three of the controls
(p < 0.05). The thickness, length, and width of the
tendon did not differ between the groups. A hyperintense signal in the
tendon was not associated with the time on hemodialysis; nor with the levels
of intact parathyroid hormone, hemoglobin, or alkaline phosphatase. Conclusion Patients on chronic hemodialysis, even those without a tendon rupture, show a
hyperintense signal in the quadriceps tendon on MRI.
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Thomas SJ, Sarver JJ, Ebaugh DD, Paul RW, Osman A, Topley M, Soloff L, Quinlan J, Kelly JD. Chronic adaptations of the long head of the biceps tendon and groove in professional baseball pitchers. J Shoulder Elbow Surg 2022; 31:1047-1054. [PMID: 34861407 DOI: 10.1016/j.jse.2021.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/11/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS The long head of the biceps tendon (LHBT) plays a significant shoulder stabilizing role during pitching, with the large forces and repetitions involved in overhead throwing likely contributing to LHBT pathology. Determining whether the LHBT undergoes adaptive changes in baseball pitchers and how these changes relate to bicipital groove morphology can improve our understanding of the biceps function at the glenohumeral joint. Therefore, the purpose of this study was to determine the chronic adaptations of the bicipital groove morphology and the LHBT in professional baseball pitchers, with a secondary purpose of evaluating biceps integrity as it relates to torsional changes of the bicipital groove. We hypothesized that the throwing arm of professional baseball pitchers would exhibit chronic adaptations of the LHBT compared with their nonthrowing arm, and that these adaptations would be related to the bicipital groove morphology. MATERIALS AND METHODS Fifty-three professional baseball pitchers were enrolled at the beginning of the 2015 Major League Baseball spring training. Ultrasound was used to bilaterally measure humeral retroversion and to capture images of the bicipital groove and the LHBT. MATLAB software was used to calculate the area of the bicipital groove, and ImageJ software was used to quantify the area, echogenicity, and circularity of the LHBT. RESULTS The dominant arm LHBT cross-sectional area was significantly smaller than the nondominant arm (9 mm2 vs. 10 mm2; P = .011), whereas the dominant arm LHBT echogenicity was significantly higher than the nondominant arm (65 optical density vs. 59 optical density; P = .002). Pitchers with more bicipital groove rotational adaptation (more retroversion) had significantly more LHBT echogenicity adaptation compared with pitchers with less bicipital groove rotational adaptation (12 vs. 2; P = .023). CONCLUSION There are significant bilateral differences in the LHBT of professional baseball pitchers. An adaptation in bony rotation was associated with a larger bilateral difference in LHBT echogenicity but was not related to bilateral differences in LHBT area or circularity. Therefore, the bilateral difference in echogenicity is impacted by bony morphology, whereas the bilateral difference in cross-sectional area may be independent of bony morphology in this healthy population.
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Affiliation(s)
- Stephen J Thomas
- College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joseph J Sarver
- Department of Bioengineering, Drexel University, Philadelphia, PA, USA
| | - D David Ebaugh
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Ryan W Paul
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alim Osman
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Matthew Topley
- Department of Kinesiology, Temple University, Philadelphia, PA, USA
| | | | | | - John D Kelly
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Jerban S, Ma Y, Afsahi AM, Lombardi A, Wei Z, Shen M, Wu M, Le N, Chang DG, Chung CB, Du J, Chang EY. Lower Macromolecular Content in Tendons of Female Patients with Osteoporosis versus Patients with Osteopenia Detected by Ultrashort Echo Time (UTE) MRI. Diagnostics (Basel) 2022; 12:1061. [PMID: 35626217 PMCID: PMC9140093 DOI: 10.3390/diagnostics12051061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 01/30/2023] Open
Abstract
Tendons and bones comprise a special interacting unit where mechanical, biochemical, and metabolic interplays are continuously in effect. Bone loss in osteoporosis (OPo) and its earlier stage disease, osteopenia (OPe), may be coupled with a reduction in tendon quality. Noninvasive means for quantitatively evaluating tendon quality during disease progression may be critically important for the improvement of characterization and treatment optimization in patients with bone mineral density disorders. Though clinical magnetic resonance imaging (MRI) sequences are not typically capable of directly visualizing tendons, ultrashort echo time MRI (UTE-MRI) is able to acquire a high signal from tendons. Magnetization transfer (MT) modeling combined with UTE-MRI (i.e., UTE-MT-modeling) can indirectly assess macromolecular proton content in tendons. This study aimed to determine whether UTE-MT-modeling could detect differences in tendon quality across a spectrum of bone health. The lower legs of 14 OPe (72 ± 6 years) and 31 OPo (73 ± 6 years) female patients, as well as 30 female participants with normal bone (Normal-Bone, 36 ± 19 years), are imaged using UTE sequences on a 3T MRI scanner. Institutional review board approval is obtained for the study, and all recruited subjects provided written informed consent. A T1 measurement and UTE-MT-modeling are performed on the anterior tibialis tendon (ATT), posterior tibialis tendon (PTT), and the proximal Achilles tendon (PAT) of all subjects. The macromolecular fraction (MMF) is estimated as the main measure from UTE-MT-modeling. The mean MMF in all the investigated tendons was significantly lower in OPo patients compared with the Normal-Bone cohort (mean difference of 24.2%, p < 0.01), with the largest Normal-Bone vs. OPo difference observed in the ATT (mean difference of 32.1%, p < 0.01). Average MMF values of all the studied tendons are significantly lower in the OPo cohort compared with the OPe cohort (mean difference 16.8%, p = 0.02). Only the PPT shows significantly higher T1 values in OPo patients compared with the Normal-Bone cohort (mean difference 17.6%, p < 0.01). Considering the differences between OPo and OPe groups with similar age ranges, tendon deterioration associated with declining bone health was found to be larger than a priori detected differences caused purely by aging, highlighting UTE-MT MRI techniques as useful methods in assessing tendon quality over the course of progressive bone weakening.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Amir Masoud Afsahi
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Alecio Lombardi
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Zhao Wei
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Meghan Shen
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Mei Wu
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
| | - Nicole Le
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Douglas G. Chang
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA;
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA 92093, USA; (Y.M.); (A.M.A.); (A.L.); (Z.W.); (M.S.); (M.W.); (N.L.); (C.B.C.); (J.D.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
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Chronic Medial Collateral Ligament Sprain Treated With Percutaneous Ultrasonic Debridement: A Case Report. Clin J Sport Med 2022; 32:e175-e177. [PMID: 33852441 DOI: 10.1097/jsm.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023]
Abstract
The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Most grade I and II injuries respond to conservative management, but symptoms persist in some patients. In these cases, treatment options are limited. Percutaneous ultrasonic debridement is increasingly being used for tendinopathy and fasciopathy refractory to conservative management, but this has not been reported as a treatment for ligament injury. Here, we present a case of a chronic grade II MCL sprain successfully treated with percutaneous ultrasonic debridement.
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Abnormal Ultrasonographic Findings of Acellular Dermal Matrix in Implant-Based Breast Reconstruction: Correlations with Histopathology. J Clin Med 2022; 11:jcm11041057. [PMID: 35207330 PMCID: PMC8877379 DOI: 10.3390/jcm11041057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Acellular dermal matrix (ADM) in implant-based breast reconstruction can show various ultrasound (US) findings. However, there are limited reports on the US features of the ADM. The aims of this study were to evaluate US findings of the ADM in implant-based breast reconstruction and correlate them with histopathological findings. Methods: Between January 2015 and August 2020, 250 women who underwent implant-based breast reconstruction with ADM and a breast US examination at 6 months to 1 year after reconstruction were retrospectively analyzed. Abnormal US findings were classified as type 1 (focal thickening with decreased echogenicity), 2 (diffusely hyperechoic), or 3 (bright echogenic spots). ADM biopsy was performed in 33 patients who underwent second stage or revisional surgeries. Results: In total, 176 consecutive women with 207 US findings were analyzed. The US findings were normal in 52.2% of the women. The percentages of type 1, 2, and 3 patients were 13.5%, 11.1%, and 23. 2%, respectively. These patients had microscopic findings that showed patchy areas with chronic inflammatory infiltrates, dense collagen bundles without degenerative or inflammatory changes, and empty spaces or degenerated foci unaccompanied by inflammation. Conclusion: Knowing the various ADM presentations on US can help avoid unnecessary invasive procedures.
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Korkmaz BY, Akturk M, Ucar M, Altınova AE, Can MA, Arslan E, Tokgoz N, Toruner F. Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in Patients with High-Risk for Diabetic Foot. Exp Clin Endocrinol Diabetes 2021; 130:525-531. [PMID: 34781374 DOI: 10.1055/a-1642-2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot. METHODS The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined. RESULTS Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups. CONCLUSION Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.
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Affiliation(s)
- Busra Yurumez Korkmaz
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Ucar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altınova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ali Can
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Arslan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nil Tokgoz
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
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Al Makhzoomi AK, Kirk TB, Allison GT. A multiscale study of morphological changes in tendons following repeated cyclic loading. J Biomech 2021; 128:110790. [PMID: 34634539 DOI: 10.1016/j.jbiomech.2021.110790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
The response of white New Zealand rabbit Achilles tendons to load was assessed using mechanical measures and confocal arthroscopy (CA). The progression of fatigue-loading-induced damage of the macro- (tenocyte morphology, fiber anisotropy and waviness), as well as the mechanical profile, were assessed within the same non-viable intact tendon in response to prolonged cyclic and static loading (up to four hours) at different strain levels (3%, 6% and 9%). Strain-mediated repeated loading induced a significant decline in mechanical function (p < 0.05) with increased strain and cycles. Mechanical and structural resilience was lost with repeated loading (p < 0.05) at macroscales. The lengthening of D-periodicity correlated strongly with the overall tendon mechanical changes and loss of spindle shape in tenocytes. This is the first study to provide a clear concurrent assessment of form (morphology) and function (mechanics) of tendons undergoing different strain-mediated repeated loading at multiple-scale assessments. This study identifies a variety of multiscale properties that may contribute to the understanding of mechanisms of tendon pathology.
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Affiliation(s)
- Anas K Al Makhzoomi
- School of Allied Health, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.
| | - Thomas B Kirk
- School of Science, Engineering and Technology, RMIT University Vietnam, Ho Chi Minh City, Vietnam
| | - Garry T Allison
- Research Office, Curtin University, Perth, Western Australia, Australia
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Yan W, Meng X, Sun J, Yu H, Wang Z. Intelligent localization and quantitative evaluation of anterior talofibular ligament injury using magnetic resonance imaging of ankle. BMC Med Imaging 2021; 21:130. [PMID: 34454471 PMCID: PMC8403355 DOI: 10.1186/s12880-021-00660-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
Background There is a high incidence of injury to the lateral ligament of the ankle in daily living and sports activities. The anterior talofibular ligament (ATFL) is the most frequent types of ankle injuries. It is of great clinical significance to achieve intelligent localization and injury evaluation of ATFL due to its vulnerability. Methods According to the specific characteristics of bones in different slices, the key slice was extracted by image segmentation and characteristic analysis. Then, the talus and fibula in the key slice were segmented by distance regularized level set evolution (DRLSE), and the curvature of their contour pixels was calculated to find useful feature points including the neck of talus, the inner edge of fibula, and the outer edge of fibula. ATFL area can be located using these feature points so as to quantify its first-order gray features and second-order texture features. Support vector machine (SVM) was performed for evaluation of ATFL injury. Results Data were collected retrospectively from 158 patients who underwent MRI, and were divided into normal (68) and tear (90) group. The positioning accuracy and Dice coefficient were used to measure the performance of ATFL localization, and the mean values are 87.7% and 77.1%, respectively, which is helpful for the following feature extraction. SVM gave a good prediction ability with accuracy of 93.8%, sensitivity of 88.9%, specificity of 100%, precision of 100%, and F1 score of 94.2% in the test set. Conclusion Experimental results indicate that the proposed method is reliable in diagnosing ATFL injury. This study may provide a potentially viable method for aided clinical diagnoses of some ligament injury.
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Affiliation(s)
- Wen Yan
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Nankai District, 92 Weijin Road, Tianjin, 300072, China
| | - Xianghong Meng
- Radiology Department, Tianjin Hospital, 406 Jiefangnan Road, Hexi District, Tianjin, 300210, China
| | - Jinglai Sun
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Nankai District, 92 Weijin Road, Tianjin, 300072, China
| | - Hui Yu
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Nankai District, 92 Weijin Road, Tianjin, 300072, China.
| | - Zhi Wang
- Radiology Department, Tianjin Hospital, 406 Jiefangnan Road, Hexi District, Tianjin, 300210, China.
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Upadhyaya V, Choudur HN. Update on sports imaging. J Clin Orthop Trauma 2021; 21:101555. [PMID: 34458092 PMCID: PMC8379491 DOI: 10.1016/j.jcot.2021.101555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/27/2022] Open
Abstract
Sports Imaging has dramatically increased in the past decade with increasing number of adolescents, young and middle-aged adults participating in non-competitive/hobby sports. Therefore, sports injuries are no longer confined to elite athletes. Furthermore, newer forms of sports such as mountain climbing, pickle ball and curling etc. are gaining popularity. Majority of the injuries in sports medicine are from musculoskeletal trauma. Therefore, it is imperative that the musculoskeletal radiologist becomes familiar with various sports related injury patterns as these are commonly encountered in daily practice. This update aims to briefly encapsulate the major aspects of sports imaging. It includes the imaging manifestations of various types of musculoskeletal injuries on different modalities (commonly US and MRI) and briefly mentions the various image guided interventions, performed both on the sports field and in the hospital setting.
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Affiliation(s)
- Vaishali Upadhyaya
- MRI Division, Department of Radiology, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, 226007, India
| | - Hema N. Choudur
- Division of MSK Imaging, McMaster University, Staff MSK Radiologist: Hamilton General Hospital, Hamilton Health Sciences, 237 Barton St.E, Hamilton, Ontario L9L 2X2, Canada,Corresponding author.
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Abstract
Ankle trauma is commonly encountered and is most often a sprain injury affecting the ligaments. Accurate diagnosis and appropriate treatment rest on knowledge of complex ligamentous anatomy of ankle and the entire spectrum of pathologies. Magnetic resonance imaging (MRI) is the imaging modality of choice for diagnosing ligament pathologies because of its multiplanar capability and high soft tissue contrast. With MRI, it is possible to triage and attribute the cause of post traumatic ankle pain to bone, ligament, or tendon pathologies, which otherwise overlap clinically. In this pictorial essay, emphasis is given to the intricate and unique anatomy and orientation of ankle ligaments. Pathologies of ankle ligaments have been elaborated.
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Affiliation(s)
| | - Darshana Sanghvi
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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Paek HJ, Luo ZB, Choe HM, Quan BH, Gao K, Han SZ, Li ZY, Kang JD, Yin XJ. Association of myostatin deficiency with collagen related disease-umbilical hernia and tippy toe standing in pigs. Transgenic Res 2021; 30:663-674. [PMID: 34304368 DOI: 10.1007/s11248-021-00275-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/19/2021] [Indexed: 11/30/2022]
Abstract
Herein, we investigate the high incidence of umbilical hernia and tippy-toe standing and their underlying changes in gene expression and proliferation in myostatin knockout (MSTN-/-) pigs. Thirty-six male MSTN-/- pigs were generated by somatic cell nuclear transfer (SCNT). These pigs presented a considerably high incidence of tippy-toe standing and umbilical hernia (69.4% and 61.1%, respectively). The tendon to body weight ratio was significantly lower than wild-type pigs (0.202 ± 0.017 vs 0.250 ± 0.004, respectively). The crimp length of the MSTN-/- tendon was significantly longer than that of wild-type pigs. The expression of MSTN and the activin type IIB (ACVR2B) was detected in the tendon and linea alba of MSTN-/- pigs. MSTN treatment significantly increased the phosphorylation of Smad2/3 in both tendon and linea alba fibroblasts. Type I collagen (Col1A) and Scleraxis (Scx) expression levels in the tendon and linea alba of MSTN-/- pigs were significantly lower than those in wild-type in vivo, whereas and cyclin-dependent kinase inhibitor 1 (p21) expression levels were higher. Treatment of tendon and linea alba fibroblasts with recombinant MSTN increased Col1A and Scx and decreased p21 expression in vivo. Moreover, there was a significant increase in fibroblast proliferation after treatment. The results indicated that MSTN regulates collagen expression and proliferation in tendon and linea alba fibroblasts; thus, MSTN deficiency causes collagen-related pathological features in MSTN-/- pigs. Hence, MSTN could be used as a therapeutic target for treating UH and tendon abnormalities.
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Affiliation(s)
- Hyo-Jin Paek
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Zhao-Bo Luo
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Hak-Myong Choe
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Biao-Hu Quan
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Kai Gao
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Sheng-Zhong Han
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Zhou-Yan Li
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Jin-Dan Kang
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China
| | - Xi-Jun Yin
- Jilin Provincial Key Laboratory of Transgenic Animal and Embryo Engineering, Yanbian University, Yanji, 133002, Jilin, China.
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Evrard L, Joostens Z, Vandersmissen M, Audigié F, Busoni V. Comparison Between Ultrasonographic and Standing Magnetic Resonance Imaging Findings in the Podotrochlear Apparatus of Horses With Foot Pain. Front Vet Sci 2021; 8:675180. [PMID: 34291100 PMCID: PMC8287171 DOI: 10.3389/fvets.2021.675180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
This prospective study aimed to blindly compare the ultrasonographic and standing magnetic resonance imaging (sMRI) findings in deep digital flexor tendon (DDFT), navicular bone, and navicular bursa in horses with foot pain, positive digital analgesia, and without definitive radiographic diagnosis. Ultrasonography detected more DDFT abnormalities (32/34 feet vs. 27/34 with sMRI) but identified less palmar navicular abnormalities (23/34 feet vs. 30/34 with sMRI). In suprasesamoidean DDFT lesions, which were mainly dorsally located, changes in echogenicity did not correspond to a particular pattern of sMRI signal change. Transcuneal ultrasonography did not allow assessment of morphology and extent of distal DDFT lesions, and sporadically discriminated the affected lobe compared to sMRI. Defects of the palmar compact bone were identified with both modalities except a parasagittal defect, which was only seen at sMRI.
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Affiliation(s)
- Laurence Evrard
- Department of Clinical Sciences of Companion Animals and Equids, Equine Division, Diagnostic Imaging Section, University of Liège, Liège, Belgium
| | - Zoë Joostens
- Medical Imaging Department, Equitom Equine Clinic, Lummen, Belgium
| | - Maxime Vandersmissen
- Department of Clinical Sciences of Companion Animals and Equids, Equine Division, Diagnostic Imaging Section, University of Liège, Liège, Belgium
| | - Fabrice Audigié
- Centre d'Imagerie et de Recherche sur les Affections Locomotrices Equines, Ecole Nationale Vétérinaire d'Alfort, Goustranville, France
| | - Valeria Busoni
- Department of Clinical Sciences of Companion Animals and Equids, Equine Division, Diagnostic Imaging Section, University of Liège, Liège, Belgium
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Usefulness of Imaging Techniques in the Diagnosis of Selected Injuries and Lesions of the Canine Tarsus. A Review. Animals (Basel) 2021; 11:ani11061834. [PMID: 34205353 PMCID: PMC8234438 DOI: 10.3390/ani11061834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Tarsal joint lesions are uncommon in dogs but may lead to serious health problems. The most common diseases involving the tarsal joint are osteochondrosis, fractures and injuries of the Achilles tendon. The basis for the diagnosis of lesions in the tarsus is a thorough orthopedic examination, sometimes performed under sedation. Imaging modalities such as radiography, ultrasonography, magnetic resonance imaging or computed tomography can facilitate the detection and assessment of lesions in the canine tarsal joint. The aim of this paper is to characterize and compare the usefulness of imaging techniques available in veterinary medicine for the diagnosis and evaluation of lesions and injuries affecting the tarsal joint in dogs. Abstract Tarsus lesions are not common in dogs, but they can cause serious health problem. They can lead to permanent changes in the joint and, in dogs involved in canine sports, to exclusion from training. The most common diseases and injuries involving the tarsal joint are osteochondrosis, fractures and ruptures of the Achilles tendon. These conditions can be diagnosed primarily through accurate orthopedic examination, but even this may be insufficient for performing a proper diagnosis. Imaging modalities such as radiography, ultrasonography, magnetic resonance imaging or computed tomography can facilitate the detection and assessment of lesions in the canine tarsal joint. This review paper briefly presents some characteristics of the above-mentioned imaging techniques, offering a comparison of their utility in the diagnosis of lesions and injuries involving the canine tarsus.
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Atici A, Bahadir Ulger FE, Akpinar P, Illeez OG, Geler Kulcu D, Unlu Ozkan F, Aktas I. Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome. Indian J Orthop 2021; 56:116-124. [PMID: 35070151 PMCID: PMC8748597 DOI: 10.1007/s43465-021-00424-3] [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: 12/26/2020] [Accepted: 05/12/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). METHODS Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. RESULTS Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. CONCLUSION The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.
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Affiliation(s)
- Arzu Atici
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Fatma Esra Bahadir Ulger
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Pinar Akpinar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Ozge Gulsum Illeez
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Duygu Geler Kulcu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Feyza Unlu Ozkan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Ilknur Aktas
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
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Brown EC, Jugé L, Knapman FL, Burke PGR, Ngiam J, Sutherland K, Butler JE, Eckert DJ, Cistulli PA, Bilston LE. Mandibular advancement splint response is associated with the pterygomandibular raphe. Sleep 2021; 44:5955974. [PMID: 33146716 DOI: 10.1093/sleep/zsaa222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/05/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To investigate whether the presence of tendinous PMR could predict treatment outcome and how it affects lateral wall mechanical properties. Mandibular advancement increases the lateral dimensions of the nasopharyngeal airway via a direct connection from the airway to the ramus of the mandible. The anatomical structure in this region is the pterygomandibular raphe (PMR), but a tendinous component is not always present. Whether tendon presence influences treatment outcome is unknown. METHODS In total, 105 participants with obstructive sleep apnea completed detailed anatomical magnetic resonance imaging with and without mandibular advancement. The study design was case-control. Variables were compared between participants with and without the tendon present. RESULTS The amount of maximum mandibular advancement decreased when pterygomandibular tendon was present (4.0 ± 1.2 mm present versus 4.6 ± 1.4 mm absent, p = 0.04). PMR tendon-absent participants had a lower posttreatment apnea hypopnea index (16 ± 12 events/hour tendon present versus 9 ± 9 events/hour absent, p = 0.007) and were more likely to have complete response (63% versus 36%, p = 0.02). However, tendon-absent participants were more likely to not complete the study (χ 2 (3) = 10.578, p = 0.014). Tendon-absent participants had a greater increase in midline anteroposterior airway diameter (1.6 ± 1.7 mm versus 0.6 ± 2.3 mm, p = 0.04). CONCLUSION When PMR tendon is absent, treatment response and amount of maximum advancement improve, possibly at the expense of reduced splint tolerability. Tendon presence may help predict a group less likely to respond to mandibular advancement splint therapy.
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Affiliation(s)
- Elizabeth C Brown
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Sydney, New South Wales, Australia
| | - Lauriane Jugé
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona L Knapman
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Peter G R Burke
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joachim Ngiam
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kate Sutherland
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane E Butler
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Danny J Eckert
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Peter A Cistulli
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lynne E Bilston
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.,Prince of Wales Clinical School, Sydney, New South Wales, Australia
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Falkowski AL, Jacobson JA, Hirschmann MT, Kalia V. MR imaging of the quadriceps femoris tendon: distal tear characterization and clinical significance of rupture types. Eur Radiol 2021; 31:7674-7683. [PMID: 33860830 PMCID: PMC8452547 DOI: 10.1007/s00330-021-07912-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/12/2021] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
Objective To characterize quadriceps femoris tendon tears on magnetic resonance (MR) imaging regarding tear extent, location, and presence of bony avulsion. Materials and methods IRB approval was obtained and informed consent was waived for this retrospective case series. Electronic medical records from all patients in our hospital system were searched for keywords: knee MR imaging, and quadriceps tendon rupture or tear. MRI studies were randomized and independently evaluated by two fellowship-trained musculoskeletal radiologists. MR imaging was used to characterize each individual quadriceps tendon as having tendinosis, tear (location, partial versus complete, size, and retraction distance), and bony avulsion. Knee radiographs were reviewed for presence or absence of bony avulsion. Descriptive statistics and inter-reader reliability (Cohen’s Kappa and Wilcoxon-signed-rank test) were calculated. Results Fifty-two patients with 53 quadriceps tears were evaluated (45 males, 7 females; mean age: 51 ± 13 years). The vastus intermedius (VI) tendon more often incurred a partial rather than a complete tear (39.6% vs. 37.7%), while the rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) incurred complete tears more commonly (64.2–66%). Subjects with bony avulsion on radiographs had higher-grade tears of the RF, VM, and VL tears (p = 0.020–0.043) but not the VI. Most tendons tore at or immediately proximal to the patella (84.8–93.6%). Gaps in retracted torn tendons measured between 2.3 and 2.7 cm. Inter-reader reliability was substantial to almost perfect (κ = 0.624–0.953). Conclusion Quadriceps femoris tendon tears most commonly involve the RF or VL/VM layers usually in proximity to the patella. A bony avulsion correlates with a more extensive tear. Key Points • Quadriceps femoris tendon tears most commonly involve the rectus femoris or vastus lateralis/vastus medialis layers. • A rupture of the quadriceps femoris tendon usually occurs in proximity to the patella. • A bony avulsion of the patella correlates with a more extensive tear of the superficial and middle layers of the quadriceps tendon.
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Affiliation(s)
- Anna L Falkowski
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48103, USA. .,Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48103, USA
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - Vivek Kalia
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48103, USA
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Campbell TM, Gao L, Laneuville O, Louati H, Uhthoff HK, Trudel G. Rotator cuff anchor repair: Histological changes associated with the recovering mechanical properties in a rabbit model. J Tissue Eng Regen Med 2021; 15:567-576. [PMID: 33817988 DOI: 10.1002/term.3195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/24/2021] [Indexed: 01/08/2023]
Abstract
Rotator cuff anchor repair is an increasingly common surgical procedure but the failure rate remains high. In order to improve surgical outcomes, a better understanding of postrepair histological and cellular responses at the tendon-bone attachment site (enthesis) is needed. We examined operated shoulders from 42 New Zealand female white rabbits. The animals underwent unilateral supraspinatus detachment followed by anchor repair a week later. To assess enthesis reformation, fibrocartilage staining area and the number of chondrocytes or nonchondrocytes were quantified at 0, 1, 2, and 4 weeks postrepair. Using linear regression, we correlated these results with the load to failure and stiffness recorded during mechanical testing of the tendons. Fibrocartilage staining and chondrocyte number increased during the first 2 weeks of enthesis formation. Between 2 and 4 weeks, fibrocartilage staining plateaued while chondrocyte number decreased. The presence of nonchondrocytes remained similar between 0- and 1-week postrepair but then decreased abruptly at 2 weeks. There was a linear correlation between fibrocartilage staining area and load to failure as well as stiffness. Nonchondrocyte number negatively correlated with stiffness. Early plateau of fibrocartilage staining and decrease in chondrocytes between 2 and 4 weeks postrepair suggest a blunted enthesis formation response in our animal model.
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Affiliation(s)
- T Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada.,Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
| | - Le Gao
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - Odette Laneuville
- Department of Biology, University of Ottawa, Ottawa, Ontario, Canada
| | - Hakim Louati
- Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hans K Uhthoff
- Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Guy Trudel
- Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Yao M, Zhang C, Cheng W, Guo J, Dong S. MRI recovery of the Achilles tendon after percutaneous tenotomy in older children. J Orthop Surg Res 2021; 16:250. [PMID: 33849595 PMCID: PMC8042722 DOI: 10.1186/s13018-021-02407-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background An observational study was conducted to evaluate the recovery of older children with relapsed congenital clubfoot who underwent an Achilles tenotomy for the second time as part of the Ponseti treatment. Methods Thirteen patients (19 feet) with congenital clubfoot underwent Achilles tenotomy where magnetic resonance images of the severed tendons were taken after 1, 3, and 6 weeks post-procedure. The participants were categorized into older children who underwent tenotomy for the first time (group A: mean, 4.9±1.8, and range, 2.8–7 years old) and older children who underwent tenotomy for a second time (group B: mean, 4.9±1.5, and range, 3–6.8 years old). The area of high signal intensity between the severed tendons on MRI scans was computed using Python programming language and compared with clinical assessment. Results Three weeks after Achilles tenotomy, groups A and B had clinically intact tendons in 9 out of 11 and 2 out of 8 feet, respectively, according to both clinical and MRI assessment. From week 1 to week 3 post-tenotomy, computational analysis showed that the mean high signal intensity area of group A decreased by 88.5±15.2%, which was significantly different (P .048 < .05) than the percent reduction of high signal intensity area of group B (69.0±24.9%). Conclusion Children who underwent Achilles tenotomy for the second time showed slower tendon recovery on the third week post-procedure. A possible reason for slower healing times may be due to the location of tenotomy in being further away from the musculotendinous junction where extrinsic healing mechanisms take place. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02407-4.
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Affiliation(s)
- Manye Yao
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018, Henan, China.
| | - Chunxu Zhang
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018, Henan, China
| | - Weyland Cheng
- Department of Orthopaedic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018, Henan, China.,Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018, Henan, China
| | - Junhong Guo
- Department of Radiology, Military Hospital of Henan Province, 18 Jinshui Road, Zhengzhou, 450014, Henan, China
| | - Shijie Dong
- Department of Radiology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Waihuan East Road, Zhengzhou, 450018, Henan, China
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Silver FH, Kelkar N, Deshmukh T. Use of vibrational optical coherence tomography to measure viscoelastic properties of muscle and tendon: A new method to follow musculoskeletal injury and pathology In vivo. J Mech Behav Biomed Mater 2021; 119:104479. [PMID: 33798938 DOI: 10.1016/j.jmbbm.2021.104479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/26/2021] [Accepted: 03/15/2021] [Indexed: 12/17/2022]
Abstract
The biomechanical properties of muscles and tendons in vivo are important parameters needed to understand musculoskeletal physiology and pathology. Values of the shear moduli reported for human musculoskeletal components using elastographic techniques range from several KPa to about 100 KPa and are much lower than the tensile moduli measured in vivo which are reported to be as high as several hundred MPa at high strains. In this paper we report the results of a pilot study to measure the mechanical properties of human muscles and tendons non-invasively and non-destructively in vivo using vibrational optical coherence tomography (VOCT). VOCT is a non-invasive technique that uses audible sound and reflected infrared light to measure the resonant frequency of each tissue component. Using VOCT we report that the moduli at the biceps muscle-tendon junction are about 24-30 MPa even though moduli in other anatomic locations of muscle and tendons can vary by as much as 10 MPa. It is concluded that the modulus and stress exerted by tendons and muscles at the muscle-tendon junction are similar and that deposition of fibrous tissue at the junction will lead to reduced values of the modulus leading to tissue pathology and muscle injury.
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Affiliation(s)
- Frederick H Silver
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, 08854, USA; OptoVibronex, LLC., Allentown, Pa, USA.
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Malmgaard-Clausen NM, Tran P, Svensson RB, Hansen P, Nybing JD, Magnusson SP, Kjaer M. Magnetic Resonance T 2 * Is Increased in Patients With Early-Stage Achilles and Patellar Tendinopathy. J Magn Reson Imaging 2021; 54:832-839. [PMID: 33719139 DOI: 10.1002/jmri.27600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND T2 * mapping has proven useful in tendon research and may have the ability to detect subtle changes at an early stage of tendinopathy. PURPOSE To investigate the difference in T2 * between patients with early tendinopathy and healthy controls, and to investigate the relationship between T2 * and clinical outcomes, tendon size, and mechanical properties. STUDY TYPE Prospective cross-sectional. SUBJECTS Sixty-five patients with early tendinopathy and 25 healthy controls. FIELD STRENGTH/SEQUENCE Three Tesla, ultrashort time to echo magnetic resonance imaging. ASSESSMENT Tendon T2 * was quantified using a monoexponential fitting algorithm. Clinical symptoms were evaluated using the Victorian Institute of Sports Assessment-Achilles/Patella (VISA-A/VISA-P). In vivo mechanical properties were measured using an ultrasound-based method that determined force and deformation simultaneously in tendons of patellar tendinopathy patients. STATISTICAL TESTS A generalized linear model adjusted for age was applied to investigate the difference between patients and controls. In the two patient groups, linear regressions were applied to investigate the association between T2 * and tendon size, clinical outcomes, and biomechanical properties. RESULTS There was a significant difference in T2 * between patients and healthy controls (204.8 [95% CI: 44.5-365.0] μsec, P < 0.05). There was a positive correlation between tendon size and T2 * for both Achilles (r = 0.72; P < 0.05) and patellar tendons (r = 0.53; P < 0.05). There was no significant correlation between VISA-A and T2 * (r = -0.2; P = 0.17) or VISA-P and T2 * (r = -0.5; P = 0.0504). Lastly, there was a negative correlation between modulus and T2 * (r = -0.51; P < 0.05). DATA CONCLUSIONS T2 * mapping can detect subtle structural changes that translate to altered mechanical properties in early-phase tendinopathy. However, T2 * did not correlate with clinical scores in patients with early-phase Achilles and patellar tendinopathy. Thus, T2 * mapping may serve as a tool for early detection of structural changes in tendinopathy but does not necessarily describe the clinical severity of disease. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Nikolaj M Malmgaard-Clausen
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Peter Tran
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Department of Orthopedic Surgery, Institute of Sports Medicine Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Faculty of Health Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Bang JY, Hahn S, Yi J, Lim YJ, Jung HK. Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis. Eur Radiol 2021; 31:6726-6735. [PMID: 33634322 DOI: 10.1007/s00330-021-07791-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/26/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE). METHODS GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features. RESULTS Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV. CONCLUSIONS SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis. KEY POINTS • Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis. • There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.
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Affiliation(s)
- Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Hyun Kyung Jung
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
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Determinants of regeneration and strength of hamstrings after anterior cruciate ligament reconstruction-fate of hamstring tendon. INTERNATIONAL ORTHOPAEDICS 2021; 45:1751-1760. [PMID: 33409561 DOI: 10.1007/s00264-020-04932-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Arthroscopic reconstruction of anterior cruciate ligament (ACL) surgical procedure using hamstring autograft is the most common surgery performed in the arena of sports medicine and arthroscopy. Most studies in literature are ambiguous regarding the fate of hamstrings based on function, regenerative potential, and cross-sectional area (CSA). The aim of this research study is analysis of the fate of hamstring tendons (both semitendinosus and gracilis) during the time course for determinants of regeneration and strength. METHODS Fifty patients who were operated for unilateral isolated ACL reconstruction from July 2015 to June 2018 were evaluated for the fate of harvested hamstring tendons which included the following: regeneration, cross-sectional area (CSA), strength, and insertion of regenerated hamstrings by isometric torque and isokinetic strength. MRI of knee was performed for both knees concerning the semitendinosus (ST), gracilis (G), Sartorius, biceps femoris, and medial head of gastrocnemius. RESULTS Eighty-four percent men and 16% women within a mean patient age of 34 ± 4.12 years were evaluated and all 50 (100%) patients demonstrated hamstring regeneration by the MRI measurements at six months and at one year post-ACL reconstruction. The torque of isometric knee flexion measured in 60° was found to be remarkably lower in the ACL-reconstructed lower extremity compared to that of the contralateral limb (87.13 ± 20.18% of BW), at 90° (49.17 ± 15.09% BW), and at 105° (43.91 ± 13.17% BW), respectively (p < 0.01). However, at 30° flexion and 45° flexion, the difference was insignificant (116.48 ± 21.07% BW for 30° and 100.16 ± 25.12% BW for 45°). CONCLUSIONS It was found that the properties of musculotendinous units of ST and G were significantly transformed after their harvesting for ACL reconstruction and these weaknesses contribute to the flexion deficit of knee in the deeper range of flexion in the operated limb. Therefore, approaches facilitating tendon regeneration and preservation must be warranted.
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Colomb E, Muscatelli S, Morash JG, Crawford EA, Holmes JR, Walton DM. Irreducible Fractures and Dislocations of the Ankle Associated With Entrapment of the Posterior Tibial Tendon Within the Tibiofibular Interosseous Space: A Case Series and Literature Review. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211000297. [PMID: 35097438 PMCID: PMC8564945 DOI: 10.1177/24730114211000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Level of Evidence: Level IV, case series.
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Affiliation(s)
- Eric Colomb
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Stefano Muscatelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joel G. Morash
- Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eileen A. Crawford
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James R. Holmes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - David M. Walton
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Omoumi P, Gondim Teixeira PA, Ward SR, Trudell D, Resnick D. Practical ultrasonographic technique to precisely identify and differentiate tendons and ligaments of the elbow at the level of the humeral epicondyles: anatomical study. Skeletal Radiol 2021; 50:1369-1377. [PMID: 33313976 PMCID: PMC8119275 DOI: 10.1007/s00256-020-03693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a practical step-by-step technique to precisely identify and differentiate tendons and ligaments attaching to the humeral epicondyles, to confirm through gross anatomical study the accurate structure identification provided by this technique and to determine the frequency at which each structure can be identified in healthy volunteers. MATERIALS AND METHODS First, ten fresh frozen cadavers (6 men, age at death = 58-92 years) were examined by two musculoskeletal radiologists and a step-by-step technique for the identification of tendons and ligaments at the level of humeral epicondyles was developed. Second, the accurate identification of structures was confirmed through gross anatomical study including anatomical sections on five specimens and layer-by-layer dissection technique on five others. Finally, 12 healthy volunteers (6 men, average age = 36, range = 28-52) were scanned by two radiologists following the same technique. RESULTS An ultrasonographic technique based on the recognition of bony landmarks and the use of ultrasonographic signs to differentiate overlapping structures was developed and validated through gross anatomical study. In healthy volunteers, most tendons and ligaments were identified and well-defined in ≥ 80% of cases, except for the extensor carpi radialis brevis and extensor digiti minimi tendons on the lateral epicondyle (having common attachments with the extensor digitorum communis) and the palmaris longus tendon on the medial epicondyle (absent, or common attachment with the flexor carpi radialis). CONCLUSION A step-by-step approach to the ultrasonographic assessment of tendons and ligaments at the humeral epicondyles allowed accurate identification of and differentiation among these structures, in particular those relevant to pathological conditions.
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Affiliation(s)
- Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | | | - Samuel R Ward
- Departments of Orthopaedic Surgery and Radiology, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA
| | - Debbie Trudell
- Department of Radiology, Teleradiology / HCOP - University of California, 408 Dickinson Street, San Diego, CA, 92103, USA
| | - Donald Resnick
- Department of Radiology, Teleradiology / HCOP - University of California, 408 Dickinson Street, San Diego, CA, 92103, USA
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