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Pirri C, Pirri N, Macchi V, Porzionato A, De Caro R, Stecco C. Ultrasound Imaging of Ankle Retinacula: A Comprehensive Review. Tomography 2024; 10:1277-1293. [PMID: 39195730 PMCID: PMC11359401 DOI: 10.3390/tomography10080095] [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: 06/19/2024] [Revised: 07/28/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
The retinacula of the ankle are specialized anatomical structures characterized by localized thickenings of the crural fascia that envelop the deep components of the lower leg, ankle and foot. The ankle retinacula include the extensor retinacula, the peroneal retinacula and flexor retinaculum. Despite their potential to explain persistent and unexplained pain following an injury, these structures are often overlooked or incorrectly diagnosed. Hence, this comprehensive review was performed aiming to investigate the use and the methodology of US imaging to assess ankle retinacula. The search was performed on PubMed and Web of Science databases from inception to May 2024. The MeSH keywords used were as follows: "Ankle Retinacula", "Foot Retinacula", "Superior extensor retinaculum", "Inferior extensor retinaculum", "peroneal retinaculum", "superior peroneal retinaculum", "inferior peroneal retinaculum", "flexor retinaculum", "Ultrasound Imaging", "Ultrasound", "Ultrasonography" and "Ultrasound examination". In total, 257 records underwent screening, resulting in 22 studies meeting the criteria for inclusion after the process of revision. Data heterogeneity prevents synthesis and consistent conclusions. The results showed that advanced US imaging holds promise as a crucial tool to perform an US examination of ankle retinacula, offering static and dynamic insights into ankle retinacula pathology. Understanding normal anatomy and US imaging is essential for accurately identifying injuries. Future research should focus on clinical trials to validate parameters and ensure their reliability in clinical practice.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padova, 35122 Padova, Italy;
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (V.M.); (A.P.); (R.D.C.); (C.S.)
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2
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Pan G. Current status of dynamic musculoskeletal ultrasound for application to treatment of orthopedic diseases. Am J Transl Res 2024; 16:2180-2189. [PMID: 39006303 PMCID: PMC11236655 DOI: 10.62347/wher3512] [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: 03/20/2024] [Accepted: 05/08/2024] [Indexed: 07/16/2024]
Abstract
In recent years, dynamic musculoskeletal ultrasound (DMUS) technology has demonstrated great potential in the diagnosis and treatment of orthopedic diseases. As a non-invasive, real-time imaging technique, it provides a dynamic view of joints and soft tissues, offering crucial insight for evaluating muscle injuries and bone damage caused by motion. This article comprehensively reviews the latest research in the field of DMUS, discussing its significant roles in managing orthopedic diseases and enhancing clinical practice. The application of DMUS is wide-ranging, including but not limited to the diagnosis of tendon injuries, ligament tears, arthritis, and soft tissue diseases. Additionally, DMUS has significant value in monitoring treatment progress and evaluating post-operative recovery. Furthermore, we discuss the use of DMUS for improving the accuracy and effectiveness of orthopedic surgeries. DMUS can provide high-quality diagnostic and therapeutic services for patients without a need for expensive equipment or complex procedures. Despite its promising outlook in orthopedics, broader clinical adoption remains limited by factors such as the steep learning curve associated with its use, the demand for specialized skills in interpreting high-quality images, and the need for extensive clinical validation. Future research should focus on standardizing operational procedures, improving the automation of image analysis, and validating its application in different orthopedic diseases through clinical trials.
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Affiliation(s)
- Guobin Pan
- Medical Equipment Department, Yantai Yantaishan Hospital Yantai 264003, Shandong, China
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3
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Pirri C, Stecco C, Güvener O, Mezian K, Ricci V, Jačisko J, Fojtik P, Kara M, Chang KV, Dughbaj M, Özçakar L. EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot. Am J Phys Med Rehabil 2024; 103:e29-e34. [PMID: 37903600 DOI: 10.1097/phm.0000000000002349] [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: 11/01/2023]
Abstract
ABSTRACT In this dynamic scanning protocol, ultrasound examination of the ankle is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.
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Affiliation(s)
- Carmelo Pirri
- From the Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy (CP, CS); Department of Physical and Rehabilitation Medicine, Mersin University Medical School, Mersin, Turkey (OG); Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine, Prague, Czech Republic (KM); Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy (VR); Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (JJ); Institute of Anatomy, Charles University, First Faculty of Medicine, Prague, Czech Republic, Department of Orthopedics, The Central Military Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic (PF); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, L Ö); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taiwan (K.-VC); National Taiwan University College of Medicine, Taipei, Taiwan (K.-VC); Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait (MD)
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4
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Melville DM, Taljanovic MS, Gimber LH, Miller M, Ahmad A, Sepich D, Latt LD. Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation. J Clin Med 2024; 13:740. [PMID: 38337434 PMCID: PMC10856550 DOI: 10.3390/jcm13030740] [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: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to directly compare MRI and US to intraoperative findings in patients who underwent surgery for suspected peroneal pathology to determine the imaging diagnostic accuracy. Operative records and diagnostic images for 21 consecutive patients who had both MRI and US prior to surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. The results of this review are compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. For the diagnosis of peroneal tendon tears, US was found to have a sensitivity of 88% and specificity of 100%, compared to 100% sensitivity and specificity for MRI. In the diagnosis of peroneal tendinopathy, both US and MRI had a sensitivity and specificity of 100%. In diagnosing peroneal subluxation, US was 100% sensitive compared to 66% for MRI, and both were 100% specific. In conclusion, US was found to be more effective in diagnosing peroneal subluxation and MRI was slightly more accurate in the diagnosis of peroneal tendon tears.
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Affiliation(s)
- David M. Melville
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85259, USA;
| | - Mihra S. Taljanovic
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
- Department of Radiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Lana H. Gimber
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
| | - Matthew Miller
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA;
| | - Aamir Ahmad
- Department of Orthopaedic Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA;
| | | | - L. Daniel Latt
- Kaiser Permanente Moanalua Medical Center, Honolulu, HI 96819, USA;
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5
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Flores DV, Bohyn C, Murray TÉ, Murphy DT, Cresswell M. Dynamic US of Musculoskeletal Disorders: A Pictorial Review with Emphasis on Techniques. Radiographics 2023; 43:e220130. [PMID: 37471248 DOI: 10.1148/rg.220130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (C.B., T.E.M., D.T.M., M.C.)
| | - Cedric Bohyn
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (C.B., T.E.M., D.T.M., M.C.)
| | - Timothy Éanna Murray
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (C.B., T.E.M., D.T.M., M.C.)
| | - Darra T Murphy
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (C.B., T.E.M., D.T.M., M.C.)
| | - Mark Cresswell
- From the Department of Radiology, Radiation Oncology and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada K1H 8L6, Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); and Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (C.B., T.E.M., D.T.M., M.C.)
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6
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Pirri C, Pirri N, Stecco C, Macchi V, Porzionato A, De Caro R, Özçakar L. Hearing and Seeing Nerve/Tendon Snapping: A Systematic Review on Dynamic Ultrasound Examination. SENSORS (BASEL, SWITZERLAND) 2023; 23:6732. [PMID: 37571516 PMCID: PMC10422582 DOI: 10.3390/s23156732] [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: 06/25/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Nina Pirri
- Department of Medicine—DIMED, School of Radiology, Radiology Institute, University of Padua, 35122 Padova, Italy;
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (C.S.); (V.M.); (A.P.); (R.D.C.)
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey;
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7
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Caldwell AS, Elangovan SM, Jacobson JA. Dynamic musculoskeletal ultrasound: slipping rib, muscle hernia, snapping hip, and peroneal tendon pathology. Pediatr Radiol 2023; 53:1553-1561. [PMID: 37286853 DOI: 10.1007/s00247-023-05700-y] [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: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
Dynamic musculoskeletal ultrasound is an important diagnostic tool that allows the practitioner to observe soft tissue structures over a range of motion and identify pathology not diagnosed on other modalities. Familiarity with this modality allows health care practitioners to appropriately refer patients for this type of examination. This article will review several indications for dynamic ultrasound imaging, including slipping rib, muscle hernia, snapping hip, and peroneal tendon pathology. The examination technique and expected findings for common pathology in each location are discussed.
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Affiliation(s)
- Antonia S Caldwell
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stacey M Elangovan
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Radiology, MLC 5031, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
| | - Jon A Jacobson
- Lenox Hill Radiology, New York, NY, USA
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
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8
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Howard A, John A, Theiss R. Peroneus Tendon Disorders: Evaluation and Non-operative Management. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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9
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Abou Diwan R, Badr S, Boulil Y, Demondion X, Maynou C, Cotten A. Presurgical Perspective and Postsurgical Evaluation of Non-Achilles Tendons of the Ankle and Retinaculum. Semin Musculoskelet Radiol 2022; 26:670-683. [PMID: 36791736 DOI: 10.1055/s-0042-1760121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The vast majority of non-Achilles ankle tendinopathies are related to overuse. This article discusses the clinical aspect, imaging appearance, and management of tendinopathies of the lateral, medial, and the anterior compartments with a focus on presurgical perspective and postsurgical evaluation.
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10
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Mateen S, Ali S, Meyr AJ. Normal Distal Excursion of the Peroneus Brevis Myotendinous Junction. J Foot Ankle Surg 2022; 61:1158-1160. [PMID: 34785130 DOI: 10.1053/j.jfas.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 02/03/2023]
Abstract
A low-lying peroneus brevis muscle belly has been described as a risk factor for the development of peroneal tendon pathology, but this finding has primarily been described based on cohorts with pre-existing clinical findings. Therefore, the objective of this investigation was to evaluate the frequency of apparently abnormal low-lying muscle bellies from a series of subjects without clinical or imaging findings of peroneal tendon pathology. One hundred consecutive MRIs were reviewed with measurement of the distance from the distal peroneal myotendinous junction to the tip of the fibula. This distance was observed to be 23.9 ± 8.8 mm (10.8-55.4 mm; 95% confidence interval 22.2-26.7 mm). If one assumed that a myotendinous junction within 2 cm of the distal tip of fibula represented an abnormal low-lying muscle, then we observed 37% of extremities without clinical or radiographic evidence of peroneal tendon pathology that would be considered anatomically "abnormal." When a low-lying muscle belly was defined as occurring within 2 cm of the distal tip of the fibula, then a probability analysis of our data distribution found a 32.6% probability for individuals to have an "abnormally" low-lying muscle belly. These results indicate that what has traditionally been defined intraoperatively as an abnormally low-lying peroneus brevis muscle belly might simply represent intraoperative confirmation bias of relatively normal structural anatomy.
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Affiliation(s)
- Sara Mateen
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Sayed Ali
- Professor, Department of Radiology, Temple University Hospital, Philadelphia, PA
| | - Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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11
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Park J, Kim YH, Choi WJ, Cho HR, Hong UJ, Yi J, Choi YS, Lim YS, Kim YU. The value of the peroneus brevis tendon cross-sectional area in early diagnosing of peroneus brevis tendinitis: The peroneus brevis tendon cross-sectional area. Medicine (Baltimore) 2022; 101:e31276. [PMID: 36316917 PMCID: PMC10662861 DOI: 10.1097/md.0000000000031276] [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: 08/21/2020] [Accepted: 09/20/2022] [Indexed: 01/05/2023] Open
Abstract
A thickened peroneus brevis tendon has been considered to be an important morphologic parameter of peroneus brevis tendinitis (PBT). Previous researchers have found that the peroneus brevis tendon thickness (PBTT) is correlated with inflammation of the peroneus brevis tendon. However, inflammatory hypertrophic change is different from simple thickness. Thus, we devised the peroneus brevis tendon cross-sectional area (PBTCSA) as a new diagnostic parameter to analyze the hypertrophy of the whole PBT. We assumed that the PBTCSA is a major morphologic parameter useful for early PBT diagnosis. Peroneus brevis tendon images were collected from 22 patients with PBT and from 22 normal subjects who underwent ankle-magnetic resonance imaging and revealed no evidence of PBT. The T1-weighted axial ankle-magnetic resonance imaging images were evaluated at the ankle level from all participants. The PBTT was measured as the thickest point at the transverse image of the peroneus brevis tendon. The PBTCSA was measured as the cross-sectional ligament whole area of the peroneus brevis tendon that was most hypertrophied in the axial A-MR images. The average PBTT was 2.22 ± 0.29 mm in the normal group and 2.85 ± 0.36 mm in the PBT group. The average PBTCSA was 6.98 ± 1.54 mm2 in the normal group and 13.11 ± 2.45 mm2 in the PBT group. PBT patients had significantly greater PBTT (P < .001) and PBTCSA (P < .001) than the normal group did. A receiver operating characteristic curve analysis revealed that the most suitable cutoff value of the PBTT was 2.51 mm, with 81.8% sensitivity and 81.8% specificity, and an AUC for the score was 0.93. The most suitable cutoff value of the PBTCSA was 10.08 mm2, with 90.9% sensitivity and 90.9% specificity, and AUC for the score was 0.98. Even though the PBTT and PBTCSA were both significantly associated with PBT, the PBTCSA was a more sensitive diagnostic parameter.
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Affiliation(s)
- Jiyeon Park
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medicine, Graduate School, Catholic University of Korea, Seoul, Republic of Korea
| | - Yun-Hong Kim
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Jun Choi
- Department of Anesthesiology and Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Uk Jin Hong
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
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12
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Grandberg C, de Oliveira DP, Gali JC. Superior peroneal retinaculum reattachment for an atraumatic peroneus brevis tendon subluxation: a case report. J Med Case Rep 2022; 16:239. [PMID: 35705971 PMCID: PMC9202114 DOI: 10.1186/s13256-022-03455-y] [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: 05/12/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Peroneal tendon subluxation is a rare pathology, generally associated with sport-induced trauma, that occurs due to the rupture of the superior peroneal retinaculum. The diagnosis is mainly clinical, but the use of imaging techniques, such as dynamic ultrasound and magnetic resonance imaging, may contribute to its clarification. Treatment may be conservative or surgical, although there is no consensus on the most appropriate technique to be employed. We report a case of subluxation of the peroneus brevis tendon, with no apparent traumatic cause, in which there was a need for a surgical approach after the failure of conservative treatment. Case presentation A 25-year-old White woman presented pain and locking of the lateral side of the left foot 2 years earlier, with no history of trauma. The patient felt pain upon palpation and presented snapping during flexion–extension of the left ankle. On dynamic ultrasonography, an anterior subluxation of the peroneus brevis tendon occurred when the ankle was in dorsiflexion, suggesting superior peroneal retinaculum injury. Surgical correction was recommended after 2 months of conservative treatment with no improvement. The chosen surgical technique was isolated reattachment of the superior peroneal retinaculum, which proved successful. Conclusions Peroneal tendon subluxation has no established preferred surgical technique. This case demonstrates superior peroneal retinaculum repair as an efficient surgical approach for this condition. Furthermore, the atraumatic mechanism of injury in this case, along with the unknown true incidence of peroneal tendon subluxation, highlights the need to consider this pathology in cases of ankle injuries.
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Affiliation(s)
- Camila Grandberg
- Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Rua Joubert Wey, 290, Sorocaba, SP, Brazil.
| | | | - Julio Cesar Gali
- Department of Surgery, Faculty of Medical and Health Sciences, Pontifical Catholic University of São Paulo, Rua Joubert Wey, 290, Sorocaba, SP, Brazil
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13
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Smith E, Shrivastava M, Botchu R. Snapping Sartorius tendon due to a medial knee ganglion: an unusual cause of medial knee pain. J Ultrasound 2022; 25:391-394. [PMID: 33788179 PMCID: PMC9148355 DOI: 10.1007/s40477-021-00580-0] [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: 01/26/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Abstract
Snapping of knee could be due to plethora of causes. We describe a case of snapping of Sartorius over a medial knee ganglion that was treated successfully by ultrasound guided aspiration with complete resolution of symptoms.
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Affiliation(s)
- E Smith
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | | | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
- Spire Parkway Hospital, Solihull, UK.
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14
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Koutsogiannis P, Frane N, Aliyev T, Regala P, Tarazi JM, Bitterman AD. Peroneus Longus and Peroneus Brevis: A Review on Pathology and Updated Treatments. JBJS Rev 2022; 10:01874474-202205000-00003. [PMID: 35749775 DOI: 10.2106/jbjs.rvw.21.00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Peroneus longus (PL) and peroneus brevis (PB) pathologies involve a variety of etiologies and degrees of dysfunction, which complicates their diagnoses. » Patient presentation includes a spectrum of disease; however, despite advanced imaging, a misunderstanding of the pathology and diagnostic algorithms has contributed to continued misdiagnoses. » This article summarizes the anatomy and the pathophysiology of the PL and the PB; it also provides updated treatment options and their associated outcomes in order to illuminate an often-misunderstood topic.
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Affiliation(s)
- Petros Koutsogiannis
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Nicholas Frane
- The Center for Orthopedic Research and Education (CORE) Institute, Phoenix, Arizona
| | - Teymur Aliyev
- Department of Physical Medicine & Rehabilitation, SUNY Downstate Medical Center, Brooklyn, New York
| | - Peter Regala
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - John M Tarazi
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Adam D Bitterman
- Department of Orthopaedic Surgery, Northwell Health-Huntington Hospital, Huntington, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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15
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Kim YH, Chai JW, Kim DH, Kim HJ, Seo J. A problem-based approach in musculoskeletal ultrasonography: heel pain in adults. Ultrasonography 2021; 41:34-52. [PMID: 34674456 PMCID: PMC8696136 DOI: 10.14366/usg.21069] [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: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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16
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Giroux É, Lamontagne M, Boudier-Revéret M. A Triathlete with Lateral Retromalleolar Pain. J Med Ultrasound 2021; 30:310-311. [PMID: 36844782 PMCID: PMC9944812 DOI: 10.4103/jmu.jmu_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- Édouard Giroux
- Department of Family Medicine, University of Montreal, Montreal, Canada
| | - Martin Lamontagne
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Montreal, Canada
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Montreal, Canada,Address for correspondence: Dr. Mathieu Boudier-Revéret, Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada, 3840 St Urbain St, Montreal, QC, H2W 1T8, Canada. E-mail:
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17
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Bruns A, Möller I, Martinoli C. Back to the roots of rheumatology - Imaging of regional pain syndromes. Best Pract Res Clin Rheumatol 2020; 34:101630. [PMID: 33272828 DOI: 10.1016/j.berh.2020.101630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Musculoskeletal regional pain syndromes (RPS) often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can, in most cases, reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods, such as ultrasound (US) may support the clinical assessment. This paper reviews the underlying pathologies of some of the most frequently encountered RPS and the role of musculoskeletal US imaging for their diagnosis and treatment. If available, data on diagnostic accuracy and comparisons with gold standards are reported. The article stresses the importance of anatomical and sonoanatomical knowledge for the proper interpretation of the US images, points out the advantages and disadvantages of this imaging tool, and suggests the future research agenda.
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Affiliation(s)
- Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada.
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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18
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Martin K, Wake J, Van Buren JP. Ultrasound Evaluation of the Peroneal Tendons in an Asymptomatic Elite Military Population: A Prospective Cohort Study. Mil Med 2020; 185:420-422. [PMID: 32074358 DOI: 10.1093/milmed/usz258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The purpose of this study was to identify the location of the peroneal tendons in relationship to the fibular groove in an asymptomatic population of elite U.S. Military Service members. MATERIALS AND METHODS The peroneal tendons of 41 active duty U.S. Army Rangers were examined. Subjects were placed in a lateral recumbent position with the ankle in a resting neutral position to visualize the tendon in a retromalleolar short-axis view. Maximum active ankle eversion followed by gravity inversion was facilitated while the ultrasound probe was maintained in its original position. Distance from the fibrous lateral ridge of the retromalleolar groove to the anterior aspect of the peroneal brevis was measured in the short axis in neutral, eversion, and inversion. RESULTS The mean sagittal distance and standard deviation was 0.48 ± 0.9 mm. No subjects demonstrated greater than 1 mm difference between positions, and no dislocations were identified. Side-to-side difference and dominant vs nondominant differences were not statistically significant. CONCLUSION The study demonstrates that the distance between the peroneal brevis and the lateral fibular ridge is consistent throughout extremes of motion. These results further the understanding of peroneal tendon function under dynamic examination. Our findings also establish side-to-side consistency prompting a bilateral examination to help identify abnormal pathology.
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Affiliation(s)
- Kevin Martin
- Evans Army Community Hospital, 650 Cochrane Cir, Fort Carson, CO 80913
| | - Jeffrey Wake
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA 98431
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19
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Fibular Tip Periostitis: New Radiographic Sign Predictive of Chronic Peroneal Tendon Subluxation-Dislocation in Pes Planovalgus. AJR Am J Roentgenol 2020; 217:439-449. [PMID: 32936017 DOI: 10.2214/ajr.20.23964] [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: 11/18/2022]
Abstract
BACKGROUND. Tearing of the superior peroneal retinaculum is a known cause of peroneal tendon subluxation-dislocation. However, with the exception of cortical avulsions at the fibular attachment, superior peroneal retinaculum injury and subsequent peroneal tendon subluxation-dislocation are typically radiographically occult. OBJECTIVE. The purpose of this study was to evaluate the previously undescribed association between radiographic fibular tip periostitis and MRI evidence of peroneal tendon subluxation-dislocation in patients with hindfoot valgus. METHODS. Thirty-five patients with radiographic fibular tip periostitis and 35 ageand sex-matched individuals without periostitis were selected from among 220 consecutively registered patients with hindfoot valgus who had undergone both ankle radiography and MRI. Studies were retrospectively assessed by two musculoskeletal radiologists in consensus and by two additional blinded radiologists independently for the presence of peroneal tendon subluxation-dislocation, presence of subfibular impingement, and hindfoot valgus angle measurements. Interobserver agreement and accuracy, sensitivity, and specificity in the detection of fibular periostitis, peroneal tendon subluxation-dislocation, and subfibular impingement were calculated, and Fischer exact, Mann-Whitney, kappa coefficient, and intraclass correlation tests were performed. RESULTS. Both the consensus and the two independent interpretations showed that the frequency of peroneal tendon subluxation-dislocation was significantly greater in the group with periostitis (62.9%, 65.7%, and 85.7%) than in the group without periostitis (5.7%, 0%, and 14.3%) (p < .001). The finding of periostitis was specific and highly sensitive for predicting peroneal tendon subluxation-dislocation. The frequency of subfibular impingement was also statistically higher in the group with periostitis than in the group without it (p < .001). The hindfoot valgus angle was statistically larger in the group with periostitis than in the control group (p = .01-.002) and among patients with versus those without peroneal tendon subluxation-dislocation (p = .002 to p < .001). The blinded readers had substantial or almost perfect agreement on all imaging interpretations (concordance rate, 82.9-95.7%; κ = 0.66-0.91). CONCLUSION. The radiographic finding of fibular tip periostitis in patients with hindfoot valgus can be a predictor of peroneal tendon subluxation-dislocation and may also suggest advanced hindfoot valgus and subfibular impingement. These radiographic associations should be recognized by the radiologist, and MRI may be recommended as clinically indicated. CLINICAL IMPACT. Chronic undiagnosed peroneal tendon subluxation-dislocation can be a persistent cause of lateral ankle pain, leading to further degeneration and the possibility of complete peroneal tendon tears. Distal fibular periostitis in patients with hindfoot valgus can be a reliable radiographic indicator of this entity and may suggest the presence of subfibular impingement.
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20
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VIDEO: Dynamic Ultrasound Evaluation for Soft-Tissue Injuries of the Extremities: Hand, Wrist, and Ankle. AJR Am J Roentgenol 2020; 214:871. [PMID: 32045309 DOI: 10.2214/ajr.19.22040] [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: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.
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21
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Bianchi S, Becciolini M. Ultrasound Features of Ankle Retinacula: Normal Appearance and Pathologic Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3321-3334. [PMID: 31119773 DOI: 10.1002/jum.15026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023]
Abstract
Disorders of retinacula are frequent in acute and repetitive microtrauma of the ankle. Ultrasound (US), thanks to its spatial resolution and dynamic capabilities, is routinely used in the evaluation of the posttraumatic ankle for accurate delineation of ligaments and tendons. In addition, US can provide a depiction of normal retinacula and a detailed assessment of their pathologic changes. An accurate US assessment of ankle retinacula is helpful in choosing the proper treatment. In this pictorial essay, we briefly review the normal anatomy of ankle retinacula, describe their normal US appearance, and present a wide range of US pathologic abnormalities.
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22
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Draghi F, Bortolotto C, Draghi AG, Gitto S. Intrasheath Instability of the Peroneal Tendons: Dynamic Ultrasound Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2753-2758. [PMID: 29672895 DOI: 10.1002/jum.14633] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
Peroneal intrasheath instability is a painful snapping condition of the lateral ankle. It consists of a transient retromalleolar subluxation of the peroneal tendons without disruption of the superior peroneal retinaculum or evidence of a previous definite trauma. In type A intrasheath instability, the peroneus longus and brevis tendons are intact, and there is an intertendinous intrasheath switch. In type B intrasheath instability, the peroneus brevis tendon has a longitudinal split tear through which the peroneus longus subluxates. Both types can be missed on a physical examination because there is no displacement of the peroneal tendons over the lateral malleolus. Dynamic ultrasound is the imaging modality of choice for evaluating retromalleolar subluxation of the peroneal tendons. This review article aims to provide an overview of the anatomic basis for peroneal intrasheath instability and provide physicians with guidelines for its ultrasound assessment.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Anna Guja Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
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23
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Abstract
This article is a comprehensive review of the current utilizations of ultrasound in the treatment of orthopedic conditions of the foot and ankle. It reviews the diagnostic and interventional applications to commonly encountered lower-extremity ailments, including plantar fasciosis, tendinosis, and peripheral nerve disorders. It also outlines minimally invasive ultrasound-guided procedures and emerging therapies as alternatives to current treatments. These emerging therapies can be used to assist surgeons and provide options for patients needing intervention. Techniques such as hydrodissection, injection, aspiration, tenotomy, and fasciotomy are discussed, giving readers insight into different treatment modalities and options to help manage their patients.
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Affiliation(s)
- Nahum Michael Beard
- Department of Family Medicine, University of Tennessee Health Science Center, Saint Francis Family Medicine, 1301 Primacy Parkway, Memphis, TN 38119, USA; Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104.
| | - Robert Patrick Gousse
- Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue Suite 520, Memphis, TN 38104
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24
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Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles. Foot Ankle Clin 2017; 22:677-687. [PMID: 29078822 DOI: 10.1016/j.fcl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disorders of the anterior tibial tendon (ATT) are rare, and relatively few series have been described in the literature. Ruptures of the ATT are more common than tendinopathies of the ATT. For those patients with a tendinopathy, initial treatment may include activity and shoe-wear modifications.
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25
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Kumar Y, Alian A, Ahlawat S, Wukich DK, Chhabra A. Peroneal tendon pathology: Pre- and post-operative high resolution US and MR imaging. Eur J Radiol 2017. [PMID: 28624011 DOI: 10.1016/j.ejrad.2017.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Peroneal tendon pathology is an important cause of lateral ankle pain and instability. Typical peroneal tendon disorders include tendinitis, tenosynovitis, partial and full thickness tendon tears, peroneal retinacular injuries, and tendon subluxations and dislocations. Surgery is usually indicated when conservative treatment fails. Familiarity with the peroneal tendon surgeries and expected postoperative imaging findings is essential for accurate assessment and to avoid diagnostic pitfalls. Cross-sectional imaging, especially ultrasound and MRI provide accurate pre-operative and post-operative evaluation of the peroneal tendon pathology. In this review article, the normal anatomy, clinical presentation, imaging features, pitfalls and commonly performed surgical treatments for peroneal tendon abnormalities will be reviewed. The role of dynamic ultrasound and kinematic MRI for the evaluation of peroneal tendons will be discussed. Normal and abnormal postsurgical imaging appearances will be illustrated.
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Affiliation(s)
- Yogesh Kumar
- Radiology, Yale New Haven Health at Bridgeport Hospital, CT, USA.
| | - Ali Alian
- Musculoskeletal Radiology, UT Southwestern Medical Center, TX, USA
| | - Shivani Ahlawat
- Musculoskeletal Radiology, Johns Hopkins University, MD, USA
| | - Dane K Wukich
- Orthopaedic Surgery, UT Southwestern Medical Center, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology, UT Southwestern Medical Center, TX, USA; Orthopaedic Surgery, UT Southwestern Medical Center, TX, USA.
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