Meniscal extrusion, cartilage, bone, and ligament lesions associated with medial meniscus posterior root tear gap.

OBJECTIVES: To determine the relationship between the severity of the tear gap resulting from medial meniscus posterior root (MMPR) tear and medial meniscal extrusion, cartilage, bone, and ligament lesions on MRI. METHODS: A total of 133 patients with MMPR tear were retrospectively evaluated. The patients were divided into two groups according to the tear gap width as minor (≤ 4 mm) and widely (4 mm<) displaced. Medial meniscal extrusion and medial compartmental chondromalacia, bone and ligament lesions were analyzed. RESULTS: There were 61 patients (56 women and 5 men) in the minor displaced group (mean age: 56.3 years, range: 29-82 years) and 72 patients (59 women, 13 men) in the widely displaced group (mean age: 53.2 years, range: 20-86 years). There was no significant difference in terms of age and sex (p = 0.31 and p = 0.09, respectively). The mean absolute extrusion was 3.51 mm (range: 1.5-5 mm) in the minor displaced group and 4.52 mm (range: 2.4-7.2 mm) in the widely displaced group (p < 0.001). High-grade medial femoral condylar chondromalacia was more common in the widely displaced group (p = 0.002). Osteophyte, bone marrow edema, and subchondral cyst in the medial compartment, and ligament injury were higher in the widely displaced group, but were not statistically significant (p > 0.05). CONCLUSION: The amount of medial meniscal extrusion and the prevalence of high-grade medial femoral condylar chondromalacia were found to be significantly more in patients with wider tear gap. Determining the amount of tear gap in the evaluation of root ligament tears on MRI is important to predict knee joint internal derangement.

Variations ignored in routine wrist MRI reports: prevalence of the median nerve anatomical variations and persistent median artery.

BACKGROUND: It is vital to know the anatomical variations of the wrist to avoid iatrogenic injuries during carpal tunnel (CT) surgery. PURPOSE: To determine the anatomical variations of the median nerve (MN) and the prevalence of persistent median artery (PMA) on wrist magnetic resonance imaging (MRI). MATERIAL AND METHODS: A total of 300 wrists evaluated by MRI during 2013-2015 were retrospectively identified. While branching of the MN distal to the CT is accepted as the normal anatomy, proximal to the tunnel and within the tunnel were considered as variations. The prevalence of PMA was also evaluated. The patients were assigned to groups according to age, gender, and wrist side and compared to determine whether there was any significant difference in terms of these variations. All evaluations were assessed with the shared decision of a musculoskeletal radiologist and a radiology resident. RESULTS: Of the 300 wrists, 38 (12.7%) and 34 (11.3%) had a bifid MN proximal to the CT and within the CT, respectively. Only one nerve trifurcation was seen within the CT. The MN exhibited branching distal to the CT in 227 (76%) patients. PMA was observed in 44 (14.7%) patients. Of the 44 PMA cases, 28 (63.6%) also had a coexisting MN variation. There was no significant difference in the prevalence of MN variations and PMA in the subgroups (P > 0.05). CONCLUSION: Nearly one in four patients (24.4%) have MN variations and 14.8% had PMA. Preoperative evaluation of these common anatomical variations with MRI will be protective against postoperative complications of CT surgery.

[Giant osteoma with intracranial extension filling sinonasal cavity: a rare case]. / Sinonazal boslugu dolduran intrakraniyal uzanimli dev osteom: Nadir bir olgu.

Osteomas are the most frequently observed benign bone tumors of paranasal sinuses. Although they are generally detected by chance during radiological analyses, they may create severe complications after intracranial extension. While computed tomography findings play a key role to differentiate osteoma from other osseous lesions of paranasal sinus, magnetic resonance imaging identifies extension to surrounding structures and possible complications. Osteoma was detected in a 28-year-old female patient who admitted with complaints of headache and difficulty in breathing. Patient was operated after diagnosis; however, we were unable to remove the mass totally due to its location and size. In this article, we report, to our knowledge, the largest defined osteoma case in the literature to date, with ethmoid sinus origin, orbital, nasal cavity and intracranial extension, accompanied with distinctive computed tomography and magnetic resonance imaging findings.

The anatomic variations of the posterior talofibular ligament associated with os trigonum and pathologies of related structures.

PURPOSE: The aim of this study is to investigate the detailed anatomy of the posterior talofibular ligament (PTFL) on MR images in patients with os trigonum. We also evaluated the pathological conditions of the PTFL, anterior talofibular ligament (ATFL), flexor hallucis longus (FHL) tendon, talus and os trigonum. METHODS: Ankle MRIs of 70 patients with os trigonum (study group) and 70 patients without it (control group) were reviewed for the anatomy of the anterior and posterior fibers of PTFL. The prevalence of PTFL and ATFL pathologies was also compared between two groups. Additionally FHL tenosynovitis and osseous pathologies were evaluated. RESULTS: The posterior fibers inserted into the lateral tubercule of the posterior process of the talus in the control group whereas if an os trigonum was present, the posterior fibers of PTFL were inserted only into the os trigonum. The origins of anterior and posterior fibers were the medial surface of the lateral malleolus and the insertion of the anterior fibers was lateral surface of the talus posterior to the lateral malleolar facet in both groups. There was a significant association between an abnormal PTFL, ATFL and the presence of os trigonum. FHL tenosynovitis was higher in the study group but it did not meet the statistical significance. The most common pathology of the talus and os trigonum was subchondral edema along the synchondrosis. CONCLUSIONS: In patients with os trigonum, the posterior fibers of the PTFL were inserted herein. In the case of an os trigonum signal alterations of ligaments were more common, which may reflect chronic instability.