MRI of Superior Capsular Reconstruction.

Massive irreparable rotator cuff tears can be a challenging problem for arthroscopists in the perioperative setting because the typical treatment, reverse total shoulder arthroplasty, may not be the best option for all patients. Superior capsular reconstruction (SCR) is an advancing treatment option for patients with rotator cuff tears that are neither amenable to primary repair nor ideal for arthroplasty. Patient selection, which is strongly dependent on preoperative imaging findings, is an important step in obtaining favorable surgical outcomes. The tissue quality and tear type are particularly important when considering SCR for a patient. When unsuccessful SCR is suspected, postoperative MRI of the shoulder offers the surgeon and radiologist a means of evaluating the integrity and fixation of the graft. Fluid-sensitive MRI sequences are best for examining the final SCR construct, with high-signal-intensity fluid interruptions within the graft and the presence or worsening of shoulder arthropathy indicating graft failure. The indications for SCR are discussed, and the normal postoperative MRI findings after SCR are described in this review. In addition, the common types of SCR graft failure and associated imaging findings are described and illustrated. ©RSNA, 2020.

Achilles tendon complex: The anatomy of its insertional footprint on the calcaneus and clinical implications.

The Achilles tendon is the largest, and most commonly torn tendon in the body. The Achilles is usually torn at a region of relative hypo-vascularity proximal to its insertion. However, partial thickness tears and other pathologies often occur at its insertion on the calcaneus. Anatomically, the insertion is a confluence of the gastrocnemius and soleus muscles that fuse to form a myotendinous unit on the posterosuperior aspect of the calcaneus. This review aims to reveal the insertional footprint as individual fascicular components attaching to facets of calcaneal tuberosity. Understanding this anatomy is essential for interpreting tear patterns and surgical implications.

Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons.

BACKGROUND: Given the high prevalence of musculoskeletal conditions in the USA, it is important for orthopedic surgeons to promptly identify patients who may be at risk for opioid misuse. QUESTIONS/PURPOSES: The aim of this literature review was to elucidate various musculoskeletal pathologies and complications, as seen on imaging, that may indicate opioid misuse or opioid use disorder. METHODS: A literature search was conducted using the PubMed, Scopus, and Cochrane Library databases for articles related to imaging findings associated with chronic opioid use or misuse in orthopedic patients. Two independent reviewers conducted the search utilizing pertinent Boolean operations. RESULTS: We reviewed 36 full-text articles and categorized the radiographic evidence of opioid misuse as follows: soft-tissue radiologic findings, cellulitis, necrotizing fasciitis, abscess formation, retained needles, discitis, myopathy and rhabdomyolysis, osteomyelitis, septic arthritis, and septic thrombophlebitis. CONCLUSION: Knowledge of the radiologic findings of opioid misuse will assist orthopedic surgeons in making timely diagnoses that may alter therapeutic regimens for their patients.