Evaluating femoral graft placement using three-dimensional magnetic resonance imaging in the reconstruction of the anterior cruciate ligament via independent or transtibial drilling techniques: a retrospective cohort study.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction is a common surgical procedure, yet failure still largely occurs due to nonanatomically positioned grafts. The purpose of this study was to retrospectively evaluate patients with torn ACLs before and after reconstruction via 3D MRI and thereby assess the accuracy of graft position on the femoral condyle. METHODS: Forty-one patients with unilateral ACL tears were recruited. Each patient underwent 3D MRI of both knees before and after surgery. The location of the reconstructed femoral footprint relative to the patient's native footprint was compared. RESULTS: Native ACL anatomical location of the native ACL had a significant impact on graft position. Native ACLs that were previously more anterior yielded grafts that were more posterior (3.70 ± 1.22 mm, P = 0.00018), and native ACL that were previously more proximal yielded grafts that were more distal (3.25 ± 1.09 mm, P = 0.0042). Surgeons using an independent drilling method positioned 76.2% posteriorly relative to the native location, with a mean 0.1 ± 2.8 mm proximal (P = 0.8362) and 1.8 ± 3.0 mm posterior (P = 0.0165). Surgeons using a transtibial method positioned 75% proximal relative to the native location, with a mean 2.2 ± 3.0 mm proximal (P = 0.0042) and 0.2 ± 2.6 mm posterior (P = 0.8007). These two techniques showed a significant difference in magnitude in the distal-proximal axis (P = 0.0332). CONCLUSION: The femoral footprint position differed between the native and reconstructed ACLs, suggesting that ACL reconstructions are not accurate. Rather, they are converging to a normative reference point that is neither anatomical nor isometric.

The effect of phasic versus combined neuromuscular electrical stimulation using the StimaWELL 120MTRS system on multifidus muscle morphology and function in patients with chronic low back pain: a randomized controlled trial protocol.

BACKGROUND: Neuromuscular electrical stimulation (NMES) is used to improve muscle strength clinically when rehabilitating various musculoskeletal disorders. However, the effects of NMES on muscle morphology and function in individuals with non-specific chronic low back pain (CLBP) have scarcely been investigated. Although research links deficits in the paraspinal musculature with subjective reports of pain and disability, it is unknown if treatment with NMES can help reverse these deficits. Therefore, the primary aim of this study is to compare the effects of two muscle therapy protocols with a medium-frequency electrotherapy device (the StimaWELL 120MTRS system) on multifidus muscle morphology and function in CLBP patients. The secondary aims are to determine the effects of these protocols subjective reports of pain intensity, pain interference, disability, and catastrophizing. METHODS: A total of 30 participants with non-specific CLBP, aged 18-60, will be recruited from local orthopedic clinics and databases. Participants will be randomized (1:1) to either the phasic or combined (phasic + tonic) muscle therapy protocols on the StimaWELL 120MTRS system. Participants will undergo 20 supervised electrotherapy treatments over a 10-week period. The primary outcomes will be multifidus morphology (e.g. cross-sectional area (CSA), fat infiltration) and function (e.g., contraction measured via %thickness change from a rested to contracted state, and stiffness at rest and during contraction). Secondary outcomes will include pain intensity, interference, disability, and catastrophizing. Both primary and secondary outcomes will be obtained at baseline and at 11-weeks; secondary outcomes measured via questionnaires will also be obtained at 6-weeks, while LBP intensity will be measured before and after each treatment. Paired t-tests will be used to assess within-group changes for all primary outcome measures. A two-way repeated-measures analysis of variance will be used to assess changes in secondary outcomes over time. DISCUSSION: The results of this trial will help clarify the role of medium-frequency NMES on lumbar multifidus morphology and function. TRIAL REGISTRATION: NCT04891692, registered retrospectively on May 18, 2021.

The effect of low back pain and lower limb injury on lumbar multifidus muscle morphology and function in university soccer players.

BACKGROUND: The lumbar multifidus muscle (LMM) plays a critical role to stabilize the spine. While low back pain (LBP) is a common complaint in soccer players, few studies have examined LMM characteristics in this athletic population and their possible associations with LBP and lower limb injury. Therefore, the purpose of this study was to 1) investigate LMM characteristics in university soccer players and their potential association with LBP and lower limb injury; 2) examine the relationship between LMM characteristics and body composition measurements; and 3) examine seasonal changes in LMM characteristics. METHODS: LMM ultrasound assessments were acquired in 27 soccer players (12 females, 15 males) from Concordia University during the preseason and assessments were repeated in 18 players at the end of the season. LMM cross-sectional area (CSA), echo-intensity and thickness at rest and during contraction (e.g. function) were assessed bilaterally in prone and standing positions, at the L5-S1 spinal level. A self-reported questionnaire was used to assess the history of LBP and lower limb injury. Dual-energy x-ray absorptiometry (DEXA) was used to acquire body composition measurements. RESULTS: Side-to-side asymmetry of the LMM was significantly greater in males (p = 0.02). LMM thickness when contracted in the prone position (p = 0.04) and LMM CSA in standing (p = 0.02) were also significantly greater on the left side in male players. The LMM % thickness change during contraction in the prone position was significantly greater in players who reported having LBP in the previous 3-months (p < 0.001). LMM CSA (r = - 0.41, p = 0.01) and echo-intensity (r = 0.69, p < 0.001) were positively correlated to total % body fat. There was a small decrease in LMM thickness at rest in the prone position over the course of the season (p = 0.03). CONCLUSIONS: The greater LMM contraction in players with LBP may be a maladaptive strategy to splint and project the spine. LMM morphology measurements were correlated to body composition. The results provide new insights with regards to LMM morphology and activation in soccer players and their associations with injury and body composition measurements.

LUMINOUS database: lumbar multifidus muscle segmentation from ultrasound images.

BACKGROUND: Among the paraspinal muscles, the structure and function of the lumbar multifidus (LM) has become of great interest to researchers and clinicians involved in lower back pain and muscle rehabilitation. Ultrasound (US) imaging of the LM muscle is a useful clinical tool which can be used in the assessment of muscle morphology and function. US is widely used due to its portability, cost-effectiveness, and ease-of-use. In order to assess muscle function, quantitative information of the LM must be extracted from the US image by means of manual segmentation. However, manual segmentation requires a higher level of training and experience and is characterized by a level of difficulty and subjectivity associated with image interpretation. Thus, the development of automated segmentation methods is warranted and would strongly benefit clinicians and researchers. The aim of this study is to provide a database which will contribute to the development of automated segmentation algorithms of the LM. CONSTRUCTION AND CONTENT: This database provides the US ground truth of the left and right LM muscles at the L5 level (in prone and standing positions) of 109 young athletic adults involved in Concordia University's varsity teams. The LUMINOUS database contains the US images with their corresponding manually segmented binary masks, serving as the ground truth. The purpose of the database is to enable development and validation of deep learning algorithms used for automatic segmentation tasks related to the assessment of the LM cross-sectional area (CSA) and echo intensity (EI). The LUMINOUS database is publicly available at http://data.sonography.ai . CONCLUSION: The development of automated segmentation algorithms based on this database will promote the standardization of LM measurements and facilitate comparison among studies. Moreover, it can accelerate the clinical implementation of quantitative muscle assessment in clinical and research settings.

Anterolateral Ligament Injury in Knee Dislocations.

PURPOSE: The purpose of this study is to describe the prevalence and associated factors of anterolateral ligament (ALL) injury in knee dislocation (KD). METHODS: A retrospective review of charts and radiological images was done for patients who underwent multiligamentous knee reconstruction surgery for KD in the authors' institution from May 2008 to December 2016. The inclusion criteria were both genders, skeletally mature, and first dislocation. Previous anterior cruciate ligament injury or surgery were the exclusion criteria. Magnetic resonance imaging was used to describe the ALL injury. The association of ALL injury with other variables related to the injury and the patient's background features was examined. RESULTS: Forty-eight patients (49 knees) were included. The mean age of the patients was 32.3 ± 10.6 years. High-energy trauma was the mechanism of dislocation in 28 (57.1%) knees. Thirty-one knees (63.3%) were classified as KD type IV. Forty-five (91.8%) knees had a complete ALL injury, and 3 (6.1%) knees had incomplete ALL injury. Forty (81.6%) knees had a complete ALL injury at the proximal fibers of the ALL, while 23 (46.9%) knees had complete distal ALL injury. None of the 46 (93.9%) knees with lateral collateral ligament injury had normal proximal ALL fibers (P = .012). Injury to the distal fibers of the ALL, as well as overall ALL injury, was not associated with any other variables (P > .05). Moreover, all patients with associated tibial plateau fractures (9; 18.4%) had abnormality of the proximal fibers of the ALL (P = .033). CONCLUSIONS: ALL injury is highly prevalent among dislocated knees. Most of the injuries are of high grade and involve the proximal, suprameniscal, fibers of the ligament. LEVEL OF EVIDENCE: Level IV, retrospective case series with no comparison group.

"Hockey wrist:" dorsal ulnotriquetral ligament injury.

BACKGROUND: Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum. METHODS: We performed a biomechanical study on 7 fresh frozen cadaveric upper extremities, with testing done on a wrist-movement stimulator to identify the position (45° of wrist flexion, 45° of wrist extension or neutral) that generated the highest and earliest strain increases in the DUTL. We performed load-to-failure testing, characterized the ligament's pattern of failure, and repaired and retested the DUTL using the same load-to-failure protocol. RESULTS: The DUTL reached 3 N∙m the earliest in 45° of wrist flexion (p = 0.02). The native DUTL failed at 0.35 N∙m (standard deviation [SD] 0.13 N∙m) per degree of angular stiffness, 12.93 N∙m of yield strength and with angular deformation of 57.73° (SD 20.62°). There was no significant difference in these variables between the native and repaired DUTL. Tearing occurred at a mean of 10 mm (SD 2 mm) proximal from the triquetrum's insertion in a transverse midsubstance pattern. CONCLUSION: This study showed a reproducible pattern of injury to the DUTL in a cadaveric model. Additional work is needed to further characterize the pathoanatomy of "hockey wrist."

CONTEXTE: La douleur cubitale au poignet, au niveau du triquetrum proximal dorsal, surtout à la pronation, à la flexion et à la déviation radiale du poignet, est fréquente chez les athlètes, particulièrement chez les joueurs de hockey. Le but de cette étude était d'évaluer la position dans laquelle le ligament ulnotriquétral dorsal (LUTD) est soumis à la pression la plus grande, le couple de torsion menant à la défaillance et le mode de blessure. Selon notre hypothèse, le LUTD est soumis au maximum de pression lorsque le poignet est en flexion, pronation et déviation radiale, et au moment de la défaillance, le ligament ulnotriquétral se déchire. MÉTHODES: Nous avons procédé à une étude biomécanique sur 7 membres supérieurs de cadavres frais congelés, et effectué des tests sur un stimulateur de mouvements du poignet pour établir la position (flexion du poignet à 45°, extension du poignet de 45° ou position neutre) générant les augmentations de pression les plus fortes et les plus rapides sur le LUTD. Nous avons procédé à des tests de mise en charge jusqu'à défaillance, caractérisé le mode de défaillance du ligament et réparé et retesté le LUTD à l'aide du même protocole de mise en charge jusqu'à défaillance. RÉSULTATS: Le LUTD a atteint 3 N∙m le plus rapidement avec une flexion du poignet à 45° (p = 0,02). Le LUTD natif a connu une défaillance à 0,35 N∙m (écart-type [É.-T.] 0,13 N∙m) par degré de raideur angulaire, 12,93 N∙m d'élasticité et avec une déformation angulaire de 57,73° (É.-T. 20,62°). On n'a noté aucune différence significative de ces variables entre les LUTD natifs et réparés. La déchirure s'est produite en moyenne à 10 mm (É.-T. 2 mm) en proximal par rapport à l'insertion du triquetrum selon un trajet transverse affectant la moitié de la substance ligamentaire. CONCLUSION: L'étude a démontré un mode reproductible de lésion du LUTD à l'aide d'un modèle cadavérique. Il faudra approfondir la recherche pour caractériser avec plus de précision l'anatomopathologie de la lésion au poignet typiquement causée par la pratique du hockey.

Acute calcific tendinopathy of the popliteus tendon: a rare case diagnosed using a multimodality imaging approach and treated conservatively.

Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues. Subsequently performed MRI revealed a thickened and heterogeneous popliteus tendon near its femoral attachment with marked edematous changes surrounding the tendon. Local ultrasound-guided glucocorticoid injection had successful clinical results with no recurrence at 8-month follow-up. In this case report we review the literature for similar previously reported cases. This case report of popliteus tendon calcific tendinopathy provides comprehensive multimodality imaging findings and a description of its non-surgical management.

A Case Report of Traumatic Partial Extensor Carpi Ulnaris Subluxation in an Elite Hockey Player With Review of the Literature.

In this article, we present a unique case of traumatic partial recurrent extensor carpi ulnaris (ECU) subluxation in an elite hockey player. To the best of our knowledge, this is the only report of partial ECU subluxation due to a split in the ECU tendon presented in the literature. This case illustrates the importance of proper diagnosis and treatment of such a lesion. We also emphasize that dynamic ultrasound is an excellent and cost-effective imaging modality that can help with the diagnosis of partial ECU subluxation. Finally, surgical treatment for failed conservative management showed excellent results in an elite athlete.

Complete tear of the distal hamstring tendons in a professional football player: a case report and review of the literature.

Semimembranosus tendon ruptures are rare and are often associated with involvement of the cruciate ligaments. We present a 24-year-old American football player who sustained a complete rupture of the semimembranosus tendon near its insertion associated with an avulsion fracture of the conjoint attachment of the lateral collateral ligament (LCL) and biceps femoris with intact cruciate ligaments and menisci during practice. At the scene he was immobilized and was taken to the hospital immediately. The diagnosis was reached after radiographs and an MRI of the affected knee were obtained. The semimembranosus tendon and the avulsion of the biceps femoris insertion were repaired surgically. We also review the literature for previously reported cases of distal hamstring injuries.

Reporting of Participant Demographics in Clinical Trials Published in General Radiology Journals.

OBJECTIVES: The reporting of research participant demographics provides insights into study generalizability. Our study aimed to determine the frequency at which participant age, sex/gender, race/ethnicity, and socioeconomic status (SES) are reported and used for subgroup analyses in radiology randomized controlled trials (RCTs) and their secondary analyses; as well as the study characteristics associated with, and the classification systems used for demographics reporting. METHODS: RCTs and their secondary analyses published in 8 leading radiology journals between 2013 and 2021 were included. Associations between study characteristics and demographic reporting were tested with the chi-square goodness of fit test for categorical variables, Wilcoxon-Mann-Whitney test for impact factor, and logistic regression for publication year. RESULTS: Among 432 included articles, 89.4% (386) reported age, 90.3% (390) sex/gender, 5.6% (24) race/ethnicity, and 3.0% (13) SES. Among articles that reported these demographics and were not specific to a subgroup, results were analyzed by age in 14.2% (55/386), sex/gender in 19.4% (66/340), race/ethnicity in 13.6% (3/22), and SES in 46.2% (6/13). Journal, impact factor, and last author continent were predictors of race/ethnicity and SES reporting. Funding was associated with race/ethnicity reporting. No study reported sex and gender separately, or documented transgender, nonbinary gender spectrum or intersex participants. A single category for race/ethnicity was used in 37.5% (9/24) of studies, consisting of either "White" or "Caucasian." CONCLUSION: The reporting of participant demographics in radiology trials is variable and not always representative of the population diversity. Editorial guidelines on the reporting and analysis of participant demographics could help standardize practices.

Segmentation of Arm Ultrasound Images in Breast Cancer-Related Lymphedema: A Database and Deep Learning Algorithm.

OBJECTIVE: Breast cancer treatment often causes the removal of or damage to lymph nodes of the patient's lymphatic drainage system. This side effect is the origin of Breast Cancer-Related Lymphedema (BCRL), referring to a noticeable increase in excess arm volume. Ultrasound imaging is a preferred modality for the diagnosis and progression monitoring of BCRL because of its low cost, safety, and portability. As the affected and unaffected arms look similar in B-mode ultrasound images, the thickness of the skin, subcutaneous fat, and muscle have been shown to be important biomarkers for this task. The segmentation masks are also helpful in monitoring the longitudinal changes in morphology and mechanical properties of tissue layers. METHODS: For the first time, a publicly available ultrasound dataset containing the Radio-Frequency (RF) data of 39 subjects and manual segmentation masks by two experts, are provided. Inter- and intra-observer reproducibility studies performed on the segmentation maps show a high Dice Score Coefficient (DSC) of 0.94±0.08 and 0.92±0.06, respectively. Gated Shape Convolutional Neural Network (GSCNN) is modified for precise automatic segmentation of tissue layers, and its generalization performance is improved by the CutMix augmentation strategy. RESULTS: We got an average DSC of 0.87±0.11 on the test set, which confirms the high performance of the method. CONCLUSION: Automatic segmentation can pave the way for convenient and accessible staging of BCRL, and our dataset can facilitate development and validation of those methods. SIGNIFICANCE: Timely diagnosis and treatment of BCRL have crucial importance in preventing irreversible damage.

Contribution of the Bony Bankart in Calculating Glenoid Bone Loss.

Background: Determining the magnitude of glenoid bone loss in patients with anterior shoulder instability is an important step in guiding management. Most calculations to estimate the bone loss do not include the bony Bankart fragment. However, if it can be reduced and adequately fixed, the estimation of bone loss may be decreased. Purpose: To derive a simple equation to calculate the surface area of the bony fragment in Bankart fractures. Study Design: Case series; Level of evidence, 4. Methods: A total of 26 patients suspected of having clinically significant bone loss underwent computed tomography imaging preoperatively, and the percentage of glenoid bone loss (%BL) was approximated with imaging software using a freehand region of interest area measurement with and without the inclusion of the bony Bankart fragment. By assuming this bony fragment as a hemi-ellipse with height, H, and thickness, d, we represented the surface are of the bony piece (Abonefragment=πHd4), and subtracted it from the overall %BL. They compared this value with the one found using imaging software. Results: Without the inclusion of the bony Bankart, the overall %BL by the standard true-fit circle measured using imaging software was 23.8% ± 9.7%. When including the bony Bankart, the glenoid %BL measured using imaging software was found to be 12.1% ± 8.5%. The %BL calculated by our equation with the bony Bankart included was 10% ± 11.1%. There was no statistically significant difference between the %BL values measured using the equation and the imaging software (P = .46). Conclusion: Using a simple equation that approximates the bony Bankart fragment as a hemiellipse allowed for estimation of the glenoid bone loss, assuming that the fragment can be reduced and adequately fixed. This method may serve as a helpful tool in preoperative planning when there are considerations for incorporating the bony fragment in the repair.

Comparison of multifidus muscle intramuscular fat by ultrasound echo intensity and fat-water based MR images in individuals with chronic low back pain.

PURPOSE: The aim of this observational cross-sectional study was to examine correlations of intramuscular fat content in lumbar multifidus (LM) by comparing muscle echo intensity (EI) and percent fat signal fraction (%FSF) generated from ultrasound (US) and magnetic resonance (MR) images, respectively. METHODS: MRI and US images from 25 participants (16 females, 9 males) selected from a cohort of patients with chronic low back pain (CLBP) were used. Images were acquired bilaterally, at the L4 and L5 levels (e.g., 4 sites). EI measurements were acquired by manually tracing the cross-sectional border of LM. Mean EI of three US images per site were analyzed (e.g., raw EI). A correction factor for subcutaneous fat thickness (SFT) was also calculated and applied (e.g., corrected EI). Corresponding fat and water MR images were used to acquire %FSF measurements. Intra-rater reliability was assessed by intraclass coefficients (ICC). Pearson correlations and simple linear regression were used to assess the relationship between %FSF, raw EI and corrected EI measurements. RESULTS: The intra-rater ICCs for all measurements were moderate to excellent. Correlations between %FSF vs. raw EI and corrected EI were moderate to strong (0.40 < r < 0.52) and (0.40 < r < 0.51), respectively. Moderate correlations between SFT and EI were also identified. CONCLUSION: US is a low-cost, non-invasive, accessible, and reliable method to examine muscle composition, and presents a promising solution for assessing and monitoring the effect of different treatment options for CLBP in clinical settings.

Intra-osseous migration in calcific rotator cuff tendinopathy- a novel depiction of temporal evolution on multimodality imaging.

We present a case of calcific tendinopathy of the rotator cuff with intraosseous migration of the calcification, treated with ultrasound-guided bursal steroid injection and followed up with multiple imaging modalities for a year following the initial presentation. The radiographs, ultrasound, CT, nuclear scintigraphy, and MRI images demonstrate the temporal evolution of the intraosseous migrated calcium and show how this pathology, in its acute phase, can mimic other pathologies like osteoid osteoma. The follow-up imaging also illustrates how the migrated intraosseous focus of calcification took a much longer time to heal compared to its intratendinous counterpart, possibly leading to the protracted course of recovery. This report also highlights a previously undescribed pattern of healing of the intraosseous migrated calcium on multiple imaging modalities.

Utility of Ultrasonography and Significance of Surgical Anatomy in the Management of de Quervain Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: The role of ultrasound in plastic surgery practice has grown significantly over the past decade, with notable applications for conditions of the upper extremity. Its utility for the management of de Quervain disease, however, remains to be established, and the prevalence of first dorsal compartment anatomical variations needs to be adequately assessed. METHODS: A systematic review was performed to evaluate the role of ultrasound in the diagnosis, anatomical characterization, and clinical management of de Quervain disease. A meta-analysis was conducted to establish the prevalence of first dorsal compartment anatomical variations in the de Quervain disease and general population, along with the diagnostic accuracy of ultrasound for their detection. Outcomes were documented and compared to alternative treatment options. RESULTS: Extensor retinaculum thickening, tendon sheath swelling, peritendinous edema, and tendon enlargement were the most common sonographic features of de Quervain disease. The prevalence of an intercompartmental septum in the de Quervain disease surgical population was shown to be significantly greater than in the general cadaveric population (67 percent versus 35 percent, respectively). Although the efficacy of energy-based therapeutic ultrasound remains elusive, ultrasound-guided corticosteroid injections were shown to be more accurate than manual injections (90 to 100 percent versus 40 to 100 percent), and to confer significantly better treatment outcomes (73 to 100 percent versus 59 to 83 percent success rates, respectively). CONCLUSIONS: Ultrasound use is essential to achieve the best evidence-based outcomes in the management of de Quervain disease. The varied prevalence of first dorsal compartment anatomical variations and high accuracy of ultrasound for their detection carry significant prognostic implications.

Seasonal Changes in Lumbar Multifidus Muscle in University Rugby Players.

PURPOSE: Although smaller lumbar multifidus muscle (LMM) was reported to be a strong predictor of lower limb injury (LLI) in Australian Football League players, LMM morphology has not been investigated in rugby athletes. This study examined seasonal changes in LMM in rugby players and whether LMM characteristics were associated with low back pain (LBP) and LLI. METHODS: Ultrasound examinations of the LMM were acquired in 21 university-level rugby players (12 women, 9 men) at preseason and end-season. LMM cross-sectional area (CSA), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing were obtained bilaterally at the L5-S1 level. The percent change in LMM thickness during contraction was calculated as follows: [(thicknesscontracted - thicknessrest)/thicknessrest × 100]. Self-reported questionnaires were used to acquire data on LBP and LLI. RESULTS: There was no significant difference in LMM characteristics between preseason and end-season measurements (P > 0.05). Preseason LMM CSA, side-to-side CSA asymmetry, and thickness at rest or during contraction were not associated with LBP or LLI. However, a lower percent thickness change in the standing position was significantly associated with having LBP during the preseason (P = 0.01) and playing season (P = 0.001), as well as LLI during the preseason (P = 0.03). CONCLUSIONS: This study provides preliminary evidence that LMM contractile ability and behavior during functional movement, such as standing, may have important implications for the susceptibility to injury among rugby athletes.

Trapezoidal fractures: Overview and introduction of a novel diagnostic classification system.

INTRODUCTION: Trapezoidal fractures account for only 0.4% of all carpal bone fractures. Owing to their rarity, there is paucity in the literature regarding the clinical findings and treatment. This paper aims to summarize the current understanding of trapezoidal fractures and present a novel classification algorithm. METHODS: A diagnostic classification algorithm was created based on the known blood supply and ligamentous attachment of the trapezoid. The proposed treatment algorithm was then applied to trapezoidal fractures in the literature to validate the algorithm and determine whether patients received treatment that was in accordance. RESULTS: A total of 19 articles, representing 22 trapezoidal fractures were included, with two additional cases presented by the authors. Presenting symptoms were pain (n = 21) and swelling (n = 12). Diagnosis was made on CT in a majority of the time, 79.2% (n = 18). All outcomes were favorable with symptomatic resolution and full range of motion after treatment, except in four patients that had co-existing wrist injuries. When the algorithm was applied, 89.5% (n = 17) of the patients received treatment in accordance with the proposed algorithm and demonstrated good outcomes. In the remaining patients (n = 2) whose treatment differed, one had diminished grip strength and the other was lost to follow-up. CONCLUSIONS: Given a degree of clinical suspicion including a history of blunt trauma to the hand and persisting pain, trapezoidal fractures should remain on the differential when plain radiographs fail to identify any fracture. Operative treatment is suggested if there is any significant displacement, compromise of the dorsal surface, or breech of the trapezoidal ligaments causing possible dislocation. LEVEL OF EVIDENCE: IV - Diagnostic.

Lumbar Multifidus Muscle Characteristics, Body Composition, and Injury in University Rugby Players.

CONTEXT: A smaller lumbar multifidus (LM) muscle was reported to be a strong predictor of lower limb injury in professional Australian Football League players. However, despite the high prevalence of low back pain (LBP) and lower limb injury in rugby players, their LM characteristics have yet to be explored. OBJECTIVE: To (1) examine LM characteristics in male and female university rugby players and their possible associations with LBP and lower limb injury and (2) investigate the relationship between LM characteristics and body composition in this group of athletes. DESIGN: Cross-sectional study. SETTING: University research center. PATIENTS OR OTHER PARTICIPANTS: Thirty-four university rugby players (20 women, 14 men). MAIN OUTCOME MEASURE(S): Ultrasound measurements of LM cross-sectional area (CSA), thickness, and percentage change in thickness during contraction were obtained bilaterally, at the L5-S1 level, in prone and standing positions. Body composition measures were obtained using dual-energy x-ray absorptiometry. Self-reported questionnaires were used to obtain LBP and lower limb injury history. RESULTS: Players who reported LBP in the previous 3 months showed a smaller percentage change in thickness during contraction in the standing position (F = 5.21, P = .03). The LM CSA side-to-side asymmetry (right versus left) was greater in players who reported having a lower limb injury in the previous 12 months (F = 4.98, P = .03). The LM CSA was significantly associated with body composition measurements. A greater percentage change in thickness during contraction was significantly associated with a lower percentage of body fat. The LM echo intensity was strongly associated with the total percentage of body fat and was significantly greater in women. CONCLUSIONS: The influence of body composition on LM morphology in athletes cannot be ignored and warrants further investigation. Our findings also provide preliminary evidence of an association among LM morphology, LBP, and lower limb injury in university rugby players.

Aneurysmal bone cyst in thoracolumbar spine.

Aneurysmal bone cysts (ABC) are rare, benign primary bone tumors. Although benign, they can be locally aggressive resulting in erosion of bone and surrounding tissues over time. In later stages, depending on the clinical urgency, immunotherapy or surgical resection remain treatment options. This report illustrates a case of a 32-year-old female who presented with chronic worsening low back pain without neurological deficits. Radiological imaging revealed a large destructive mass arising from the thoracic spine invading into the central canal, causing critical central stenosis and cord compression. Histopathology revealed ABC. This case highlights the importance of including ABCs and other 'benign'/locally aggressive lesions in the differential of patients with insidious musculoskeletal complaints. This case also demonstrates that one can be neurologically asymptomatic despite having critical central canal stenosis and cord compression if the causative lesion is slow growing. Understanding this allows us to arrange for most appropriate management.

Effect of Teaching Session on Resident Ability to Identify Anatomic Landmarks and Anterior Cruciate Ligament Footprint: A Study Using 3-Dimensional Modeling.

BACKGROUND: Femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) is an intricate procedure that requires highly specific surgical skills. PURPOSE: To report the ability of residents to identify femoral landmarks and the native ACL footprint before and after a structured formal teaching session as a reflection of overall surgical skill training for orthopaedic surgery residents in Canada. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 13 senior orthopaedic residents were asked to identify a femoral landmark and an ACL footprint on ten 3-dimensional (3D)-printed knee models before and after a teaching session during the fall of 2018. The 3D models were made based on actual patients with different anatomic morphologic features. ImageJ software was used to quantify the measurements, which were then analyzed through use of descriptive statistics. RESULTS: Before and after the teaching session, residents attempted to identify a specific anatomic location (bifurcate and intercondylar ridge intersection) with a mean error per participant ranging from 5.00 to 10.95 mm and 4.79 to 12.13 mm in magnitude, respectively. Furthermore, before and after the teaching session, residents identified the specific position to perform the surgical procedure (ACL femoral footprint), with a mean error per participant ranging from 4.58 to 8.80 mm and 3.87 to 11.07 mm in magnitude, respectively. The teaching session resulted in no significant improvement in identification of either the intersection of the bifurcate and intercondylar ridges (P = .9343 in the proximal-distal axis and P = .8133 in the anteroposterior axis) or the center of the femoral footprint (P = .7761 in the proximal-distal axis and P = .9742 in the anteroposterior axis). CONCLUSION: Although a formal teaching session was combined with a hands-on session that entailed real surgical instrumentation and fresh cadaveric specimens, the intervention seemed to have no direct impact on senior residents' performance or their ability to demonstrate the material taught. This puts into question the format and efficacy of present teaching methods. Also, it is possible that the 3D spatial perception required to perform these skills is not something that can be taught effectively through a teaching session or at all. Further investigation is required regarding the effectiveness and application of surgical skill laboratories and simulations on the competencies of orthopaedic residents.