Volumetric Classification: Unveiling the True Extent of Rotator Cuff Tears.

INTRODUCTION: Rotator cuff injury diagnosis involves comprehensive clinical, physical, and imaging assessments, with MRI being pivotal for detecting and classifying these injuries. However, the absence of a universally accepted classification system necessitates a more precise approach, advocating for the use of three-dimensional (3D) modeling to better understand and categorize rotator cuff tears. METHODOLOGY: This research was conducted as a prospective, single-institution study on 62 patients exhibiting full-thickness rotator cuff tears. Utilizing preoperative 1.5T MRI, the study aimed to create a more detailed classification system based on volumetric and surface area measurements. Advanced 3D modeling software was employed to transform MRI data into precise 3D representations, facilitating a more accurate analysis of the lesions. RESULTS: The study unveiled a novel classification system rooted in volumetric and surface area assessments, revealing significant discrepancies in the existing two-dimensional classifications. Approximately 45% of the cases demonstrated inconsistencies between traditional classifications and 3D measurements. Notably, medium-sized lesions were often overestimated, while small and large lesions were consistently underestimated in their severity. The volumetric and surface area-based classifications provided a more accurate depiction, highlighting the limitations of relying solely on coronal plane assessments in MRI. Comparative analysis confirmed the improved accuracy of the 3D method. CONCLUSION: The integration of 3D imaging and volumetric analysis offers novel advancement in diagnosing and classifying rotator cuff injuries. This study's findings challenge the conventional reliance on 2D MRI, proposing a more detailed and accurate classification system that enhances the precision of surgical planning and potentially improves patient outcomes. The incorporation of comprehensive 3D assessments into the diagnostic process represents a significant step forward in the orthopedic imaging field.

Can three-dimensional models enhance understanding and knowledge of rotator cuff tears?

OBJECTIVES: Magnetic resonance imaging (MRI) is currently the standard diagnostic tool for rotator cuff tears. However, its two-dimensional (2D) output, displayed on a monitor, can complicate the interpretation of anatomy. Three-dimensional (3D) imaging may offer a solution to this issue. This study aimed to demonstrate the diagnostic and interpretive value of a 3D model in assessing lesion anatomy. The hypothesis was that 3D models, compared to 2D MRI, can enhance the comprehension and knowledge of rotator cuff injuries, improve the application of classifications for total tears, and provide a more precise definition of the size and type of tear. METHODS: A prospective single-centre study was conducted. 3D models for rotator cuff tears were created and analysed in conjunction with preoperative MRI for each patient up to 2 months before surgery. The 3D models were based on the preoperative MRI. Collected data included 2D plane measurements by MRI in coronal and sagittal planes, descriptions of 3D lesion geometry (new shapes), 3D measurements in coronal and sagittal planes, arthroscopic classifications of rotator cuff injuries, and arthroscopic measurements in coronal and sagittal planes. RESULTS: After examining 25 cases, 3D imaging demonstrated similar arthroscopic values post-bursectomy in the sagittal plane (16.70 â€‹mm for 3D and 18.28 â€‹mm for post-bursectomy, p-value â€‹= â€‹0.189), although these measurements did not align with those of MRI (which underestimated measurements, p-value â€‹= â€‹0.010). Both MRI measurement and 3D imaging showed similar measurement accuracy in the coronal plane when compared to arthroscopic measurements taken before and after bursectomy. The creation of 3D objects enabled the analysis of new geometries, including the length, width, and depth of each lesion. These geometries included the rectangle, rectangular trapezoid, scalene trapezoid, irregular pentagon, and irregular hexagon. CONCLUSIONS: 3D models can enhance the understanding and knowledge of rotator cuff injuries. They can be a promising tool for diagnosing and interpreting the anatomy of the injury, particularly in the sagittal plane. The new 3D understanding of the pathological process has led to the description of new geometric features not visible in conventional 2D MRI. LEVEL OF EVIDENCE: II - Development of diagnostic criteria on consecutive patients (all compared to "gold" standard).

Ultrasound imaging of onychopapilloma: Evaluation of 43 cases.

INTRODUCTION: Onychopapilloma is a benign tumor presenting as an isolated benign warty distal matrix and bed lesion in association with longitudinal erythronychia for which no underlying cause can be identified. Diagnosis might be challenging due to other, more severe, causes of erythronychia. OBJECTIVES: This study aimed to investigate the clinical and sonographic features of onychopapilloma using high-frequency ultrasound. METHODS: Between February 2022 and May 2023, a cross-sectional study was conducted, involving 39 patients displaying clinical features suggestive of onychopapilloma. These patients were selected at random and underwent examination using high-frequency ultrasound. High-frequency ultrasound assessments of the nail unit were carried out using 33 MHz and 24 MHz high-frequency linear transducers. An experienced radiologist performed the ultrasound scans while participants assumed an orthostatic seated position. Subsequently, the collected ultrasound images were independently evaluated by two radiologists specializing in nail injuries, ensuring a blinded assessment. This evaluation aimed to provide comprehensive insights into the imaging characteristics of onychopapilloma. RESULTS: High-frequency ultrasound revealed oval or linear hyperechoic masses located in the middle of the nail plate, without vascularity or posterior acoustic shadowing. Nail plate irregularity, thickening, and nail bed indentation were observed in some cases. These findings demonstrate that high-frequency ultrasound can aid in the diagnosis and surgical planning of onychopapilloma, providing detailed visualization of the lesion and surrounding structures. CONCLUSIONS: This imaging method could represent a potential tool to differentiate onychopapilloma from other nail conditions, especially malignant neoplasms. However, further research is needed to validate these findings and assess long-term outcomes.

Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications?

Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.

Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications? / Avaliação do posicionamento dos parafusos na cirurgia de Latarjet: Existe correlação entre paralelismo à glenoide e complicações radiográficas?

Abstract Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.

Resumo Objetivo Avaliar se o paralelismo dos parafusos com a glenoide na cirurgia de Latarjet interfere no posicionamento do enxerto e verificar a reprodutibilidade de um método de mensuração da posição dos parafusos. Métodos Estudo retrospectivo, multicêntrico, de pacientes com instabilidade anterior do ombro submetidos à cirurgia de Latarjet modificada e no mínimo 1 ano de seguimento pós-operatório. Dois médicos radiologistas analisaram as imagens tomográficas pós-operatórias, adquiridas em um banco de dados, para avaliação do posicionamento dos parafusos e das complicações radiográficas. Resultados Foram avaliados 34 pacientes, com idades entre 21 e 60 anos, sendo que um deles tinha acometimento bilateral dos ombros, totalizando 35 ombros avaliados. A avaliação tomográfica dos ângulos de inclinação dos parafusos não apresentou diferença entre os observadores. Houve concordância intra e interobservador para avaliação dos seguintes parâmetros cirúrgicos: posição do enxerto, presença ou não de complicações radiográficas. Conclusão A técnica descrita para mensuração do paralelismo dos parafusos na cirurgia de Latarjet apresentou uma concordância intra e inter observador muito boa e excelente, respectivamente. O paralelismo do parafuso com a glenoide é recomendado; no entanto, não é condição obrigatória e única para se evitar as complicações radiográficas.

Medical planning for mass gathering sports events in brazil / Planificación médica para eventos deportivos masivos en brasil / Planejamento médico para eventos esportivos de massa no brasil

ABSTRACT Introduction: Medical planning for mass gathering events is founded on the structuring of assistance to the population involved and the preservation of the response capacities of the local healthcare system. Large sporting events attended by crowds are increasingly common in society. These events have been shown to be dangerous, generating higher incidences of injuries and illnesses than usual. Thus, planning and the interaction among various public and private sectors are required for the prevention of and response to emergencies and incidents involving multiple victims. Methods: Recently published studies on medical planning for large sports events and current federal agency legislation were selected to conduct an updated review on the subject. Results: After reading titles and abstracts, 159 papers were chosen for a full reading, 50 of which met the eligibility criteria and were included as the basis for this review. The size of the audience, the weather, and the behavior of the crowd seem to contribute significantly to the estimated need for resources in sporting events. Conclusion: Mass events require planning for prevention and to strengthen the resilience of host communities. There is a still a lack of evidence that these events increase the risk of the mass spreading of disease. Level of Evidence: V; Expert opinion .

RESUMEN Introducción: La planificación médica de eventos masivos tiene como pilares la estructuración de la atención a la población involucrada y la preservación de las capacidades de respuesta del sistema local de salud. Los grandes eventos deportivos a los que asisten multitudes son cada vez más comunes en la sociedad. Estos eventos han demostrado ser peligrosos, generando una mayor incidencia de lesiones y enfermedades de lo habitual. Por lo tanto, es necesaria la planificación y la interacción de diversos sectores, públicos y privados, para la prevención y respuesta a emergencias o incidentes con múltiples víctimas. Métodos: Se seleccionaron estudios recientes publicados sobre la planificación médica de grandes eventos deportivos y la legislación vigente en organismos federales con el objetivo de realizar una revisión actualizada sobre el tema. Resultados: Después de leer los títulos y resúmenes, se eligieron 159 artículos para lectura completa y 50 cumplieron los criterios de elegibilidad y se utilizaron como base para esta revisión. El tamaño del público, las condiciones climáticas y el comportamiento de la multitud parecen contribuir significativamente a la estimación de los requisitos de recursos en los eventos deportivos. Conclusión: Los eventos masivos requieren una planificación para la prevención y el fortalecimiento de la resiliencia de las comunidades anfitrionas. Todavía no hay pruebas de que estos eventos aumenten el riesgo de propagación masiva de enfermedades. Nivel de Evidencia: V; Opinión experta .

RESUMO Introdução: O planejamento médico para eventos de massa tem como pilares a estruturação dos atendimentos à população envolvida e a preservação da capacidade de resposta do sistema de saúde local. Grandes eventos esportivos frequentados por multidões são cada vez mais comuns na sociedade. Esses eventos têm se mostrado perigosos, gerando maiores incidências de lesões e doenças do que o habitual. Dessa forma, é necessário planejamento e interação de diversos setores, públicos e privados, para prevenção e resposta à ocorrência de emergências ou incidentes com múltiplas vítimas. Métodos: Foram selecionados trabalhos recentes publicados sobre o planejamento médico para grandes eventos esportivos e a legislação vigente em órgãos federais com o objetivo de realizar uma revisão atualizada sobre o assunto. Resultados: Após a leitura de títulos e resumos, 159 trabalhos foram escolhidos para leitura integral e 50 preencheram os critérios de elegibilidade e foram usados como base para esta revisão. O tamanho do público, as condições climáticas e o comportamento da multidão parecem contribuir significativamente para a estimativa da necessidade de recursos em eventos esportivos. Conclusão: Eventos de massa exigem planejamento para prevenção e fortalecimento da resiliência das comunidades anfitriãs. Ainda faltam evidências de que esses eventos aumentem o risco de propagação maciça de doenças. Nível de evidência: V; Opinião do especialista .

PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS.

INTRODUCTION: Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. MATERIALS AND METHODS: An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). RESULTS: A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). CONCLUSION: There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

Pelvic incidence and osteitis pubis in professional soccer players / Incidência pélvica e osteíte púbica em jogadores profissionais de futebol

ABSTRACT Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

RESUMO Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

Higher Meniscal Slope Is a Risk Factor for Anterior Cruciate Ligament Injury in Skeletally Immature Patients.

PURPOSE: To evaluate the relation between the femoral intercondylar index, tibial slope, and meniscal slope between 3 different groups of skeletally immature patients: primary anterior cruciate ligament (ACL) injury (group 1), ACL reconstruction failure (group 2), and control group, without an ACL injury history (group 3). METHODS: This retrospective study evaluated magnetic resonance imaging scans of the knees of 605 skeletally immature patients obtained between 2015 and 2020. The inclusion criteria were as follows: patients younger than 16 years who were skeletally immature and underwent knee magnetic resonance imaging for any reason. RESULTS: A total of 605 skeletally immature patients were included in the study. The ratio of patients with ACL injury (cases) to those without ACL injury (controls) was 1:2.5. Patients with ACL injury had significantly greater medial meniscal slope and lateral meniscal slope values than the control group without ACL injury (P < .001). There was no statistically significant difference between patients with primary ACL injury and those with ACL reconstruction failure for all measured variables. CONCLUSIONS: The medial and lateral meniscal slope values were significantly higher in skeletally immature patients with ACL injury than in the control group of patients without ACL injury. There was no statistically significant difference in measurements of the femoral intercondylar index, lateral meniscal slope, medial meniscal slope, lateral tibial slope, or medial tibial slope between patients with primary injury and those with ACL reconstruction failure. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.

Spine trauma: Radiological approach and new concepts.

The spine is the main stabilizer and load bearer of the axial skeleton. It is also important for the protection of neural structures, such as the spinal cord, nerve roots, and cauda equina. In the healthy skeleton, most injuries are a consequence of high-energy trauma and can lead to severe dysfunction, such as tetraplegia or paraplegia. In order to avoid such disabilities, it is important to recognize details that will guide treatment, and that will determine the necessity or not to have surgery. Familiarity with radiography, CT, and MRI in evaluating spine trauma is necessary, as, in some cases, all three methods will be useful in determining management and surgical planning. The most important factor in determining management in the thoracolumbar spine is the posterior ligamentous complex (PLC). Therefore, familiarity with its anatomy, primary and secondary signs of its injuries, is essential for radiologists in the emergency setting. Spine fractures are a very heterogeneous group of disorders. Management can be both conservative and surgical. It is important for radiologists to be aware of classifications and patterns for these injuries.

Professional soccer is associated with radiographic cam and pincer hip morphology.

PURPOSE: Femoroacetabular impingement (FAI) syndrome is characterized by a triad: symptoms, clinical signs and imaging findings. Some individuals, especially athletes, have only imaging alterations. The objective of this study was to evaluate the prevalence of cam and pincer morphology in professional soccer players compared with a control group of non-athletes and to investigate the association between the age at which players start playing competitive soccer more than three times per week and duration of the soccer career with the prevalence of these radiographic findings. METHODS: The prevalence of cam and pincer morphology in sixty professional adult male soccer players and thirty-two male controls was determined using pelvic anteroposterior radiography. Data were recorded for all hips and correlated with the age at which the players started competitive soccer practice and with the duration of their soccer career. RESULTS: The prevalence of morphological FAI in the soccer players was 92.5% versus 28.1% in the controls (p < 0.001). The duration of the soccer career was positively correlated with the alpha angle (p = 0.033) and negatively correlated with the retroversion index (p = 0.009). The age at which competitive play began was inversely correlated with the alpha angle (p < 0.001). CONCLUSION: The study showed a high prevalence of cam and pincer morphology in Brazilian professional soccer players compared with controls. The duration of the soccer career was associated with an increased alpha angle and a decreased retroversion index, and the age at which competitive soccer participation began was negatively associated with alpha angle values. Finally, this manuscript provides data about the association between greater exposure to soccer and cam and pincer morphological changes in the hip; specifically, cam morphology was more common in patients who began participating in sports at earlier ages. This information serves as an alert for coaches of youth teams to manage the training load in youth athletes. LEVEL OF EVIDENCE: III.

Professional football can be considered a healthy sport?

PURPOSE: This study aimed to compare the results of knee MRIs of former football players with no previous knee surgeries with non-regular practitioners of impact sports, matched by age and sex, and combine these results with other variables such as current quality of life and pain in the knees. METHODS: The study participants were 16 male former professional football players and 21 male volunteers from different non-sports professional areas. All participants underwent bilateral magnetic resonances. Specific knee evaluations with regard to osteoarthritis and quality of life were performed in both groups by applying the Knee Injury and Osteoarthritis Outcome Score (KOOS) subjective questionnaires and SF-36, respectively. RESULTS: The between-group comparison revealed significant differences on: pain, symptoms, and quality of life related to the knee in KOOS subscales; physical aspects and vitality subscale of SF-36; and former soccer players had worst magnetic resonances scores than controls. CONCLUSION: Results of this study indicate probable specific adverse effects associated with participating in professional football. LEVEL OF EVIDENCE: Cross-sectional study, Level III.

Analisys of pectoralis major tendon in weightlifting athletes using ultrasonography and elastography / Estudo do tendão do músculo peitoral maior utilizando ultrassonografia e elastografia em atletas de levantamento de peso

ABSTRACT Objective To evaluate tendinopathy of the pectoralis major muscle in weightlifting athletes using ultrasound and elastography. Methods This study included 20 patients, 10 with rupture of the pectoralis major muscle and 10 control patients. We evaluated pectoralis major muscle contralateral tendon with ultrasonographic and elastography examinations. The ultrasonographic examinations were performed using a high-resolution B mode ultrasound device. The elastography evaluation was classified into three patterns: (A), if stiff (more than 50% area with blue staining); (B), if intermediate (more than 50% green); and (C), if softened (more than 50% red). Results Patients’ mean age was 33±5.3 years. The presence of tendinous injury measured by ultrasound had a significant different (p=0.0055), because 80% of cases had tendinous injury versus 10% in the Control Group. No significant differences were seen between groups related with change in elastography (p=0.1409). Conclusion Long-term bodybuilders had ultrasound image with more tendinous injury than those in Control Group. There was no statistical significance regarding change in tendon elasticity compared with Control Group.

RESUMO Objetivo Avaliar tendinopatia do músculo peitoral maior em praticantes de levantamento de peso utilizando ultrassonografia e elastografia. Métodos Participaram do estudo 20 sujeitos, sendo 10 com ruptura do tendão do músculo peitoral maior e 10 como controles. Avaliou-se o tendão músculo peitoral maior contralateral por meio de exames ultrassonográficos e elastografia. O aparelho de ultrassonografia utilizado era de alta resolução, e a avaliação foi realizada no modo B. A avaliação por elastografia foi classificada em três padrões, a saber: (A) se endurecido (mais de 50% de área com coloração azul); (B), se intermediário (mais de 50% verde); e (C), se amolecido (mais de 50% vermelho). Resultados A média de idade da amostra foi 33±5,3 anos. Foi encontrada diferença estatisticamente significante (p=0,0055) quanto à presença de tendinopatia avaliada pela ultrassonografia, pois 80% dos casos apresentaram tendinopatia músculo peitoral maior versus 10% nos pacientes controles. Não foram encontradas diferenças significantes entre os grupos quanto à presença de alteração na elastografia (p=0,1409). Conclusão Os pacientes praticantes de musculação de longa data apresentaram imagem à ultrassonografia com maior tendinopatia em relação aos controles, e não foi obtida significância estatística quanto à elastografia em relação aos controles.

Early osteoarthritis and reduced quality of life after retirement in former professional soccer players

OBJECTIVES: This study aims to compare the prevalence of osteoarthritis in two groups: one comprising former professional soccer players and the other comprising non-professional-athlete participants. METHODS: Twenty-seven male former professional soccer players and 30 male volunteers from different non-sports professional areas participated in the study. All participants underwent bilateral knee radiography and magnetic resonance imaging. In addition, the quality of life, knee pain and joint function were evaluated and compared using questionnaires given to all participants in both groups. Specific knee evaluations, with regard to osteoarthritis and quality of life, were performed in both groups using the Knee Injury and Osteoarthritis Outcome Score subjective questionnaires and the Short-form 36. The chi-squared test, Fisher's exact test, the Mann-Whitney U test and Student's t-test were used for group comparisons. RESULTS: The between-groups comparison revealed significant differences in the following: pain, symptoms and quality of life related to the knee in the Knee Injury and Osteoarthritis Outcome Score subscales; the physical aspects subscale of the SF-36; total whole-organ magnetic resonance imaging scores with regard to the dominant and non-dominant knees. Former soccer players had worse scores than the controls in all comparisons. CONCLUSIONS: Both the clinical and magnetic resonance evaluations and the group comparisons performed in this study revealed that former soccer players have a worse quality of life than that of a control group with regard to physical aspects related to the knee; these aspects include greater pain, increased symptoms and substantial changes in radiographic and magnetic resonance images of the knee. .

MRI evaluation of the MTP plantar plates compared with arthroscopic findings: a prospective study.

BACKGROUND: Instability of the lesser metatarsophalangeal (MTP) joints has been widely reported and plantar plate insufficiency is a key part of this pathologic process. The diagnosis is made clinically but can be aided by imaging studies, particularly magnetic resonance imaging (MRI); however, the sensitivity and accuracy of this method compared to direct visualization of these lesions has not yet been established, nor has interobserver accuracy of MRI been assessed for evaluation of plantar plate pathology. In this study, our goals were to identify the accuracy of the MRI in describing plantar plate tears when compared to direct arthroscopic visualization using an anatomic grading system and to test the influence of an anatomic grading system in the accuracy of the MRI readings. METHODS: We evaluated the clinical exam, MRI scans, and arthroscopic findings of 35 patients with lesser MTP instability. RESULTS: Using an anatomic grading system, a distinct improvement in the radiological evaluation and interpretation occurred. Knowledge of the pattern of plantar plate tears by a radiologist enabled them to locate and describe the type of tears of the plantar plate on the MRI. The amount of training and the experience of the radiologist were also important factors in our study. The senior radiologists had much better levels of accuracy (Group A, 77.0%; Group B, 88.5%) than less experienced radiologists. CONCLUSION: Prior knowledge of the pathophysiology and morphological types of lesions of the plantar plates was helpful for accurate identification and description of the tears by the radiologist. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Osteíte por BCG / Osteitis after BCG vaccination

Os autores relatam o caso de um menino de 1 ano e 9 meses que apresentou lesão osteolítica na região proximal do úmero direito. Com base na história clínica e em achados histológicos, os autores suspeitaram de osteíte pósvacina BCG. Após o início do tratamento antituberculose, os sintomas desapareceram e o paciente apresentou melhora radiológica. Os autores descrevem esta entidade incomum na prática pediátrica e alertam para possíveis complicações da vacina BCG.

The authors report the case of a 21-month-old boy with an osteolytic lesion in the proximal region of the right humerus. Based on the clinical history and histological findings, the authors suspected osteitis following BCG vaccination. Symptoms remitted after antituberculosis therapy was initiated, and the patient presented radiological improvement. The authors describe this uncommon entity in pediatric practice and call attention to possible complications of BCG vaccination.

Avaliação da reprodutibilidade da tomografia computadorizada no estadiamento da pancreatite aguda / Reproducibility in the assessment of acute pancreatitis with computed tomography

OBJETIVO: Medir a reprodutibilidade da tomografia computadorizada sem e com contraste na avaliação da gravidade da pancreatite aguda. MATERIAIS E MÉTODOS: Cinqüenta e um exames de tomografia computadorizada abdominal sem e com contraste de pacientes com pancreatite aguda foram analisados por dois radiologistas (observadores 1 e 2). Calculamos o índice morfológico pela tomografia computadorizada sem e com contraste, separadamente, e o índice de gravidade da tomografia computadorizada para pancreatite aguda. Medimos a reprodutibilidade intra- e interobservador da tomografia computadorizada através do índice kappa (kapa). RESULTADOS: Para a concordância interobservador obtivemos kapa de 0,666, 0,705, 0,648, 0,547 e 0,631 para índice morfológico sem e com contraste, presença de necrose pancreática, extensão da necrose pancreática e índice de gravidade da tomografia computadorizada, respectivamente. Para a concordância intra-observador dos observadores 1 e 2 obtivemos, respectivamente, kapa de 0,796 e 0,732 para o índice morfológico sem contraste; 0,725 e 0,802 para o índice morfológico com contraste; 0,674 e 0,849 para a presença de necrose pancreática; 0,606 e 0,770 para a extensão da necrose pancreática; e 0,801 e 0,687 para o índice de gravidade da tomografia computadorizada. CONCLUSÃO: O estadiamento da pancreatite aguda pela tomografia computadorizada por meio do índice morfológico e do índice de gravidade da tomografia computadorizada é um método bastante reprodutível. O não-uso do contraste não afeta a reprodutibilidade da tomografia computadorizada para o cálculo do índice morfológico.

OBJECTIVE: To evaluate the reproducibility of unenhanced and contrast-enhanced computed tomography in the assessment of patients with acute pancreatitis. MATERIALS AND METHODS: Fifty-one unenhanced and contrast-enhanced abdominal computed tomography studies of patients with acute pancreatitis were blindly reviewed by two radiologists (observers 1 and 2). The morphological index was separately calculated for unenhanced and contrast-enhanced computed tomography and the disease severity index was established. Intraobserver and interobserver reproducibility of computed tomography was measured by means of the kappa index (kappa). RESULTS: Interobserver agreement was kappa = 0.666, 0.705, 0.648, 0.547 and 0.631, respectively for unenhanced and contrast-enhanced morphological index, presence of pancreatic necrosis, pancreatic necrosis extension, and disease severity index. Intraobserver agreement (observers 1 and 2, respectively) was kappa = 0.796 and 0.732 for unenhanced morphological index; kappa = 0.725 and 0.802 for contrast-enhanced morphological index; kappa = 0.674 and 0.849 for presence of pancreatic necrosis; kappa = 0.606 and 0.770 for pancreatic necrosis extension; and kappa = 0.801 and 0.687 for disease severity index at computed tomography. CONCLUSION: Computed tomography for determination of morphological index and disease severity index in the staging of acute pancreatitis is a quite reproducible method. The absence of contrast-enhancement does not affect the computed tomography morphological index reproducibility.