Parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement / Lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular

Abstract Objective: To describe cases of parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement, correlating the clinical and imaging data. Materials and Methods: This was a retrospective descriptive case series of parafoveal chondral lesion of the femoral head in 21 patients who underwent computed tomography and magnetic resonance arthrography scans of the hip, having then received an imaging-based diagnosis of femoroacetabular impingement. Results: Of the 21 patients evaluated, 15 (71%) had cam-type femoroacetabular impingement, whereas five (24%) had mixed-type impingement, and one (5%) had pincer-type impingement. Twelve patients (57%) had a low frequency of physical activity, which was significantly associated with the presence of cam-type impingement (p = 0.015). Although the extent of the lesion correlated significantly with the acetabular coverage angle (p = 0.04), it did not correlate significantly with the alpha angle or femoral head-neck offset value (p = 0.08 and p = 0.06, respectively). We also found no correlation between the extent of the lesion and the other main parameters that define the femoroacetabular impingement types. Conclusion: This was one of the largest case series of parafoveal chondral lesion of the femoral head in patients with imaging findings of femoroacetabular impingement. The extent of such lesions does not appear to correlate with the parameters of femoroacetabular impingement, with the exception of the acetabular coverage angle.

Resumo Objetivo: Descrever casos de lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular, correlacionando dados clínicos e de imagem. Materiais e Métodos: Esta foi uma série de casos descritiva retrospectiva de lesão condral parafoveal da cabeça femoral em 21 pacientes submetidos a tomografia computadorizada e artrorressonância magnética do quadril e que receberam diagnóstico por imagem de impacto femoroacetabular. Resultados: Dos 21 pacientes avaliados, 15 (71%) tiveram impacto femoroacetabular do tipo cam, enquanto cinco (24%) tiveram impacto do tipo misto e um (5%) teve impacto do tipo pincer. Doze pacientes (57%) apresentaram baixa frequência de atividade física, sendo esta significativamente associada a impacto do tipo cam (p = 0,015). Houve correlação significativa entre a extensão da lesão e o ângulo de cobertura acetabular (p = 0,04), porém, não se correlacionou significativamente com o ângulo alfa ou com o valor do deslocamento cabeça-colo femoral (p = 0,08 e p = 0,06, respectivamente). Também não encontramos correlação entre a extensão da lesão e os outros principais parâmetros que definem os tipos de impacto femoroacetabular. Conclusão: Esta foi uma das maiores casuísticas de lesão condral parafoveal da cabeça femoral em pacientes com achados de imagem de impacto femoroacetabular. A extensão dessas lesões não parece se correlacionar com os parâmetros do impacto femoroacetabular, com exceção do ângulo de cobertura acetabular.

An Overlooked Entity in Diagnosing Hip Pain with Neuropathy in an Athletic Young Adult: A Case Report

@#Hip pain is frequently encountered in the athletic community. Femoro-acetabular impingement (FAI) is a common cause of hip pain in young adults. However, it is important to appreciate the uncommon diagnosis and the role of imaging for unexplained hip pain. The pathology behind a posterior hip pain is often misdiagnosed as the cause of hip pain is non-specific, extensive and elusive. We managed to detect the pathology through magnetic resonance arthrography (MRA) of hip with gadolinium enhancement after a series of inconclusive history, physical examination and imaging findings were completed. This particular case vignettes an overlooked osteoid osteoma that leads to the delay in diagnosis and increase morbidity.

Intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children / 中国骨伤

OBJECTIVE@#To investigate clinical effects of intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children.@*METHODS@#From January 2013 to July 2018, 18 children with intercondylar fracture of humerus were treated by operation, including 13 males and 5 females aged from 3 to 12 years old with an average age of (8.50±2.57) years old. According to Toniolo & Wilkinson classification, 8 children were typeⅠand 10 children were typeⅡ. During the operation, closed reduction and internal fixation were performed under the monitoring of intraoperative radiography, open reduction and internal fixation were performed in necessity. Mayo score of elbow joint was used to evaluate clinical effect at 6 months after operation.@*RESULTS@#All children were underwent arthrography monitoring during operation, 5 children were treated with closed reduction and internal fixation for intraoperative arthrography found no fracture of articular cartilage, 11 children by closed reduction and internal fixation because of fracture of articular cartilage involving the joint space with displacement less than 2 mm, and 2 children by closed or open reduction and internal fixation for fracture of articular cartilage surface with displacement above 2 mm, which 1 child with smooth of joint surface was performed closed reduction and internal fixation, 1 child without smooth of joint surface and displacement above 2 mm was performed open reduction and internal fixation. All children were followed up from 8 to 26 months with an average of (20.28±4.40) months. All factures were healed from 6 to 9 weeks with an average of (7.33±0.77) weeks. Postoperative Mayo score of elbowjoint at 6 months was (89.44±11.36), and 12 patients got excellent results, 5 good and 1 poor. One patient occurred partial limitation of flexion or extension of elbow joint. No elbow deformity and other complications occurred.@*CONCLUSION@#The treatment of intercondylar fracture of humerus in children under monitoring of intraoperative radiography could reduce opertaion injuries and complications, confirm the reduction effect of articular surface of cartilage in time and clearly, and promote recovery of elbow joint function.

Comparative Study between Multi-slice Computed Tomographic Arthrography and Arthroscopy in the Evaluation of Rotator Cuff Tears / Estudo comparativo entre artrotomografia computadorizada multi-slice e artroscopia na avaliação das lesões do manguito rotador

Abstract Objective To compare the imaging findings of anatomical alterations using multi-slice computed tomographic arthrography in the evaluation of rotator cuff tears in the shoulder, correlating them with the arthroscopy (the gold standard diagnostic test) findings. Materials and Methods A longitudinal, prospective, comparative study of diagnostic accuracy performed in the period between June 2016 and June 2017 in patients of both sexes, aged between 40 and 70 years, with shoulder rotator cuff tendon tears and therapeutic need to undergo shoulder arthroscopy. Patients with contraindication to magnetic resonance imaging were included. After multi-slice computed tomographic arthrography, all patients underwent arthroscopy. Results To obtain the results, the following parameters were determined: sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa coefficient, and contrast between the imaging method and arthroscopy. Conclusion In the impossibility of performing magnetic resonance imaging (the gold standard imaging technique), multi-slice computed tomographic arthrography is an imaging examination capable of evaluating/diagnosing rotator cuff tears.

Resumo Objetivo Comparar os achados por imagem das alterações anatômicas da artrotomografia computadorizada multi-slice na avaliação das lesões do manguito rotador do ombro e correlacioná-los com os achados da artroscopia (exame diagnóstico padrão-ouro). Materiais e Métodos Estudo longitudinal, prospectivo, comparativo de acurácia diagnóstica, feito de junho de 2016 a junho de 2017, em pacientes de ambos os sexos, com idades entre 40 e 70 anos, com lesão dos tendões do manguito rotador do ombro, e que tinham necessidade terapêutica de fazer artroscopia do ombro. Foram incluídos pacientes com contraindicação à realização de ressonância magnética. Após a artrotomografia computadorizada multi-slice, todos os pacientes foram submetidos a artroscopia. Resultados Para a obtenção dos resultados, os seguintes parâmetros foram considerados: sensibilidade, especificidade, acurácia, valor preditivo positivo, valor preditivo negativo, coeficiente Kappa, e contraposição do método de imagem com a artroscopia. Conclusão Na impossibilidade da realização da ressonância magnética (exame de imagem padrão-ouro), a artrotomografia computadorizada multi-slice se mostra um exame de imagem capaz de avaliar/diagnosticar as lesões do manguito rotador.

Computed Tomography Arthrography Findings of Idiopathic Adhesive Capsulitis of the Hip: An Analog of Adhesive Capsulitis of the Shoulder

OBJECTIVE: To identify useful imaging findings for the diagnosis of idiopathic adhesive capsulitis of the hip (ACH) on computed tomography arthrography (CTA). MATERIALS AND METHODS: Twenty-eight consecutive patients (29 hips; 7 males; mean age, 45.7 years; age range, 17–67 years) with ACH from October 2009 to March 2017 and 29 age- and sex-matched control patients from 2014 to 2016 were enrolled. All CTA images were evaluated by 2 radiologists independently for joint distensibility (anterior-posterior [AP] and superior-inferior [SI] joint cavity filling ratios), the presence of contrast filling around the ligamentum teres, and extracapsular contrast leakage. Fisher's exact test, Mann-Whitney U test, analysis of variance, and receiver operating characteristic curves were used for statistical analysis. P value less than 0.05 was considered to indicate statistical significance. RESULTS: The anterior joint cavity was significantly more obliterated in the ACH group (mean size, 3.7–4.0 mm) than in the control group (mean size, 4.8–5.0 mm; p < 0.05). The AP filling ratio was also significantly lower in the ACH group (0.6 vs. 1.1; p < 0.05) and decreased more as the ACH stage increased (mean anterior joint cavity size: 1.15 mm in stage 3 vs. 4.68 mm in stage 1; p < 0.05). Extracapsular contrast leakage was more common in the ACH group (27–28 vs. 20–21; p = 0.041 and 0.025, respectively). CONCLUSION: On CTA, the anterior joint cavity may have earlier and more marked obliteration than joint cavities on other sides, and may be accompanied by extracapsular contrast leakage in ACH. These CTA findings may be helpful in the diagnosis of ACH.

Evaluation of Inferior Capsular Laxity in Patients with Atraumatic Multidirectional Shoulder Instability with Magnetic Resonance Arthrography

OBJECTIVE: To compare inferior capsular redundancy by using magnetic resonance arthrography (MRA) images in patients with multidirectional instability (MDI) of the shoulder and control subjects without instability and thereby develop a screening method to identify the presence of shoulder MDI. MATERIALS AND METHODS: The MRA images of patients with MDI of the shoulder (n = 65, 57 men, 8 women; mean age, 24.5 years; age range, 18–42 years) treated over an eight-year period were retrospectively reviewed; a control group (n = 65, 57 men, 8 women; mean age, 27.4 years; age range, 18–45 years) without instability was also selected. The inferior capsular redundancy was measured using a new method we named the glenocapsular (GC) ratio method. MRA images of both groups were randomly mixed together, and two orthopedic surgeon reviewers measured the cross-sectional areas (CSAs) and sagittal capsule-head ratios on oblique sagittal images, as well as the axial capsule-head ratios on axial images and GC ratios on oblique coronal images. RESULTS: The CSAs and GC ratios were significantly higher in patients than in controls (both, p 1.42 was found to be most suggestive of MDI of the shoulder, owing to its high sensitivity (92.3%) and specificity (89.2%). CONCLUSION: GC ratio can be easily measured and used to accurately screen for MDI of the shoulder.

Accuracy of Magnetic Resonance Arthrography in Detecting Rotator Cuff Tears / Precisión de la artrografía por resonancia magnética en la detección de desgarros del manguito rotador

ABSTRACT Objective: Shoulder pain, a common cause of productivity loss and health-related expense, is commonly due to rotator cuff tears. Magnetic resonance (MR) imaging with intra-articular gadolinium, MR arthrography, is accepted internationally as an excellent modality for evaluating the rotator cuff. Ultrasound is cheaper and only slightly less sensitive in detecting rotator cuff tears, but MR is superior in detecting ancillary lesions. Magnetic resonance arthrography was introduced at the University Hospital of the West Indies (UHWI), Jamaica, in July 2003. This study aimed to evaluate our experience with MR arthrography and assess its accuracy. Methods: A retrospective study was carried out. All MR arthrography cases performed at UHWI between July 2003 and July 2006 were reviewed. Medical records were reviewed to determine surgical correlation. Results: A total of 140 MR arthrograms were performed; 55% of the patients were female. Ages ranged from the second to the ninth decade, having a distribution approaching but not attaining a normal distribution (p = 0.03) with clustering in the middle years. Magnetic resonance arthrography demonstrated torn rotator cuffs in 40 patients, none of whom was under the age of 40 years (p < 0.001). Fifteen patients had surgery which confirmed torn rotator cuffs in all 15. Conclusion: Magnetic resonance arthrography was found to be accurate in detecting rotator cuff tears. It should be considered in the evaluation of patients with suspected rotator cuff tears. For patients under the age of 40 years, sonography could be used as an alternative.

RESUMEN Objetivo: El dolor en el hombro, el cual es causa común de pérdida de productividad y gastos relacionados con la salud, se debe comúnmente a desgarros del manguito rotador. La imagen por resonancia magnética (IRM) con gadolinio intra-articular - conocida como artrografía RM - se acepta internacionalmente como una excelente modalidad para evaluar el manguito rotador. El ultrasonido es más barato y sólo ligeramente menos sensible a la hora de detectar desgarros del manguito rotador, pero la RM es superior en la detección de lesiones secundarias. La artrografía por resonancia magnética se introdujo en el Hospital Universitario de West Indies (HUWI), Jamaica, en julio de 2003. Este estudio tuvo como objetivo evaluar nuestra experiencia con la artrografía RM y evaluar su precisión. Métodos: Se realizó un estudio retrospectivo. Se revisaron todos los casos de artrografías RM realizadas en HUWI entre julio de 2003 y julio de 2006. Se revisaron las historias clínicas a fin de determinar la correlación quirúrgica. Resultados: Un total de 140 artogramas RM fueron realizados. El 55% de los pacientes eran mujeres. Las edades variaron del segundo al noveno decenio, con una distribución que se acercaba pero no llevaba a alcanzar una distribución normal (p = 0.03), concentrándose en los años intermedios. La artrografía de resonancia magnética mostró desgarros de los manguitos rotadores en 40 pacientes, ninguno de los cuales tenía menos de 40 años (p < 0.001). Quince pacientes tuvieron cirugía que confirmaba desgarros de los manguitos rotadores en los 15. Conclusión: Se halló que la artrografía por resonancia magnética era exacta a la hora de detectar los desagarros del manguito rotador. Debe considerarse en la evaluación de pacientes con sospecha de desgarros del manguito rotador. Para los pacientes menores de 40 años de edad, la sonografía podría ser utilizada como alternativa.

Magnetic resonance arthrography of the shoulder: a painful procedure? / Artrorressonância do ombro: procedimento doloroso?

Abstract Objective: To compare the pain expected to that effectively caused by magnetic resonance arthrography of the shoulder and, secondarily, to describe a simplified approach to the technique for articular access. Materials and Methods: We prospectively evaluated 40 participants who used a visual analog scale and a simplified categorical scale to indicate the level of pain expected and that experienced after the procedure, comparing the two with the Wilcoxon matched-pairs test. We also determined gender-related differences in pain conditions using the Mann-Whitney U test. In addition, we described a modified technique involving radiographic localization and the use of standard puncture needles for articular access. Results: Analysis of the visual analog scales showed that the pain experienced was less than had been expected, with median scores of 1.75 and 3.75, respectively (p < 0.001). The level of pain expected was higher among women than among men, with median scores of 8.0 and 3.0, respectively (p = 0.014), as was the level of pain experienced, with median scores of 3.0 and 1.5, respectively (p = 0.139). The overall categorical evaluation corroborated that difference (p = 0.03). Articular access with the modified technique was successful in all patients. Conclusion: Magnetic resonance arthrography of the shoulder is less painful than patients expect. In addition, digital radiographic guidance combined with the use of standard puncture needles appears to improve the efficiency of the method.

Resumo Objetivo: Comparar a expectativa de dor com a efetivamente produzida em procedimentos de artrorressonância do ombro e, secundariamente, descrever abordagem simplificada da técnica de acesso articular. Materiais e Métodos: Avaliamos, prospectivamente, 40 participantes, que assinalaram a sua expectativa álgica e a dor pós-procedimento em escalas visual analógica e categórica simplificada, que foram comparadas por meio de teste pareado de Wilcoxon. Também determinamos a diferença do quadro doloroso por gênero, com aplicação do teste U de Mann-Whitney. Descrevemos, ainda, técnica de localização radiográfica e emprego de agulhas simples de punção para acesso articular. Resultados: A análise das escalas visuais analógicas demonstrou que a dor experimentada foi inferior à esperada (medianas de 1,75 e 3,75, respectivamente; p < 0,001). As mulheres tinham expectativa de dor superior aos homens (medianas de 8,0 e 3,0; p = 0,014), assim como maior dor experimentada (medianas de 3,0 e 1,5; p = 0,139), respectivamente. Avaliação categórica global corroborou tal tendência (p = 0,03). O acesso articular, empregando técnica adaptada, foi obtido com sucesso em todos os pacientes. Conclusão: A artrorressonância do ombro é menos dolorosa do que se imagina. Adicionalmente, a orientação radiográfica digital aliada ao emprego de agulhas simples de punção aumentam a eficiência do método.

Utilidad de la artrografía en la decisión terapéutica en niños con displasia del desarrollo de cadera de tres meses a tres años de edad / Usefulness of the arthrogram in the decision therapy in children with developmental dysplasia of the hip from 3 months to 3 years of age

Resumen: Objetivo: Evaluar la utilidad de la artrografía como herramienta en la decisión terapéutica de pacientes con displasia del desarrollo de cadera (DDC). Material y métodos: 19 niños con diagnóstico de DDC habitual de edad entre tres meses y tres años, sin antecedentes quirúrgicos, Tonis II o III y expediente radiográfico completo. Para cada caso se registró la decisión terapéutica radiográfica y artrográfica por tres observadores independientemente, en el análisis estadístico el estándar fue la cirugía realizada necesaria para lograr una reducción concéntrica y cobertura acetabular adecuada. Resultados: 20 casos, 19 pacientes, de los cuales 18 fueron unilateral y uno bilateral. Fueron 17 niñas (89%) y dos niños (11%). Edad promedio: un año tres meses (de cuatro meses a dos años 11 meses), 11 Tonis II (55%) y nueve Tonis III (45%). El coeficiente de correlación intraclase (CCI) en relación con la decisión terapéutica radiográfica fue de 0.8933 y para la artrografía fue de 0.7205. El CCI de la decisión terapéutica radiográfica en relación con el estándar fue de 0.7933 y para la artrográfica fue de 0.6219. Se confirmó que en los 20 casos revisados la utilidad de la artrografía (CCI 0.6219) es menor que la de las radiografías (CCI 0.7933). La utilidad de la artrografía fue mayor en los pacientes con Tonis II con una edad entre nueve meses y dos años.

Abstract: Objective: To evaluate the utility of arthrography as a tool in therapeutic decision in developmental dysplasia of hip (DDH). Material and methods: 19 children with true DDH with age between three months and three years, without previous surgical treatment, with Tonis II or III, and complete X-rays. For each case; therapeutic decision was registered for X-rays and arthrography by three independent observers, we took like standard, surgery in each patient necessary to obtain a concentric reduction and good acetabular coverage. Results: 20 cases, 19 patients. 18 unilateral, 1 bilateral. They were 17 girls (89%) and 2 children (11%). Average Age: 1 year 3 months (4 months to 2 years 11 months). 11 Tonis II (55%) and 9 Tonis III (45%). The intraclass coefficient of correlation (ICC) in relation to the decision therapeutic radiographic was of 0.8933 and for the arthrography of 0.7205. And ICC of the decision therapeutic radiographic in connection with the standard was of 0.7933 and for the arthrography it was of 0.6219. We confirm that in our 20 cases, the utility of the arthrography (ICC 0.6219), is smaller to the X-rays (ICC 0.7933). The utility of the arthrography was bigger in the patients with Tonis II, and an age between nine months and two years.

Artrografía de las extremidades, ¿cómo se hace? / Arthrography of Extremities, How is it Done?

La artrografía, a pesar de ser una técnica antigua, ha recobrado validez en los últimos años por su utilidad en la evaluación de estructuras que no se pueden valorar correctamente mediante técnicas de imagen no invasivas. El propósito de este artículo es realizar una revisión de las técnicas de artrografía por fluoroscopia de las principales articulaciones en las extremidades (hombro, codo, muñeca, cadera, rodilla y tobillo), con el fin de brindar al lector múltiples abordajes para cada una de ellas, con base en la anatomía articular.

Arthrography, despite being an old technique, has regained validity in recent years due to its usefulness in the assessment of structures that cannot be correctly assessed using non-invasive imaging techniques. The purpose of this article is to review the fluoroscopic arthrography techniques of the main joints in the extremities (shoulder, elbow, wrist, hip, knee and ankle), in order to provide the reader with multiple approaches for each of them, based on articular anatomy.

Arthrography in treatment of humeral condyle fractures with displacement of less than 2 mm in children / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of arthrography in the treatment of lateral condylar fracture of humerus with displacement of ≤ 2 mm in children.Methods A retrospective study was performed in the 21 children with lateral condylar fracture of humerus who had received arthrography in their surgery at Department of Pediatric Orthopedics,Honghui Hospital,Xi'an Jiaotong University College of Medicine from April 2015 to December 2016.They were 14 boys and 7 girls,aged from 5 to 12 years (average,8.6 years).Their primary diagnosis was made within one week from injury and they all had a displacement of ≤ 2 mm.Of them,2 were treated by plaster fixation because intraoperative arthrography found no fracture of articular cartilage (group A),11 by simple closed pining because intraoperative arthrography found fracture of articular cartilage involving the joint space (group B),and 8 by open reduction and fixation with kirschner wire because intraoperative arthrography found displacement of the involved articular surface (group C).The therapeutic efficacy was evaluated at final follow-ups by the Dhillon scoring system.Results All the 21 children were followed up from 9 to 23 months (average,16 months).The fracture union time ranged from 8 to 10 weeks (average,9 weeks) for groups A and B and from 11 to 13 weeks (average,12 weeks) for group C.By the Dhillon scores at final follow-ups,the therapeutic efficacy was evaluated as excellent in one and as good in one in group A,as excellent in 8 cases,as good in 2 cases and as fair in one in group B,and as excellent in 6 cases,as good in one and as fair in one in group C.No early closure of epiphysis,osteonecrosis or fishtail deformity was found in either group A or group B;one case of partial limitation of elbow flexion or extension,one case of fishtail deformity and one case of femoral head necrosis were observed in group C.No infection or skin necrosis was found in any of the 3 groups.Conclusions Because intraoperative arthrography can definitely judge whether the articular surface is intact or unstable,it can make up for the insufficiency of X-rays in judging integrity of the articular surface.In combination with closed reduction,percutaneous puncture or open reduction and internal fixation,intraoperative arthrography can contribute to an increased rate of successful surgery,and reduced complications due to redisplacement.

Evaluation of the Subscapularis Tendon Tears on 3T Magnetic Resonance Arthrography: Comparison of Diagnostic Performance of T1-Weighted Spectral Presaturation with Inversion-Recovery and T2-Weighted Turbo Spin-Echo Sequences

OBJECTIVE: To compare the T1-weighted spectral presaturation with inversion-recovery sequences (T1 SPIR) with T2-weighted turbo spin-echo sequences (T2 TSE) on 3T magnetic resonance arthrography (MRA) in the evaluation of the subscapularis (SSC) tendon tear with arthroscopic findings as the reference standard. MATERIALS AND METHODS: This retrospective study included 120 consecutive patients who had undergone MRA within 3 months between April and December 2015. Two musculoskeletal radiologists blinded to the arthroscopic results evaluated T1 SPIR and T2 TSE images in separate sessions for the integrity of the SSC tendon, examining normal/articular-surface partial-thickness tear (PTTa)/full-thickness tear (FTT). Diagnostic performance of T1 SPIR and T2 TSE was calculated with arthroscopic results as the reference standard, and sensitivity, specificity, and accuracy were compared using the McNemar test. Interobserver agreement was measured with kappa (κ) statistics. RESULTS: There were 74 SSC tendon tears (36 PTTa and 38 FTT) confirmed by arthroscopy. Significant differences were found in the sensitivity and accuracy between T1 SPIR and T2 TSE using the McNemar test, with respective rates of 95.9–94.6% vs. 71.6–75.7% and 90.8–91.7% vs. 79.2–83.3% for detecting tear; 55.3% vs. 31.6–34.2% and 85.8% vs. 78.3–79.2%, respectively, for FTT; and 91.7–97.2% vs. 58.3–61.1% and 89% vs. 78–79.3%, respectively, for PTTa. Interobserver agreement for T1 SPIR was almost perfect for T1 SPIR (κ = 0.839) and substantial for T2 TSE (κ = 0.769). CONCLUSION: T1-weighted spectral presaturation with inversion-recovery sequences is more sensitive and accurate compared to T2 TSE in detecting SSC tendon tear on 3T MRA.

Utilidad de la artrografía intraoperatoria para el tratamiento de fracturas en niños / Usefulness of intraoperative arthrogram in the treatment of pediatric fractures

Introducción: El objetivo de este estudio fue evaluar las indicaciones y las complicaciones de una serie consecutiva de niños con fracturas a quienes se les realizó artrografía intraoperatoria. Materiales y Métodos: Se evaluó retrospectivamente a pacientes pediátricos con fracturas de codo o tobillo sometidos a una artrografía intraoperatoria, entre enero de 2009 y julio de 2014. Se analizaron los datos demográficos, la evolución clínica posoperatoria (criterios de la Clínica Mayo y puntaje de la AOFAS), la evolución radiográfica y las complicaciones derivadas del uso de material de contraste intrarticular. Resultados: Se evaluaron 25 pacientes (16 niños, 9 niñas) con una edad promedio de 7.6 años (rango 4-15). El seguimiento promedio fue de 30.1 meses. Quince tenían fracturas de codo y 10, de tobillo. Según el puntaje de la Clínica Mayo, 14 pacientes tuvieron resultados excelentes y uno fue bueno (promedio 99; rango 85-100). Los 10 pacientes con fracturas de tobillo obtuvieron resultados excelentes según el puntaje de la AOFAS (promedio 98,5; rango 95-100). No ocurrieron infecciones ni reacciones adversas relacionadas con el uso del medio de contraste. Tres pacientes tuvieron complicaciones no relacionadas con el uso del medio de contraste. Conclusión: La artrografía es un procedimiento simple, de bajo costo, que agrega poco tiempo quirúrgico y permite una mejor evaluación de estructuras intrarticulares para la toma de decisiones intraoperatorias. Es una herramienta útil que debe ser tenida en cuenta en el tratamiento de algunas fracturas en pediatría. Nivel de Evidencia: IV

Introduction: The objective of this study is to assess the indications and complications of a consecutive series of children with fractures where intraoperative arthrogram was performed. Methods: We retrospectively evaluated children with elbow or ankle fractures who underwent intraoperative arthrogram between January 2009 and July 2014. We assessed demographic data, postoperative clinical outcomes (Mayo Clinic and AOFAS scores), radiographic outcome and complications arising from the use of intra-articular contrast material. Results: Twenty-five patients (16 boys, 9 girls) with an average age of 7.6 years (range 4-15) were evaluated. The average follow-up was 30.1 months. There were 15 patients with elbow fractures and 10 with ankle fractures. According to Mayo Clinic score, results were excellent in 14 patients and good in one patient (average 99; range 85-100). Ten patients with ankle fractures presented excellent results according to AOFAS score (average 98.5; range 95-100). There were no in fections or adverse reactions related to the use of contrast. Three patients presented complications unrelated to the use of contrast. Conclusion: Arthrogram is a simple, low-cost procedure, adds short surgical time and allows better assessment of intraarticular structures for intraoperative decision-making. It is a useful tool that should be taken into account in the treatment of some pediatric fractures. Level of Evidence: IV

Assessment of Capsular Insertion Type and of Capsular Elongation in Patients with Anterior Shoulder Instability and It's Correlation with Surgical Outcome: A Quantitative Assessment with Computed Tomography Arthrography

BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.

Assessment of Capsular Insertion Type and of Capsular Elongation in Patients with Anterior Shoulder Instability and It's Correlation with Surgical Outcome: A Quantitative Assessment with Computed Tomography Arthrography

BACKGROUND: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. METHODS: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. RESULTS: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. CONCLUSIONS: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.

Effects of iodinated contrast agent, xylocaine and gadolinium concentration on the signal emitted in magnetic resonance arthrography: a samples study / Efeitos do contraste iodado, da xilocaína e da concentração de gadolínio no sinal emitido em exames de artrorressonância magnética: estudo por amostras

Objective: To investigate the effects of dilution of paramagnetic contrast agent with iodinated contrast and xylocaine on the signal intensity during magnetic resonance arthrography, and to improve the paramagnetic contrast agent concentration utilized in this imaging modality. Materials and Methods: Samples specially prepared for the study with three different concentrations of paramagnetic contrast agent diluted in saline, iodinated contrast agent and xylocaine were imaged with fast spin echo T1-weighted sequences with fat saturation. The samples were placed into flasks and graphical analysis of the signal intensity was performed as a function of the paramagnetic contrast concentration. Results: As compared with samples of equal concentrations diluted only with saline, the authors have observed an average signal intensity decrease of 20.67% for iodinated contrast agent, and of 28.34% for xylocaine. However, the increased gadolinium concentration in the samples caused decrease in signal intensity with all the dilutions. Conclusion: Minimizing the use of iodinated contrast media and xylocaine and/or the use of a gadolinium concentration of 2.5 mmol/L diluted in saline will improve the sensitivity of magnetic resonance arthrography. .

Objetivo: Investigar, mediante quantificação da intensidade do sinal emitido em amostras, se a diluição do agente de contraste paramagnético com contraste iodado e xilocaína alteram o sinal emitido pelo meio de contraste paramagnético durante o exame de artrorressonância magnética, e aperfeiçoar a concentração de contraste paramagnético utilizada no exame. Materiais e Métodos: Foi realizada sequência de pulso fast spin eco ponderada em T1 com saturação de gordura, utilizando três diferentes concentrações de contraste paramagnético diluídas em solução salina, contraste iodado e xilocaína. As amostras foram colocadas em frascos e a análise gráfica da intensidade do sinal em função da concentração de contraste paramagnético foi realizada. Resultados: Constatou-se que as diluições de contraste paramagnético em contraste iodado e xilocaína diminuíram, em média, a intensidade do sinal em 20,67% para o contraste iodado e 28,34% para a xilocaína, em comparação com as amostras de concentração idêntica diluídas apenas em solução salina. Porém, o aumento da concentração de gadolínio nas amostras ocasionou a diminuição da intensidade do sinal emitido pelo gadolínio, para todas as diluições. Conclusão: Minimizar o uso do meio de contraste iodado e da xilocaína e/ou a utilização de uma concentração de gadolínio com 2,5 mmol/L, diluída em solução salina, irá aperfeiçoar a sensibilidade do exame de artrorressonância magnética. .

Characteristics of Magnetic Resonance Arthrography Findings in Traumatic Posterosuperior Rotator Cuff Tears

BACKGROUND: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. METHODS: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. RESULTS: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. CONCLUSIONS: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.

Shoulder Manipulation After Distention Arthrography: Does Audible Cracking Affect Improvement in Adhesive Capsulitis? A Preliminary Study

OBJECTIVE: To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder. METHODS: A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention. RESULTS: The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05). CONCLUSION: These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.

Characteristics of Magnetic Resonance Arthrography Findings in Traumatic Posterosuperior Rotator Cuff Tears

BACKGROUND: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. METHODS: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. RESULTS: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. CONCLUSIONS: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.

Dual-Energy Computed Tomography Arthrography of the Shoulder Joint Using Virtual Monochromatic Spectral Imaging: Optimal Dose of Contrast Agent and Monochromatic Energy Level

OBJECTIVE: To optimize the dose of contrast agent and the level of energy for dual-energy computed tomography (DECT) arthrography of the shoulder joint and to evaluate the benefits of the optimized imaging protocol. MATERIALS AND METHODS: Dual-energy scans with monochromatic spectral imaging mode and conventional single energy scans were performed on a shoulder phantom with 10 concentrations from 0 to 210 mg/mL of iodinated contrast medium at intervals of 15 or 30 mg/mL. Image noise, tissue contrast, and beam hardening artifacts were assessed to determine the optimum dose of contrast agent and the level of monochromatic energy for DECT shoulder arthrography in terms of the lowest image noise and the least beam hardening artifacts while good tissue contrast was maintained. Material decomposition (MD) imaging for bone-iodine differentiation was qualitatively assessed. The optimized protocol was applied and evaluated in 23 patients. RESULTS: The optimal contrast dose and energy level were determined by the phantom study at 60 mg/mL and 72 keV, respectively. This optimized protocol for human study reduced the image noise and the beam-hardening artifacts by 35.9% and 44.5%, respectively. Bone-iodine differentiation by MD imaging was not affected by the iodine concentration or level of energy. CONCLUSION: Dual-energy scan with monochromatic spectral imaging mode results in reduced image noise and beam hardening artifacts.