Degloving intramuscular injuries of the semimembranosus and adductor longus muscles in adolescent soccer players.

Degloving muscle injury was described for the rectus femoris where the inner bipennate component is dissociated from its superficial unipennate component. The semimembranosus muscle displays a distinctive dual morphology, featuring both unipennate and bipennate muscle fibers. Nevertheless, this specific tear pattern has not been previously documented. Conversely, the adductor longus muscle showcases an elongated intramuscular tendon segment, indicating a multipennate morphology. We present two separate cases of previous undescribed degloving injuries of the semimembranosus and the adductor longus in teenage soccer players with MRI and ultrasound diagnosis, ultrasound-guided hematoma aspiration, and recovery timelines for return-to-play.

Assessment of knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT): a novel protocol and preliminary results.

OBJECTIVE: To propose a protocol for assessing knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT). MATERIALS AND METHODS: We enrolled five patients with unilateral chronic ACL tears referred for WBCT. Bilateral images were obtained in four positions: bilateral knee extension, bilateral knee flexion, single-leg stance with knee flexion and external rotation, and single-leg stance with knee flexion and internal rotation. The radiation dose, time for protocol acquisition, and patients' tolerance of the procedure were recorded. A blinded senior radiologist assessed image quality and measured the anterior tibial translation (ATT) and femorotibial rotation (FTR) angle in the ACL-deficient and contralateral healthy knee. RESULTS: All five patients were male, aged 23-30 years old. The protocol resulted in a 16.2 mGy radiation dose and a 15-min acquisition time. The procedure was well-tolerated, and patient positioning was uneventful, providing good-quality images. In all positions, the mean ATT and FTR were greater in ACL-deficient knees versus the healthy knee, with more pronounced differences observed in the bilateral knee flexion position. Mean lateral ATT in the flexion position was 9.1±2.8 cm in the ACL-injured knees versus 4.0±1.8 cm in non-injured knees, and mean FTR angle in the bilateral flexion position was 13.5°±7.7 and 8.6°±4.6 in the injured and non-injured knees, respectively. CONCLUSION: Our protocol quantitatively assesses knee instability with WBCT, measuring ATT and FTR in diverse knee positions. It employs reasonable radiation, is fast, well-tolerated, and yields high-quality images. Preliminary findings suggest ACL-deficient knees show elevated ATT and FTR, particularly in the 30° flexion position.

Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability.

OBJECTIVE: To evaluate anterolateral ligament abnormalities (ALL) at MRI scans and correlate with data from clinical instability tests (Lachman and pivot shift) performed under anesthesia in patients with acute anterior cruciate ligament (ACL) tears. Furthermore, perform multivariate analysis with other variables to isolate the ALL contribution to instability from other abnormalities. METHODS: Retrospective analysis of MRI and instability tests of 95 patients with ACL tears. The ALL was classified as no abnormality, abnormality without discontinuity, and discontinuity. Injuries in other knee ligament structures and menisci were also assessed. Results of instability tests (pivot shift and Lachman) with the patient anesthetized for arthroscopic ACL reconstruction were obtained from the patient database. Statistical analysis was performed using the IBM SPSS 22. RESULTS: ALL abnormalities and iliotibial band (ITB), lateral (LCL), and medial (MCL) collateral ligament injuries showed a statistically significant correlation with the pivot shift test. The ALL MRI abnormalities were associated with the high-grade pivot shift results (p < 0.0005), with an odds ratio of 55.9 for high degrees of pivot shift in patients with abnormal ALL. The logistic model for all variables analyzed with the results of the pivot shift test demonstrated that the ALL was the only variable with a statistically significant correlation in the model (p < 0.0005). CONCLUSION: MRI ALL abnormalities in patients with ACL injuries have a significant association with pivot shift test results in patients under anesthesia. The logistic model for high - grade pivot shift test results demonstrated that ALL abnormalities were the only variable with significant correlation. KEY POINTS: • Evaluating the anterolateral ligament with MRI in acute anterior cruciate ligament injuries is useful to predict higher grades of pivot shift test in the moment of the arthroscopic reconstruction. • An abnormal anterolateral ligament presented an odds ratio of 55 for high degrees of pivot shift. • ALL MRI abnormalities association with knee instability is independent from other internal knee injuries.

Venous thrombosis: a mimic of musculoskeletal injury on MR imaging.

Clinical signs and symptoms of venous thrombosis and musculoskeletal pathologies frequently overlap. Sometimes, patients with venous thrombosis undergo MR examinations under an equivocal suspicion of muscle, tendon or articular injury. A low pretest clinical suspicion and lack of familiarity with the conventional MR imaging signs of venous thrombosis may result in failure to diagnose venous thrombosis, delaying treatment and raising morbimortality. In MR imaging, thrombosis presents as venous ectasia with intraluminal heterogeneous content. Small vein thrombosis is often identified as having a branching aspect. Perivenous edema and inflammatory soft tissue changes may be the most prominent findings. The purpose of this paper is to illustrate MR findings of venous thrombosis in patients who underwent MR examinations due to suspected musculoskeletal pathologies. Cases of venous thrombosis in different sites of the body diagnosed through MR are presented.

Acute Ligament Injuries of the Elbow.

Ulnar collateral, radial collateral, lateral ulnar collateral, and annular ligaments can be injured in an acute trauma, such as valgus stress in athletes and elbow dislocation. Recognizing normal anatomy in magnetic resonance imaging and ultrasonography studies is important to identify ligamentous abnormalities in these imaging modalities.

Computed tomography (CT), X-ray, and MRI evaluation of two anterolateral knee reconstruction techniques: lateral extra-articular tenodesis (LET) and the anterolateral ligament (ALL) reconstruction.

The anterolateral ligament (ALL) and capsule of the knee are anatomical structures involved in rotational stability and pivot-shift control. As such, it has been demonstrated that the extra-articular anterolateral procedures improve clinical outcome when performed as an augmentation of the anterior cruciate ligament (ACL) reconstruction in specific groups of patients. This review describes the postoperative imaging findings of two techniques used to perform these procedures, using magnetic resonance imaging (MRI), computed tomography (CT), and radiography. The first technique described is the lateral extra-articular tenodesis (LET), which uses a strip of the iliotibial band that is harvested, passed underneath the lateral collateral ligament (LCL) and fixed posterior, and proximal to the lateral femoral epicondyle (LFE), preserving ITB insertion on Gerdy's tubercle. The second technique described is the ALL reconstruction, a procedure that attempts to recreate the anatomy of the ALL, using most often a gracilis autograft. In this procedure, femoral fixation is performed proximal and posterior to the LFE, and tibial fixation is slightly distal to the joint line, halfway from Gerdy's tubercle to the fibular head. The main objective of this review is to provide an overview of the postoperative imaging aspects of these two procedures with MRI, CT, and radiography and to describe possible complications. As they become more common, it is important for the radiologist and the orthopedic surgeon to understand their particularities in combination with the already well-known ACL reconstruction.

Magnetic Resonance Imaging Evaluation of the Anterolateral Ligament and the Iliotibial Band in Acute Anterior Cruciate Ligament Injuries Associated With Segond Fractures.

PURPOSE: To evaluate the magnetic resonance imaging (MRI) characteristics of Segond fractures, including the structures attached to the avulsed fragment, the integrity of anterolateral ligament (ALL) and iliotibial band (ITB), and fragment size and location. METHODS: This was a retrospective, cross-sectional study with MRI scans from 2016 to 2019 with the term "Segond" in the reports, signs of acute trauma, and a bony anterolateral tibial avulsion (Segond) fracture. Two experienced observers accessed images to evaluate fragment dimensions (anteroposterior, mediolateral, and craniocaudal) and distances from anatomic landmarks (Gerdy's tubercle, articular surface, and posterolateral tibial corner). ALLs and ITBs also were evaluated, both for integrity and for attachment to the avulsed bony fragment. Data were statistically evaluated for significant correlations. RESULTS: Forty-eight knee MRIs of patients suffering from a combined anterior cruciate ligament and Segond injury were evaluated. The ALL presented with edema in 28 cases (58.3%) and was torn in 3 cases (6.3%). The ALL was attached to the bone fragment in all cases and the ITB also was attached in 25 cases (52.1%). Receiver operating characteristic curves also demonstrated that the larger each of the dimensions and the volume of the fragment, the greater the probability of ITB fibers being inserted. Also, the narrower the distance from the fragment to the center of Gerdy's tubercle, the greater the probability of iliotibial band fibers being attached. Interobserver correlation varied from 0.87 to 0.97 for all measurements. CONCLUSIONS: In all combined ACL injuries and Segond fracture MRI cases, the complete ALL inserted on the avulsed bony fragment, whereas the posterior part of the ITB was only attached in 52.1% of the cases. Segond fracture fragment size was predictive for the structures attached to it. The ALL was abnormal in 64.5% of cases and presented a clear discontinuity in 6.3%. LEVEL OF EVIDENCE: Case Series, Level IV.

Magnetic Resonance Imaging Evaluation of the Anterolateral Ligament in Acute Anterior Cruciate Ligament Injuries in an Adolescent Population.

PURPOSE: To evaluate the frequency of anterolateral ligament (ALL) injuries in acute anterior cruciate ligament (ACL) injuries in adolescent patients using magnetic resonance imaging (MRI) and characterize other potential intra- and extra-articular knee injuries that are associated with ALL injuries. METHODS: Patients between 14 and 17 years of age with acute ACL injuries (trauma for <3 weeks before examination) were retrospectively evaluated with MRI over 24 months (January 2016-December 2017). Among this population, ALL was classified as not visible, normal, or injured. Injuries were separated into strains (partial injuries), complete injuries, or Segond fractures. Possible abnormalities of the menisci, collateral ligaments, popliteal tendon, posterior cruciate ligament (PCL), iliotibial tract (ITT), and bone injuries were evaluated. Associations were calculated between ALL injuries and injuries of these other knee structures, as well as age and gender. RESULTS: ALL was visible in 171 of the 184 MRI-evaluated knees (92.9%). ALL was considered normal in 68 (39.8%) and damaged in 103 (60.2%) patients. ALL injuries were considered partial in 56 (54.4%) and total in 44 (42.7%) cases. Only 3 (2.9%) cases were Segond fractures. ALL injuries were associated with ITT (P < .0001), lateral meniscus (P = .04), lateral collateral ligament (P = .01), popliteal tendon (P = .001), and medial collateral ligament (P = .009) injuries, in addition to bone contusions in the lateral compartment of the knee (P < .0001). There was no correlation between ALL injuries and medial meniscus (P = .054) or PCL (P = .16) injuries. CONCLUSIONS: MRI evaluation showed ALL injuries are present in 60.2% of acute ACL injuries in adolescent patients. These injuries are associated with the medial and lateral collateral ligaments, ITT, lateral meniscus injuries, and bone contusions, but they are not associated with medial meniscus or PCL injuries. LEVEL OF EVIDENCE: Level IV, case series.

Magnetic resonance imaging assessment of the normal knee anterolateral ligament in children and adolescents.

OBJECTIVE: To characterize the anterolateral ligament (ALL) in normal knees of pediatric patients by magnetic resonance imaging (MRI) and to establish the age at which it is possible to visualize its presence and whether there are differences between male and female populations. MATERIALS AND METHODS: MRI scans of patients younger than 18 years were retrospectively evaluated. The exams were performed in 1.5-T scanners. The ALL was characterized dichotomously as visualized or not visualized based on the assessment criteria of this structure in adult patients. The characterization of the ALL was divided according to sex and age. RESULTS: A total of 363 knee MRI scans were evaluated, 200 from male and 163 from female patients. The ALL was more frequently visualized in coronal sequences. The mean ALL visualization in pediatric patients was 69.4% and was lower in younger patients and higher in patients close to 18 years. It was not possible to visualize the ALL in female patients younger than 7 years or in male patients younger than 6 years. In patients between 17 and 18 years of age, the ALL was visualized in 100% of cases in both sexes. CONCLUSIONS: Visualization of the ALL increased with age in both sexes. Only after age 13 in females and age 15 in males was visualization of the ALL close to 70%; thus, below these ages, we believe that the characterization of this structure with conventional protocols is still imprecise.

Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging in Acute Injuries of the Anterior Cruciate Ligament.

PURPOSE: To evaluate the epidemiology of injuries and abnormalities of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in cases of acute anterior cruciate ligament (ACL) injury. METHODS: MRIs of patients with acute ACL injury were evaluated. Acute injuries of the ACL were considered in cases in which the patient reported knee trauma occurring less than 3 weeks prior and when bone bruise in the femoral condyles and tibial plateau was identified. ALL abnormality was considered when it showed proximal or distal bone detachment, discontinuity of fibers, or irregular contour associated with periligamentous edema. The ALL was divided into femoral, tibial, and meniscal portions, and the lesions and/or abnormalities of each portion were characterized. The correlation of ALL injury with injuries of the lateral meniscus was evaluated. RESULTS: A total of 101 MRIs were initially evaluated. The ALL was not characterized in 13 (12.8%) examinations, resulting in 88 (87.1%) cases of injury evaluation. Of these, 55 (54.4%) patients had a normal ALL, and 33 (32.6%) showed signs of injury. Among the cases with injury, 24 (72%) patients showed proximal lesions, 7 (21%) showed distal lesions, and 2 (6.0%) patients presented both proximal and distal lesions. The meniscal portion of the ALL appeared abnormal in 16 (48%) patients. No relationship was found between ALL injury and lateral meniscus injury. CONCLUSIONS: Based on MRI analysis of acute ACL injuries with bone bruising of the lateral femoral condyle and lateral tibial plateau, approximately a third demonstrated ALL injuries of which the majority was proximal. LEVEL OF EVIDENCE: Level IV, case series.

Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament.

PURPOSE: Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. METHODS: Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. RESULTS: Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. CONCLUSION: ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation, especially if a high degree of anterolateral instability is present on physical examination. LEVEL OF EVIDENCE: III.

MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans.

OBJECTIVE: This study evaluated the ability of routine 1.5-T MRI scans to visualize the anterolateral ligament (ALL) and describe its path and anatomic relations with lateral knee structures. MATERIALS AND METHODS: Thirty-nine 1.5-T MRI scans of the knee were evaluated. The scans included an MRI knee protocol with T1-weighted sequences, T2-weighted sequences with fat saturation, and proton density (PD)-weighted fast spin-echo sequences. Two radiologists separately reviewed all MRI scans to evaluate interobserver reliability. The ALL was divided into three portions for analyses: femoral, meniscal, and tibial. The path of the ALL was evaluated with regard to known structural parameters previously studied in this region. RESULTS: At least a portion of the ALL was visualized in 38 (97.8%) cases. The meniscal portion was most visualized (94.8%), followed by the femoral (89.7%) and the tibial (79.4%) portions. The three portions of the ALL were visualized in 28 (71.7%) patients. The ALL was characterized with greater clarity on the coronal plane and was visualized as a thin, linear structure. The T1-weighted sequences showed a statistically inferior ligament visibility frequency. With regard to the T2 and PD evaluations, although the visualization frequency in PD was higher for the three portions of the ligament, only the femoral portion showed significant values. CONCLUSION: The ALL can be visualized in routine 1.5-T MRI scans. Although some of the ligament could be depicted in nearly all of the scans (97.4%), it could only be observed in its entirety in about 71.7% of the tests.

Anterolateral Ligament and Kaplan Fiber Injury Both Occur Frequently in Acute Anterior Cruciate Ligament-Injured Knees.

BACKGROUND AND OBJECTIVES: The association of ALL and KF injuries in anterior cruciate ligament (ACL)-deficient knees remain topics of conflicting research despite improved magnetic resonance imaging (MRI). We aimed to evaluate the rate of the anterolateral ligament (ALL) and Kaplan fibers (KF) injuries in adults with acute ACL injuries using MRI. METHODS: We retrospectively reviewed 64 patients with clinical and MRI diagnoses of acute ACL tears. Two radiologists analyzed and categorized the status of the ALL and KF in all patients as intact, partially injured, or completely injured. Interobserver agreement was assessed. Injuries to the collateral ligaments, ITB and posterior cruciate ligament (PCL) were also evaluated. RESULTS: The mean age of the patients was 33 years. ALL injuries were observed in 46 (71%) patients, among whom 33 (71%) had partial and 13 (28%) had complete injuries. KF injuries were identified in 32 (50%) patients, with 28 (87.5%) of them having partial and 4 (12.5%) having complete injuries. Combined injuries of both ALL and KF were found in 25 (32.4%) patients (p-value of 0.266). The agreement between the examiners ranged from moderate to substantial (Kappa between 0.55 and 0.75), with the highest agreement observed in cases of KF injuries (Kappa = 0.75). CONCLUSIONS: ALL and KF injuries were prevalent in acute ACL-injured knees with rates of injury of 71% and 50%, respectively. ALL injuries were more frequent and more frequently severe compared to KF injuries.

Accuracy of an artificial intelligence algorithm for detecting moderate-to-severe vertebral compression fractures on abdominal and thoracic computed tomography scans.

Objective: To describe the accuracy of HealthVCF, a software product that uses artificial intelligence, in the detection of incidental moderate-to-severe vertebral compression fractures (VCFs) on chest and abdominal computed tomography scans. Materials and Methods: We included a consecutive sample of 899 chest and abdominal computed tomography scans of patients 51-99 years of age. Scans were retrospectively evaluated by the software and by two specialists in musculoskeletal imaging for the presence of VCFs with vertebral body height loss > 25%. We compared the software analysis with that of a general radiologist, using the evaluation of the two specialists as the reference. Results: The software showed a diagnostic accuracy of 89.6% (95% CI: 87.4-91.5%) for moderate-to-severe VCFs, with a sensitivity of 73.8%, a specificity of 92.7%, and a negative predictive value of 94.8%. Among the 145 positive scans detected by the software, the general radiologist failed to report the fractures in 62 (42.8%), and the algorithm detected additional fractures in 38 of those scans. Conclusion: The software has good accuracy for the detection of moderate-to-severe VCFs, with high specificity, and can increase the opportunistic detection rate of VCFs by radiologists who do not specialize in musculoskeletal imaging.

Objetivo: Descrever a acurácia do software HealthVCF na detecção incidental de fraturas compressivas de corpos vertebrais moderadas a graves em exames de tomografia computadorizada do tórax e abdome. Materiais e Métodos: Foram incluídos 899 exames consecutivos de pacientes com idades entre 51 e 99 anos. As imagens foram retrospectivamente avaliadas pelo software e por dois radiologistas especializados em musculoesquelético que investigaram fraturas compressivas de corpos vertebrais com perda da altura somática > 25%. A análise comparativa foi realizada entre o software e um radiologista geral, usando a avaliação do especialista como referência. Resultados: O software apresentou uma acurácia de 89,6% (IC 95%: 87,4­91,5%) para fraturas compressivas moderadas a graves, com sensibilidade de 73,8%, especificidade de 92,7% e valor preditivo negativo de 94,8%. Entre as 145 tomografias positivas detectadas pelo software, o radiologista geral deixou de relatar as fraturas em 62 (42,8%) e o algoritmo detectou fraturas adicionais em 38 dessas tomografias. Conclusão: O software possui boa acurácia na detecção de fraturas compressivas moderadas a graves, com alta especificidade, podendo aumentar a taxa de detecção oportunística dessas fraturas por radiologistas não especializados em musculoesquelético.

Unsuspected cerebrospinal fluid leak following a minor sacral fracture: A case report.

We describe a unique case of a 38-year-old female who presented at the emergency room due to a minor sacral fracture and local pain complicated by an initially undiagnosed cerebrospinal fluid (CSF) leak. This case emphasizes the importance of radiologists being attentive to subtle imaging findings of CSF leaks on computed tomography (CT) examinations, even in cases of low-energy traumas, as well as the complementary role of a dedicated magnetic resonance (MR) imaging protocol for such diagnosis.

Where is tibial edema located in cases of osteomeniscal impingement?

Objective: To characterize the location of tibial edema related to meniscal degeneration with a flap displaced into the meniscotibial recess (osteomeniscal impingement) on magnetic resonance imaging (MRI). Materials and Methods: We evaluated 40 MRI examinations of patients submitted to surgery due to inferior displacement of a meniscal flap tear into the meniscotibial recess and peripheral bone edema. Tibial edema was quantified in the coronal and axial planes. Results: On coronal MRI sequences, edema started in the tibial periphery and extended for a mean of 5.6 ± 1.4 mm, or 7.4 ± 2.1% of the tibial plateau. In the craniocaudal direction, the mean extension was 8.8 ± 2.9 mm. The mean ratio between the extent of craniocaudal and mediolateral edema was 1.6 ± 0.6. In the axial plane, the edema started in the medial periphery and extended for a mean of 6.2 ± 2.0 mm, or 8.2 ± 2.9% of the tibial plateau. In the anteroposterior measurement, the mean start and end of the edema was 21.4 ± 5.4 mm and 35.7 ± 5.7 mm, respectively, or 43.4 ± 10.2% and 72.8 ± 11.1% of the tibial plateau. Conclusion: Apparently, tibial edema resulting from osteomeniscal impingement always starts in the periphery of the meniscus. In the coronal plane, it appears to be more extensive in the craniocaudal direction than in the mediolateral direction. In the axial plane, we found it to extend, on average, approximately 6.2 mm in the mediolateral direction and to be most commonly located from the center to the posterior region of the medial tibial plateau.

Objetivo: Caracterizar a localização do edema ósseo tibial relacionado a lesão meniscal degenerativa com fragmento deslocado no recesso meniscotibial (impacto osteomeniscal) por meio de ressonância magnética (RM). Materiais e Métodos: Quarenta RMs de pacientes submetidos a cirurgia por fragmento deslocado do menisco medial no recesso meniscotibial e edema ósseo periférico foram avaliadas. Edema ósseo tibial foi quantificado nos planos coronal e axial. Resultados: No plano coronal, o edema iniciou-se na periferia tibial e estendeu-se por 5,6 ± 1,4 mm, ou 7,4 ± 2,1% do platô. Na direção craniocaudal, o edema estendeu-se em média 8,8 ± 2,9 mm. A média entre a extensão do edema craniocaudal e mediolateral foi 1,6 ± 0,6. No plano axial, o edema iniciou-se na periferia medial e estendeu-se por 6,2 ± 2,0 mm, ou 8,2 ± 2,9% da medida da tíbia. Na medida anteroposterior, o edema iniciou-se em 21,4 ± 5,4 mm e terminou em 35,7 ± 5,7 mm ou iniciou-se em 43,4 ± 10,2% e terminou em 72,8 ± 11,1% do platô tibial. Conclusão: O edema ósseo tibial relacionado aos casos de impacto osteomeniscal sempre se inicia na periferia do menisco. Ele é mais extenso na direção craniocaudal do que mediolateral no plano coronal. No plano axial, ele estende-se por 6,2 mm de medial a lateral e é mais frequentemente localizado no centro da região posterior do platô medial.

Iliotibial band reconstruction with allograft fasciae latae tissue: Imaging aspects of a novel surgical technique.

We describe a unique case of 43-year-old male who presented with a persistent lateral knee pain caused by impingement between a femoral surgical screw and the iliotibial band, which was treated with surgical resection of the screw debris. The patient had reincidence of the symptoms and a magnetic resonance showed a wide and unrepairable tear of the iliotibial band, which was treated with interposition of a folded fasciae latae allograf. After the procedure, the patient had excellent clinical results and imaging evaluation showed progressive allograft integration. This case highlights the imaging findings and surgical aspects of an iliotibial band reconstruction, a novel surgical procedure that could be considered in patients with an unrepairable iliotibial band injury.

Patient demographic and magnetic resonance imaging evaluation of isolated posterolateral corner knee injuries.

Background: Posterolateral stability of the knee is maintained by capsular, ligamentous and tendinous structures, which collectively are known as the posterolateral corner (PLC). Injuries to the PLC of the knee rarely occur without associated anterior (ACL) or posterior cruciate (PCL) ligament tears. The main objectives of our study were to report patient demographics and magnetic resonance imaging (MRI) findings of patients with isolated PLC injuries. Methods: This study consists of a retrospective analysis of knee MRI from January 2011 to June 2016, in two hospitals in São Paulo, Brazil, where PLC injuries without associated ACL and PCL injuries were identified in MRI by two radiologists specialized in musculoskeletal injuries. Relative and absolute frequencies were used to describe the injuries of each of the PLC structures in the study cases. Results: A total of 23 cases of PLC injuries without associated cruciate ligament injuries were identified. The mean age of patients was 32.0±8.1 years and 91% patients were male. The main sport associated with isolated PLC injury was Brazilian Jiu-Jitsu (48%), followed by soccer (35%). MRI evaluations of the knees showed lateral collateral ligament (LCL) injuries in 70% of cases, popliteus tendon injuries in 26% of cases and distal biceps tendon injuries in 30% of cases. The popliteofibular ligament (PFL) was damaged in 83% of cases. An associated ALL injury was observed in 43% of cases. Conclusions: Isolated PLC injuries occurred mainly in young men when practicing Brazilian Jiu-Jitsu and soccer. The LCL was the most frequently injured larger structure in association, and the capsuloligamentous structures (PFL) were the most frequently injured structures overall. ALL injuries occurred in approximately half of the cases, most often concomitantly with LCL injuries.

Imaging of solitary and multiple osteochondromas: From head to toe - A review.

Osteochondromas account for 20%-50% of all benign bone lesions. These tumors may present as solitary non-hereditary lesions, which are the most common presentation, or as multiple tumors associated with hereditary conditions. Plain radiography is the imaging method of choice and demonstrates the typical cortical and medullary continuity of the tumor with the underlying bone. Magnetic resonance imaging is often performed to evaluate cartilage cap thickness, which correlates with malignant transformation. Other local complications include compression of adjacent neurovascular bundles, muscles, and tendons, bursitis, tendon tears, stalk fracture, and angular or rotational long bone deformities. Although the imaging features of osteochondromas are largely known, only a few papers in the literature have focused on their main complications and image-based follow-up. This paper aimed to illustrate the main complications of osteochondromas, suggest an image-based algorithm for management and follow-up and discuss differential diagnosis.