MRI classification of calf injuries - a reliability study and correlation with return to play in professional rugby players.

OBJECTIVE: To assess the validity and reliability of the calf injury classification system proposed by the Olympic Park group which focuses on connective tissue structure integrity on MRI. MATERIALS AND METHODS: A retrospective study analysing calf muscle group injuries in an English Premiership professional rugby union club using the MRI classification proposed by the Olympic Park group. Classification on MRI examinations of 28 calf injuries sustained over a 6-year period was performed by three independent musculoskeletal radiologists to determine the inter-observer variability and correlation of the grade of injury with return-to-full-training (RTFT) time. RESULTS: RTFT time ranged from 5 to 110 days (mean = 40.1, SD = 26.4) following calf muscle injury. The Olympic Park classification injury grade demonstrated moderate to strong correlation with RTFT time (Spearman's rank correlation coefficient, 0.661-0.715, p < 0.01). RTFT time was statistically different between different injury grades (one-way ANOVA, p < 0.01). Inter-observer agreement of the overall grade between radiologist pairs was fair to moderate (weighted kappa 0.406-0.583). CONCLUSION: The Olympic Park classification system demonstrates moderate to strong correlation with time to RTFT following calf injury. Inter-observer reliability is fair to moderate.

MRI features of ERSA (exercise-related signal abnormality) lesions in professional soccer players.

OBJECTIVE: This study aims to describe the prevalence, anatomy and morphology of ERSA (exercise-related signal abnormality) lesions, a previously undescribed pattern of muscle signal changes on MRI in professional soccer players with suspected acute thigh muscle injury. METHODS: A multicenter retrospective review was performed of 287 MRIs of professional soccer players referred for suspected acute thigh injury from August 2017 to February 2020. MR images were reviewed for muscle signal abnormalities corresponding to a peritendinous ovoid region or a subfascial ring of faint increased signal on fluid-sensitive MR images. Imaging features including anatomical site, morphology, and craniocaudal length were recorded. Concomitant acute muscle injury was graded in accordance with the British Athletics Muscle Injury Classification (BAMIC). RESULTS: ERSA lesions comprising a peritendinous ovoid region, a subfascial ring, or both, were identified in 40 muscles across 31/287 studies (10.8%). These lesions had a mean length of 15.8 cm and were predominantly located in the proximal or mid-portions of muscles. Affected muscles were rectus femoris (n = 22), adductor longus (n = 11), semitendinosus (n = 6) and biceps femoris (n = 1). 21/31 studies (67.7%) had a BAMIC grade 1-4 injury in a separate muscle, which were largely (81%) in a separate anatomic compartment or contralateral. CONCLUSION: ERSA lesions were evident on MRI in 10.8% of our cohort of professional soccer players referred for suspected acute thigh muscle injury. Characteristic morphology and the longitudinal length (mean 15.8 cm) distinguish ERSA lesions from recognized patterns of acute muscle injury.

MRI findings of tibialis anterior friction syndrome: a mimic of tibial stress injury.

OBJECTIVE: To describe a distinct constellation of MRI demonstrated soft tissue abnormalities centred around the tibialis anterior tendon in a subset of patients presenting as suspected tibial stress injury. MATERIALS AND METHODS: A retrospective review was performed of the clinical and MRI imaging findings from 5 selected patients referred for MRI with suspected tibial stress injury. MRI studies at presentation of each case were systematically reviewed for peritendinous fluid, tibialis anterior tendon change, tibialis anterior muscle and myotendinous junction oedema, periosteal oedema over the tibia and tibial marrow oedema. RESULTS: All 5 cases were athletes (3 soccer players, 2 runners) of between 20 and 40 years of age. On MRI, all 5 cases demonstrated peritendinous fluid around an intact tibialis anterior tendon. This fluid was maximal at the junction of mid and distal thirds of the lower leg, and extended down to the superior extensor retinaculum, with a mean cranio-caudal length of 13 cm (range 8-17 cm). Associated oedema was present in the surrounding subcutaneous tissue, tibial periosteum and distal tibialis anterior musculotendinous junction. CONCLUSION: Peritendinous fluid around an intact tibialis anterior tendon over the mid-to-distal third tibia, with surrounding subcutaneous, periosteal and tibialis anterior myotendinous junction oedema is demonstrable on MRI in a subset of patients presenting as suspected tibial stress injury. A friction syndrome of tibialis anterior between the superior extensor retinaculum and the anterior tibia is proposed as the aetiology of this entity.

Should the webspaces be a review area for Mortons neuroma on computed tomographies performed for metatarsalgia?

PURPOSE: Morton's neuroma-bursal complex (MNBC) is a common cause of metatarsalgia which is usually investigated with ultrasound. Patients presenting with metatarsalgia may also have computed tomography (CT) as part of their investigation to look for alternative causes such as stress fracture. Although CT is considered to be of most use in assessing the bones in this scenario, the soft tissues can also be reviewed. This study analyses whether MNBC can reliably be detected on CT in patients presenting with metatarsalgia. MATERIAL AND METHODS: 43 cases were identified on the Radiology Information System where both CT and ultrasound had been undertaken to assess for metatarsalgia. Two blinded consultant musculoskeletal radiologists retrospectively reviewed the CTs to determine the presence or absence of MNBC and this was compared to the ultrasound reports. RESULTS: There was a mean sensitivity of 45.5% and mean specificity of 62.5%. Mean accuracy was 52.3% and Youden's index was 0.080. There was fair agreement between the two reviewers with Cohen's κ of 0.62. CONCLUSIONS: Sensitivity and specificity of CT for MNBC are poor. CT should not be used as an isolated modality to make a definite diagnosis regarding the presence or absence of a MNBC.

The frondiform ligament sling: a sonographic landmark for injection into the sinus tarsi.

Localisation and injection of the sinus tarsi can be challenging, particularly for the less experienced musculoskeletal sonographer/practitioner. The inferior extensor retinaculum arises from the sinus tarsi in the form of three roots (medial, intermediate and lateral) which are collectively termed the frondiform ligament. This is readily identified on ultrasound and can be used as a reference point to aid the safe delivery of injectate material into the sinus tarsi. This article describes the technique and its anatomical basis.

Efficacy of ultrasound-guided steroid injections for pain management of midfoot joint degenerative disease.

OBJECTIVE: To examine the efficacy of ultrasound (US)-guided injections for midfoot joint degenerative changes. MATERIALS AND METHODS: The US images and radiographs of 63 patients with midfoot joint degenerative changes were retrospectively reviewed. In those patients who had US-guided intra-articular steroid injection, the response to the injection was recorded by reviewing the 2-week pain diaries and clinical notes. Partial or complete pain relief was defined as a positive response and the same or increased level of pain as a negative response to the injection. RESULTS: Fifty-nine (59/63, 93.6%) patients with midfoot joint degenerative changes received US-guided injection. The majority of patients had a positive response up to 3 months post-injection (78.4% still experiencing pain relief at 2 weeks, 57.5% at 3 months and fewer than 15% of patients further than 3 months post-injection). The number of positive therapeutic responses did not differ significantly between patients with diagnostic and non-diagnostic response (p = 0.2636). CONCLUSIONS: US-guided intra-articular injections for midfoot degenerative changes can have a good therapeutic result in the majority of patients up to 3 months post-injection. Therapeutic response cannot be predicted by a positive diagnostic response.

Chronic Wear-Induced Bearing Dislocation in a Fixed-Bearing Unicompartmental Knee Arthroplasty: A Case Report.

Case: We present a case of late onset, bearing wear-induced failure of locking mechanism, resulting in bearing dislocation and rapidly progressive severe metallosis in a medial fixed-bearing (FB) unicompartmental knee arthroplasty (UKA). Conclusion: Bearing dislocation is a rare complication of chronic wear in FB UKA, and early recognition is essential to prevent metallic component articulation-induced metallosis and catastrophic failure.

Lesions of the heel fat pad.

OBJECTIVE: The heel fat pad (HFP) is a specialized soft tissue structure formed of adipose tissue that overlies the inferior and posterior aspect of the calcaneus and provides the cushioning effect of the heel. Lesions of the HFP are rare and can be a cause of debilitating heel pain that may often pose a challenge to clinicians. This study provides a series of lesions identified within the HFP. METHODS AND MATERIALS: A retrospective review of heel pad lesions over a 12 year period was conducted at our tertiary orthopaedic oncology centre. All lesions of the heel fat pad were included in the study. Plantar fasciitis was excluded. RESULTS: There were 17 heel pad lesions identified, of which the majority (n = 15) were benign. CONCLUSION: We highlight a wide spectrum of pathologies that can occur in the HFP. Although rare, clinicians should be aware of these lesions, to initiate appropriate management.

Radiation exposure during the treatment of spinal deformities.

AIMS: To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. METHODS: Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). RESULTS: There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. CONCLUSION: The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible. Cite this article: Bone Joint J 2021;103-B(4):1-7.

Myositis ossificans of mobile wad of Henry-Tennis elbow mimic.

Lateral epicondylitis also known as "tennis elbow" is the most common cause of lateral elbow pain. Several pathologies can mimic symptoms of tennis elbow. We present a case of myositis ossificans within the mobile wad of Henry (MWH), which presented with symptoms of tennis elbow and believe this to be the first reported case in literature.

Exploring the correlation between increased femoral anteversion and pars interarticularis defects in the lumbar spine: A single center experience.

INTRODUCTION: Altered femoral version can result in lumbar hyperlordosis and hip spine syndrome. We conducted a retrosepctive study to evalute if there is correlation between altered femoral version and pars defect. MATERAL AND METHODS: A cohort of pateints with CT rotational profile and MR of lumbar spine over a 12 year period were included in the sutdy. The femoral version was calculated and the MR was evaluated for pars defect. RESULTS: 130 patients had CT rotational profile and MR of lumbar spine with a female predomiannce (94 female and 36 males) and average age of 24.3 years. There were 6 patients with bilateral pars defects involving L5 (3 with increased femoral version, 2 with decreased version and one had normal version). CONCLUSION: Increased femoral anterversion is not associated with increased prevalence of pars defects.

Technical report: dynamic assessment of plantar fasciitis and plantar fascia tears utilising dorsiflexion of the great toe.

Discrimination between plantar fasciitis and partial tears of the plantar fascia can be difficult on ultrasound given laxity of the plantar fascia in the region of its calcaneal insertion and anisotropy. Dynamic assessment with great toe dorsiflexion can improve visualisation of the proximal portion of the plantar fascia on ultrasound, by straightening the plantar fascia due to the windlass mechanism. This article describes the technique and its anatomical basis.

Temporal stability and assignment power of adaptively divergent genomic regions between herring (Clupea harengus) seasonal spawning aggregations.

Atlantic herring (Clupea harengus), a vital ecosystem component and target of the largest Northwest Atlantic pelagic fishery, undergo seasonal spawning migrations that result in elusive sympatric population structure. Herring spawn mostly in fall or spring, and genomic differentiation was recently detected between these groups. Here we used a subset of this differentiation, 66 single nucleotide polymorphisms (SNPs) to analyze the temporal dynamics of this local adaptation and the applicability of SNP subsets in stock assessment. We showed remarkable temporal stability of genomic differentiation corresponding to spawning season, between samples taken a decade apart (2005 N = 90 vs. 2014 N = 71) in the Gulf of St. Lawrence, and new evidence of limited interbreeding between spawning components. We also examined an understudied and overexploited herring population in Bras d'Or lake (N = 97); using highly reduced SNP panels (N SNPs > 6), we verified little-known sympatric spawning populations within this unique inland sea. These results describe consistent local adaptation, arising from asynchronous reproduction in a migratory and dynamic marine species. Our research demonstrates the efficiency and precision of SNP-based assessments of sympatric subpopulations; and indeed, this temporally stable local adaptation underlines the importance of such fine-scale management practices.