Magnetic resonance imaging in patellar lateral femoral friction syndrome (PLFFS): prospective case-control study.

OBJECTIVES: To describe morphologic abnormalities and signs of patellar lateral femoral friction syndrome (PLFFS) detected by magnetic resonance imaging (MRI). MATERIALS AND METHODS: Prospective study of 56 knees (21 patients and 30 controls) studied by 3Tesla MRI. Comparative analysis of clinical data, quantitative and qualitative imaging criteria in a population of patients with anterior knee pain associated with an abnormal MRI signal along the lateral alar folds of the infrapatellar fat pad, a characteristic sign of PLFFS, and a control population with no anterior knee pain or abnormal signal from the infrapatellar fat pad. RESULTS: Patients with PLFFS have anterior and/or lateral knee pain. Their knee has anatomical predispositions for instability, primarily with patella alta (P<0.0001), patellar tilt more than 13.5° (P<0.0001), a patellar nose length less than 9 mm (P=0.0037), a patellar nose ratio less than 0.25 (P<0.0001), a TT-TG distance more than 10 mm (P<0.0001), and a trochlear prominence more than 4 mm (P=0.0056). In 35% of patients, patellar chondropathy is visible, and 48% of patients have patellar or trochlear subchondral abnormalities. CONCLUSION: Anterior, lateral, and medial knee pain may be related to PLFFS. Anatomical predispositions contributing to instability are found in these patients. There may be associated chondropathies and osteochondropathies.

[Transient elastography of calcaneal tendon: preliminary results and future prospects]. / Élastographie transitoire du tendon calcanéen: résultats préliminaires et perspectives.

PURPOSE: To evaluate transient ShearWave elastography of the normal Achilles' tendon. PATIENTS AND METHODS: The Achilles' tendon of 30 normal subjects were prospectively assessed using a Rubi V1Sq prototype (Supersonic Imagine). Quantitative elastography maps displayed in kilopascals with a scale of 0 to 600kPa were generated from transverse and longitudinal images at 3 different levels of plantar flexion. Subgroups were compared and analyzed based on proven or suspected variation factors (age, gender, level of physical activity). RESULTS: On sagittal images, mean elasticity was 104±46kPa during extension, 464±144kPa in neutral position and 410±196kPa during maximum dorsiflexion. There was significant increase in elasticity when the Achilles' tendon was maximally stretched (p<0.01). The intra-individual correlation between right and left tendons during ankle extension was good (Pearson Coefficient 0.8; p<0.01). Finally, physically active subjects showed significantly greater elasticity than non-active subjects (p<0.05). CONCLUSION: Transient ShearWave elastography of the Achilles' tendon is a simple technique that provides real-time information about tissue elasticity.

Suture anchor reinsertion of distal biceps rupture: clinical results and radiological assessment of tendon healing.

INTRODUCTION: The present study consisted in a clinical follow-up of patients with distal rupture of the biceps brachii tendon managed by suture anchor reinsertion to the radial tuberosity. Tendon apposition on the cortical bone is the least resistant reinsertion technique according to biomechanical studies. A parallel radiological (X-ray and MRI) study was therefore performed to assess the exact quality of tendon healing and its correlation to clinical results. PATIENTS AND METHODS: Twenty-eight patients were followed up retrospectively at a mean 22 months (minimum FU: six months) with clinical examination (mobility, force, satisfaction, residual pain, and return to work) and radiological assessment (standard X-ray exploration for heterotopic ossification, and MRI for quality of healing of the tendon apposed to the cortical bone). RESULTS: Forty percent of cases showed complications (mainly neurological) which resolved without sequelae under medical treatment. Mobility was normal in all but eight patients who showed -5° to -20° supination loss. Force in flexion-supination was 91% of that on the contralateral side. On X-ray, only 46% of patients were free of ossification. On MRI, reinsertion was judged anatomic in 19 patients (70%), moderate in six and poor in two, with one iterative rupture. Statistical analysis revealed that the greater the number of suture tacks through the tendon, the greater the force in patients with less than two weeks' interval to surgery and satisfactory reinsertion on MRI. DISCUSSION: Many reinsertion techniques have been reported, giving clinical results similar to one another and to the present findings. The complications rate, in contrast, varies according to technique and surgical approach. Radiologically, 70% of reinsertions were satisfactory: healing with the tendon apposed on the cortical bone is thus a reliable technique. Heterotopic ossification is considered benign in the literature. The present radiological study refined this notion by identifying three types of ossification: pure asymptomatic intratendon ossification; pure asymptomatic tuberosity ossification without impact on healing on the radial tuberosity; and tuberosity ossification with associated boney metaplasia of the terminal part of the reinserted tendon, impairing healing and leading to less satisfactory clinical results. To ensure anatomic healing of the distal biceps tendon, we recommend less than two weeks' interval to surgery and at least two suture tacks to obtain good apposition on the radial tuberosity.

Small bowel obstruction due to broad ligament hernia: computed tomography findings.

We report a case of surgically confirmed small bowel obstruction due to hernia through a defect in the broad ligament. Multi-detector computed tomography (CT) demonstrated the presence and the precise location of this very unusual internal pelvic hernia. Those CT findings are presented here.