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.

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.

Anatomical and radiological study applied to distal radius surgery.

PURPOSE: The purpose of this study was to determine, during anterior plating of the distal radius, the length of a screw above which there is a risk for the extensor tendons and the optimal shape of an anterior plate. It was also to determine the projection of the axis of the distal third of the radius on the distal articular surface in case of wrist arthroplasty in order to simplify the procedure. METHODS: We studied 74 dry radii from adult cadavers. Each one underwent a CT scan. We measured the thickness of each radius at the dorsal tubercle level, at the second compartment level and at the third compartment level. We calculated the metaphyseal-epiphyseal angles of the lateral column and of the intermediate column (Rikli and Regazzoni in J Bone Joint Surg (Br) 78(4):588-592, 1996). We also calculated the projection of the longitudinal axis of the most distal 7 cm of the radius on the distal carpal surface of the radius. RESULTS: Mean thickness at the dorsal tubercle level was 22.1 mm (18-26.1). The mean slope of the lateral column was 155° (143-167) while that of the intermediate column was 145° (134-153). We have found a statistically significant difference (p < 0.0001) between these two slopes. The axis of the distal radius was projected on the posterior-lateral quadrant of the distal articular surface. CONCLUSIONS: The emergence of new implants needs a precise evaluation of a fractured, an arthritic or a reconstructed distal radius. The double slope of the distal radius complicates the manufacturing of an "anatomical" plate. The optimal shape is between these two slopes. Moreover, ancillaries for wrist replacement are still approximations, which means that it is important to know the projection of the radial axis on the articular surface of the distal radius.

[Rotator cuff tears: value of 3.0T MRI]. / Perforations de la coiffe des rotateurs: intérêt de l'IRM 3,0T.

PURPOSE: To demonstrate the value of 3.0T MR imaging for the detection of rotator cuff tendon tears and surgical planning by correlating imaging findings to surgical findings. Materials and methods. Prospective follow-up of patients who underwent 3.0T MR imaging of the shoulder in our department between November 2005 and June 2007. Surgical findings were correlated to imaging findings for 48 patients who underwent surgery: detection, size, partial thickness or complete, and tendon edges. RESULTS: In this patient group, the positive predictive value of MRI for detecting surgical tears was 100% (100% of complete tears and 92% of partial thickness tears). No change in surgical management was recorded when arthroscopy was performed based on MRI findings (size of tear). CONCLUSION: 3.0 T MRI is valuable for the detection of small tears, especially for partial thickness tears due to increased spatial resolution. The identification of surgical candidates and surgical planning are improved due to more accurate measurements of tear size and quality of the tendon edges.

[Evaluation of the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy]. / Evaluation de l'efficacité des infiltrations canalaires et foraminales de corticoïdes guidées par TDM dans le traitement des radiculalgies par conflit disco radiculaire.

PURPOSE: To evaluate the efficacy of CT-guided epidural and transforaminal steroid injections in patients with diskogenic radiculopathy. MATERIALS AND METHODS: Seventy patients underwent CT guided injections after failure of medical management. Only patients with minimal degenerative changes and diskogenic monoradicular symptoms were treated. Only two patients with fibrosis were included. RESULTS: 78.6% of patients experienced persistent symptomatic improvement. No difference was noted between lumbar segments and there was no more failures with epidural injections compared to transforaminal injections. Cervical disk herniations responded better than lumbar disk herniations. Good results were obtained in younger patients (M=46.25 years), symptomatic for 3-4 months or less, and with clear radicular symptoms and clinical neurological deficits (hypoesthesia, absent DTR) without motor deficit. No patient with severe spinal stenosis (S-) was included and the disk herniations were small (b1, b2, c1, c2 or d1, d2). Only a single injection was needed. Cortivazol provided superior results compared to dexamethasone. CONCLUSION: CT-guided injections should be included in the therapeutic armamentarium after standard medical management, with cure as the goal.

[Combined bipolar radiofrequency and cementoplasty of bone metastases]. / Radiofréquence bipolaire et cimentoplastie dans le traitement des métastases osseuses.

Bone metastases are the most common cause of pain in cancer patients. Pain management in cancer patients, often revealing the disease and always present at advanced stages, is an important and difficult task. Pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous neurolysis, infiltrations, alcoholizations and cementoplasty may be considered. More recently RF ablation has been proposed. On weight-bearing bones, RF can be combined with acrylic cement injection. The authors present here this very effective new technique which is complementary to classical pain management techniques.

[Ganglion cyst rupture in the retro-femoral fat: a report of two cases]. / Rupture de kyste mucoïde dans la graisse rétro-fémorale: à propos de deux cas.

Ganglion cysts are ubiquitous cystic lesions without synovial wall and inconstant communication with the articular cavity. The later must nonetheless always be carefully looked for. We report two cases of ganglion cyst rupture in the retrofemoral fat simulating phlebitis with thigh cellulitis. To the best of our knowledge, this has not been previously reported in the literature. Familiarity with this entity ensures adequate medical diagnosis and management, avoiding unnecessary imaging and laboratory work-up and inappropriate use of anticoagulant and antibiotic.

[Pain management in bone metastasis of pulmonary origin: new interventional and metabolic techniques]. / Nouvelles techniques interventionnelles et métaboliques dans la prise en charge des métastases osseuses.

Invasion of bone by a metastatic lesion is the most common cause of pain in cancer patients. Pain management in these patients is an important and difficult task. The pain is not always properly controlled by high doses of specific medication, radiation therapy or chemotherapy. When these therapies do not provide adequate pain relief, percutaneous vertebroplasty, cementoplasty, radiofrequency ablation and internal radiotherapy appear to be elegant and efficient complementary alternative pain control methods.

[True isolated atherosclerotic aneurysm of the axillary artery]. / Anévrisme vrai isolé d'origine athéromateuse de l'artère axillaire.

The true atherosclerotic aneurysm of the axillary artery is a rare condition. It either presents as a pulsatile axillary mass or arterial emboli in the hand and fingers. We report the case of a 70-year-old man with a 5 cm aneurysm of the axillary artery presenting with embolic disease to the hand. Angiography is helpful and provides valuable preoperative anatomic details. Surgery remains the treatment of choice but endovascular treatment can also be considered.

[Fluid-fluid level in an intra-osseous ganglion cyst of the talus]. / Niveau liquide-liquide dans un kyste mucoïde intra-osseux du talus.

The author report a very rare case of fluid-fluid level in an intra-osseous ganglion cyst of the talus that was detected on CT and MR imaging. Pre-operative diagnosis was suggested by the presence of a communication between the talo-cuboid joint and the cyst, as shown at MR Arthrography.

Percutaneous ethanol injection into parathyroid adenomas: mid- and long-term results.

The aim of this study was to evaluate mid- and long-term results of ultrasonically guided ethanol injection into parathyroid adenomas. From 1988 to 1996, 27 patients (mean age 77 +/- 13 years) were treated for parathyroid adenomas by percutaneous ethanol injection. The survey included clinical information, plasma calcium, phosphorus and PTH (1-84) evaluation. Follow-up lasted 22.6 +/- 10 months. No major complications were observed for 63 ethanol injections. Biochemical recovery was 58%, biochemical improvement at 3 months was 33%, and failure was 7%. Four of 15 cured patients presented a recurrence of the disease 1 or 2 years after the first treatment. Ultrasonically guided ethanol injection can be useful in the treatment of parathyroid adenomas when surgery is not possible. The immediate results are interesting but not as good as those obtained with surgery. A regular biochemical survey is necessary so that recurrences can be recognized and treated at an early stage.

[Subcutaneous trochanteric bursitis: an unrecognized cause of peritrochanteric pain revealed by imaging]. / La bursite sous-cutanée trochantérique. Cause méconnue de douleur péritrochantérienne révélée par l'imagerie.

We present four cases of subcutanea trochanterica bursitis (one involving both sides). The bursitis was acute and inflammatory in two cases, chronic and microtraumatic in one, asymptomatic in one and septic in the last case. The acutely inflamed bursa may contain a blood effusion increasing the pain. CT and MRI provide distinctive images for the diagnosis of these particular types of periarticular diseases.

[Comparison between iopamidol and ioxaglate in digital arteriography of the lower limbs]. / Comparison du iopamidol et du ioxaglate en artériographie numérisée des membres inférieurs.

This prospective study concerning 100 subtraction angiographies of the lower limbs compared two iodine concentrations of iopamidol (300 and 370 mg l/l) and ioxaglate (320 and 350 mg l/l). More pain and movements disturbed the subtraction with iopamidol 370 in comparison with ionic contrast media (p < 0.005). The quality of the contrast was better with ioxaglate 350 (p = 0.05) than with the others. This one appears to be a good compromise for this type of examination.

[MRI of the semicircular canals in cranio-facial asymmetries and craniomandibular syndrome]. / IRM des canaux semi-circulaires dans les asymétries crânio-faciales et le syndrome crânio-mandibulaire.

The cranio-mandibular syndrome (CMS) is often secondary to an cranio-facial asymmetry (CFA); it associate a painful masticatory dysfunction syndrome with functional and aching clinical signs in relation with a functional torticollis required for oculo-labyrinthal equilibration maintenance. Our anatomical and functional MRI protocol uses tridimensional study of semi-circular canals (SCC) up relation to the medial cerebral axis (MCA), and permit to measure precisely these CFA and propose, with a multispecialist approach, an adapted treatment of the SCM. Application of MRI to SCC asymmetry looks to its future use for spatial intracranial referencial of cerebral structures.

[Spontaneous disappearance of herniation pit on the femoral neck]. / Disparition spontanée d'une lacune sous-corticale du col fémoral.

The authors present a case of a 39 years old patient who had a herniation pit of the left femoral neck, 5 years ago. This lesion disappeared spontaneously. To our knowledge, no report of healing of a herniation pit has been previously described.

[Percutaneous angioscopy and angioplasty in the treatment of arteriopathies of the lower limbs]. / Angioscopie et angioplastie percutanées dans le traitement des artériopathies des membres inférieurs.

Since 1987, the authors have routinely combined angioscopy with angioplasty of peripheral arteries. In a series of 251 angioplasties carried out in 191 patients, angioscopy was found to be more specific and more sensitive than arterial angiography in the etiological diagnosis of arterial stenoses and/or obstructions. Angioscopic findings modified the angioplasty procedure in 29% of cases. Using an inflatable catheter remains the most commonly used approach (230 cases); in 10 cases, this was preceded by thromboaspiration and in 4 cases by dotterization. Angioscopic support was useful in carrying out difficult manoeuvres (monitoring of the angioplasty in 4 cases, correct orientation of the guide into the lumen in 14 cases, installation of an endoprosthesis in 9 cases, arterial biopsy in 5 cases and sampling of an atheroma in 8 cases).

[Chondrosarcoma of the femur neck simulating a normal variant. A difficult diagnostic pitfall]. / Chondrosarcome du col fémoral simulant une variante de la normale. Un redoutable piège diagnostique.

We report a case of chondrosarcoma of the femoral neck wrongly considered as a normal variant during a long time due to the initial aspect on the plain films and its location. Precise radiological criteria must allow the differential diagnosis and will be detailed.