Increased signal in the proximal patellar tendon: normal or pathologic?

OBJECTIVE: To determine the clinical significance of T2 signal hyperintensity in the proximal patellar tendon seen on MRI of the knee. MATERIALS AND METHODS: MRIs of 100 patients who underwent MRI of the knee between 1 May 2018 and 15 July 2018 were retrospectively evaluated. All examinations were performed on 3-Tesla MRI scanners with a dedicated knee coil and in accordance with our institution's standard knee MRI protocol. The presence of increased T2 signal was assessed on both sagittal and axial T2-weighted fat-saturated images. The amount of increased signal in the proximal patellar tendon on T2-weighted images was characterized as: none, mild, moderate, or severe. A corresponding chart review of the referring physicians' notes was performed to determine the presence of clinical symptoms of patellar tendinopathy. Patellar tendinopathy was considered present if the clinical notes described tenderness on palpation of the inferior patellar pole, infrapatellar tenderness, or patellar tendinosis/tendinitis. RESULTS: The majority (66%) of knee MRIs demonstrated the presence of increased T2 signal in the proximal patellar tendon. Only 4.5% of these patients had associated clinical findings of patellar tendinopathy. CONCLUSION: Although increased T2 signal in the proximal patellar tendon is a common finding, only in rare cases are there associated clinical symptoms. Thus, increased T2 signal in the proximal patellar tendon may not be a pathological finding in the absence of clinical findings of patellar tendinopathy.

Elbow Arthroplasty: From Normal to Failure.

Total elbow arthroplasty is currently an established surgical treatment for several pathologies of the elbow. Although initially used primarily in the treatment of rheumatoid arthritis, indications for total elbow arthroplasty have expanded and now include trauma, primary and secondary osteoarthritis, fracture nonunion, and following neoplasm resection. Desired outcomes of elbow arthroplasty include decreasing patient pain, restoration of function and mobility, and prevention of or treatment for instability. In comparison with total elbow arthroplasty, radial head replacements are most commonly performed following trauma. An additional technique, capitellar resurfacing arthroplasty, was developed in an effort to prevent early-onset osteoarthritis secondary to altered elbow biomechanics following radial head replacement. Complications of these surgeries include loosening, fracture, instability and dissociation, bushing wear, and particle disease.

Outcomes of Demineralized Bone Matrix Enriched with Concentrated Bone Marrow Aspirate in Lumbar Fusion.

BACKGROUND: Multiple studies have demonstrated that a significant amount of variability exists in various demineralized bone matrix (DBM) formulations, which casts doubts on its reliability in consistently promoting fusion. Bone marrow aspirate (BMA) is a cellular based graft that contains mesenchymal stem cells (MSCs) and growth factors can confer osteogenic and osteoinductive potential to DBM. The goal of this study was to describe the outcome of DBM enriched with concentrated BMA in patients undergoing combined lumbar interbody and posterolateral fusion. METHODS: Eighty patients with a minimum of 12 months of follow-up were evaluated. Fusion and rates of complication were evaluated. Functional outcomes were assessed based on the modified Odom's criteria. Multiple logistic regression analysis was used to examine the effects of independent variables on fusion outcome. RESULTS: The overall rate of solid fusion (i.e patients with both solid posterolateral and interbody fusion) was 81.3% (65/80). Specifically, the radiographic evidence of solid posterolateral and interbody fusions were 81.3% (65/80) and 92.5% (74/80), respectively. Seven (8.75%) patients developed hardware-related complications, 2 (2.5%) patients developed a postoperative infection and 2 (2.5%) patients developed clinical pseudarthrosis. Charlson comorbidity index (CCI) scores of 3 and 4 were associated with non-solid unions (CCI-3, p = 0.048; CCI-4, p = 0.03). Excellent or good outcomes were achieved in 58 (72.5%) patients. CONCLUSIONS: Patients undergoing lumbar fusion using an enriched bone graft containing concentrated BMA added to DBM can achieve successful fusion with relatively low complications and good functional outcomes. Despite these findings, more studies with higher level of evidence are needed to better understand the efficacy of this promising graft option.

MR Imaging and US of the Wrist Tendons.

The tendons of the wrist are commonly symptomatic. They can be injured, infected, or inflamed. Magnetic resonance imaging and ultrasonography are useful tools for evaluating the wrist. Pathologic conditions of the wrist tendons include de Quervain tenosynovitis, extensor carpi ulnaris tendinopathy, rheumatoid tenosynovitis, infectious synovitis, tendon tears, hydroxyapatite deposition disease, intersection syndrome, tenosynovial giant cell tumor, and fibroma of the tendon sheath. In this article, we review the normal appearance of the wrist tendons, discuss relevant anatomy, and give an overview of common pathologic conditions affecting the wrist tendons. Online supplemental material is available for this article. ©RSNA, 2016.

Magnetic resonance arthrography and the prevalence of acetabular labral tears in patients 50 years of age and older.

OBJECTIVE: Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph. MATERIALS AND METHODS: From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tönnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on radiographs. RESULTS AND CONCLUSIONS: On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.

Treatments for Kienböck disease: what the radiologist needs to know.

The etiology of Kienböck disease, or avascular necrosis of the lunate, is controversial, and there are a myriad of treatments aimed at correcting the various hypothesized pathologies. Interventions to reduce mechanical stress on the lunate have been used for decades, including radial osteotomy with or without radial shortening, ulnar lengthening and metaphyseal core decompression procedures. However, these procedures require preservation of lunate architecture. Newer procedures to revascularize the lunate bone have emerged in the last 10 years, such as pedicled corticoperiosteal vascularized bone grafting. Once there is collapse of the radiocarpal joint or midcarpal arthrosis, the conventional treatments have included proximal row carpectomy and complete or partial wrist joint arthrodesis. Newer salvage procedures such as lunate excision with autologous or synthetic interposition grafts are now being used when possible. As this disease is relatively rare, radiologists may not be familiar with the expected post-operative radiologic findings and complications, especially of the newer treatments. The goals of this paper are to review the available treatment options and their expected appearance on postoperative imaging, with discussion of possible complications when appropriate.

Ganglion Cyst of the Anterior Cruciate Ligament.

We present the case of a 55-year-old woman with a presumed ganglion cyst associated with the anterior cruciate ligament (ACL), demonstrated by MRI. The ACL is an uncommon location for ganglion cysts to occur.

Stump Entrapment of the Torn Anterior Cruciate Ligament.

We present a case of anterior cruciate ligament stump entrapment in a 24-year-old gentleman who traumatically injured his knee. The anterior stump became entrapped in the intercondylar notch and after a process of inflammation and fibrosis, produced a mass similar to the more familiar cyclops lesion that may complicate anterior cruciate ligament reconstruction.

Solitary fibrous tumor of pleura: a case report and review of clinical, radiographic and histologic findings.

We present a case of solitary fibrous tumor of pleura (SFTP) in a 63-year-old male. Clinical manifestations of this entity, including paraneoplastic syndromes, are discussed, albeit absent in our presented case. Furthermore radiographic findings and pathologic correlations are provided. SFTP remains a rare neoplasm for which radiographic features are suggestive yet nonspecific, and immunohistochemistry remains as the diagnostic method of choice.

Lipoma Arborescens of the Knee in a 17-Year-Old Man.

We present a case of lipoma arborescens of the knee in a 17-year-old man, discuss its characteristic imaging findings, and review the relevant differential diagnoses.