Imaging features for the evaluation of skin and nail infections.

Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions.

Apophyseal injuries in soccer players.

Soccer is the most popular sport worldwide, and it is associated with high injury rates, with most of these injuries occurring in the lower extremities. Particularly, in youth soccer players with immature skeleton, the physeal plate is two to five times weaker than the surrounding fibrous structures, and therefore more vulnerable to injury. The physeal plate consists of epiphyses and apophyses, with the former serving as tendon attachment sites and being subject to traction forces. There are two types of apophyseal injury: (i) apophyseal avulsion, which consists of an acute separation across the physeal plate; and (ii) apophysitis, an injury caused by chronic and repetitive contraction of musculotendon unit, leading to inflammation of the growth plate cartilage. Apophyses of the hip and pelvis are the most commonly injured in youth soccer players, due to vigorous contractions during sports activities and the fact that they tend to fuse later compared to other epiphyseal centers, making them more susceptible to injury. In this review, we will discuss the anatomy of lower limb apophyses and clinical and imaging findings of apophyseal injuries in youth soccer players, as well as briefly review treatment options and complications.

Can three-dimensional models enhance understanding and knowledge of rotator cuff tears?

OBJECTIVES: Magnetic resonance imaging (MRI) is currently the standard diagnostic tool for rotator cuff tears. However, its two-dimensional (2D) output, displayed on a monitor, can complicate the interpretation of anatomy. Three-dimensional (3D) imaging may offer a solution to this issue. This study aimed to demonstrate the diagnostic and interpretive value of a 3D model in assessing lesion anatomy. The hypothesis was that 3D models, compared to 2D MRI, can enhance the comprehension and knowledge of rotator cuff injuries, improve the application of classifications for total tears, and provide a more precise definition of the size and type of tear. METHODS: A prospective single-centre study was conducted. 3D models for rotator cuff tears were created and analysed in conjunction with preoperative MRI for each patient up to 2 months before surgery. The 3D models were based on the preoperative MRI. Collected data included 2D plane measurements by MRI in coronal and sagittal planes, descriptions of 3D lesion geometry (new shapes), 3D measurements in coronal and sagittal planes, arthroscopic classifications of rotator cuff injuries, and arthroscopic measurements in coronal and sagittal planes. RESULTS: After examining 25 cases, 3D imaging demonstrated similar arthroscopic values post-bursectomy in the sagittal plane (16.70 â€‹mm for 3D and 18.28 â€‹mm for post-bursectomy, p-value â€‹= â€‹0.189), although these measurements did not align with those of MRI (which underestimated measurements, p-value â€‹= â€‹0.010). Both MRI measurement and 3D imaging showed similar measurement accuracy in the coronal plane when compared to arthroscopic measurements taken before and after bursectomy. The creation of 3D objects enabled the analysis of new geometries, including the length, width, and depth of each lesion. These geometries included the rectangle, rectangular trapezoid, scalene trapezoid, irregular pentagon, and irregular hexagon. CONCLUSIONS: 3D models can enhance the understanding and knowledge of rotator cuff injuries. They can be a promising tool for diagnosing and interpreting the anatomy of the injury, particularly in the sagittal plane. The new 3D understanding of the pathological process has led to the description of new geometric features not visible in conventional 2D MRI. LEVEL OF EVIDENCE: II - Development of diagnostic criteria on consecutive patients (all compared to "gold" standard).

Ultrasound imaging of onychopapilloma: Evaluation of 43 cases.

INTRODUCTION: Onychopapilloma is a benign tumor presenting as an isolated benign warty distal matrix and bed lesion in association with longitudinal erythronychia for which no underlying cause can be identified. Diagnosis might be challenging due to other, more severe, causes of erythronychia. OBJECTIVES: This study aimed to investigate the clinical and sonographic features of onychopapilloma using high-frequency ultrasound. METHODS: Between February 2022 and May 2023, a cross-sectional study was conducted, involving 39 patients displaying clinical features suggestive of onychopapilloma. These patients were selected at random and underwent examination using high-frequency ultrasound. High-frequency ultrasound assessments of the nail unit were carried out using 33 MHz and 24 MHz high-frequency linear transducers. An experienced radiologist performed the ultrasound scans while participants assumed an orthostatic seated position. Subsequently, the collected ultrasound images were independently evaluated by two radiologists specializing in nail injuries, ensuring a blinded assessment. This evaluation aimed to provide comprehensive insights into the imaging characteristics of onychopapilloma. RESULTS: High-frequency ultrasound revealed oval or linear hyperechoic masses located in the middle of the nail plate, without vascularity or posterior acoustic shadowing. Nail plate irregularity, thickening, and nail bed indentation were observed in some cases. These findings demonstrate that high-frequency ultrasound can aid in the diagnosis and surgical planning of onychopapilloma, providing detailed visualization of the lesion and surrounding structures. CONCLUSIONS: This imaging method could represent a potential tool to differentiate onychopapilloma from other nail conditions, especially malignant neoplasms. However, further research is needed to validate these findings and assess long-term outcomes.

Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications?

Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.

MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review.

Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.

Medical planning for mass gathering sports events in brazil / Planificación médica para eventos deportivos masivos en brasil / Planejamento médico para eventos esportivos de massa no brasil

ABSTRACT Introduction: Medical planning for mass gathering events is founded on the structuring of assistance to the population involved and the preservation of the response capacities of the local healthcare system. Large sporting events attended by crowds are increasingly common in society. These events have been shown to be dangerous, generating higher incidences of injuries and illnesses than usual. Thus, planning and the interaction among various public and private sectors are required for the prevention of and response to emergencies and incidents involving multiple victims. Methods: Recently published studies on medical planning for large sports events and current federal agency legislation were selected to conduct an updated review on the subject. Results: After reading titles and abstracts, 159 papers were chosen for a full reading, 50 of which met the eligibility criteria and were included as the basis for this review. The size of the audience, the weather, and the behavior of the crowd seem to contribute significantly to the estimated need for resources in sporting events. Conclusion: Mass events require planning for prevention and to strengthen the resilience of host communities. There is a still a lack of evidence that these events increase the risk of the mass spreading of disease. Level of Evidence: V; Expert opinion .

RESUMEN Introducción: La planificación médica de eventos masivos tiene como pilares la estructuración de la atención a la población involucrada y la preservación de las capacidades de respuesta del sistema local de salud. Los grandes eventos deportivos a los que asisten multitudes son cada vez más comunes en la sociedad. Estos eventos han demostrado ser peligrosos, generando una mayor incidencia de lesiones y enfermedades de lo habitual. Por lo tanto, es necesaria la planificación y la interacción de diversos sectores, públicos y privados, para la prevención y respuesta a emergencias o incidentes con múltiples víctimas. Métodos: Se seleccionaron estudios recientes publicados sobre la planificación médica de grandes eventos deportivos y la legislación vigente en organismos federales con el objetivo de realizar una revisión actualizada sobre el tema. Resultados: Después de leer los títulos y resúmenes, se eligieron 159 artículos para lectura completa y 50 cumplieron los criterios de elegibilidad y se utilizaron como base para esta revisión. El tamaño del público, las condiciones climáticas y el comportamiento de la multitud parecen contribuir significativamente a la estimación de los requisitos de recursos en los eventos deportivos. Conclusión: Los eventos masivos requieren una planificación para la prevención y el fortalecimiento de la resiliencia de las comunidades anfitrionas. Todavía no hay pruebas de que estos eventos aumenten el riesgo de propagación masiva de enfermedades. Nivel de Evidencia: V; Opinión experta .

RESUMO Introdução: O planejamento médico para eventos de massa tem como pilares a estruturação dos atendimentos à população envolvida e a preservação da capacidade de resposta do sistema de saúde local. Grandes eventos esportivos frequentados por multidões são cada vez mais comuns na sociedade. Esses eventos têm se mostrado perigosos, gerando maiores incidências de lesões e doenças do que o habitual. Dessa forma, é necessário planejamento e interação de diversos setores, públicos e privados, para prevenção e resposta à ocorrência de emergências ou incidentes com múltiplas vítimas. Métodos: Foram selecionados trabalhos recentes publicados sobre o planejamento médico para grandes eventos esportivos e a legislação vigente em órgãos federais com o objetivo de realizar uma revisão atualizada sobre o assunto. Resultados: Após a leitura de títulos e resumos, 159 trabalhos foram escolhidos para leitura integral e 50 preencheram os critérios de elegibilidade e foram usados como base para esta revisão. O tamanho do público, as condições climáticas e o comportamento da multidão parecem contribuir significativamente para a estimativa da necessidade de recursos em eventos esportivos. Conclusão: Eventos de massa exigem planejamento para prevenção e fortalecimento da resiliência das comunidades anfitriãs. Ainda faltam evidências de que esses eventos aumentem o risco de propagação maciça de doenças. Nível de evidência: V; Opinião do especialista .

Evaluation of Screws Positioning in Latarjet Surgery: Is There a Correlation between Parallelism to Glenoid and Radiographic Complications? / Avaliação do posicionamento dos parafusos na cirurgia de Latarjet: Existe correlação entre paralelismo à glenoide e complicações radiográficas?

Abstract Objective To evaluate whether the parallelism of screws with glenoid in Latarjet surgery interferes in the positioning of the graft and to verify the reproducibility of a method of measuring screws positioning. Methods Retrospective, multicenter study, of patients with anterior shoulder instability submitted to modified Latarjet surgery and at least one year of postoperative follow-up. Two radiologists analyzed the postoperative tomographic images, acquired in a database, to evaluate the positioning of screws and radiographic complications. Results We evaluated 34 patients, aged between 21 and 60 years, one of them with bilateral shoulder involvement, totaling 35 shoulders evaluated. The tomographic evaluation of the inclination angles of the screws showed no difference between the observers. There was intra- and interobserver agreement to evaluate the following surgical parameters: graft position, presence or not of radiographic complications. Conclusion The technique described for measuring the parallelism of screws in Latarjet surgery presented a very good and excellent intra-observer agreement, respectively. Screw parallelism with glenoid is recommended; however, it is not a mandatory and unique condition to avoid radiographic complications.

Resumo Objetivo Avaliar se o paralelismo dos parafusos com a glenoide na cirurgia de Latarjet interfere no posicionamento do enxerto e verificar a reprodutibilidade de um método de mensuração da posição dos parafusos. Métodos Estudo retrospectivo, multicêntrico, de pacientes com instabilidade anterior do ombro submetidos à cirurgia de Latarjet modificada e no mínimo 1 ano de seguimento pós-operatório. Dois médicos radiologistas analisaram as imagens tomográficas pós-operatórias, adquiridas em um banco de dados, para avaliação do posicionamento dos parafusos e das complicações radiográficas. Resultados Foram avaliados 34 pacientes, com idades entre 21 e 60 anos, sendo que um deles tinha acometimento bilateral dos ombros, totalizando 35 ombros avaliados. A avaliação tomográfica dos ângulos de inclinação dos parafusos não apresentou diferença entre os observadores. Houve concordância intra e interobservador para avaliação dos seguintes parâmetros cirúrgicos: posição do enxerto, presença ou não de complicações radiográficas. Conclusão A técnica descrita para mensuração do paralelismo dos parafusos na cirurgia de Latarjet apresentou uma concordância intra e inter observador muito boa e excelente, respectivamente. O paralelismo do parafuso com a glenoide é recomendado; no entanto, não é condição obrigatória e única para se evitar as complicações radiográficas.

Imaging findings of lower limb involvement following COVID-19.

Coronavirus disease 2019 (COVID-19) is known mainly by the severe acute respiratory syndrome, with myalgia as a common clinical symptom. Recent reports described musculoskeletal complications related to COVID-19 such as myositis, neuropathy and arthropathy. Radiologists and ordering physicians should be aware of lower limb complications following severe COVID-19 for optimal patient care.

PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS.

INTRODUCTION: Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. MATERIALS AND METHODS: An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). RESULTS: A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). CONCLUSION: There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

Automatic MRI segmentation of pectoralis major muscle using deep learning.

To develop and validate a deep convolutional neural network (CNN) method capable of selecting the greatest Pectoralis Major Cross-Sectional Area (PMM-CSA) and automatically segmenting PMM on an axial Magnetic Resonance Imaging (MRI). We hypothesized a CNN technique can accurately perform both tasks compared with manual reference standards. Our method is based on two steps: (A) segmentation model, (B) PMM-CSA selection. In step A, we manually segmented the PMM on 134 axial T1-weighted PM MRIs. The segmentation model was trained from scratch (MONAI/Pytorch SegResNet, 4 mini-batch, 1000 epochs, dropout 0.20, Adam, learning rate 0.0005, cosine annealing, softmax). Mean-dice score determined the segmentation score on 8 internal axial T1-weighted PM MRIs. In step B, we used the OpenCV2 (version 4.5.1, https://opencv.org ) framework to calculate the PMM-CSA of the model predictions and ground truth. Then, we selected the top-3 slices with the largest cross-sectional area and compared them with the ground truth. If one of the selected was in the top-3 from the ground truth, then we considered it to be a success. A top-3 accuracy evaluated this method on 8 axial T1-weighted PM MRIs internal test cases. The segmentation model (Step A) produced an accurate pectoralis muscle segmentation with a Mean Dice score of 0.94 ± 0.01. The results of Step B showed top-3 accuracy > 98% to select an appropriate axial image with the greatest PMM-CSA. Our results show an overall accurate selection of PMM-CSA and automated PM muscle segmentation using a combination of deep CNN algorithms.

Bilateral pectoralis major MRI in weightlifters: findings of the non-injured side versus age-matched asymptomatic athletes.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) features of the contralateral side in weightlifting athletes with pectoralis major (PM) tears. We hypothesized that MRI of the non-injured side may present increased pectoralis major tendon (PMT) length and thickness and greater pectoralis major muscle (PMM) volume and cross-sectional area when compared with the control group. METHODS: We retrospectively identified MRI cases with unilateral PM injury and reviewed imaging findings of the contralateral side. Also, we evaluated MRI from ten asymptomatic control weightlifting athletes, with PM imaging from both sides. Two musculoskeletal radiologists independently reviewed MRI and measured PMT length, PMT thickness, PMM volume (PMM-vol) and PMM cross-sectional area (PMM-CSA), as well as humeral shaft cross-sectional area (Hum-CSA) and the ratio between PMM-CSA and Hum-CSA (PMM-CSA/Hum-CSA). Data were compared between the non-injured side and controls. The MRI protocol from both groups was the same and included T1 FSE and T2 FATSAT axial, coronal, and sagittal images, one side at a time. RESULTS: We identified 36 male subjects with unilateral PM injury with mean age 35.7 ± 8 years and 10 age- and gender-matched controls (p = 0.45). A total of 36 PM MRI with non-injured PM and 20 PM MRI studies were included in this study. PMT length and PMT thickness were significantly higher in contralateral PM injury versus control subjects (both P < 0.001). Also, PM-CSA and Hum-CSA were greater in the contralateral PM injury group (P = 0.032 and P < 0.001, respectively). PMT thickness > 2.95 mm had 80.6% sensitivity and 90.0% specificity to differentiate the non-injured PM group from controls. CONCLUSION: Non-injured side MR imaging of patients with previous contralateral PM lesion demonstrates greater PMT thickness and length as well as PM-CSA and Hum-CSA than controls.

Pelvic incidence and osteitis pubis in professional soccer players / Incidência pélvica e osteíte púbica em jogadores profissionais de futebol

ABSTRACT Introduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

RESUMO Introdução. A osteíte púbica é uma doença inflamatória comum da sínfise púbica, definida como síndrome de dor crônica causada por microtraumas de repetição. Uma vez que são necessárias mudanças adaptativas na pelve para adequar o equilíbrio das estruturas miotendíneas, o objetivo deste estudo foi avaliar a correlação entre e a incidência pélvica e a osteíte púbica em jogadores profissionais de futebol. Materiais e Métodos. Estudo transversal, observacional, conduzido com jogadores profissionais de futebol de cinco times profissionais durante a pré-temporada. Foram excluídos do estudo atletas com anormalidades congênitas prévias ou com história de cirurgia. As radiografias de pelve foram avaliadas por dois médicos radiologistas quanto aos achados compatíveis com osteíte púbica, e os seguintes parâmetros foram medidos: incidência pélvica (PI), inclinação sacral (SI) e versão pélvica (PV). Resultados. Foram incluídos 107 participantes, com média de idade de 25,6 ± 3,1 anos. Achados compatíveis com osteíte púbica estavam presentes em 74,8% dos indivíduos (80/107). Não houve correlação estatística entre osteíte púbica e PI (52,3°± 12,7° vs. 48,4° ± 10,8°; p = 0,156), SI (43,1° ± 9,8° vs. 39,9° ± 10,1°; p = 0,146) ou PV (9,2° ± 6,3° vs. 8,6° ± 7,5°; p = 0,649). A concordância entre os médicos radiologistas foi excelente (p < 0,0001). Conclusões. Não houve correlação significativa entre os parâmetros pélvicos e o diagnóstico radiográfico de osteíte púbica. Nível de Evidência II; Estudo diagnóstico.

Diagnosis of Achilles Insertional Tendinopathies by Algometry.

INTRODUCTION: Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard with regard to the amount of force to be used during the evaluation. Algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values. GOAL: To determine a cutoff value for pain threshold (PT) in the assessment of AIT. DESIGN: This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion. METHODS: Forty asymptomatic individuals and forty patients with AIT, matched by age and sex, were evaluated and submitted to algometry for PT and for visual analog scale (VAS) levels with 3 kgf at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was assessed through the interclass correlation coefficient (ICC). Sensitivity and specificity calculations of PT and of VAS were calculated and plotted on a receiver operating characteristic curve. RESULTS: The lowest ICC found was 0.788. With regard to the diagnosis through PT , the 4.08-kgf value showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of AIT through VAS with 3 kgf, the value of 2.98 was estabilished (sensitivity of 92.5% and specificity of 97.5%). CONCLUSION: Algometry was shown to be a simple and reliable method for diagnosing AIT. Values of PT less than 4.08 kgf were found to be predictors of the disease.

Arthroscopic Superior Capsule Reconstruction Using Three-Dimensional Preoperative Planning: Technique Description.

We describe a technique using a fascia lata autograft with 3-dimensional (3D) printing to reconstruct the rotator cuff. Prototyping constitutes the construction of physical prototypes with high complexity after virtual studies. Such models increase the knowledge of the characteristics and size of rotator cuff injuries, thus improving the accuracy of determining the correct size of the graft to be used in superior capsule reconstruction. We present a case of superior capsule reconstruction using 3D printing for enhancing the accuracy of fascia lata allograft size and tension determination; 3D reconstruction has never been described in the literature for rotator cuff injuries.

Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study.

BACKGROUND: Traditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program. OBJECTIVE: This study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing. METHODS: One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation. RESULTS: Most of the applicants (n=122, 99%) answered positively (with responses of "agree" or "strongly agree") that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms. CONCLUSIONS: The use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicant's experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones.

Hip apophyseal injuries in soccer players: can MRI findings be useful to define when to return to play?

OBJECTIVE: To describe magnetic resonance imaging (MRI) findings in professional soccer players with acute apophyseal injury of the hip and to assess their relationship with return to sports. MATERIAL AND METHODS: Adolescent soccer players with diagnosis of apophyseal injury in the anterosuperior and anteroinferior iliac spine were retrospectively evaluated between 2008 and 2016. All athletes underwent hip MRI examination within 4 days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data. RESULTS: Mean displacement of the apophysis was 4.8 ± 4.6 mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7 days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0 mm (p < 0.001). There was a significant correlation between displacement of the apophysis and return to sports, as well as between both and the presence of muscular edema. A displacement of the apophysis of 3.0 mm might serve as a parameter to predict return to sports/activity before 40 days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment. CONCLUSION: Displacement of the apophysis and presence of muscular edema evaluated by MRI showed a significant correlation with return to sports in athletes with acute apophyseal injuries of the anterosuperior and anteroinferior iliac spines.

Relationship between anterior cruciate ligament rupture and the posterior tibial and meniscal slopes in professional soccer athletes.

OBJECTIVE: Several anatomical parameters have been associated with increased risk of anterior cruciate ligament rupture; however, published studies provide conflicting results. The objectives of this study are to assess whether there is a relationship between anterior cruciate ligament rupture and the lateral and medial posterior tibial slopes, as well as the lateral and medial posterior meniscal slopes and posterior tibial and meniscal delta-slopes. MATERIALS AND METHODS: A retrospective case-control study was conducted in professional soccer athletes, using images from knee magnetic resonance imaging scans in athletes with clinical and radiological diagnosis of anterior cruciate ligament rupture, and control group, with no signs of ligament rupture. RESULTS: The lateral and medial posterior tibial slopes, the lateral and medial posterior meniscal slopes, and the posterior tibial and meniscal delta-slopes showed significant differences between the groups (p < 0.05). Multivariate analysis logistic regression revealed that the lateral and medial posterior meniscal slopes proved to be predictors for increased risk of anterior cruciate ligament rupture in professional soccer players. CONCLUSION: Posterior tibial and meniscal slopes and tibial and meniscal delta-slopes are related to a greater risk of rupture of the anterior cruciate ligament in professional male soccer athletes. The lateral and medial posterior meniscal slopes are predictors for ligament rupture.

Higher Meniscal Slope Is a Risk Factor for Anterior Cruciate Ligament Injury in Skeletally Immature Patients.

PURPOSE: To evaluate the relation between the femoral intercondylar index, tibial slope, and meniscal slope between 3 different groups of skeletally immature patients: primary anterior cruciate ligament (ACL) injury (group 1), ACL reconstruction failure (group 2), and control group, without an ACL injury history (group 3). METHODS: This retrospective study evaluated magnetic resonance imaging scans of the knees of 605 skeletally immature patients obtained between 2015 and 2020. The inclusion criteria were as follows: patients younger than 16 years who were skeletally immature and underwent knee magnetic resonance imaging for any reason. RESULTS: A total of 605 skeletally immature patients were included in the study. The ratio of patients with ACL injury (cases) to those without ACL injury (controls) was 1:2.5. Patients with ACL injury had significantly greater medial meniscal slope and lateral meniscal slope values than the control group without ACL injury (P < .001). There was no statistically significant difference between patients with primary ACL injury and those with ACL reconstruction failure for all measured variables. CONCLUSIONS: The medial and lateral meniscal slope values were significantly higher in skeletally immature patients with ACL injury than in the control group of patients without ACL injury. There was no statistically significant difference in measurements of the femoral intercondylar index, lateral meniscal slope, medial meniscal slope, lateral tibial slope, or medial tibial slope between patients with primary injury and those with ACL reconstruction failure. LEVEL OF EVIDENCE: Level III, retrospective comparative trial.