Anterior Chest Wall Non-traumatic Arthropathies: A Crucial but Often Overlooked Site.

OBJECTIVE: The purpose of this study was to describe the distribution of Anterior Chest Wall (ACW) arthropathies in a tertiary care center and identify clinical, biological and imaging findings to differentiate osteoarthritis (OA) from non-osteoarthritis (N-OA) etiologies. METHODS: Search from medical records from January 2009 to April 2022, including patients with manubriosternal and/or sternoclavicular and/or sternocostal joint changes confirmed by ultrasonography, computed tomography or magnetic resonance imaging. The final study group was divided into OA and N-OA subgroups. RESULTS: A total of 108 patients (34 males and 74 females, mean age: 47.3 ± 13 years) were included. Twenty patients had findings of OA, while 88 were diagnosed with N-OA pathologies. SpA was the most common etiology in the N-OA group (n = 75). The other N-OA etiologies were less common: rheumatoid arthritis (n = 4), Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome (n = 3), infectious arthritis (n = 3) and microcrystalline arthropathies (n = 3). Regarding the distinctive features, ACW pain was the inaugural manifestation in 50% of patients in OA group and 18.2% of patients in N-OA group (p = 0.003); high inflammatory biomarkers were more common in N-OA group (p = 0.033). Imaging findings significantly associated with OA included subchondral bone cysts (p < 0.001) and intra-articular vacuum phenomenon (p < 0.001), while the presence of erosions was significantly associated with N-OA arthropathies (p = 0.019). OA was independently predicted by the presence of subchondral bone cysts (p = 0.026). CONCLUSION: ACW pain is a common but often underestimated complaint. Knowledge of the different non-traumatic pathologies and differentiation between OA and N-OA etiologies is fundamental for appropriate therapeutic management.

Microcomputed tomographic analysis of the ulnar trochlear notch in medium- and large-breed canine cadavers with and without medial coronoid disease.

Medial coronoid disease (MCD) is a common disease often associated with thoracic limb lameness in medium- and large-breed dogs. The term MCD includes subchondral changes of the medial coronoid process (MCP), as well as pathologies of both cartilaginous surfaces. As there are only a few comprehensive and detailed studies on the trabecular structure of the medial coronoid, the goal of this study was to compare the trabecular structure of the ulnar trochlear notch of canine cadavers with and without MCD using different micro-computed tomographic (micro-CT) parameters. Fifty-eight elbow joints from 29 canine cadavers of MCD-predisposed and non-predisposed breeds (control group) were examined radiographically, macroscopically and by microcomputed tomography. The study included elbow joints of eight Labrador Retrievers (21.6-37 kg), seven Golden Retrievers (26.3-42 kg), seven Bernese Mountain dogs (31-47 kg) and seven dogs of non-predisposed breeds (19.7-52 kg) (control group). The final diagnosis of MCD was based on necropsy and micro-computed tomographic examinations. Micro-CT examinations were performed using XtremeCT II (Scanco Medical, Zurich, Switzerland) and the following parameters were examined: bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), connectivity density (Conn.D) and degree of anisotropy (DA). Twenty-four elbows of 44 elbows of the predisposed breeds (Labrador Retrievers, Golden Retrievers Bernese Mountain dogs) showed subchondral changes and lesions of the cartilage surfaces. The result of this study is a higher density (BV/TV) of the trabecular bone of the ulnar trochlear notch in elbows affected by MCD compared to the control group. The increased density due to trabecular reconstruction in the ulnar trochlear notch is likely the result of selectively increased loading during life.

Physical therapy for end-stage hemophilic arthropathy: a case report.

This report introduces a young adult who has been in bed for more than ten years with end-stage hemophilic arthropathy. He didn't have access to factor VIII (FVIII) in the early stage of hemophilia due to the high costs of clotting replacement therapy. As a result, he is experiencing some difficulties, such as joint contracture, muscular atrophy, severe pain, and poor function of cardiopulmonary. He came to visit us for a comprehensive rehabilitation program, and, finally, he achieved the basic goal of self-care in daily life.

Clinical, radiographic and molecular characterization of two unrelated families with multicentric osteolysis, nodulosis, and arthropathy.

BACKGROUND: Multicentric osteolysis nodulosis and arthropathy (MONA) is a rare autosomal recessive disorder characterized by marked progressive bone loss and joint destruction resulting in skeletal deformities. MONA is caused by MMP2 deficiency. Here we report clinical and molecular analyses of four patients in two families from Pakistan and Finland. METHODS: Clinical analyses including radiography were completed and blood samples were collected. The extracted DNA was subjected to whole-exome analysis or target gene sequencing. Segregation analyses were performed in the nuclear pedigree. Pathogenicity prediction scores for the selected variants and conservation analyses of affected amino acids were observed. RESULTS: The phenotype in the four affected individuals was consistent with multicentric osteolysis or MONA, as the patients had multiple affected joints, osteolysis of hands and feet, immobility of knee joint and progressive bone loss. Long-term follow up of the patients revealed the progression of the disease. We found a novel MMP2 c.1336 + 2T > G homozygous splice donor variant segregating with the phenotype in the Pakistani family while a MMP2 missense variant c.1188 C > A, p.(Ser396Arg) was homozygous in both Finnish patients. In-silico analysis predicted that the splicing variant may eventually introduce a premature stop codon in MMP2. Molecular modeling for the p.(Ser396Arg) variant suggested that the change may disturb MMP2 collagen-binding region. CONCLUSION: Our findings expand the genetic spectrum of Multicentric osteolysis nodulosis and arthropathy. We also suggest that the age of onset of this disorder may vary from childhood up to late adolescence and that a significant degree of intrafamilial variability may be present.

Can ultrasound replace MRI in diagnosing causes of ankle impingement in different compartments?

PURPOSE: This prospective study aims to determine the role of ultrasound (US) in diagnosing different types of ankle impingement due to osseous and soft tissue pathologies and to compare the results with magnetic resonance imaging (MRI), which is considered our gold standard. METHODS: The study population included 90 patients with unilateral ankle pain who presented with symptoms and signs suggestive of ankle impingement. Their age ranged from 17 to 57 years, with a mean age of 33.7 years. Using US and MRI, our cases were classified into bony and soft tissue ankle impingement. They were further classified according to the anatomical compartments affected, into anteromedial, anterior, anterolateral, posteromedial, and posterior. RESULTS: 90 patients were enrolled in this study: 51 males and 39 females. In our study, posterior ankle impingement was the commonest impingement type, while anteromedial ankle impingement was the rarest type, followed by posteromedial impingement. The accuracy of US in diagnosing osseous impingement was found to have the following: sensitivity 70.37%, specificity 100%, PPV 100%, NPV 75%, accuracy 84.31%, and p value < 0.001; meanwhile, the accuracy of US in diagnosing soft tissue impingement was found to have the following: sensitivity 83.33%, specificity 100%, PPV 100%, NPV 87.10%, accuracy 92.16%, and p value < 0.001. CONCLUSION: US is a good diagnostic tool in bone and soft tissue impingements, with a significant p value of 0.001 for both. US cannot replace MRI as a diagnostic tool, but as a widely available imaging modality, it can save time and cost and allows dynamic imaging.

Clinical and molecular characterization in a cohort of patients with progressive pseudorheumatoid dysplasia.

Progressive pseudorheumatoid dysplasia (PPRD), a rare autosomal recessive syndrome, is a type of skeletal dysplasia associated with pain, stiffness, swelling of multiple joints, and the absence of destructive changes. PPRD occurs due to loss of function pathogenic variants in WISP3 (CCN6) gene, located on chromosome 6q22. In this study, 23 unrelated Egyptian PPRD patients were clinically diagnosed based on medical history, physical and radiological examinations, and laboratory investigations. Sequencing of the whole WISP3 (CCN6) exons and introns boundaries was carried out for all patients. A total of 11 different sequence variations were identified in the WISP3 (CCN6) gene, five of them were new pathogenic variants: the NM_003880.3: c.80T>A (p.L27*), c.161delG (p.C54fs*12), c.737T>C (p.Leu246Pro), c.347-1G>A (IVS3-1G>A), and c.376C>T (p.Q126*). The results of this study expand the spectrum of WISP3 (CCN6) pathogenic variants associated with PPRD. Clinical and genetic analysis is important for proper genetic counseling to curb this rare disorder in the families.

Comparative evaluation of radiographic and computed tomographic findings in dogs with bilateral medial coronoid disease (MCD) presenting with unilateral forelimb lameness.

OBJECTIVES: The purpose of this study was to compare the radiographic and computed tomographic (CT) findings of dogs with diagnosed bilateral medial coronoid disease, which showed clinically only unilateral lameness of the forelimbs. MATERIALS AND METHODS: Medical records, including radiographs and CT images of dogs with diagnosed bilateral MCD showing only a unilateral forelimb lameness clinically were reviewed retrospectively. Depending on the gait of each dog we established two groups to investigate their radiographs and CT data comparatively. Group I: affected non-lame limb. Group II: affected lame limb. Several evaluation systems were used to assess which factors are important for clinical decision making and a patient tailored therapeutic plan. RESULTS: Data from 84 affected elbow joints (42 dogs) diagnosed with MCD by computed tomography were included. Both the radiological and the CT analysis showed that there are significant differences between Groups I and II. Group I had a lower modified International Elbow Working Group Score (IEWG), the values of the Trochlear notch sclerosis were only slightly deviated, and this group showed less often a dislocation of the fragment compared to group II. Furthermore, the size of the fragment (both the median and the mean value) of the forelimbs from group II was almost twice as big as the one from group I. The following sizes of the fragments were calculated (group I versus (vs.) group II)-median: 0.09 cm2 vs. 0.16 cm2, mean value: 0.112 cm2 vs. 0.202 cm2. It could be shown that a larger fragment is more likely to dislocate than a smaller one. CLINICAL SIGNIFICANCE: This study provides some evidence towards a better understanding of which diagnostic parameters and findings might be important in clinical decision making. Nevertheless, a "decision tree" for the correct therapy of MCD could not be determined in this study.

CT-Based Calculation Model Assists Precise Treatment for Anterior and Posterior Ankle Bony Impingement.

OBJECTIVE: Ankle arthroscope is the preferred tool for ankle surgeons to treat ankle impingement. However, there is no relevant report on how to improve the accuracy of arthroscopic osteotomy through preoperative planning. The aims of this study were to investigate a novel method to obtain the bone morphology in anterior and posterior ankle bony impingement through computed tomography (CT) calculation model, use this method to guide surgical decision-making, and compare the postoperative efficacy and actual bone cutting volume with conventional surgery. METHODS: This retrospective cohort study includes 32 consecutive cases with anterior and posterior ankle bony impingement by arthroscopy from January 2017 to December 2019. Mimics software was utilized to calculate the bony morphology and measure the volume of the osteophytes by two trained software engineers. The patients were divided into the precise group (n = 15) and the conventional group (n = 17) according to whether obtain and quantify the osteophytes' morphology with CT based calculation model preoperative. All patients were evaluated clinically using visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, active dorsiflexion and plantarflexion angle before and after surgery at both 3 months and 12 months postoperatively. We obtained the shape and volume of bone cutting through Boolean calculation. Clinical outcomes and radiological data were compared between the two groups. RESULTS: The VAS score, AOFAS score, active dorsiflexion angle and plantarflexion angle were significantly improved in both groups postoperatively. In comparison of the VAS score, AOFAS score, and active dorsiflexion angle, the precise group were higher than the conventional group in the follow-up at 3 and 12 months postoperatively with statistical difference. The difference between the virtual bone cutting volume and the actual bone cutting volume of the anterior edge of distal tibia in the conventional group and precise group were 244.20 ± 147.66 mm3 and 76.53 ± 168.51 mm3 , respectively, there was statistical difference between the two groups (t = -2.927, p = 0.011). CONCLUSION: Using a novel method of obtaining and quantifying the bony morphology with CT-based calculation model for anterior and posterior ankle bony impingement can help guide surgical decision-making preoperatively and assist precise bone cutting during the operation, which can improve the efficacy and evaluate the accuracy of osteotomy postoperatively.

Acute Charcot arthropathy as a first presentation of type 2 diabetes mellitus.

Charcot arthropathy in people with diabetes is generally seen when diabetes has been well established, and therefore it is not routinely considered as a differential diagnosis in people presenting with erythematous and oedematous joints in primary care. We present two cases of acute Charcot arthropathy as a first presentation of type 2 diabetes mellitus. The first case describes a man in his 70s, who presented with a 5-week history of right foot pain, treated initially in the community as cellulitis. A diagnosis of acute Charcot arthropathy was made in the emergency department following review by the orthopaedic and podiatry department. The second case describes a woman in her 40s who presented with a 2-week history of ankle pain. Charcot arthropathy is associated with significant morbidity and mortality, and these cases highlight the importance of including Charcot arthropathy in the differential diagnosis when people present with atypical joint swelling.

Use of Ultrasonography in Diagnosis of Medial Compartment Disease of the Elbow in Dogs.

OBJECTIVE: The objective of this prospective study was to evaluate the use of ultrasonography in the diagnosis of medial coronoid process disease in unclear cases. STUDY DESIGN: Fifteen elbows (on thirteen dogs) for which radiography and computed tomography did not lead to a clear diagnosis of medial coronoid process disease were included. On each elbow, ultrasonography was performed with a high frequency linear transducer (12-18Hz). Then, arthroscopic examination of the joint was performed by a surgeon who was unaware of ultrasonographic findings to confirm medial coronoid process disease. RESULTS: At least one ultrasonographic lesion was detected in 13 out of 15 elbows. The main reported ultrasonographic lesions were joint effusion (10/15 elbows) and an abnormal shape of the medial coronoid process (irregular, ill-defined or fragmented) (9/15). CONCLUSION: Ultrasonography can be a helpful additional diagnostic tool to confirm medial coronoid process disease of the elbow joint before performing arthroscopy in unclear cases. Further studies will be needed to evaluate the use of higher frequency transducers and determine if it could improve the diagnostic value of ultrasonography.

The Correlation Between the HEAD-US-C Score and HJHS in Hemophilic Arthropathy of the Knee.

OBJECTIVES: We aimed to discuss the correlation between the Hemophilia Early Detection Ultrasound in China (HEAD-US-C) score and the Hemophilia Joint Health Score version 2.1 (HJHS 2.1) of the knee joint in patients with hemophilia. METHODS: We included 70 male patients with hemophilia admitted to The Second Hospital of Shanxi Medical University; the patients' bilateral knee joints were evaluated using the HEAD-US-C score and HJHS. We analyzed factors influencing hemophilia arthropathy of the knee and examined the correlation between the HEAD-US-C score and HJHS. RESULTS: The joint injury severity was positively correlated with age and the number of bleeds (P < .001). Further, the HEAD-US-C score and HJHS differed according to the severity (both P < .001), but not type (P = .163 and P = .283, respectively), of hemophilia. There was a significant correlation between the HEAD-US-C score and HJHS (P < .001). CONCLUSIONS: Overall, all joint lesions observed on ultrasound corresponded to clinical joint functional abnormalities. Therefore, the HEAD-US-C is important for hemophilic arthropathy evaluation and is useful in explaining abnormal joint function.

The use of subchondral bone topography to approximate the center of rotation of the elbow joint in dogs.

OBJECTIVES: The aim of this study was to compare the approximate center of rotation in normal and diseased elbows in dogs. STUDY DESIGN: Cross-sectional study SAMPLE POPULATION: Computer tomography scans of nine dogs with unilateral fragmented medial coronoid process (FMCP). METHODS: A board certified radiologist confirmed that each dog had unilateral FMCP, and a normal contralateral elbow. Digital 3D models of all elbow joints were uploaded into a surgical planning software package. Four axes approximating the center of rotation (COR) of elbow joints were generated using five geometric shapes based on subchondral topography of the humeral condyle radius and ulna. Images showing the locations where axes exited the medial and lateral cortex of the humeral condyle were captured and imported into a second software package, for measurement of distances between exit points and the origin of a system of axes. RESULTS: In normal joints 20/27 (74%) axes exited the medial cortex, and 25/27 (93%) axes exited the lateral cortex cranial and distal to the medial and lateral epicondyles, respectively. In diseased joints 22/27 (81%) axes exited medial cortex and 19/27 (70%) axes exited the lateral cortex, caudal and distal to the medial and lateral epicondyles, respectively. CONCLUSION: Based on CT- derived geometry, the COR of elbow affected with FMCP was generally more caudal than normal. CLINICAL SIGNIFICANCE: External landmarks approximating the location of the elbow COR are provided, and while not validated, may assist in planning, creation, and assessment of procedures for FMCP.

How to assess, detect, and manage joint involvement in the era of transformational therapies: Role of point-of-care ultrasound.

BACKGROUND: Patients with haemophilia experience recurring hemarthroses, mainly involving knees, elbows and ankles, which lead to haemophilic arthropathy, the major chronic complication of haemophilia. With new approaches to haemophilia treatment leading to fewer joint bleeds and, in some cases, no bleeding events, assessing whether current outcome assessment tools provide adequate sensitivity and specificity for management and care of patients with haemophilia is needed. METHODS: An overview of current imaging tools for monitoring joint health, novel osteochondral damage and synovial proliferation biomarkers, and the relationship between assessments for functionality and imaging modalities is provided. Usefulness and sensitivity of point-of-care ultrasound (POCUS) to complement other assessments and use of ultrasound to monitor haemophilic arthropathy are also examined. RESULTS: This review provides rationale for haemophilia teams to move beyond traditional outcomes in joint imaging, as well as guidance and evidence on assessment of joint health for potential new treatment modalities, such as gene therapy. The role of POCUS in the existing paradigm for haemophilia care and management along with the use of ultrasound as a complement to other outcome assessment tools are also discussed. Finally, the clinical effects of subclinical bleeding on joint function are described, to motivate screening for synovial proliferation. CONCLUSION: POCUS can facilitate the early detection of joint damage and can monitor disease progression while providing insights into the efficacy of treatment regimens, and should be considered as an essential assessment tool for managing the care of patients with haemophilia.

Deep learning-based diagnosis of stifle joint diseases in dogs.

In this retrospective, analytical study, we developed a deep learning-based diagnostic model that can be applied to canine stifle joint diseases and compared its accuracy with that achieved by veterinarians to verify its potential as a reliable diagnostic method. A total of 2382 radiographs of the canine stifle joint from cooperative animal hospitals were included in a dataset. Stifle joint regions were extracted from the original images using the faster region-based convolutional neural network (R-CNN) model, and the object detection accuracy was evaluated. Four radiographic findings: patellar deviation, drawer sign, osteophyte formation, and joint effusion, were observed in the stifle joint and used to train a residual network (ResNet) classification model. Implant and growth plate groups were analyzed to compare the classification accuracy against the total dataset. All deep learning-based classification models achieved target accuracies exceeding 80%, which is comparable to or slightly less than those achieved by veterinarians. However, in the case of drawer signs, further research is necessary to improve the low sensitivity of the model. When the implant group was excluded, the classification accuracy significantly improved, indicating that the implant acted as a distraction. These results indicate that deep learning-based diagnoses can be expected to become useful diagnostic models in veterinary medicine.

Reliability of haemophilia early arthropathy detection with ultrasound (HEAD-US) in children: a comparative magnetic resonance imaging (MRI) study.

BACKGROUND: Ultrasound (US) has been proven to be reliable in the assessment of early haemophilic arthropathy in the adult haemophilic population, however few studies so far focused on the reliability of US specifically in the paediatric haemophilic population. We were interested if the changing appearance of the growing bone hinders the ultrasonographic evaluation of the pathologic processes caused by haemophilic arthropathy. The aim of the study was to assess the reliability of US for evaluation of haemophilic arthropathy in children in comparison to magnetic resonance imaging (MRI). PATIENTS AND METHODS: The study included all children aged 6 years or more with severe haemophilia in the country (n = 10). We assessed their elbows, knees, and ankles bilaterally by US and compared the results to the MRI as the reference standard. Pearson correlation coefficient (r) was used to analyse correlation. RESULTS: The correlation with MRI for the US for the total score was excellent for all joints (r = 0.849 for the elbows, r = 1 for knees, r = 0.842 for ankles). The correlation of scores for specific joint components showed fair, moderate, or excellent correlation for all joint components in all joints. The correlation was the lowest for the evaluation of cartilage and bone in the ankles (r = 0.546 and r = 0.478) and bone in the elbows (r = 0.499). CONCLUSIONS: Our study proved that US using the HEAD-US method performed by paediatric radiologists is a reliable tool for detection and quantification of haemophilic arthropathy in children in comparison to MRI.

Bone density of the humeral condyle in Labrador retrievers with medial coronoid process disease.

OBJECTIVES: To estimate, using CT imaging, differences in the regional bone density of the humeral condyle in Labrador retriever elbows with and without medial coronoid process disease. MATERIALS AND METHODS: The elbows of Labrador Retrievers that had undergone CT were reviewed. Scans were divided into three categories: elbows without medial coronoid process disease; elbows with medial coronoid process disease involving fragmentation of the radial incisure; elbows with medial coronoid process disease involving fragmentation of the medial coronoid apex. A templating technique was employed to define the weight-bearing regions of the medial and lateral portion of the humeral condyle and estimates of volumetric bone density (defined by Hounsfield unit measurement) were compared across the three groups. RESULTS: CT evaluation was performed on 122 elbows in 81 dogs. There was a higher mean Hounsfield unit measurement in the medial and lateral portions of the humeral condyles in elbows with medial coronoid process disease involving fragmentation of the medial coronoid apex compared with elbows with medial coronoid process disease involving fragmentation of the radial incisure. CLINICAL SIGNIFICANCE: Dogs with apical fragmentation of the medial coronoid process exhibited significantly higher estimated bone mineral density within the medial portion of the humeral condyle when compared to dogs with radial incisure fragmentation. The medial portion of the humeral condyle may be associated with the pathogenesis of apical but not radial incisure medial coronoid process fragmentation in Labrador Retrievers.

CT attenuation of the medial coronoid process is reduced in dogs with medial coronoid disease but independent of arthroscopic disease severity.

OBJECTIVE: To compare the attenuation of the medial coronoid process (MCP) in dogs with and without arthroscopically confirmed evidence of medial coronoid disease (MCD). ANIMALS: The database at our institution was searched for cases with thoracic limb lameness, diagnosed with MCD by arthroscopic examination that had CT as part of their investigation and compared with a control group of elbow joints from cadavers euthanized for reasons unrelated to MCD. A total of 84 elbow joints were included that met these criteria. PROCEDURES: Following CT, a standardized measurement of the MCP was obtained from apex to base and the mean attenuation, SD, and total area were recorded. A comparative measurement was obtained from the proximal radial cortex at the level of the nutrient foramen. Elbow joint arthroscopy was carried out using standard portals, and the modified Outerbridge score was (MOS) used to score elbow joint cartilage. Descriptive and inferential statistics were carried out using MLwiN and R. RESULTS: Attenuation of the MCP was reduced in dogs with MCD compared with those with no MCD (P < .002). No significant differences were observed in the attenuation between categories of severity (MOS). There was good inter- and intraobserver agreement between measurements (intraclass correlation coefficient = 0.89 and 0.95, respectively). CLINICAL RELEVANCE: MCP attenuation is reduced in dogs with MCD compared with dogs with no evidence of MCD. This finding may be a useful tool for early detection of MCD, but there is no relationship with arthroscopic lesion severity.

Knee Plical Pathology and Impingement Syndromes.

Impingement syndromes are caused by anatomic variability of normal structures, altered biomechanics, or a combination of both. Imaging manifestations of painful impingement syndromes can explain patient symptoms and guide appropriate management. This article discusses the MR imaging findings associated with synovial plica syndrome and other impingement syndromes of the knee joint. Relevant embryology and anatomic variation of synovial plicae are presented, with emphasis on features predisposing to patient symptoms. The most common knee impingement syndromes are reviewed including iliotibial band fraction syndrome, Hoffa fat pad impingement/lateral patellar tendon lateral femoral condyle friction syndrome, and suprapatellar/quadriceps fat pad impingement.

In-Office Needle Arthroscopy (IONA): may a traditionally orthopedic procedure enter the portfolio of interventional radiology?

Arthroscopy has historically proved to allow accurate evaluation of the intra-articular structures of the knee, thanks the possibility of direct vision and palpation, and reduced perioperative morbidity. Over the last decade, the diagnostic role of arthroscopy has been further increased by its quite effective use in the treatment of the lesions. The recent and important advances in the technological-instrumental field have produced a safe visualization system used to pose a diagnosis in an outpatient setting, employing reduced-diameter arthroscopes (In-Office Needle Arthroscopy, IONA). The accuracy of MRI is unanimously recognized, but it shows some weaknesses when compared to arthroscopy that is the gold standard technique in case of chondral lesions, meniscal tears, or atypical synovial pathologies. In this short report, we propose the interventional musculoskeletal radiologist as possible performer of IONA, in specific settings, providing the patient, suffering from acute and chronic knee joint diseases, with a complete diagnostic approach, when MRI is not definitive.