High insertion of conjoint tendon is associated with inguinal-related groin pain: a MRI study.

PURPOSE: To compare the insertions of the conjoint tendon (CT) on MRI in athletes with and without symptoms and to assess their relationship to groin pain with surgery as a reference. MATERIALS AND METHODS: Between January and May 2017, patients with inguinal-related groin pain undergoing Shouldice repair were prospectively enrolled and underwent MRI. Exams were independently reviewed by two radiologists blinded to surgical results to assess types of CT insertion as high muscular without (type 1) or with tendinous expansion (type 2) or low muscular (type 3). Radiological and surgical results were compared. Patients were compared with a gender- and age-matched control group of asymptomatic athletes. RESULTS: One hundred twenty-eight walls (64 in patients, 64 in controls) in 64 subjects (32 patients and 32 controls, only men; mean age, 31.7 ± 10 years; range, 15.0-54.8) were analyzed. CT insertion was defined as types 1, 2, and 3 in 32/128 (25%), 35/128 (27%), and 61/128 (48%) walls, respectively, with 22/64 (34%), 27/64 (42%), and 15/64 (23%) in patients and 10/64 (16%), 8/64 (12.5%), and 46/64 (72%) in controls. Type s1+2 were significantly more frequent in patients compared with that in controls (p < 0.01). MRI predicted a high CT insertion with a sensitivity and specificity of 97% (95%CI 85-99) and 62% (95%CI 36-82). The intra- and inter-reader agreement for the prediction of the type of insertion was excellent (k > 0.75). CONCLUSION: A high CT insertion is more frequent in athletes with groin pain and may be a predisposing factor. MRI could help predict the type of CT insertion. KEY POINTS: • MR imaging should be included in the initial workup of patients with inguinal-related groin pain. • MR imaging can be used to visualize the type of insertion with acceptable results. • High insertion of the conjoint tendon may be a predisposing factor for inguinal-related groin pain.

Retrospective Analysis of Responders and Impaired Patients with Knee Osteoarthritis Treated with Two Consecutive Injections of Very Pure Platelet-Rich Plasma (PRP).

OBJECTIVES: To assess the effectiveness of two consecutive intraarticular injections of PRP to treat knee osteoarthritis (KOA), discriminating between responders and impaired patients. METHODS: This retrospective study included 73 consecutive patients who were referred for two intra-articular PRP injections (one week apart) for treating symptomatic moderate/severe KOA. Biological characterization of the PRP, including platelets, leukocytes and erythrocytes, was evaluated. Patient's subjective symptoms were recorded before the treatment and 1 year after the second injection using pain VAS and WOMAC scores. Responders were defined by an improvement of 10 points on WOMAC. RESULTS: At a 1-year follow up, we found 36 (49.3%) patients who fulfilled the criteria of responders, and 21 (28.8%) patients were impaired. A statistically and clinically significant global improvement of -29.2 ± 14.3 (p < 0.001) points in WOMAC score was observed 1 year after treatment in the responder group, with a higher response rate in patients with KL 2 (57.7%) compared to KL IV (28.6%). The percentage of patients with KL IV was higher in the impaired group (48.0%) compared to the responders (16.6%). As expected, the evaluation of the functionality of the knee in the impaired group indicates that it significantly worsened after one year from treatment (p = 0.027). However, the average pain score remained stable with no significant differences after 1 year (p = 0.843). No clinical complications or severe adverse events after the PRP injections were reported. CONCLUSION: The present study suggests that two intra-articular injections of 10 mL of very pure PRP provide pain and functional improvement in symptomatic KOA.

Rotator cuff tears: should abduction and external rotation (ABER) positioning be performed before image acquisition? A CT arthrography study.

OBJECTIVE: To evaluate the impact of abduction and external rotation (ABER) positioning performed before image acquisition on the assessment of rotator cuff tears. METHODS: Twenty-seven consecutive patients with clinically suspected rotator cuff tears underwent an initial CT arthrogram of the shoulder in neutral position, immediately followed by temporary ABER positioning, before a second CT acquisition in neutral position. Two observers blinded to potential pre-procedure ABER positioning independently analysed the randomly distributed images. Lesions were classified into partial-thickness (PT) and full-thickness (FT) tear subtypes. Lesion detection and measurements of pre- and post-ABER studies were compared. RESULTS: We found no influence of pre-test ABER positioning on FT detection or measurements. Every PT detected on pre-ABER study was also detected on post-ABER study (28/28 for reader 1, and 32/32 for reader 2). Seven and eight additional PT were found by readers 1 and 2, respectively, on post-ABER study. Lesion size increased after ABER in terms of area (P < 0.001 for both readers) and Ellman's grade (P = 0.02 and 0.002 for reader 1 and 2, respectively). CONCLUSION: ABER positioning before CT is associated with improved delineation of partial tears, a higher number of detected tears and modification of treatment planning.

Effects of Axial Traction during Direct MR-Arthrography of the Wrist in Sports Injuries.

PURPOSE: To evaluate the degree of joint distraction during direct MR arthrography with axial traction in sports injuries. To confirm the effect of axial traction on the quality of wrist opacification. PATIENTS AND METHODS: Seventeen patients (11 male, 6 female) underwent wrist MR arthrography without (mean: 39 years (SD 11.6))., and 20 patients (16 male, 4 female) with axial traction (mean: 28 years (SD 7.1)). Subgroups were defined according to pathology: degenerative, ligamentous, traumatic, normal (ie patients without MR-arthrography lesions). Radioscaphoid, radiolunate, lunocapitate, ulna Triangular Fibrocartilage (TFC), scapho-lunate, luno-triquetral, ulnocarpal, Carpo-Metacarpal (CMC) I and III and distal radio-ulnar spaces were measured for all patients. Differences in joint space width were compared between subgroups. Joint space opacification was subjectively scored from 0 (no opacification) to 3 (fully opacified), and compared between the groups with and without traction. RESULTS: The difference in joint space was statistically significant (p<0.05) for radioscaphoid, radiolunate, lunocapitate and ulnocarpal spaces, but only in patients with ligamentous tears. Opacification score was significantly higher for ulnocarpal (p=0.0275) and CMC III joint spaces (p=0.0272) with axial traction. CONCLUSION: Axial traction resulted in a significantly higher radioscaphoid, radio-lunate, lunocapitate and ulnocarpal joint spaces width. This positive effect of axial traction raises the suspicion of sports ligamentous lesions.