Anteroposterior Radiographs Research Articles

Postoperative femoral head cartilage injury after hip arthroscopic treatment for femoroacetabular impingement syndrome and labral tear

BackgroundPostoperative femoral head cartilage injury (FHCI) is a rare condition that can be observed in a certain proportion of patients undergoing hip arthroscopy. However, the prevalence and associated factors of FHCI, and the effect of this condition on clinical outcomes still remain unknown.Patients and methodsConsecutive patients who were diagnosed with femoroacetabular impingement syndrome (FAIS) and labral tear and underwent hip arthroscopic treatment in our institute between July 2020 and July 2021 were retrospectively evaluated. Supine anteroposterior hip radiographs, cross-table lateral radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) were obtained preoperatively. Postoperative MRI, at least 6 months after arthroscopy, was performed. Postoperative FHCI was evaluated by two surgeons through MRI. Preoperative patient-reported outcomes (PROs) including visual analog scale (VAS) for pain, and modified Harris Hip Score (mHHS) before surgery and at final followup were obtained.ResultsA total of 196 patients were included. Postoperative FHCI was identified in 21 (10.7%) patients. The intraobserver reliability of the observer A and B for detecting postoperative FHCI using 3.0-T MRI was high (k = 0.929, and k = 0.947, respectively). The interobserver reliability between the two observers for detecting FHCI using 3.0-T MRI was high (k = 0.919). There was no significant difference in preoperative and postoperative mHHS, VAS, and percentage of patients who surpassed minimal clinically important difference (MCID) and achieved patient acceptable symptom state (PASS) between patients with and without postoperative FHCI (P > 0.05).ConclusionAlthough postoperative FHCI was observed in 10.7% of patients, which was associated with larger labrum, this condition did not result in inferior clinical outcomes.Level of evidence IV, retrospective case series.Trial registration The Chinese Clinical Trial Registry approved the registration (ChiCTR2200061166). The date of registration is 2022-06-15.

Factors associated with postoperative coronal imbalance in adult patients with severe and rigid scoliosis: a retrospective study

BackgroundExtensive studies examined coronal imbalance (CIB) in adolescent and adult degenerative scoliosis; however, few studies addresses on CIB in adult with severe rigid scoliosis (SRS). Therefore, we analyzed postoperative SRS patients to identify factors associated with postoperative CIB.MethodsIn this retrospective study, we investigated SRS patients undergoing one-stage posterior column osteotomy (PCO) and fusion at our hospital between August 2012 and January 2019. The preoperative, postoperative and follow-up whole-spine anteroposterior (AP) radiographs were evaluated. Potential risk factors for postoperative CIB were analyzed using the LASSO regression, and independent risk factors were identified using binary logistic regression. A nomogram prediction model was constructed and validated.ResultsNinety eligible SRS patients were included. Postoperative radiographs showed a main curve correction rate of 54.17 ± 14.02%; however, follow-up CIB persisted in 26.67% of patients. Three independent variables affecting follow-up CIB were identified by LASSO regression, including preoperative CIB+ [OR = 12.414 (95% CI: 2.228, 69.162), P = 0.004], major curve flexibility index < 10% [OR = 14.300 (95% CI: 2.200, 92.957), P = 0.005], and immediate postoperative CIB [OR = 5.169 (95% CI: 1.387, 19.263), P = 0.014]. ROC and DCA analysis demonstrated that the nomogram had good predictive performance.ConclusionsPreoperative CIB+, major curve flexibility index < 10%, and immediate postoperative CIB were significantly associated with postoperative CIB. These findings offer valuable guidance to improve surgical outcomes and reduce complications.

Validating rasterstereography to evaluate thoracic kyphosis in patients with Scheuermann's disease.

Evaluate the validity of rasterstereography compared to low-dose, biplanar spine radiography for assessing thoracic kyphosis (TK) angles in Scheuermann's disease patients. This prospective study included all the Scheuermann's disease patients consulting our clinic from 2016 to 2018. Recruited patients underwent two-dimensional low-dose biplanar anteroposterior full-length spine radiography and rasterstereography on the same day. Relationships between the TK angles measured were evaluated using Pearson correlation coefficients. Agreement between radiographic and rasterstereographic TK angles was evaluated using two-way intraclass correlation coefficients (ICCs) and Bland-Altman plots. Proportional biases were assessed using the slope regression lines fitted to Bland-Altman plots. The mean demographic and radiological characteristics of the 52 patients (20 girls; 39%) included were: age 13.1 ± 2years; BMI 17.3 ± 2.8; and TK max. 50.4° ± 10°. Rasterstereographic TK angles were strongly correlated with radiographic TK angles evaluated from T2-T12 (r = 0.677) and from C7-Max (r = 0.704), with 'good' agreement (ICC > 0.75). A proportional bias was revealed in the slope regression line fitted to the Bland-Altman plot from the C7-Max radiography and the rasterstereography measurements (p = 0.034) but not from the T2-T12 and rasterstereographic TK angles (p = 0.997). Rasterstereography is a reliable means of quantifying TK angles in Scheuermann's disease patients. It could directly reduce the number of radiographic scans patients need over time, minimising their radiation exposure.

A new classification system for distal clavicle fractures: based on fracture location and ligament integrity.

Although various classification systems have been introduced for the description of distal clavicle fractures, there is no consensus on the best classification system that is helpful in determining treatment and prognosis. The objective of this study was to establish a new classification system for distal clavicle fractures and to verify the reliability of the new classification system by evaluating the inter- and intraobserver agreement. A total of 1075 consecutive patients with distal clavicle fractures were selected from five university-affiliated hospitals between 2012 and 2022. The distal fragment size (DFS), the coracoclavicular distance (CCD) and the acromioclavicular distance (ACD) were measured on anteroposterior radiographs of each acromioclavicular joint. Twenty independent investigators evaluated 1075 radiographs of distal clavicle fractures, completing the fracture typing according to the new classification system and selecting a treatment choice for each case. This procedure was repeated 3 months later. Fleiss κ values were calculated to estimate the inter- and intraobserver agreement. The new classification categorizes distal clavicle fractures into three types based on the relationship between fracture location and ligament footprints. Type I fractures occur distal to the coracoclavicular (CC) ligaments with or without ligament injury. Type II fractures occur CC ligament attachment regions with ligament injury Type III fractures occur proximal to the CC ligaments without ligament injury. Several subtypes (types IA, IB, IC, ID, IIA, IIB, IIC, IID, and IIE) were further introduced according to fracture displacement and ligament integrity. The inter- and intraobserver reliability of our new classification system was substantial (κ = 0.622 vs. 0.678). Inter- and intraobserver reliability for treatment choice was perfect (κ = 0.846 vs. 0.882). The new classification system which takes into account fracture location and ligament integrity brought few disputes in category division and treatment selection.

Modified Distalization Shoulder Angle and Lateralization Shoulder Angle show weakly correlation with clinical outcomes following reverse shoulder arthroplasty

IntroductionThe focus in reverse shoulder arthroplasty (RSA) has been on the lateralization and distalization of prosthesis positioning, influenced by implant design and surgical technique. There's no consensus on the optimal amount of lateralization and distalization or the best radiographic parameters for evaluating placement. This study examines the correlation and the predictive value between previously described modified distalization shoulder angle (DSA) and lateralization shoulder angle (LSA) with postoperative outcomes, which aim to differentiate the contributions of the humeral and glenoid components in the global distalization and lateralization of the RSA. The LSA was divided into the glenoid lateralization angle (GLA) and the humeral lateralization angle (HLA); the modified distalization shoulder angle (mDSA) was divided into the glenoid distalization angle (GDA) and the humeral distalization angle (HDA). Our hypothesis was that these new angles play a marginal role in predicting clinical outcomes. Materials and MethodsRetrospective analysis of 83 RSA patients from 2017-2021 at San Pietro Fatebenefratelli Hospital, Rome. Angles were measured using true anteroposterior radiographs. Clinical outcomes were assessed using the Constant-Murley Score (CS), a visual analogue scale (VAS) for pain, and range of motion (ROM). ResultsA weak correlation was found between the modified angles and clinical outcomes. Modified DSA (mDSA) correlated positively with internal rotation and negatively with VAS score. Glenoid distalization angle (GDA) correlated positively with abduction, forward flexion, and CS. Humeral distalization angle (HDA) correlated positively with internal rotation and negatively with VAS. Glenoid lateralization angle (GLA) and humeral lateralization angle (HLA) showed negative correlation with internal rotation and positive correlation with VAS. ConclusionModified DSA and LSA show marginal correlation with postoperative outcomes and have limited predictive value. Further research with larger, diverse populations is needed to refine these metrics and their clinical utility.

Risk factors for proximal radial abnormalities in children with untreated chronic Monteggia fractures: a review of 142 cases

BackgroundThe risk factors for proximal radial abnormalities (PRA) in paediatric patients with untreated chronic Monteggia fractures (CMFs) are unclear. This multicentre study aimed to evaluate the risk factors for PRA in children with untreated CMFs.Materials and methodsThe clinical data of 142 patients (mean age at the time of injury: 5.73 years) with untreated unilateral CMFs were retrospectively reviewed. The radial neck-shaft angle (RNSAP) and radial head size (RHL) were measured on anteroposterior (AP) and lateral (L) radiographs, respectively. The RHL size was the ratio of the widest width of the proximal radial metaphysis to the narrowest radial neck width. The En-RNSAP and En-RHL were the ratios of the enlargement (En) of the RNSAP angle and RHL size of the injured elbow to those of the uninjured elbow, respectively. Paired-sample t-tests, single-factor analyses and multiple linear regression analyses were performed to evaluate the correlation between the differences in these parameters between the injured and uninjured elbows and the assessed risk factors. These risk factors included institution, sex, laterality, age at injury, time from injury to diagnosis, direction of RH dislocation, distance of RH dislocation (DD-RH), presence of radial or median nerve injury, heterotopic ossification and immobilization of the elbow after injury.ResultsIn children with untreated CMFs (mean time from injury to diagnosis: 14.6 months), Student’s t-test revealed a significant difference in the RHL size (P < 0.001) but not in the RNSAP angle (P = 0.075) between the injured and uninjured elbows. Pearson correlation analysis revealed a potential correlation between En-RHL and age at the time of injury (P = 0.069), time from injury to diagnosis (P < 0.001) and DD-RH (P < 0.001), excluding other risk factors (P > 0.05). Multiple linear regression analysis revealed that age at the time of injury (P = 0.047), time from injury to diagnosis (P = 0.007) and DD-RH (P = 0.001) were risk factors for an increased En-RHL in patients with untreated CMFs; the variability in En-RHL among the other three risk factors was 21.4%.ConclusionsIn paediatric patients with unilateral untreated CMFs, PRA of the injured elbow consisted mainly of RH enlargement or radial neck narrowing rather than valgus deformities of the proximal radius. Older age at injury, increased time from injury to diagnosis and DD-RH were risk factors for more severe PRA.Level of evidenceIII.

Radiological features of the carpometacarpal joint in hamate body fracture on anteroposterior hand X-ray image

BackgroundHamate body fractures are rare and can be overlooked due to the diagnostic difficulty on X-ray. We focused on the carpometacarpal joint space width (CMC-JSW) and examined the features of this fracture on versatile anteroposterior hand X-ray images, initially taken for hand trauma cases. MethodsTen patients (nine males and one female; mean age, 34 years) diagnosed with a hamate body fracture on CT in our facility between January 2013 and October 2023 were included in this study. The fracture types were dorsal type in six cases and shear type in four cases. The 4th and 5th CMC-JSWs were measured on anteroposterior hand radiography and CT sagittal sections. If the metacarpal and hamate bones appeared to overlap due to depression, the width was expressed as a negative value (overlap sign). CMC-JSWs were compared between the types or unaffected sides using the Mann–Whitney U test. The correlation with X-ray and CT measurements was analyzed using the Spearman test. ResultsThe average CMC-JSWs (IV: −0.52 mm, V: −1.33 mm) in hamate body fractures on X-ray were minus and these values were significantly lower than unaffected side (IV: 1.51 mm, V: 1.48 mm) (p < 0.05, p < 0.001). CMC-JSW (IV: −1.64 mm) and CMC-JSW (V: −2.70 mm) of dorsal type were significantly lower than shear type (IV: 1.17 mm, V: 0.72 mm) (p < 0.05). CMC-JSW values on X-ray were positively correlated with those on CT (IV: ρ = 0.796, V: ρ = 0927). ConclusionsDecreased CMC-JSW, correlated with CT sagittal sections, and “overlap sign” on anteroposterior hand X-ray were possible radiological characteristics of hamate body fracture. Care should be taken to avoid overlooking shear-type fractures because of subtle CMC-JSW decreases.

A novel method of acetabular component anteversion measurement on plain radiographs

BackgroundAcetabular component anteversion (ACA) markedly impacts the outcome of total hip arthroplasty (THA) and thus is routinely measured on radiographs postoperatively. However, clinical ACA measurement methods are either too complicated or subjective due to three drawbacks: complex calculations, measurement of obscured points, and complex geometric drawings. This study aimed to develop a precise and convenient novel method of measuring ACA on routine radiographs without the three drawbacks and to verify its accuracy and reliability by comparing it against existing methods.MethodsA novel geometric principle to measure ACA was developed. Accordingly, a protractor was designed to measure radiographic anteversion (RA) on anteroposterior (AP) hip radiographs. Three researchers measured RA twice, using the protractor, McLaren’s, and Pradhan’s method on 26 computer-simulated radiographs with pre-set RAs and 20 actual radiographs. Accuracy was assessed by errors on simulated radiographs, and reliability was assessed by results of measurements on simulated and actual radiographs.ResultsThe absolute error of the novel method (1.01° ± 1.06°) was lower than McLaren’s method (1.34° ± 1.16°) (p < 0.05) and not significantly different from Pradhan’s method (1.10° ± 1.02°) (p = 0.392). The protractor’s intra-rater and inter-rater reliability were good-to-excellent or excellent and higher or equivalent to the two other methods.ConclusionsThe novel method avoids the three major drawbacks of conventional methods. Its accuracy is significantly higher than McLaren’s method and comparable to Pradhan’s. The novel method has higher or non-inferior accuracy and reliability than McLaren’s and Pradhan’s methods.

Correlation between severity of knee joint osteoarthritis and alignment of patellofemoral and patellar height on radiographs.

The correlation between the morphological structure of the patellofemoral joint (PFJ) and the severity of knee joint osteoarthritis (KOA) remains uncertain. This study aims to investigate the correlation between the severity of knee joint osteoarthritis and the alignment of patellofemoral and patellar height on radiographs. This multi-center, retrospective study analyzed the magnetic resonance imaging (MRI) scans and anteroposterior radiographs of 534 adult outpatients with KOA. To evaluate the radiographic severity of KOA, anteroposterior radiographs of the knee and the Kellgren-Lawrence (K-L) grade were used. Knee MRI scans were used to measure the patellar length ratio (PLR), sulcus angle (SA), lateral patellar tilt angle (LPTA), and the distance between tibial tuberosity and trochlear groove (TT-TG). We examined the association between the configuration of the PFJ, arrangement, and harshness of the KOA. Information on participants' demographics, such as age, sex, side, height, and weight, was collected. A chi-squared test was used for the correlation of radiographic severity of KOA with sex and the affected side. Spearman correlation was used for patellofemoral alignment or morphology and the radiographic severity of lateral KOA. Multiple linear regression models were used for the association between LPTA, SA, TT-TG, and severity of KOA after accounting for demographic variables. The study comprised of 534 patients; of these, 339 (63%) were female. A total of 586 knees were evaluated in this study. Age showed a strong positive correlation with KOA severity (r=0.516, P <0.01), whereas LPTA showed a strong negative correlation (r=-0.662, P <0.01). Additionally, SA (r=0.616, P <0.05), and TT-TG showed a strong positive correlation (r=0.770, P <0.01) with tibiofemoral osteoarthritis (TFOA) severity. Multiple linear regression analysis indicated that knee osteoarthritis severity (β=-2.946, P <0.001) and side (β=-0.839, P=0.001) was associated with LPTA; knee osteoarthritis severity (β=5.032, P <0.001) and age (β=-0.095, P <0.001) was associated with SA; knee osteoarthritis severity (β=2.445, P <0.001), sex (β=-0.326, P=0.041), body mass index (β=-0.061, P=0.017) and age (β=-0.025, P <0.001) was associated with TT-TG. The radiographic severity of KOA positively correlated with PLR, SA, and TT-TG, but negatively correlated with LPTA. Radiographic severity of KOA was positively associated with age, SA, and TT-TG but negatively associated with LPTA.

Deep learning-based automated measurement of hip key angles and auxiliary diagnosis of developmental dysplasia of the hip

ObjectivesAnteroposterior pelvic radiographs remains the most widely employed method for diagnosing developmental dysplasia of the hip. This study aims to evaluate the accuracy of an artificial intelligence model in measuring angles in pelvic radiographs of the hip. The assessment seeks to demonstrate the efficacy of the artificial intelligence model in diagnosing both developmental dysplasia of the hip and borderline developmental dysplasia of the hip through the analysis of pelvic radiographs.MethodsA total of 1,029 patients, including 273 men and 757 women, were retrospectively included in this study. The anteroposterior pelvic radiographs were randomly divided into three sets: the training set (720 cases), the validation set (103 cases), and the test set (206 cases). Key anatomical points on the anteroposterior pelvic radiographs were identified. The Sharp, Tönnis, and Center Edge angles were calculated automatically based on the corresponding criteria. The hip development status was compared between measurements obtained from the artificial intelligence model and those defined manually by two radiologists. The area under the receiver operating characteristic curve was utilized to assess the diagnostic performance of the artificial intelligence model.ResultsThe results obtained from both manual measurements and the artificial intelligence model demonstrated no significant differences in the Sharp, Tönnis, and Center edge angles (all p > 0.05). The intra-class correlation coefficients and correlation coefficient r values exceeded 0.75, indicating that both the artificial intelligence model and manual measurements exhibited good repeatability and a positive correlation. Notably, the artificial intelligence model provided measurements more faster than those conducted by radiologists (p = 0.001). The artificial intelligence model also demonstrated high diagnostic accuracy, sensitivity, and specificity for developmental dysplasia of the hip. The performance of the artificial intelligence model in diagnosing developmental dysplasia of the hip was robust. Additionally, the results from the artificial intelligence model and manual measurements were largely consistent with clinical diagnosis results (p = 0.01). The artificial intelligence model can effectively evaluate hip conditions by measuring the Sharp, Tönnis, and Center edge angles, which are consistent closely with clinical diagnosis results.ConclusionsThe results of the artificial intelligence model measurements demonstrate a high degree of consistency with those obtained through manual measurements. The angles of Sharp, Tönnis, and Center edge, as evaluated by the deep learning-based convolutional neural network model, exhibit robust diagnostic performance in identifying both developmental dysplasia of the hip and borderline developmental dysplasia of the hip. Consequently, the artificial intelligence model has the potential to fully replace manual measurements of these critical hip angles, providing a more efficient and precise alternative for diagnosing both conditions of the hip.

Subsidence of the Corail stem in total hip arthroplasty: no influence of bony contact

IntroductionThis study investigated stem subsidence following primary total hip arthroplasty (THA) with a Corail stem in patients who underwent two-staged bilateral THA. The second outcome of interest was to investigate whether a specific single cortical bone contact point might reduce postoperative stem subsidence.MethodsThe present study was conducted following the STROBE guidelines. The records of patients who underwent THA between 2016 and 2023 were accessed. All patients who underwent two-staged bilateral THA were retrieved. The direct contact between the stem and the cortical bone was assessed at various points in the metaphysis and the distal portion of the stem (diaphysis) in both anteroposterior radiographs of the pelvis (medial and lateral bone contact) and a Lauenstein view of the hip (anterior and posterior bone contact). The following parameters were measured and compared to assess stem subsidence: distance from the proximal femur at the stem bone interface and the tip of the lesser trochanter (distance A); distance from the tip of the lesser trochanter and the tip of the femoral stem (distance B).ResultsIn total, 250 patients were included, 45% (149 of 250 patients) were women and 61% (153 of 250 THAs) were implanted primarily on the right side. The mean age of patients at the time of the first THA was 64.3 ± 10.0 years and the mean body mass index (BMI) was 28.0 ± 4.9 kg/m2. The mean length of the follow-up was 14.1 ± 10.8 months. The overall stem subsidence following THA was 2.8 ± 0.7 mm (P < 0.006). A direct cortical bone-implant contact did not exert a statistically significant difference in subsidence of the THA stem at the metaphysis and diaphysis (P > 0.5). Stem subsidence following THA with a collarless cementless Corail stem was approximately 2.8 mm at 14 months.ConclusionsDirect cortical bone contact of the stem at diaphysis and metaphysis seems not to influence stem subsidence following THA using the Corail stem.

Development and accuracy of an artificial intelligence model for predicting the progression of hip osteoarthritis using plain radiographs and clinical data: a retrospective study

BackgroundPredicting the progression of hip osteoarthritis (OA) remains challenging, and no reliable predictive method has been established. This study aimed to develop an artificial intelligence (AI) model to predict hip OA progression via plain radiographs and patient data and to determine its accuracy.MethodsThis retrospective study utilized anteroposterior pelvic radiographs of consecutive patients with hip OA who underwent primary unilateral total hip arthroplasty. Radiographs diagnosed with Kellgren–Lawrence (KL) grade 0–2 were extracted from 361 patients and 1697 images. This AI model was developed to predict whether OA would progress from KL grade 0–2 to KL grade ≥ 3 within n years (n = 3, 4, 5). A gradient-boosting decision tree approach was utilized according to feature extractions obtained by a convolutional neural network from radiographs and patient data (height, body weight, sex, age, and KL grade given by an orthopedic surgeon) with five-fold cross-validation. The model performance was assessed using accuracy, specificity, sensitivity, and the area under the receiver operating characteristic curve (AUC).ResultsThe mean accuracy, specificity, sensitivity, and AUC of our prediction model were, respectively, 81.8%, 88.0%, 66.7%, and 0.836 for 3 years; 79.8%, 85.0%, 71.6%, and 0.836 for 4 years; and 78.5%, 80.4%, 76.9%, and 0.846 for 5 years.ConclusionsThe proposed AI model performed adequately in predicting hip OA progression and may be clinically applicable with additional datasets and validation.

The Effect of L5 Morphology on Prevention of L5-S1 Degeneration Following Floating Fusion for Degenerative Spine Disorders.

Retrospective Study. The selection of floating fusion or lumbosacral fusion arises when treating patients with instability or stenosis of the lower lumbar spine concomitantly radiographic degeneration of L5-S1. This study aimed to investigate the preoperative anatomical or morphological factors affecting the survivorship of the L5-S1 after floating fusion. This study included 77 patients who had undergone floating fusion surgery through the TLIF approach. Preoperative radiographic parameters were evaluated using anteroposterior and lateral lumbar spine radiographs. The patients were divided into two groups according to the Modified Pfirrmann Grading and total endplate score. Multivariable regression analysis was performed to explore the relationships between the anatomical or morphological characteristics of L5 and the degeneration of L5-S1. The disc degeneration group exhibited a smaller height ratio of the iliac crest (Hi) and a less L5 deep position. Furthermore, the right/left height of L4 (Hr/Hl) and the right/left width of transverse process of L5 (CRt/CLt) were significantly higher in the disc and endplate degeneration groups. Multiple logistic regression analysis revealed that Hi and CRt were independently associated with L5-S1 disc degeneration, whereas Hr was a significant risk factor for L5-S1 endplate degeneration. Anatomical and morphological characteristics of L5, such as smaller Hi, higher CRt and Hr, were associated with an increased risk of L5-S1 degeneration in patients after floating fusion. These findings may indicate the fusion level when addressing lower lumbar degenerative diseases and the concurrent radiographic degeneration of L5-S1.

Comparison of Imaging Characteristics in Pediatric Patients With Trochlear Versus Medial Femoral Condyle Osteochondritis Dissecans.

Although osteochondritis dissecans (OCD) lesions are well-described in the femoral condyles and have been associated with varus limb alignment, there is limited data on OCD lesions in the trochlea. To compare the baseline imaging characteristics in pediatric patients with trochlear OCD with those with medial femoral condyle (MFC) OCD to understand whether measures of coronal plane alignment predispose to OCD development by anatomic location. Cross-sectional study; Level of evidence, 3. This study retrospectively reviewed all pediatric patients (age ≤18 years) diagnosed with isolated trochlear OCD at a tertiary-care medical center from January 2016 to May 2023; all included patients had weight-bearing hip-to-ankle alignment radiographs. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), Caton-Deschamps Index (CDI), patellar tilt, and sulcus angle were measured on initial/preoperative anteroposterior and lateral knee radiographs. Tibial tubercle-trochlear groove (TT-TG) distance and OCD lesion size were measured on initial/preoperative magnetic resonance imaging sequences. Patients were 1 to 2 matched based on age (±2 years) and sex to a cohort with isolated MFC OCD. A total of 18 extremities in 16 patients were included in the trochlear OCD cohort and matched to 36 extremities in the MFC OCD cohort. The mean age at the first clinical visit for all patients was 14.8 ± 1.5 years and did not differ significantly between the two groups (P = .40). The extremities with trochlear OCD had significantly less varus HKA (1°± 2° vs -1°± 2°; P = .004) and MAD (4 ± 8 vs -3 ± 8 mm; P = .004) compared with the MFC cohort as well as lower mLDFA (86°± 2° vs 88°± 2°; P = .004). There were no differences in MPTA, CDI, patellar tilt, sulcus angle, TT-TG distance, or OCD lesion size between groups. Pediatric patients with trochlear OCD had statistically less varus coronal plane alignment compared with age- and sex-matched patients with MFC OCD, with the latter exhibiting more significant varus based on the HKA and MAD.

Frontal plane mechanical leg alignment estimation from knee x-rays using deep learning

ObjectiveLower limb malalignment can complicate symptoms and accelerate knee osteoarthritis (OA), necessitating consideration in study population selection. In this study, we develop and validate a deep learning model that classifies leg alignment as “normal” or “malaligned” from knee antero-posterior (AP)/postero-anterior (PA) radiographs alone, using an adjustable hip-knee-ankle (HKA) angle threshold. Material and MethodsWe utilized 8,878 digital radiographs, including 6,181 AP/PA full-leg x-rays (LLRs) and 2,697 AP/PA knee x-rays (2,292 with positioning frame, 405 without). The model’s evaluation involved two steps: In step 1, the model’s predictions on knee images cropped from LLRs were compared against the ground truth from the original LLRs. In step 2, the model was tested on knee AP radiographs, using corresponding same-day LLRs as a proxy for ground truth. ResultsThe model effectively classified alignment, with step one achieving sensitivity and specificity of 0.92 for a threshold of 7.5°, and 0.90 and 0.85 for 5°. For positioning frame images, step two showed a sensitivity of 0.85 and specificity of 0.81 for 7.5°, and 0.79 and 0.74 for 5°. For non-positioning frame images, sensitivity and specificity were 0.91 and 0.83 for 7.5°, and 0.9 and 0.86 for 5°. ConclusionThe model developed in this study accurately classifies lower limb malalignment from AP/PA knee radiographs using adjustable thresholds, offering a practical alternative to LLRs. This can enhance the precision of study population selection and patient management.

Assessment of trabecular bone score (TBS) in the prediction of vertebral fracture in postmenopausal osteoporosis

The study aimed to evaluate the role of trabecular bone score (TBS) as determinant in the risk for vertebral fracture (VF) and define specific TBS threshold/s in women with postmenopausal osteoporosis.We studied 107 women with postmenopausal osteoporosis characterized by L1-L4 T-score ≤ −3.0 with (group 1) and without (group 2) VF, or L1-L4 T-score ≤ −1.0 and ≥ −2.4 and multiple vertebral fractures (VF) (group 3). We assessed 30 postmenopausal women with L1-L4 T-score ≤ −1.0 and ≥ −2.4 and no VF as controls (group 4). We measured L1-L4, femoral neck and total hip areal bone mineral density (aBMD) by dual X-ray absorptiometry (DXA) (QDR 4500; Hologic, Waltham, MA) and calculated TBS from de-identified DXA L1-L4 scans by the TBS iNsight software (Medimaps, Geneva, Switzerland). The assessment of VF was performed by means of anteroposterior and left lateral standardized radiographs of the thoracic and lumbar spine. We calculated the FRAX® value in all subjects for the assessment of 10-year fracture risk for major and hip fractures.Forty-two subjects with L1-L4 T-score ≤ −3.0 had at least one VF (group 1), while 41 have no VF (group 2). Twenty-four subjects had L1-L4 T-score ≤ −1.0 and ≥ −2.4 and at least 3 VF (group 3). We observed significantly lower TBS values in group 1 and group 3 compared to group 2 (p < 0.001) and group 4 (p < 0.05). L1-L4 aBMD and TBS values were not significantly associated in all groups. Interestingly, TBS values were independently associated with the presence of VF (log odds ratio − 8, p < 0.001) but not with the number of VF by the stepwise regression analysis. Furthermore, when we applied the cut-off value of TBS associated with degraded microarchitecture and elevated fracture risk (< 1.23), only 52 % of the subjects had VF. The cut-off value of TBS below which VF could be predicted was calculated by the receiver operating characteristic curve analysis and was 1.13.Our study demonstrates an independent association between altered trabecular microarchitecture, assessed by TBS, and the occurrence of VF in postmenopausal women with osteoporosis. This association is significant for values of TBS lower than those reported by population-based studies. Cut-off values of TBS need further evaluation by specifically designed studies assessing disease- specific thresholds for fracture risk.

A rare occurrence of enchondroma with pathological fracture of proximal femur in an adult female: A case report

Enchondroma occurrence in the proximal femur is a very uncommon condition. We report a 40-year-old female with a history of accidental slip and fall, sustained injury to her left lower limb, and was unable to bear weight on the injured leg since the fall. Anteroposterior radiograph of the pelvis with bilateral hips shows a well-defined lytic lesion in the neck of the femur with some calcified matrix and no periosteal reaction with the left femoral subtrochanteric fracture. Magnetic resonance imaging scan revealed hypointense signals on T1 and hyperintense signals on T2 sequence over the proximal femur as well as left subtrochanteric femur fracture. After preanesthetic evaluation, bone curettage with excision biopsy with open reduction and internal fixation with long proximal femoral nail and bolts and iliac crest bone graft was done. A biopsy sample sent for histopathological examination reveals enchondroma. Complete weight bearing was started after four months. No recurrence was noted on follow up.

The Critical Shoulder Angle as a Highly Specific Predictor of a Full-Thickness Rotator Cuff Tear: A Case-Control Study

Background: The critical shoulder angle (CSA) has become an important topic of study in patients with rotator cuff tears (RCTs). However, there are conflicting data on whether the CSA can differentiate between patients with normal shoulder pathology and full-thickness RCTs on shoulder radiographs. Purpose/Hypothesis: The purpose of this study was to define the relationship between full-thickness RCTs and the CSA. It was hypothesized that patients with full-thickness RCTs would have an increased CSA compared with matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This retrospective case-control study identified patients with magnetic resonance imaging scans showing full-thickness RCTs between 2009 and 2019. A 1 to 1 propensity score match was performed to identify a control group with normal rotator cuffs while controlling for baseline participant characteristics—including age, sex, body mass index, and tobacco use. A total cohort of 532 was identified, with 266 cases and 266 controls. Two independent observers measured CSAs on true anteroposterior shoulder radiographs. Results: There was no difference in baseline participant characteristics between the RCT and the non-RCT groups (P > .05). The mean CSA for the entire cohort was 33.6°± 4.2°. The CSA did not significantly vary by sex (P = .088) or tobacco usage (P = .16). The mean CSA for the RCT case group, 36.2°± 3.3°, was significantly different from the mean CSA for the control group, 30.9°± 3.3° (P < .0001). The receiver operating characteristic curve analysis produced an area under the curve of 0.88 (P < .0001). At CSAs ≥35°, there was a 67.7% sensitivity and 89.4% specificity for having a full-thickness RCT. Last, each degree of increase in the CSA increased the risk of having an associated RCT by 1.7 times (OR, 1.7 [95% CI, 1.551-1.852]; P < .0001). Conclusion: Patients with RCTs had significantly higher CSAs compared with matched controls. Increased CSA was an independent risk factor for RCTs, with an odds ratio of 1.7 per degree. The CSA is an accurate test (area under the curve, 0.88) with good sensitivity (67.7%) and specificity (89.4%) at values ≥35°. The CSA is a simple, reproducible measurement that can assist in clinical decision-making regarding full-thickness RCTs.

Global tilt angle in spinal alignment of asymptomatic older women with low bone mass

This study investigated the relationship between sagittal spinal alignment and musculoskeletal health in older women, particularly those exhibiting diminished bone density without apparent symptoms. The study assessed the impact of global tilt (GT) and the presence of coronal malalignment on spinal health. The research involved 165 asymptomatic older women with an average age of 68.91 ± 7.25 years and average body mass index of 24.26 ± 3.66 kg/m². Comprehensive standing anteroposterior and lateral spine radiographs were used for assessment. Through multivariate linear regression analysis, the study identified significant correlations between increased GT angles and various factors, including coronal malalignment, the C7 slope, and pelvic incidence. This led to the formulation of a predictive GT model: GT = −9.79 + 0.06 × menopausal period + 0.19 × body mass index (BMI)− 0.81 × average T score – 0.11 × grip strength + 3.03 × (presence of coronal malalignment) + 0.08 × sagittal vertical axis (SVA) + 0.12 × C7 slope − 0.35 × upper lumbar lordosis (ULL) − 0.43 × lower lumbar lordosis (LLL) + 0.70 × pelvic incidence (PI), with an adjusted R² of 0.816. The study findings highlight the prevalence of coronal malalignment in this demographic and its significant associations with critical spinal parameters. The proposed GT predictive model may enable development of personalized treatment plans for older women with low bone mass.

Possibility of diagnosing rotator cuff tears in areas with scarce medical resources: can non-standard anteroposterior radiographs accurately predict rotator cuff tears?

Due to the scarcity and high cost of MRI in resource-constrained regions, prompt diagnosis and treatment of rotator cuff tears remain problematic in these areas. Therefore, extensive research has been conducted to predict rotator cuff tears using simple and affordable anteroposterior radiographs. It remains unclear whether non-standard anteroposterior radiographs would have a notable impact on the preciseness of the diagnosis. We analyzed patients treated for shoulder pain at hospitals. These patients underwent shoulder joint MRI and standard anteroposterior radiographs, were categorized into those with rotator cuff tears and a control group. We assessed whether the radiographs were standard anteroposterior radiographs using classification criteria from previous studies. Three assessors independently measured the acromiohumeral interval, upwards migration index, acromion index, critical shoulder angle, and double-circle radius ratio in radiographic images. The intraclass correlation coefficient and receiver operating characteristic curves were used to assess measurement reliability and predictive capabilities of each predictive method for rotator cuff tears. This study included 102 non-standard radiographs that met the research criteria for the measurement and analysis. The intragroup correlation coefficients for the acromiohumeral interval, upwards migration index, and double-circle radius ratio were above 0.7 (0.77, 0.71, 0.76), while those for the acromion index and critical shoulder angle exceeded 0.8 (0.86 and 0.87). In non-standard radiographs, the double-circle radius ratio reliably predicted rotator cuff tears (p < 0.05), contrary to the other methods (p > 0.05). The areas under the receiver operating characteristic curves of the double-circle radius ratio, estimated by the three researchers for rotator cuff tears. This study found that non-standard radiographs significantly impaired the diagnostic performance of the acromiohumeral interval, upwards migration index, acromion index, and critical shoulder angle. Only the double-circle radius ratio maintained its predictive power (although this diminished capability may fall short of clinical relevance) and demonstrated high applicability. These findings indicate the need for researchers to prioritize the quality of radiographs and focus on reducing the sensitivity of the prediction method in relation to radiograph quality. The capability exhibited by the double-circle radius ratio warrants further investigation, to facilitate a simplified diagnosis of rotator cuff tears.