Bone Edema Research Articles

Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears.

Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). Clinical review. Level 4. The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. 2.

Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows implant bio-integration at 1-year follow-up

BackgroundA new bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) was developed for proximal interphalangeal joint (PIPJ) correction-arthrodesis. The main purpose of this clinical study was to assess implant bio-integration at 1-year follow-up. MethodsTwenty-four patients, previously treated for a Hammertoe deformity using the bio-integrative, fiber-reinforced implant, were enrolled in this follow-up study. One-year follow-up included clinical examination, patient reported outcomes, radiographs, Magnetic Resonance Imaging (MRI) and bio-integration scoring. ResultsProximal interphalangeal joint (PIPJ) radiographic fusion rate was 92% (n = 22). MRI was analyzed for 24 (100%) patients. In 100% of patients (n = 24), the border between implant and surrounding tissue was scored as partially visible. There were no cyst formation or fluid accumulation findings. Mild bone edema was detected in 29% (n = 7) and is attributed to the chronic distribution of forces due to chronic abnormal gait and pasture. None of the edema findings were considered as adverse implant-related finding. The mean bio-integration score was 7.71 ± 0.46. ConclusionsThis study demonstrates safe bio-integration of the newly developed fiber-reinforced implant at 1-year follow-up without negative side effects.

Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis.

Background:Magnetic resonance imaging (MRI) has been used as a diagnostic and prognostic instrument to evaluate the results of conservative treatment for plantar fasciitis. However, there are scarce data available relative to changes in the plantar fascia after operative treatment. The primary objective of this study is to evaluate the imaging changes in patients with recalcitrant plantar fasciitis treated operatively by means of proximal medial gastrocnemius release.Methods:Thirteen patients with recalcitrant plantar fasciitis were studied with MRI preoperatively and 1 year after operative treatment. Quantitative (plantar fascia thickness) and qualitative variables (hyperintensity in the plantar fascia, insertional calcaneus bone edema, a plantar fascia tear, and the presence of perifascial collections) were assessed by 2 musculoskeletal radiologists. Clinical results were also measured with American Orthopaedic Ankle & Society (AOFAS), visual analog scale (VAS) pain, and 36-Item Short Form Health Survey (SF-36) scales.Results:The mean plantar fascia thickness was 6.59 mm preoperatively and 6.37 mm postoperatively (P = .972). No statistically significant differences were found in any of the qualitative variables on comparing the pre- and postoperative periods. Patients reported clinical improvements in pain VAS, AOFAS measurement, and the physical subdomains of the SF-36 scale.Conclusion:Quantitative and qualitative variables assessed for the plantar fascia on MRI did not show any significant change after medial gastrocnemius release despite clear clinical improvement.Level of Evidence:Level II, perspective cohort study.

The joint involvement in adult onset Still's disease is characterised by a peculiar magnetic resonance imaging and a specific transcriptomic profile

Adult onset Still's disease (AOSD) is a rare systemic autoinflammatory disease, characterised by fever, arthritis, and skin rash, and joint involvement is one of its clinical manifestations. The aims of this work were to assess joint involvement, to describe main patterns of involvement, and associated clinical characteristics. In this work, we aimed at assessing the joint involvement in AOSD by using MRI, to describe main patterns and associated clinical characteristics. In addition, we aimed at assessing the global transcriptomic profile of synovial tissues in AOSD to elucidate possible pathogenic pathways involved. We also evaluated the global transcriptomic profile of synovial tissues to elucidate possible pathogenic pathways involved in the disease. Thus, AOSD patients, who underwent to MRI exam on joints, were assessed to describe patterns of joint involvement and associated clinical characteristics. Some synovial tissues were collected for RNA-sequencing purposes. The most common MRI finding was the presence of synovitis on 60.5%, mainly in peripheral affected joints, with low to intermediate signal intensity on T1-weighted images and intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. Bone oedema and MRI-bone erosions were reported on 34.9% and 25.6% MRI exams, respectively. Patients with MRI-bone erosions showed a higher prevalence of splenomegaly, a more frequent chronic disease course, lower levels of erythrocyte sedimentation rate, and ferritin. In AOSD synovial tissues, a hyper-expression of interleukin (IL)-1, IL-6, and TNF pathways was shown together with ferritin genes. In conclusion, in AOSD patients, the most common MRI-finding was the presence of synovitis, characterised by intermediate to high signal intensity on T2-fat-saturated weighted and STIR images. MRI-bone erosions and bone oedema were also observed. In AOSD synovial tissues, IL-1, IL-6, and TNF pathways together with ferritin genes resulted to be hyper-expressed.

Ulnar-Sided Traumatic Wrist Pain. High Resolution Ultrasound Effectiveness versus MRI Assessment and Accuracy

Abstract Background: This work was conducted to assess the effectiveness of high resolution Ultrasonography (USG) compared with Magnetic Resonance Imaging (MRI) in inves-tigating causes of ulnar sided wrist pain in traumatic patients, as this entity represents a diagnostic dilemma, owing to the anatomical complexity and small sized structures, as well as diversity of causes. Imaging plays an important role in guiding the diagnosis and minimizing unwanted surgical interventions. Aim of Study: To evaluate the diagnostic performance of both ultrasonography and MRI in ulnar sided wrist pain, high-lightening both the strengths and weaknesses of these two imaging modalities. Patients and Methods: This study included fifty patients presenting with ulnar sided wrist pain. MRI and Ultrasonog-raphy were done in all patients. Results: Out of 50 patients, 30 males (60%) and 20 females (40%), age ranging 23-65 years, were included in this study. A comparative analysis was done using MRI versus USG findings. The sensitivity, specificity, and accuracy of USG for Scapho-lunate ligament injury were 45.5%, 100%, 88% respectively, as MRI was positive in 11 cases, while USG only diagnosed 5 cases. The sensitivity, specificity, and accuracy for Triangular Fibrocartilage (TFCC) tear, were 64.71%, 90.91% and 82% respectively, as MRI was positive in 17 cases, while USG diagnosed 14 cases. For Extensor Carpi Ulnaris (ECU) injury, were 100%, 89.1% and 92% respectively, as MRI was positive in 13 cases, while USG diagnosed 17 cases. For extensor carpi ulnaris tendon sublux-ation, were 100%, 100% and 100% respectively, as both modalities were successful in diagnosing the same three cases, for ganglion cysts, were 100%, 100% and 100% respectively. For trabecular bone edema, MRI was positive in 24 cases, and for distal radioulnar joint instability MRI was positive in 9 cases, which were not diagnosed by USG, with lack of agreement between both modalities. Conclusion: Both magnetic resonance imaging and mus-culoskeletal ultrasound are essential and complement each other in the evaluation of causes of ulnar sided wrist pain in trauma patients. Musculoskeletal ultrasound is highly recom-mended for the examination of tendon injuries, while MRI is more efficient and suitable for assessing deeper structures, such as bone or ligaments.

Typical MRI‑pattern suggests peak maturation of the ACI graft 2 years after third‑generation ACI: a systematic review

Objectives:The purpose of the present article was (1) to systematically review the current literature and (2) to collect data regarding the postoperative magnetic resonance imaging (MRI) appearance of third-generation autologous chondrocyte implantation (ACI) grafts and (3) to provide an overview of imaging findings at various postoperative time points.Methods:A systematic review of the literature in Medline (Pubmed) and Embase was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles which reported the post-operative MRI morphological outcomes following the use of third-generation ACI for treatment of knee cartilage lesions were included. All MRI results were allocated to six different time intervals: ≤ 3 months, > 3–6 months, > 6 months–1 year, > 1 year–2 years, > 2–5 years and > 5 years after surgery.Results:A total of 22 studies were included and the study populations ranged from 13 to 180 patients adding up to a total of 951 patients. Parameters such as defect fill, border integration, surface contour, graft morphology and integrity of the subchondral lamina all improve gradually with a peak two years following surgery suggesting complete graft maturation at this time point. After this peak, a statistically insignificant decline is noted for most of the parameters. Signal intensity was found to gradually shift from hyperintense to isointense in the first 36 months and to hypointense later on. Contrarily, subchondral bone edema is not only a postoperative feature of the procedure but also can reappear or persist up to ten years after surgery. As graft failures can appear after two years, consequently, the MRI composite score is also affected.Conclusion:Recurring patterns in postoperative MRI appearance were observed in certain parameters including defect filling, graft signal intensity and structure, border integration of the graft while parameters like subchondral bone tend to be unpredictable. Given the heterogenous findings in terms of clinical correlation, and relating that aspect to the patterns found in this review, an MRI is justified at three months, one year, two years and five years after surgery, unless the clinical symptomatology and individual patient needs dictate otherwise.

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

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. 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 4days after onset of clinical complaint. Images were independently analyzed by two radiologists. Medical records were reviewed to obtain clinical data. Mean displacement of the apophysis was 4.8 ± 4.6mm. Bone edema was present in 82% of athletes and muscular edema in 41%. The mean time to return to sports was 37.3 ± 14.7days. The difference between the measurements of the two radiologists was close to zero with agreement limits below 1.0mm (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 3.0mm might serve as a parameter to predict return to sports/activity before 40days, with a sensitivity of 92% and specificity of 96%, considering conservative physiotherapy treatment. 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.

Possible Correlation Between Kyphosis of Lumbar Osteoporosis Fractures and the Spinal Signal Intensity Ratio (SSIR).

The aim of this study was to examine the correlation between the risk of increasing kyphosis as well as collapse of the osteoporotic vertebral body fractures and the intensity of the bone edema in magnetic resonance imaging (MRI) scans. Inclusion criteria included the following: age >18 years and osteoporotic vertebral body fracture grade I-IV according to OF classification. Exclusion criteria included the following: other pathological fractures due to primary tumors or metastasis, OF grade V fractures, and AO type B or C fractures. This was a retrospective study from pseudonymized data of a tertiary spine center. No additional imaging were performed. Measurements of bisegmental kyphosis angle of the fracture for involvement of both endplates and monosegmental angle for involvement of 1 endplate, as well as vertebral body height loss in initial radiographs and at follow-ups after 3 and 6 months have been performed. Also, the initial signal intensity of the vertebral body edema was measured using integrated tool of the DICOM viewer (Impax V6.5 Agfa, Brentford, UK) in addition to the signal intensity of the cerebrospinal fluid (CSF) as reference for T1, T2, and separate target illumination radar (STIR) sequences of the MRI scans. A quotient from the signal intensity of the vertebral body edema and the reference (CSF) has been generated. Patients have been divided to 4 groups according to the ratio (<1, 1-2, 2-3, >3) and compared in regards to the results of the degree of kyphosis and vertebral collapse at follow-ups and final examination. The statistical analysis was performed using linear regression using statistic software SPSS version 26. Forty-four patients have been included: 9 males and 35 females with an average age of 71.5 years. The analysis showed a significant correlation between the increasing kyphosis at follow-ups and the quotient of the signal intensity for STIR and T2 weighing with P = .002 (SD ±2.664) for STIR and P = .001 (SD ±1.616) for T2 sequences. Furthermore, there was only a correlation between the intensity ratio and kyphosis for STIR weighting at last examination (P = .017; SD ±1.360). There was no correlation between the height loss and the signal intensity. Level 2.

Magnetic resonance imaging as a diagnostic tool for periodontal disease: A prospective study with correlation to standard clinical findings-Is there added value?

To evaluate the correlation between standard clinical findings, radiographic (OPT) and magnetic resonance imaging (MRI) as well as to assess whether MRI is capable of providing additional information related to the severity and extent of periodontal disease. 42 patients with generalized periodontitis received pre-interventional MRI scans. These were compared to MR images of a periodontal healthy control group (n=34). The extent of the osseous oedema, detected by MRI, was set in correlation with clinical periodontitis-associated findings. A highly significant correlation between bone oedema and clinical testings such as probing depth (p<0.0001) and bleeding on probing (p<0.0001) was revealed. The oedema exceeded the extent of demineralized bone. Patients with a positive BOP test showed a 2.51-fold increase in risk of already having a bone oedema around the respective tooth even if probing depth was ≤3mm (logistic binary regression analysis, OR 2.51; 95% CI: 1.54-4.11; p<0.0001). MRI findings correlated with standard clinical findings, and MRI was able to depict intraosseous changes before any osseous defect had occurred.

Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment

To report the arthroscopic treatment results of a degenerative medial meniscus tear with a displaced flap into the meniscotibial recess, tibial peripheral reactive bone edema, and focal knee medial pain. As a secondary objective, we propose to identify possible factors associated with a good or poor prognosis of the surgical treatment of this lesion. From 2012 to 2018, patients who had this specific meniscus pathology and underwent arthroscopic surgical treatment were retrospectively evaluated. Patients with Kellgren-Lawrence (KL) classification greater than 2 were excluded. KL classification, the presence of an Outerbridge grade III/V chondral lesion of the medial compartment, limb alignment, body mass index, and smoking were evaluated. The subjective outcomes included the International Knee Documentation Committee score, improvement in the pain reported by patients, and the Global Perceived Effect (GPE) scale score. A total of 69 patients were evaluated. The mean age was 58.6 ± 7.1 years. The follow-up time was 48.7 ± 20.8 months. Fifty-five (79.7%) patients reported pain improvement. The postoperative International Knee Documentation Committee was 62.6 ± 15.4, and the mean GPE was 2.3 ± 2.6. Fourteen patients (20.3%) showed no improvement in pain, and 7 patients (10.2%) presented complications. Groups that improved (GPE > 0) and did not improve (GPE < 0) did not present differences regarding age, sex, follow-up time, chondral lesions, or body mass index. Patients without improvement had a greater incidence of smoking (P= .001), varus alignment (P= .008), and more advanced KL classification (P < .001). In the multivariate analysis based on the GPE score, KL classification (P= .038) and smoking (P= .003) were significant. Arthroscopic surgical treatment of degenerative medial meniscal tears with a meniscal flap displaced into the meniscotibial recess and adjacent focal bone edema in the tibia shows good results in approximately 80% of cases. Smoking and KL grade 2 were factors associated with poor prognosis of surgical treatment. Level IV (case series).

Knee articular cartilage injury treatment with matrix-induced autologous chondrocyte implantation (MACI): correlation at 24 and 120\xa0months between clinical and radiological findings using MR arthrography

ObjectiveTo evaluate the long-term evolution of matrix-induced autologous chondrocyte implantation (MACI) with magnetic resonance (MR) arthrography and verify the correlation between radiological and clinical findings.Materials and methodsTwenty-six patients (20 m/6f) were diagnosed with knee chondral injuries and treated with MACI implantation. Each patient received MR arthrography and clinical examination at mid-term (range 22–36 months) and long term (range 96–194 months) after surgery. MR arthrography was performed with dedicated coil and a 1.5-Tesla MR unit. The modified MOCART scale was used to evaluate the status of chondral implants. Implant coating, integration to the border zone, and the surface and structure of the repaired tissue were evaluated. Presence of bone marrow oedema was evaluated. The Cincinnati Knee Rating System (CKRS) was used for clinical assessment.ResultsAt long term, 4/26 patients had complete alignment; 5/26 had a complete integration of the margins; in 4/26 cases, the implant surface was undamaged; in 14/26 cases, the reparative tissue was homogeneous. In 9/26 cases, the implant showed isointense signal compared to articular cartilage, while the presence of subchondral bone oedema was documented in 19/26 cases. The average radiological score decreased from 59.2 (mid-term) to 38.6 (long term). The average clinical score decreased from 8.9 to 8.3.ConclusionsDecrease in clinical results was not significant (0.6 points p = .06), but mMOCART scores decreased significantly (p = .00003). Although imaging studies showed deterioration of the grafts, the patients did not have significant clinical deterioration (231/250).

HUMAN UMBILICAL CORD-DERIVED MESENCHYMAL STEM CELLS OR MICROFRACTURES ASSOCIATED TO A COLLAGEN MATRIX FOR BILATERAL KNEE CHONDRAL LESIONS REPAIR: A CLINICAL COMPARATIVE STUDY

<h3>Backgroud</h3> Collagen matrix associated to microfractures is a recognized option for chondral lesions repair. However, microfractures damage the subchondral bone and recruit an undefined amount of cells, what can lead to poor quality tissue repair. Allogenic human umbilical cord-derived mesenchymal stem cells (HUC-MSC) showed ease to obtaining, inflammatory response control, no ethic issue, no immune response. These cells can be stored in large and defined amount and be available for one-step surgery, what could improve chondral repair when associated to collagen matrix. This study aimed to compare short-term outcomes of using HUC-MSC or microfractures associated to a collagen matrix for bilateral knee chondral lesions repair. <h3>Methods</h3> The study was approved by CONEP: 1.695.843 / CAEE: 56776716.1.1001.0020. In a prospective study, three patients (mean age of 40,6 years) with bilateral knee full-thickness chondral lesions were evaluated. As the study group (SG), the right knees were treated by collagen matrix plus HUC-MSC. As the control group (CG), the left knees were treated by collagen matrix plus microfractures. Chondral defects were located in the patella (2) and the trochlea (1), and mean size was 4,6 cm2 in the SG and 3,3 cm2 in the CG. All the HUC-MSC were obtained from donors with negative serology to infections. After in vitro expansion, the HUC-MSC had 97% viability; showed negative culture bacterial and/or fungi growth, absence of mycoplasma and endotoxins; flow cytometry analysis showed positive to CD90, CD105, CD29 and CD73 and negative to CD45, CD34, CD14, CD19 and HLA-DR and normal karyotype by GTG cytogenetic analysis. By knee arthrotomy, collagen matrix Chondro-Gide was implanted on the chondral defect on both groups. SG was associated to the injection of 40 × 10⁶ of HUC-MSC. In the CG, microfractures were performed before matrix implantation. KOOS, VAS and MRI results were compared pre and postoperatively. <h3>Results</h3> After 12 months of follow-up, KOOS and VAS scores were improved postoperatively in both groups as compared to a baseline. On the SG, all MRI showed signs of full-filling, smooth surface, complete integration to adjacent cartilage, and no bone edema. MRI showed the same findings on the CG, except one, and two knees showed bone edema. No adverse effects, rejection or complications were noted in both groups. <h3>Conclusion</h3> HUC-MSC associated to collagen matrix is a safe one-step procedure for knee chondral lesions repair and shows good outcomes when compared to collagen matrix plus microfractures in the short-term.

Radiographic assessment in rheumatoid arthritis: From daily practice to clinical trials

Imaging evaluation in rheumatoid arthritis (RA) has evolved significantly in last decades. Even if the modern imaging technics like ultrasound and magnetic resonance imaging have unequivocal place in the assessment of early disease (especially for synovial inflammation, bone oedema, erosions), radiographic evaluation of hands and feet is still the most widely used imaging technic for quantification of joint damage in RA. In the current review we aim to address some practical issues related to the radiographic evaluation in RA from daily practice perspective, followed by a broader approach from the clinical trials point of view.

Long head biceps tendon instability: diagnostic performance of known and new MRI diagnostic signs.

The aim of this work was to evaluate the inter-observer agreement and diagnostic performance values of 7 MRI signs (3 known and 4 new) of long head biceps tendon instability. MRI of 86 patients were retrospectively evaluated. Inter-observer agreement and diagnostic performance of each diagnostic sign and of all combined signs (with the exception of detour sign) were tested for identification of biceps tendon instability, with arthroscopy as the reference standard. Agreement between expert operators was moderate to good. Sensitivity, specificity, and sign accuracy showed a variation respectively of the following: humeral chondral print 72-80%, 62-68%, and 70-76%; subchondral bone edema 24-31%, 84-97%, and 50%; biceps tendon angle 60-71%, 97-100%, and 74-81%, biceps tendon-groove distance 31-47%, 90-100%, and 56-64%; long head biceps subluxation/dislocation on axial plane 49-53%, 97-100%, and 66-70%; displacement sign 74-80%, 74-100%, and 74-87%; detour sign 51-64%, 58-81%, and 62-64%; and all signs 98-100%, 32-61%, and 75-86%. These diagnostic signs, both known and new, individually and/or in combination, provide a valid tool in the MRI diagnosis of long head biceps tendon instability.

High incidence of superficial and deep medial collateral ligament injuries in \u2018isolated\u2019 anterior cruciate ligament ruptures: a long overlooked injury

PurposeIn anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically ‘isolated’ ACL ruptures.MethodsPatients who underwent ACL reconstruction for complete ‘presumed isolated’ ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient’s characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.ResultsHundred patients with a mean age of 22.3 ± 4.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus ‘ramp’ lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (p < 0.01). Logistic regression analysis identified younger age (OR 1.2, p < 0.05), simultaneous sMCL injury (OR 6.75, p < 0.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54, p < 0.01) as predictive factors for a dMCL injury.ConclusionThe incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment.Level of evidenceIII.

Основні типи ушкоджень хребців при пухлинах хребта (ретроспективне дослідження)

Damage to the vertebrae as a result of neoplastic processes leads to serious health consequences for people of all ages and genders. Unsuccessfully constructed tactics for the treatment of primary and metastatic spinal lesions are the result of severe orthopedic and neurological complications, which can lead to fatal consequences. To decide what type of surgery to perform, you need to have more information than the type of tumor. To create a rational algorithm for the treatment of patients with loss of spinal support due to neoplastic lesions of the thoracic and lumbar vertebrae should consider the features of damage to the anatomical structures of the spinal motor segment and identify the main types of vertebral injuries. The purpose of the study was based on a prospective analysis of patients with spinal cord injuries, and description of the types of vertebral injuries. Material and methods. In the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine. In the period from 2008 to 2017, 264 patients with pathological changes in the spine were diagnosed. The age of patients was from 18 to 81 years. There were 137 men and 131 women. 39 (14.8%) patients did not have vertebral body deformity accompanied by bone edema, 168 (63.6%) patients had vertebral body damage without destruction of other anatomical structures, 52 (19.7%) patients were diagnosed with deformation of the vertebral body with damage to the arches and joints, and 5 (1.9%) patients had damage to the posterior support complex. Results and discussion. As a result of a prospective analysis of patients with spinal tumors, 5 types of vertebral lesions were identified by cancer: 1 – without deformation, accompanied by bone edema and visualized on MRI; 2 – deformation of the vertebral body up to 30% without damage to the posterior wall or with a small defect; 3 – deformation of the vertebral body &gt; 30%, but &lt; 60% with damage to the posterior vertebral wall; 4 – deformation of the vertebral body&gt; 60% with damage to the posterior vertebral wall; 5 – deformation of the vertebral body with damage to the arches and joints. Conclusion. As a result of damage to the anatomical structures of the vertebrae by the tumor process, important morphological features were identified: the degree of damage to the vertebral body; the magnitude of local kyphosis; deformation of the posterior wall of the vertebral body, on the basis of which the types of vertebral injuries are determined

MRI features of low-grade and high-grade chondrosarcoma in enchondromatosis

To identify magnetic resonance imaging (MRI) features which aid differentiation of low-grade chondral tumours (LGCT-enchondroma and grade 1 chondrosarcoma) from high-grade chondral tumours (HGCT) in patients with enchondromatosis. Approval from our local Research and Innovation Centre of The Institute of Orthopaedics was gained. Patients with enchondromatosis who had biopsy and/or resection of chondral lesions over a 13-year period were identified. The pre-biopsy MRI study was assessed by two experienced musculoskeletal radiologists for tumour origin (intramedullary or surface), cortical expansion, cortical destruction, bone marrow oedema, periosteal reaction, soft tissue mass and soft tissue oedema. MRI features were compared with the final histopathological diagnosis. The study group comprised 25 males and 16 females, with a mean age of 34.9 years (range 6-81 years). Fifty-nine lesions were assessed (12 patients had > 1 tumour treated), including 43 LGCT and 16 HGCT. Significant MRI features suggesting malignant transformation to HGCT for both observers included bone oedema (p = < 0.001 and 0.002), periosteal reaction (p = 0.01) and soft tissue oedema (p = 0.001 and 0.05). Cortical destruction and soft tissue mass were predictors of HGCT in major long bones, but no significant differentiating features were identified in the hands and feet. The presence of bone oedema, periosteal reaction and soft tissue oedema on MRI may indicate a high-grade malignant transformation of chondral tumours in patients with enchondromatosis.

Imbalanced MMP-3 and MMP-12 serum levels in systemic lupus erythematosus patients with Jaccoud's arthropathy and a distinctive MRI pattern.

Metalloproteinase (MMP)-3 and MMP-12 are proteolytic enzymes especially implicated in joint inflammation. This study aims to evaluate their association with arthritis features and hand MRI abnormalities in patients with SLE. Fifty SLE patients, with a mean (s.d.) age of 48.1 (14.6) years were tested for MMP-3 and MMP-12 serum levels, then further classified according to the presence of X-ray erosions and joint deformities. Eighteen RA patients aged 47.9 (11.8) and 14 healthy people aged 46.0 (11.0) were enrolled as control groups. A subgroup of 28 SLE patients underwent a dominant-hand MRI; the detected changes were classified and semi-quantitatively scored as capsular swelling, synovitis, edematous or proliferative tenosynovitis, bone oedema, bone erosions. Statistical analysis was performed using multiple regression models. MMP-3 were significantly higher in patients with Jaccoud's arthropathy (JA) (22.1 ng/ml, P < 0.05) and independently associated with hsCRP serum levels (B-coeff 0.50; r = 0.30; P < 0.05). MMP-12 serum levels were significantly lower in patients with JA (0.18 ng/ml, P < 0.05) and inversely associated with the prednisone daily dose (B-coeff -0.03; r = -0.44; P < 0.01). Capsular swelling and edematous tenosynovitis, the most prevalent hand MRI changes in patients with JA, associated with higher MMP-3 (B-coeff 0.12; r = 0.66; P < 0.01 and B-coeff 0.08; r = 0.59; P < 0.01, respectively) and lower MMP-12 serum levels (B-coeff -7.4; r = -0.50; P < 0.05 and B-coeff -5.2; r = -0.44; P = 0.05, respectively). Imbalanced MMP-3 and MMP-12 serum levels are influenced by inflammation and glucocorticoids in SLE patients and associated with JA and distinctive hand MRI changes.

Mechanisms of Action And Effects of Pulsed Electromagnetic Fields (PEMF) in Medicine

Pulsed Electromagnetic Field (PEMF) therapy is a non-invasive and non-thermal treatment widely used nowadays to treat various types of disorders and traumas, both in humans and animals. Initially applied only for wound healing, today it finds many applications in medicine for the treatment of bone fractures, arthritis, inflammation, edema, and pain. Although their mechanisms of action are still being studied today, and mainly related to the calcium signaling pathway, they are effective in the adjuvant treatment of many human diseases in different medical specialties. This work aims to report the main evidence and research in the medical field with particular reference to the application of PEMF to some medical specialties as regenerative medicine (wound care), sports medicine, orthopedics, and physiotherapy. Finally, this work also wanted to deepen one of the most recent applications of PEMF in the field of complex diseases, i.e. in the adjuvant treatment of cancer. Pulsed electromagnetic field therapy may play an important role in medicine as a complementary treatment for various human diseases and, by deepening the studies in the future, it will be possible not only to understand the exact mechanisms of action but also to extend its application to other pathologies both in the medical and veterinary fields.

Dual-energy CT in the diagnosis of occult acute scaphoid injury: a direct comparison with MRI

ObjectivesScaphoid injuries occult on plain radiography often require further imaging for definitive diagnosis. We investigate the utility of dual-energy computed tomography (DECT) for the detection of acute bone marrow oedema and fracture of scaphoid compared to MRI.Materials and methodsTwenty patients who presented acutely (without prior injury) to the emergency department with clinically suspected occult scaphoid fracture and had MRI of the wrist were prospectively recruited to have DECT (GE Revolution CT). Material decomposition images of the water-calcium base pair were generated and assessed in conjunction with the monochromatic images to permit correlation of marrow signal changes with any cortical disruption for fracture confirmation. The assessment was performed by two musculoskeletal radiologists blinded from MRI results. The statistical difference of MRI and reviewers’ detection of acute bone oedema (1 = present, 0 = absent) was performed using the Friedman test (SPSS v.16).ResultsMRI showed acute scaphoid fracture and/or bone marrow oedema in 14/20 patients of which 6 also had cortical disruption. On DECT, reviewer A identified oedema in 13 and cortical disruption in 10 patients while reviewer B identified oedema in 10 and cortical disruption in seven of the 14 MRI positive patients. No statistically significant difference in oedema detection on MRI and reviewers of DECT (p value 0.61) but DECT was more sensitive at detecting cortical disruption.ConclusionDECT has the capability to detect acute scaphoid oedema in addition to cortical fractures. However, compared to MRI, DECT has lower contrast resolution and less sensitive in the detection of mild oedema.Key Points• Dual-energy CT is able to detect acute traumatic scaphoid marrow oedema.• Dual-energy CT has greater detection rate of scaphoid fractures than MRI.• Dual-energy CT is an alternative to MRI for occult scaphoid injury.