CT Arthrography Research Articles

Lateral Joint Distraction Through Distal Fibula Lengthening Osteotomy for Lateral Compartment Ankle Osteoarthritis

Category: Ankle; Trauma Introduction/Purpose: Lateral compartment ankle OA, commonly due to trauma such as ankle fracture, is not very rare. However there's no definite established surgical treatment option. In this study, we suggest distal fibula lengthening osteotomy for lateral joint distraction as one of treatment surgical option. We have experienced favorable clinical outcome for 3 cases of post- traumatic lateral compartment ankle OA with joint space narrowing treated with distal fibula distraction osteotomy. We report the case series with the surgical technique and the clinical-radiological outcome. Methods: From April 2016 to August 2021, three ankles which underwent distal fibula distraction osteotomy were included in this study. All three ankles had a history of OR/IF due to fractures in the ankle joint and were diagnosed with lateral compartment OA. We defined lateral compartment OA when clinical symptoms and radiologic findings were consistent. Clinically, the point of pain was characterized as the lateral compartment of the ankle joint, not the syndesmosis or peri fibular area. Radiologically, joint space narrowing is showed in X-ray, and CT arthrography or MRI confirmed cartilage denudation of the lateral compartment. Results: 1) Clinical outcomes (Table 1) Case 1: The AOFAS score improved from 69 preoperatively to 93 postoperatively, and the Pain vas score improved from 7 to 0. According to patient's subjective expression, daily activity became 'Boxing available' from 'Hard to run'. Case 2: The AOFAS score improved from 73 preoperatively to 91 postoperatively, and the Pain vas score improved from 5 to 0. According to patient's subjective expression, daily activity became 'No pain on daily activity' from 'Hard to walk'. Case 3 is not described because there has been no progress for more than 1 year after surgery. 2) Radiologic outcomes (Table 2) Lateral joint space, talocrural angle, talar tilt angle and tibia axis-talar dome angle were all changed close to the contralateral ankle index after surgery. Conclusion: Painful ankle OA localized to the lateral compartment in young age is uncommon and there is no definite surgical method. Distal fibula distraction osteotomy is reasonable surgical method that does not burden patients and surgeon. In our study, distal fibula distraction osteotomy showed favorable clinical-radiological outcomes. So, we recommend this method for painful lateral compartment OA in young ages.

One-stop-shop CT arthrography of the wrist without subject repositioning by means of gantry-free cone-beam CT

Modern cone-beam CT systems are capable of ultra-high-resolution 3D imaging in addition to conventional radiography and fluoroscopy. The combination of various imaging functions in a multi-use setup is particularly appealing for musculoskeletal interventions, such as CBCT arthrography (CBCTA). With this study, we aimed to investigate the feasibility of CBCTA of the wrist in a “one-stop-shop” approach with a gantry-free twin robotic scanner that does not require repositioning of subjects. Additionally, the image quality of CBCTA was compared to subsequent arthrograms on a high-end multidetector CT (MDCTA). Fourteen cadaveric wrists received CBCTA with four acquisition protocols. Specimens were then transferred to the CT suite for additional MDCTA. Dose indices ranged between 14.3 mGy (120 kVp/100 effective mAs; full-dose) and 1.0 mGy (70 kVp/41 effective mAs; ultra-low-dose) for MDCTA and between 17.4 mGy (80 kVp/2.5 mAs per pulse; full-dose) and 1.2 mGy (60 kVp/0.5 mAs per pulse; ultra-low-dose) for CBCTA. Subjective image quality assessment for bone, cartilage and ligamentous tissue was performed by seven radiologists. The interrater reliability was assessed by calculation of the intraclass correlation coefficient (ICC) based on a two-way random effects model. Overall image quality of most CBCTA was deemed suitable for diagnostic use in contrast to a considerable amount of non-diagnostic MDCTA examinations (38.8%). The depiction of bone, cartilage and ligaments in MDCTA with any form of dose reduction was inferior to any CBCTA scan with at least 0.6 mAs per pulse (all p < 0.001). Full-dose MDCTA and low-dose CBCTA were of equal quality for bone tissue visualization (p = 0.326), whereas CBCTA allowed for better depiction of ligaments and cartilage (both p < 0.001), despite merely one third of radiation exposure (MDCTA–14.3 mGy vs. CBCTA–4.5 mGy). Moderate to good interrater reliability was ascertained for the assessment all tissues (ICC 0.689–0.756). Overall median examination time for CBCTA was 5.4 min (4.8–7.2 min). This work demonstrates that substantial dose reduction can be achieved in CT arthrography of the wrist while maintaining diagnostic image quality by employing the cone-beam CT mode of a twin robotic X-ray system. The ability of the multi-use X-ray system to switch between fluoroscopy mode and 3D imaging allows for “one-stop-shop” CBCTA in minimal examination time without the need for repositioning.

Combination CT and MRI shoulder arthrography: a novel technique and improved patient journey

Glenohumeral dislocation is the most common joint dislocation seen in the acute care setting, with an incidence of primary dislocation of 40 per 100,000 person years in males in a study of the UK population.1 This is most likely explained by the bony morphology of this joint giving less stability than the other large joints and the increased reliance on static and dynamic soft-tissue structures for stability. Perhaps more significantly, the incidence of subsequent re-dislocation in these patients, particularly the young, male, “high-risk” population is extremely high, up to 72% of males aged 12–22 years in one study.

Contrast solution properties and scan parameters influence the apparent diffusivity of computed tomography contrast agents in articular cartilage.

The inability to detect early degenerative changes to the articular cartilage surface that commonly precede bulk osteoarthritic degradation is an obstacle to early disease detection for research or clinical diagnosis. Leveraging a known artefact that blurs tissue boundaries in clinical arthrograms, contrast agent (CA) diffusivity can be derived from computed tomography arthrography (CTa) scans. We combined experimental and computational approaches to study protocol variations that may alter the CTa-derived apparent diffusivity. In experimental studies on bovine cartilage explants, we examined how CA dilution and transport direction (absorption versus desorption) influence the apparent diffusivity of untreated and enzymatically digested cartilage. Using multiphysics simulations, we examined mechanisms underlying experimental observations and the effects of image resolution, scan interval and early scan termination. The apparent diffusivity during absorption decreased with increasing CA concentration by an amount similar to the increase induced by tissue digestion. Models indicated that osmotically-induced fluid efflux strongly contributed to the concentration effect. Simulated changes to spatial resolution, scan spacing and total scan time all influenced the apparent diffusivity, indicating the importance of consistent protocols. With careful control of imaging protocols and interpretations guided by transport models, CTa-derived diffusivity offers promise as a biomarker for early degenerative changes.

Kinematic 4D CT case-control study of wrist in dart throwing motion "in vivo": comparison with other maneuvers.

To compare the diagnostic performance of scapholunate gap (SLG) measurements acquired with dart throwing (DT), radio-ulnar deviation (RUD), and clenching fist (CF) maneuvers on 4D CT for the identification of scapholunate instability. In this prospective study, 47 patients with suspected scapholunate interosseous ligament (SLIL) tears were evaluated from March 2015 to March 2020 with semiautomatic quantitative analysis on 4D CT. Five parameters (median, maximal value, range, and coefficient of variation) for SLG, lunocapitate angle (LCA), and radioscaphoid angle (RSA) obtained during DT maneuver were evaluated in patients with and without SLIL tears. CT arthrography was used as the gold standard for the SLIL status. The SLG values obtained were also compared with those obtained during CF and RUD maneuvers. Significant differences in all SLG- and LCA-derived parameters are found between patients with and without SLIL tears with DT (p < 0.003). The best diagnostic performance for the diagnosis of SLIL tears was obtained with median and maximal SLG values (sensitivity and specificity of 86-89% and 95%) and with maximal and range LCA values (sensitivity and specificity of 86% and 74%). No significant differences were observed for RSA values (p > 0.275). The SLG range obtained with DT maneuver was the only dynamic parameter statistically different between patients with partial and complete torn SLIL (p = 0.037). 4D CT of the wrist during DT showed a similar performance than RUD and a better performance than CF for the differentiation between patients with and without SLIL tears. • Four-dimensional computed tomography can dynamically assess scapholunate instability. • The best results for differentiating between patients with and without SLIL tears were obtained with SLG median and maximal values. • The dart throwing and radio-ulnar deviation maneuvers yielded the best results for the dynamic evaluation of scapholunate instability.

The Imaging Diagnosis of Patients with Shoulder Pain Caused by Sports Injury.

The shoulder joint is the most complex and movable joint of the human body. A variety of diseases can affect the shoulder joint and cause shoulder pain. Sports injuries are an important and common cause of shoulder pain. In the clinical diagnosis of shoulder joint injury, the most commonly used diagnostic methods are X-ray photography and CT imaging, but X-ray photography has poor ability to distinguish shoulder joints and other tiny tissue structures and has a sense of inspiration for shoulder joint injuries. In addition, CT arthrography has a certain risk to the lesion and is easy to form trauma, and it cannot clearly show the shoulder joint structures such as the rotator cuff and the labrum. Therefore, this article conducts MR imaging diagnostic research on patients with shoulder pain caused by sports injuries and plays an important role in imaging. This article deeply studied the clinical manifestations of shoulder joint pain and image processing technology, designed a research experiment on imaging diagnosis results of patients with shoulder joint pain caused by sports injuries, selected 87 patients with shoulder joint pain in a hospital, and analyzed X-ray photography, CT imaging, and MR imaging diagnosis, three methods to compare the diagnostic accuracy and inspection results and conduct an in-depth analysis of the causes of shoulder joint injury. The experimental results showed that there were 87 patients with shoulder joint pain, 65 patients with rotator cuff tear were diagnosed using arthroscopy, and 63 patients with rotator cuff tear were diagnosed by MR imaging. The accuracy rate was as high as 95.6%. Among them, the proportion caused by sports injuries is the highest, reaching 56%.

Ultrasound With Artificial Intelligence Models Predicted Palmer 1B Triangular Fibrocartilage Complex Injuries

To calculate the diagnostic accuracy from the confusion matrix using deep learning (DL) on ultrasound (US) images of Palmer 1B triangular fibrocartilage complex (TFCC) injury. Twenty-nine wrists of 15 healthy volunteers (11 men; mean age, 34.9 years ± 9.7) (control group) and 20 wrists of 17 patients (11 men; mean age 41.0 years ± 12.2) with TFCC injury (Palmer type IB) (injury group) were included in the study. The diagnosis of Palmer 1B TFCC injury was made using magnetic resonance imaging, computed tomography arthrography, and intraoperative arthroscopic findings. In total, 2,000 images were provided to each group, 80% of which were randomly selected by AI and used as training data; the remaining data were used as test data. Transfer learning was conducted using a pretrained 3 separate models (GoogLeNet, ResNet50, ResNet101). Model evaluation was performed using a confusion matrix. The area under a receiver operating characteristic curve was also calculated. The occlusion sensitivity was used to visualize the important features. For the prediction of TFCC injury by the DL model, the best score of accuracy was 0.85 in GoogLeNet, a recall was 1.0 in ResNet50 and ResNet101, and a specificity was 0.78 in GoogLeNet. In predicting the TFCC injury for the test data, the best score of the AUC was 0.97 on ResNet101. Visualization of important features showed that AI predicted the presence of injury by focusing on the morphology of the articular disc. US images using the DL model predicted Palmer 1B TFCC injury with high accuracy, with the best scores of 0.85 for accuracy on GoogLeNet, 1.00 for sensitivity on ResNet50 and ResNet101, and 0.78 for specificity on GoogLeNet. The use of DL for US imaging of Palmer 1B TFCC injury predicted the injury as well as magnetic resonance imaging and computed tomography arthrography LEVEL OF EVIDENCE: IV; retrospective case series study.

Computed tomography assisted diagnosis and treatment of a comminuted fracture of the plantar aspect of the medial trochlear ridge and the proximal tubercle of the talus in a foal

SummaryIsolated fractures of the proximal tubercle of the talus and the medial trochlear ridge of the talus have been reported in the equine literature. A comminuted, intra‐articular fracture of the plantar medial trochlear ridge and proximal tubercle of the talus has not been previously reported. The current case report describes this unique comminuted fracture in a 6‐week‐old Thoroughbred foal with acute onset lameness. The diagnosis was achieved by a combination of radiography, ultrasonography and computed tomography (CT) followed by CT arthrography. Surgical removal of the fracture fragments was recommended; the intra‐articular fracture fragments were removed under arthroscopic visualisation of the plantar pouch of the tarsocrural joint; due to ligamentous attachments and partial extra‐articular nature, the fracture fragment of the proximal tubercle of the talus was removed via an arthrotomy extension of the medial arthroscopy portal. On follow‐up examination 12 months post‐operatively, the yearling showed no clinical evidence of lameness or radiographic evidence of secondary degenerative joint disease.

Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist

BackgroundIn wrist arthrograms, aberrant contrast material is frequently seen extending into the soft tissue adjacent to the ulnar styloid process. Since the prestyloid recess can mimic contrast leakage in CT arthrography, this study aims to provide a detailed analysis of its morphologic variability, while investigating whether actual ulnar-sided leakage is associated with injuries of the triangular fibrocartilage complex (TFCC).MethodsEighty-six patients with positive wrist trauma history underwent multi-compartment CT arthrography (40 women, median age 44.5 years). Studies were reviewed by two board-certified radiologists, who documented the morphology of the prestyloid recess regarding size, opening type, shape and position, as well as the presence or absence of ulnar-sided contrast leakage. Correlations between leakage and the presence of TFCC injuries were assessed using the mean square contingency coefficient (rɸ).ResultsThe most common configuration of the prestyloid recess included a narrow opening (73.26%; width 2.26 ± 1.43 mm), saccular shape (66.28%), and palmar position compared to the styloid process (55.81%). Its mean length and anterior–posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively. Ulnar-sided contrast leakage was reported in 29 patients (33.72%) with a mean extent of 12.30 ± 5.31 mm. Leakage occurred more often in patients with ulnar-sided TFCC injuries (rɸ = 0.480; p < 0.001), whereas no association was found for lesions of the central articular disc (rɸ = 0.172; p = 0.111).ConclusionsSince ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist.

Dual-layer spectral detector CT arthrography of the shoulder: assessment of image quality and value in differentiating calcium from iodine.

Dual-layer spectral detector computed tomography (DLCT) may potentially improve CT arthrography through enhanced image quality and analysis of the chemical composition of tissue. To evaluate the image quality of monoenergetic reconstructions from DLCT arthrography of the shoulder and assess the additional diagnostic value in differentiating calcium from iodine. Images from consecutive shoulder DLCT arthrography examinations performed between December 2016 and February 2018 were retrospectively reviewed for hyperattenuating lesions within the labrum and tendons. The mean attenuation of the target lesion, noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of the virtual monoenergetic images obtained at 40-200 keV were compared with conventional 140-kVp images. Two evaluators independently classified each target lesion as contrast media or calcification, without and with DLCT spectral data. Receiver operating curve (ROC) analysis was performed to assess the diagnostic performance of shoulder DLCT arthrography, without and with the aid of spectral data. The study included 20 target lesions (18 DLCT arthrography examinations of 17 patients). The SNRs of the monoenergetic images at 40-60 keV were significantly higher than those of conventional images (P < 0.05). The CNRs of the monoenergetic images at 40-70 keV were significantly higher than those of conventional images (P < 0.001). The ability to differentiate calcium from iodine, without and with DLCT spectral data, did not significantly differ (P = 0.441 and P = 0.257 for reviewers 1 and 2, respectively). DLCT had no additive value in differentiating calcium from iodine in small, hyperattenuating lesions in the labrum and tendons.

Ex vivo comparison of 3 Tesla magnetic resonance imaging and multidetector computed tomography arthrography to identify artificial soft tissue lesions in equine stifles.

OBJECTIVETo determine the diagnostic performance of computed tomographic arthrography (CTA) and 3 Tesla magnetic resonance imaging (MRI) for detecting artificial meniscal, meniscotibial ligament (MTL) lesions and cruciate ligament (CL) lesions in horses.STUDY DESIGNEx vivo controlled laboratory study.ANIMALSNineteen stifles from adult horses.METHODSStablike defects (n = 84) (16 mm long, 10 mm deep) were created in the menisci (n = 35), CLs (n = 24), and MTLs (n = 25) via arthroscopy prior to MRI and CTA (80 mL contrast at 85 mg/mL per joint). Two radiologists, unaware of the lesions, reached a consensus regarding the presence of lesions, based on 2 reviews of each study. Sensitivity and specificity of MRI and CTA were determined using arthroscopy as a reference and compared with McNemar's tests.RESULTSThe sensitivity and specificity of MRI (41% and 86% respectively) and CTA (32% and 90% respectively) did not differ (P = .65). The sensitivity (MRI: 24%‐50%; CTA:19%‐40%) and specificity (MRI: 75%‐92%; CTA 75%‐100%) of imaging modalities did not differ when detecting lesions of the menisci, MTLs, and CLs (P = .1‐1.0). The highest sensitivities were achieved when MTLs were evaluated with MRI (50%) and CLs with both modalities (40%).CONCLUSIONSThe diagnostic performance of CTA was comparable with that of MRI, with a low to moderate sensitivity and high specificity.CLINICAL SIGNIFICANCEComputed tomographic arthrography should be considered as an adjunct to diagnose CL injuries. This is important for equine clinicians, as the CL cannot be visualized adequately using basic imaging techniques preoperatively.

Imaging assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears: what is the best option for quantitative assessment?

To compare four different methods for the quantitative assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears. A total of 160 consecutive patients who underwent CT arthrography to evaluate a suspected scapholunate ligament tear were prospectively included in this study approved by the local ethics committee. MR images were available for 65 of these patients. Two readers independently evaluated the dorsal scaphoid displacement on conventional radiographs with the dorsal tangential line (DTL) method, the posterior radioscaphoid angle (PRSA) on both CT and MR, and the radioscaphoid congruency ratio on MR. These measurements were compared in groups of patients with and without scapholunate ligament tears. The measurement interobserver agreement was considered excellent for the DTL and the PRSA on CT (ICC = 0.93 and 0.88, respectively), good for the PRSA (ICC = 0.65) on MR, and moderate for the RSCR (ICC = 0.49). There was a significant increase in the values of DTL and PRSA on CT between patients with normal and ruptured SLIL (p < 0.0001). The same tendency was seen on MR-based methods, but these differences were only significant for one reader. The only method that allowed the differentiation between patients with normal and partially ruptured SLIL was the PRSA on CT. PRSA on CT yielded the best diagnostic performance for SLIL rupture (a sensitivity and a specificity of 70-82% and 70-72%). DTL on standard radiographs and the PRSA on CT are the most consistent imaging indicators of SDD with an excellent interobserver reproducibility. • Dorsal scaphoid displacement is an important prognostic factor in patients with scapholunate instability. • Quantitative assessment of dorsal scaphoid displacement can be performed on conventional radiographs and CT with an excellent reproducibility. • The posterior radioscaphoid angle on CT yielded the best diagnostic performance for the identification of scapholunate ligament tears and the only method allowing differentiation between patients with normal and partially torn ligaments.

Validation of watershed-based segmentation of the cartilage surface from sequential CT arthrography scans.

This study investigated the utility of a 2-dimensional watershed algorithm for identifying the cartilage surface in computed tomography (CT) arthrograms of the knee up to 33 minutes after an intra-articular iohexol injection as boundary blurring increased. A 2D watershed algorithm was applied to CT arthrograms of 3 bovine stifle joints taken 3, 8, 18, and 33 minutes after iohexol injection and used to segment tibial cartilage. Thickness measurements were compared to a reference standard thickness measurement and the 3-minute time point scan. 77.2% of cartilage thickness measurements were within 0.2 mm (1 voxel) of the thickness calculated in the reference scan at the 3-minute time point. 42% fewer voxels could be segmented from the 33-minute scan than the 3-minute scan due to diffusion of the contrast agent out of the joint space and into the cartilage, leading to blurring of the cartilage boundary. The traced watershed lines were closer to the location of the cartilage surface in areas where tissues were in direct contact with each other (cartilage-cartilage or cartilage-meniscus contact). The use of watershed dam lines to guide cartilage segmentation shows promise for identifying cartilage boundaries from CT arthrograms in areas where soft tissues are in direct contact with each other.

The distribution in joint recesses and adjacent synovial compartments of loose bodies determined on MR and CT arthrographies of ankle joint.

Loose bodies (LBs) are intraarticular free bodies and may cause synovial inflammation.Accurate and complete determination of the number and location of LBs before surgery are very important for effective treatment.The location, number and distribution of LBs in the ankle joint may be determined successfully by high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA).For this purpose, MRA and CTA may increase the diagnostic and therapeutic success of the arthroscopy.

The Evolving Roles of MRI and Ultrasound in First-Line Imaging of Rotator Cuff Injuries.

Rotator cuff tears are the most likely source of shoulder pain in adults and may cause protracted disability. Management of rotator cuff tears is associated with considerable costs. Accurate diagnosis can guide surgical planning and help achieve a favorable clinical outcome. Although radiography remains the initial imaging test for shoulder injury, the roles of MRI and ultrasound (US) as first-line imaging after radiography are evolving. This article leverages current literature and the practical experience of subspecialty musculoskeletal radiologists from different institutions in describing a practical approach to imaging rotator cuff pathology. Both MRI and US are accurate for identifying rotator cuff tears, but each has advantages and shortcomings. As both modalities currently represent reasonable first-line approaches, considerable practice variation has evolved. Given the low cost of US, imagers should strive to optimize the quality of shoulder US examinations and to build referrer confidence in this modality. The roles of direct CT and MR arthrography as well as imaging evaluation of the postoperative rotator cuff are also considered. Through careful selection among the available imaging modalities and optimal performance and interpretation of such examinations, radiologists can positively contribute to the diagnosis and treatment of patients with rotator cuff injuries.

A threshold volume of 10ml is suggested for detecting articular cartilage defects in equine carpal joints using CT arthrography: Ex vivo pilot study.

Computed tomographic arthrography (CTA) has been described as a method for detecting articular cartilage defects in equine carpal joints; however, published studies on the effects of contrast volume for lesion detection are currently lacking. The purpose of this prospective, experimental, pilot study was to determine a threshold volume of iodinated contrast for CTA of the antebrachiocarpal (ABC) and middle carpal (MC) joints for detection of articular cartilage surface defects. Articular cartilage defects were iatrogenically created in the surfaces of the ABC and MC joints of 20 equine cadaver limbs using arthroscopy. Unaltered articular surfaces within some joints acted as controls. Joints were imaged precontrast using multidetector CT. The ABC and MC joints were injected with a 150mg iodine/ml nonionic contrast medium, in 5ml increments from 5 to 50ml per joint with CT performed subsequent to each increment. Cartilage defects were measured grossly using a caliper. Detection (qualitative) and measurement (quantitative) of the defects were independently performed by two board-certified radiologists using medical imaging software. At each volume of contrast, the interrater reliability for gross examination and the two observers in the detection of a defect was calculated (Gwet's AC1). Logistic mixed-effects models of selected volumes, 0, 5, 10, 15, and 50ml, demonstrated that at 10ml contrast and above, no statistically significant difference between either observer and gross examination for defect detection was identified for either joint. Findings supported using a dose of 10ml for 150mg iodine/ml concentration contrast media when performing CTA of equine carpal joints.

Dual energy CT arthrography in shoulder instability: successful iodine removal with virtual non-contrast images and accurate 3D reformats of the glenoid for assessment of bone loss

ObjectiveTo evaluate the image quality of dual energy CT (DECT) of the shoulder after arthrography and of virtual non-contrast (VNC) 3D reformats of the glenoid and to compare glenoid measurements on VNC 3D reformats and on 2D CTs.Materials and methodsDECT arthrography (80 kV/140 kV) was performed in 42 shoulders of 41 patients with instability using diluted iodinated contrast media (80 mg/ml). VNC images and VNC 3D reformats of the glenoid were calculated using image postprocessing. Dose parameters, CT values of intraarticular iodine and muscle, image contrast (iodine/muscle), and image quality (5-point scale: 1 = worst, 5 = best) were evaluated. Two independent readers assessed glenoid morphology and performed glenoid measurements on 2D and 3D images.ResultsCalculation of VNC images and VNC 3D reformats was successful in 42/42 shoulders (100%). The effective dose was mean 1.95 mSv (± 0.9 mSv). CT values of iodine and muscle were mean 1014.6 HU (± 235.8 HU) and 64.5 HU(± 8.6 HU), respectively, and image contrast was mean 950.2 HU (± 235.5 HU). Quality of cross-sectional images, VNC images, and VNC 3D reformats was rated good (median 4 (4–5), 4 (3–4), 4 (3–5), respectively). Detection of an osseous defect was equal on 2D and 3D images (13/42, P > 0.99) with no difference for measurement of the glenoid diameter with mean 28.3 mm (± 2.8 mm) vs. 28.4 mm (± 2.9 mm) (P = 0.5), width of the glenoid defect with 3.2 mm (± 2.1 mm) vs. 3.1 mm (± 2.3 mm) (P = 0.84), surface area with 638.5 mm2 (± 127 mm2) vs. 640.8 mm2 (± 129.5 mm2) (P = 0.47), and surface area of the defect with 46.6 mm2 (± 44.3 mm2) vs. 47.2 mm2 (± 48.0 mm2) (P = 0.73), respectively.ConclusionDECT shoulder arthrography is feasible and allows successful iodine removal with generation of VNC images and accurate VNC 3D reformats of the glenoid for assessment of bone loss.

Long-term outcome for repair of osteochondral lesions of the talus by osteochondral autograft: A series of 56 Mosaicplasties®

IntroductionThe present study analyzed results in 56 osteochondral Mosaicplasty® autografts for osteochondral lesion of the talus (OLT) at more than 5 years’ follow-up. HypothesisMosaicplasty® shows long-term efficacy and low morbidity in the treatment of OLT. Patients and methodsA multicenter retrospective study included patients treated by Mosaicplasty® with more than 5 years’ follow-up. Preoperative data were collected from medical files, and all patients were reassessed. AOFAS scores and FAOS were calculated at last follow-up. Imaging comprised standard radiographs and MRI or CT arthrography of the ankle. ResultsFifty-six patients were included, with a mean age of 34 years (range, 18-60 years). Seventeen involved work accidents. Mean follow-up was 8.5 years (range, 5-20 years). Mean AOFAS score at follow-up was 80.6±19.4 and mean FAOS 77.8±21.5. Work accident, preoperative osteoarthritis and untreated laxity correlated significantly with poorer results. At last follow-up, 22 patients (39%) showed signs of osteoarthritis. There was no morbidity implicating the malleolar osteotomy. There were 11 cases (20%) of persistent patellar syndrome at the donor site. DiscussionThe present results were comparable to those reported elsewhere, showing that functional results of Mosaicplasty® autograft for OLT do not deteriorate over the long term. Work accidents correlated significantly with poorer functional outcome. Any associated instability must always be treated. Malleolar osteotomy provides good exposure without additional morbidity. Level of evidenceIV; retrospective study.

Effects of steroid injection during rehabilitation after arthroscopic rotator cuff repair.

BackgroundThis study aims to compare the clinical outcomes of steroid injections during the rehabilitation period after arthroscopic rotator cuff repair (ACRC).MethodsAmong patients who underwent ARCR, 117 patients who met the inclusion and exclusion criteria were enrolled. Pain and range of motion (ROM) recovery at the 3-, 6-, and 24-month follow-up visits and functional outcome at the 24-month follow-up were compared between 45 patients who received ultrasound-guided subacromial steroid injection at postoperative week 4 or 6 and 72 patients who did not. Functional outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) score and Constant score. Healing of the repaired tendon and retear were observed at the 6-month follow-up via magnetic resonance imaging (MRI) or computed tomography (CT) arthrography.ResultsAt the 3-month follow-up, the steroid injection group showed lower visual analog scale scores than the control group (p<0.05) and showed faster recovery of forward flexion and internal rotation (p<0.05). From the 6-month follow-up, the two groups did not show differences in pain and ROM, and the ASES score and Constant score also did not significantly differ at the 24-month follow-up. The two groups did not differ in retear rate as determined by MRI or CT arthrography at the 6-month follow-up.ConclusionsThis study demonstrated that ultrasound-guided subacromial steroid injection at 4 or 6 weeks after ARCR leads to quick pain reduction and ROM recovery until 3 months after surgery. Therefore, subacromial steroid injection is speculated to be an effective and relatively safe method to assist rehabilitation.

Interdisciplinary consensus statements on imaging of scapholunate joint instability

ObjectivesThe purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.MethodsNineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists.ResultsTen of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.ConclusionsDelphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.Key Points• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability.• Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability.• Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.