Tendinous Lesions Research Articles

Return to Work After Subcutaneous Transposition of the Extensor Indicis Proprius to Repair Inveterate Ruptures of Extensor Pollicis Longus

Background/Objectives: An Extensor Pollicis Longus (EPL) subcutaneous rupture is a substantial complication in post-traumatic or degenerative wrist and tendinous lesions. The diagnosis is essentially dictated by a clinical evaluation; in fact, it is characterized by the inability to extend the thumb interphalangeal joint and to retropose the thumb while the hand is resting on a surface. The tendinous transposition using the Extensor Indicis Proprius (EIP) as a donor tendon is a well-known surgical technique performed to restore functional activity to the thumb, and it is preferred for the closer cerebellar network with the thumb itself. However, there is a dearth of clinical results and scientific evidence in the literature. The aim of this study is to evaluate the return-to-work eligibility after an inveterate EPL subcutaneous rupture repaired with a transposition of the EIP. Methods: Patients who reported a subcutaneous rupture of the EPL due to rheumatic diseases or who had undergone previous hand or wrist surgery were excluded; however, all patients tested positive for traumatic wrist hypertension. The surgical technique involves three small incisions to achieve tenorrhaphy of the EIP at the distal head of the EPL. Dynamic tests are carried out intraoperatively to verify the tightness and sufficient rigidity of the suture. The objective evaluation involves the range of motion, pinch strength, and power extension of the thumb and the index finger. Patient-reported outcome measures for pain and patient satisfaction include the Numeric Pain Rating Scale and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Results: A total of 12 patients were eligible (7 W, 5 M, mean age 56.3 years) and were followed for at least one year. There were no surgery-related complications. After the cast was removed 3 weeks after surgery, patients could extend their thumbs, put them back, and use their index fingers. An immediate improvement in objective and subjective assessments was reported. At 10 weeks, nine patients (75%) returned to full work with no pain and without the aid of rehabilitation; two patients (17%) returned to full work with no symptoms 2 weeks later; and only one patient (8%) with a neurological disease required physical therapy, achieving pain control and restoration of full mobility approximately six months after surgery. Conclusions: This surgical technique seems to address satisfactory results in terms of skill recovery and rapid return to work. A tailored rehabilitation program should be implemented for selected patients with neurological conditions that may prolong the adaptation process of the transposed tendon, the coordination, and the independent function of the thumb and index finger.

Single-Site Endoscopic Surgery for Soft Tissue Lesions: An Innovative Technique.

Purpose We aimed toreport an innovative single-site endoscopic surgery for soft tissue lesions performed at our center. Methods All patients who underwent soft tissue surgery were reviewed. All consecutive patients who underwent single-site endoscopic surgery betweenSeptember 2019 andMarch 2024 were included in the study. Data were extracted from our medical records database, including sex, age, diagnosis, sites of surgery, surgery, operation time, blood loss, and follow-up. Results There were 10 females and five males in the current study, with ages ranging from one year to 26 years (median = nine years). Conditions for surgery included enlargement of the leg (n = 5), fibro-adipose vascular anomaly (n = 4), microcystic lymphatic malformation (n = 3), venous malformation with thrombosis (n = 3), and borderline tumor (n = 2). Surgical sites included the lower extremity (n = 13) and upper extremity (n = 2). Perioperative thrombosis prophylaxis included elastic compression and subcutaneous low-molecular-weight heparin in patients who had venous malformation and localized intravascular coagulopathy for three or more days. Surgery included tumor en blocresection, tumor partial resection, lymphedema debulking, microcystic lymphatic malformation debulking, limb debulking, intramuscular lesion radical resection, thrombectomy, Achilles lengthening, relaxation of the ankle capsule, gastrocnemius recession, and tendon transfer. Technical success was obtained in all patients. Operative duration ranged from 66 to 455 minutes (median = 183 minutes). Blood loss ranged from 5 to 700 mL (median = 50 mL). One patient received a blood transfusion. Conclusions This retrospective review demonstrates the feasibility of using a single-site endoscopic approach to resection of subcutaneous, muscularand tendinous lesions and proof of principle for future soft tissue surgery.

Flexor Hallucis Longus decompression under ultrasound guidance: A cadaver study

IntroductionThe Flexor Hallucis Longus (FHL) is a muscle that can be subject to multiple impingements caused by exaggerated plantar flexion in athletes. The most common impingement is due to inflammation of the tendon at the retrotalar pulley. The constraints exerted on the FHL are responsible for a pathology called functional Hallux Limitus. Surgical treatment consists of tenolysis of the FHL arthroscopically or via open surgery, by opening the pulley. The objective of this study was to evaluate the risk of lesions of the neurovascular pedicle and the posterior tibial tendon after tenolysis of the Flexor Hallucis Longus under ultrasound guidance. HypothesisThe hypothesis of this study is that tenolysis of the Flexor Hallucis Longus could proceed under ultrasound guidance without associated tendon lesions or neurovascular lesions. Material and methodsThirteen cadaveric specimens were studied, resulting in an analysis of 26 feet. Following identification of the Flexor Hallucis Longus, tenolysis with a 19-gauge needle under ultrasound guidance was performed by an orthopedic specialist after hydrodissection to push back the posterior tibial pedicle. The dissection of the cadavers made it possible to verify the positioning of the posterior tibial pedicle, the FHL tendon and the opening of the retrotalar pulley. ResultsFive cadaveric subjects, 10 cases, underwent a complete opening of the retrotalar pulley under ultrasound guidance. In 16 cases, the opening was partial, with a section of the pulley of 65.87±18%. The cases of partial openings showed no neurovascular or tendinous lesions. The 10 cases of complete opening resulted in 5 lesions of the tibial nerve, 4 vascular lesions: 1 venous and 3 arterial, and 6 lesions of the FHL tendon. ConclusionTenolysis of the Flexor Hallucis Longus under ultrasound guidance at the level of its retrotalar pulley was systematically associated with neurovascular lesions in the event of complete release of the pulley by the method studied, unlike a partial release where no lesion was found. Level of EvidenceIII; case-control study.

Ulnar-Sided Upper Extremity Traumatic Wounds: What Should We Expect to Find?

Background: Upper limb traumatic injuries have a significant impact on social and professional life; however, there is still a paucity of studies focusing on the injuries of the ulnar border of the forearm, wrist and hand. Methods: We designed a retrospective single-blinded study, including all patients with deep traumatic wounds affecting the ulnar side of the forearm, wrist or hand, that received surgical treatment from 2006 until 2016. A characterisation of the sample, assessment of concomitant injuries and clinical outcomes, as well as neurological and functional evaluation were performed. Results: We obtained a sample of 61 patients, 69% with injuries affecting the wrist and 90% of patients with a neurological lesion, most frequently of the ulnar nerve lesion (UNL). Concomitant injuries included tendinous lesions, more frequently of the flexor carpi ulnaris (64%) and fractures (13%). And 39% of patients presented an ulnar artery lesion, without significant differences in outcomes regarding the completion of arteriorrhaphy or not. At the end of the 8.6 years follow-up, 34% of patients had no deficits; however, patients with UNL showed worse functional scores and greater risk of sequelae. Besides motor function compromise, sensory deficits were also associated with worst functional outcomes. Conclusions: The UNL subgroup showed important impairment of the first ray, probably related to the level of UNL. Furthermore, besides the implications of the motor sequelae, sensory deficits were also associated with worst functional scores. Due to the high percentage of neurovascular and tendinous lesions in ulnar-sided upper extremity wounds, the authors recommend surgical exploration of these lesions. Level of Evidence: Level IV (Therapeutic).

Caso clínico - Rutura do Tendão de Aquiles: do Diagnóstico à Retoma Desportiva

Achilles tendon ruptures are the most common tendinous lesions in the adult population. The incidence has been rising, and it is more common between men and athletes. Achilles tendon rupture is a very relevant injury for athletes as it can threaten their career, with 20% to 40% not returning to elite sport. With the advent of better rehabilitation programs and new options available, the conservative treatment has become more popular and recent studies demonstrated similar outcomes compared with surgery. The conservative option is based on the principle of cast splint immobilization or functional braces, early weight-bearing and physical rehabilitation. The surgical treatment is based in open, mini-open and percutaneous approaches, with the goal to restore length and tension of the tendon. Percutaneous and mini-open techniques seem to have some benefit, as they reduce the risk of complications and an earlier return to physical activities.

Ultrasound evaluation shows increase in laxity after partial common extensor origin detachment but not after additional lesion of the radial band of the lateral collateral ligament

PurposeThe lateral elbow musculature conveys a dynamic valgus moment to the elbow, increasing joint stability. Muscular or tendinous lesions to the anterior half of the common extensor origin (CEO) may provoke a deficiency in the elbow dynamic stabilizers, regardless of their traumatic, degenerative, or iatrogenic aetiology. Furthermore, a role for the radial band of the lateral collateral ligament (R-LCL) has been postulated in the aetiology of lateral elbow pain. This study aimed to evaluate the effects of sequential lateral releases with dynamic ultrasound, evaluating its capability to detect lesions of the CEO and of the R-LCL.MethodsUltrasound investigation of the lateral compartment of the elbow was performed on nine cadaveric specimens with a 10 MHz linear probe in basal conditions, after the release of the anterior half of the CEO and after complete R-LCL release. The lateral joint line widening (λ) was the primary outcome parameter, measured as the linear distance between the humeral and radial articular surfaces.ResultsThe release of the anterior half of the CEO significantly increased λ by 200% compared to the starting position (p = 0.0008) and the previously loaded position (p = 0.0015). Conversely, further release of the R-LCL caused only a marginal, non-significant increase in λ.ConclusionsUltrasound evaluation can detect changes related to tendon tears or muscular avulsions of the CEO and can depict lateral elbow compartmental patholaxity by assessing articular space widening while scanning under dynamic stress. However, it cannot reliably define if the R-LCL is injured. Iatrogenic damage to the CEO should be carefully avoided, since it causes a massive increase in compartmental laxity.

Recurrence and return to sport after surgery for shoulder instability: arthroscopic Bankart versus Latarjet procedure.

BackgroundSurgeons differ in their preferences concerning the best surgical technique for treating shoulder instability in sportspeople. The purpose was to evaluate the risk of recurrence and the likelihood of return to sport for the 2 principal shoulder stabilization techniques used to treat shoulder instability in sportspeople.MethodsWe screened sportspeople who had undergone shoulder stabilization for inclusion in this cohort study. For eligibility, patients had to have undergone surgery by one of the 2 techniques: Latarjet or arthroscopic Bankart between 2005 and 2011, and aged from 18 to 35 years. We excluded acromioclavicular dislocation, tendinous lesion, global or posterior instability, bone fracture or severe glenoid bone loss, neurological lesion, other surgical technique, and orthopedic treatment. Patients were contacted by telephone between 2009 and 2012 and asked to participate in follow-up after surgery. The primary endpoint was recurrence, evaluated by determining frequency and time to recurrence (or censoring) with Cox models. The secondary endpoint was the return to sport (training and competition).ResultsFollow-up telephone interviews were conducted with 120 sportspeople (response rate of 61.5%), one of whom was excluded due to the occurrence of a new contralateral dislocation before returning to sport after surgery (Latarjet n = 80, Bankart n = 39). The risk of recurrence was significantly higher (P < .001) for Bankart (n = 7, 17.9%) than for Latarjet (n = 2, 2.5%) interventions. Being under the age of 20 years was a significant risk factor for recurrence (P = .007). Return to sport was significantly more frequent among sportspeople undergoing Latarjet procedures, for both training (P = .031) and competition (P = .038), and was also significantly more rapid for training (P = .034) with a mean time to return to training of 5.1 months for Latarjet procedures, versus 6.4 months for Bankart procedures.ConclusionThe Latarjet surgical technique results in fewer recurrences than the Bankart technique, with a higher rate of return to sport (training, competition) and a faster return to training for sportspeople practicing potentially risky sports in competition. Age was also identified as an additional risk factor for recurrence. It is important to take these factors into account when considering the indications for surgery.

Imaging of the Posttraumatic Knee in Pediatric Patients.

Owing to its continuous transformation, the musculoskeletal system of pediatric patients presents some unique features with respect to both anatomy and physiology. The lesional pattern of the knee in pediatric patients is both similar to and in many aspects different from the lesional pattern in adults with knee injuries. In the case of pediatric patients, meniscal, tendinous and ligamentous lesions occur most frequently as a consequence of traumatic episodes. The purpose of the present study is to emphasize the importance of MRI examinations in pediatric patients exhibiting symptoms of knee joint injury. The imaging assessment of the extent of the lesions, which can be either simple or complex alterations, can directly influence the clinical management of these cases by appreciating the growth potential of the specific segment of immature skeleton involved.

Role of Ultrasound and Magnetic Resonance Imaging in Evaluation of ‎Elbow Pain

The elbow is a complex joint designed to withstand a wide range of dynamic exertional forces. There are multiple lesions causing pain at the elbow. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior elbow. The purpose of this study is to evaluate the role of ultrasound and ‎magnetic resonance imaging in identifying elbow pain causes. Sixty patients (36male and 24 female) were enrolled in this study who are complaining from elbow pain and or any discomfort at elbow region. ‎Tendinous elbow lesions (flexor and extensor tendon injury) were the most detectable lesions (50/172) (29.0%), followed by ligamentous lesions (medial and lateral collateral ligament injuries) (42/172) (24.41%), bony lesions (38/172) (22.09%), muscle lesions (24/172) (13.95%) and nerve lesions come last with (20/172) (11.76%). Ultrasound is a rapid cheap modality of choice regarding screening of elbow tendionous and ligamentous injury to lesser degree bony and neural lesions, MRI should be considered to assess precisely the extent of any ‎injury in addition to the value of bone visualization & nerve evaluation. Magnetic resonance neurography is a potentially useful diagnostic tool in the evaluation of ulnar neuropathy at the elbow especially ulnar nerve.

Il prelievo delle cellule staminali mesenchimali dal tessuto adiposo

The treatment of chondral and tendinous lesions with staminal cells is today widely used and well accepted by the scientific community. In our first attempts, we did not pay much attention to the phase of sampling mesenchymal cells from the adipose tissue. Local complications and aesthetic gripes led us to a constant evolution in the sampling technique. Today, we have achieved a good sampling technique with a very low rate of local complications and virtually invisible scars.

A Test for the Clinical Evaluation of the Flexor Digitorum Superficialis of the Fifth Finger.

Patients with wounds of the FDS5 were included in this study. Under local or regional anesthesia, 3 described clinical tests were performed to assess the function of the FDS5: (i) the classic test; (ii) Stein's modified test, and (iii) Mecott's modified test. We determined sensitivity, specificity, and predictive values of all such tests. The integrity of the tendon was assessed surgically. Correlation among blinded observers was also established. A total of 28 subjects with a mean age of 28 years (ranging from 5 to 56) participated in this study. The classic test obtained a sensitivity of 100% and a specificity of 72%; Stein's test resulted in a sensitivity of 83% and a specificity of 95%, whereas Mecott's test reached a sensitivity of 100% and a specificity of 95%. Among the 3 tests described and used in our study, Mecott's modified test proved to be more sensitive and specific than the other two; therefore, we consider this to be the test that should be used in determining the integrity of the FDS5.

A prospective study of surgical management of chronic neglected tendoachilles rupture with teuffer technique

Aim: Injuries of Achilles tendon are relatively common in middle aged athletes and it's one of the most common tendons to be ruptured. As Achilles tendon rupture is both a serious injury and one of the most common tendinous lesions, various treatment modalities are devised. We conducted a prospective study to analyze outcome of surgical management of chronic neglected tendoachilles rupture with Teuffer technique. Materials and Methods: Our study included 20 patients of chronic neglected tendoachilles rupture. Those who visited VIMS orthopedic outpatient department were examined and included in our study once they satisfied the inclusion criteria and after thorough preoperative analysis patients were operated under spinal anaesthesia with Teuffer’s technique. Post operatively patients were put on pop slab and progressive strengthening and rehabilitation program was followed. Patients were followed up at 4 weeks, 8 weeks, 3 months and at 6 months and final outcomes were measured using modified Rupp scoring. Results: Final outcome were measured using modified Rupp scoring which showed 10 excellent, 4 good, 4 fair and 2 poor results. Conclusion: Results of reconstruction of chronic Achilles tendon ruptures using Teuffer’s technique showed the technique to be, a strong and stable repair that allows early weight bearing and ambulation, with favorable clinical results, in most patients.

Cooling and Cryopreservation of Equine Platelet-Rich Plasma With Dimethyl Sulfoxide and Trehalose

Equine platelet-rich plasma (PRP) has been used in horses to repair bone, articular and tendinous lesions, laminitis, and even endometritis. However, platelets have a very limited lifespan, which makes it difficult to prepare and use PRP, except in loco. With the aim to produce PRP with higher platelet viability for clinical purposes, the effects of the cryoprotectants dimethyl sulfoxide (DMSO) and trehalose were evaluated on cooled (4°C) and cryopreserved (−196°C) equine PRP. The protocols of cooling and cryopreservation were performed independently, comparing the following treatments: fresh PRP, PRP + 6% DMSO, PRP + 300 mM of trehalose, and PRP only. The PRP samples were prepared by double centrifugation of the blood of six ponies, further divided into four aliquots. The cooled or cryopreserved aliquots were stored for 14 days. All samples were evaluated for the platelet count, the mean platelet volume, and the release of transforming growth factor beta 1 (TGF-β1). The number of platelets in the fresh PRP and cooled samples was similar; however, platelet count was higher in the fresh PRP than in cryopreserved samples. The release of TGF-β1 was higher in the fresh PRP (105891 ± 52398 pg/mL), but the stored samples still released significant amounts of this growth factor (27291 ± 9625 pg/mL).

Concordance of US and MRI for diagnosis of ligamentous and tendinous injuries around the ankle

PurposeTo estimate the accuracy of ultrasonography in detection of tendinous and ligamentous injuries around the ankle in comparison to MRI. Materials and methods60 patients referred with unilateral painful ankles are subjected to ankle ultrasonography and the results are compared with ankle MRI between December 2015 and September 2016. Results132 pathologies including 62 tendon lesions, 46 ligamentous lesions, 10 bursitis and 14 joint effusion were diagnosed by MRI. Ultrasonography detected 59 tendinous lesions (missed 3 partial tears) with allover accuracy of 96%, 41 ligamentous lesions (missed 1 stretching lesion, 2 partial tears and 1complete tear) with allover accuracy of 94.3%, all bursal lesions detected and 2 cases with joint effusion were missed by ultrasonography. ConclusionUltrasonography is an accurate and sensitive modality in detecting tendinous and ligamentous lesions around the ankle and represent with MRI complementary tool for diagnosis and can be used alone is some conditions

Use of Intramedullary Cannulated Headless Screws in the Treatment of Hand Fractures - An Anatomical Study on Long Fingers

Objective To quantify the cartilaginous and tendinous lesions produced upon percutaneous introduction of intramedullary cannulated screws as osteosynthesis material in metacarpal and phalangeal fractures. Materials and Methods Seven anatomical models and one non-replanted hand were used. The measurements of 30 metacarpals and proximal and middle phalanges were taken. Cannulated screws with complete and partial threads were placed percutaneously through the metacarpal head and the proximal and middle phalanges, reproducing the actions performed in the clinic. The following measurements were performed: A) Percentage of the damaged cartilaginous area and its location. B) Damage to the extensor apparatus and its distance to the bone insertion point. C) Bone marrow size. Results (A) The percentages of the damaged areas in the metacarpals, proximal and middle phalanges were 5.7%, 13.35% and 9.62%, respectively. (B) The damage to the extensor apparatus was less than 3 mm with a 4-mm distance to the bone insertion point and (C) We have obtained the measurements of the intramedullary bone and from them, we calculated the width of the most appropriate screw. Conclusion In conclusion, the use of retrograde and percutaneous cannulated screws is a reliable technique with regard to the associated morbidity, and we present an approximation regarding the most appropriate screw for each location.

Radiofrequency preserves histoarchitecture and enhances collagen synthesis in experimental tendon injury.

We investigated the action of radiofrequency (RF) on the healing process after inducing experimental lesions of the Achilles tendon in rats. Wistar rats were surgically subjected to bilateral partial transverse sectioning of the Achilles tendon. The right tendon was treated with radiofrequency (RFT), whereas the left tendon served as a control (CT). On the third postoperative day, the rats were divided into three experimental groups consisting of ten rats each, which were treated with monopolar radiofrequency (Tonederm™) until they were sacrificed on the 7th, 14th or 28th days. The histological specimens were studied for inflammatory cell content, collagen types I and III, immunostaining and morphometry. Total collagen were biochemically analyzed and to evalute fibroblast and myofibroblast proliferation by vimentin and α-actin smooth muscle immunohistochemistry methods. Statistical analysis was performed using the Student's t-test, the sign test and the Kruskal-Wallis test to compare tendons treated with radiofrequency with the non-treated tendons (α=5%; α=10%). Larger amounts of collagen I with hydroxyproline content and myofibroblast cells were clearly evident within 7 days (p<0.05). No difference was observed in the inflammatory cell content between the groups. We found better collagen arrangement with RF administration across the entire time studied. Radiofrequency administration preserves histoarchitecture and enhances collagen synthesis during the initial phases of cicatrization, suggesting that the treatment can provide improved stiffness during the most vulnerable phases of tendon healing. Clinical studies may include RF among the therapeutic tools in tendinous lesion management.

Avulsion microtraumatique isolée du tubercule mineur de l’humérus chez un joueur de tennis adolescent : à propos d’un cas et revue de la littérature

Isolated avulsion fractures of the lesser tuberosity of the humerus are uncommon in skeletally immature athletes. Three different mecanisms of injury have been described and knowledge of their existence, together with a complete physical examination is important for early diagnosis. We present the case of a 13-year-old tennis player with an avulsion-fracture after a “normal” forehand. X-ray and MRI rapidly confirmed the diagnosis. As our case demonstrates, isolated avulsion fractures of the lesser tuberosity with minimal displacement, early diagnosis and non top level athletes can have excellent results with conservative treatment. In agreement with the literature, we advise surgical treatment if displacement is severe, tendinous lesions are associated or if diagnosis is made at a chronic stage.

Effects of boric acid on the healing of Achilles tendons of rats.

Tendinous lesions are among the most frequent pathologies encountered in sportsmen. The objectives of new treatments are to improve the healing process and reduce the recovery time. Boron plays an important role in the wound repair process by increasing components of extracellular matrix and angiogenesis. This animal study aimed to investigate the effect of boric acid on healing of the Achilles tendon. The right Achilles tendons of 40 rats were completely sectioned, and the rats were randomly divided into five groups. Each group consisted of eight rats. Groups 1 and 2 were oral boric acid groups with the doses of 4 and 8mg/kg/day boric acid, respectively. Group 3 was the local boric acid group (8mg/kg boric acid intratendinous injection). Group 4 was administered both oral and local boric acid (8mg/kg/day orally and 8mg/kg boric acid intratendinous injection), and group 5 was the control group with no boric acid application. At the end of the fourth week, all the rats were killed and histopathological examination of the Achilles tendon repair site was made. Histopathological examination of the tissue sections revealed more properly oriented collagen fibres, more normal cellular distribution of tenocytes and more properly organized vascular bundles in group 1 and group 2, which were the groups administered oral boric acid. Pathological sum scores of groups 1 and 2 were less than those of the other groups, and the differences between the oral boric acid groups (group 1 and group 2) and the other three groups (groups 3, 4 and 5) were statistically significant (p=0.001). As boric acid is safe and toxicity even after very high doses is unusual, oral boric acid may be used as an agent to improve the healing process of tendon injuries. However, biomechanical tests should also be performed to show the effect of boric acid on strength and endurance of the tendon before it can be used in clinical practice.

Changes in sports injuries incidence over time in world-class road cyclists.

This is a descriptive epidemiologic survey on all traumatic and overuse injuries which occurred in 2 groups of male elite road cyclists based on retrospective clinical interviews and physical examinations. The historical group consisted of 65 professional road cyclists surveyed from 1983 to 1995. The contemporary group included 65 elite racers still active and reporting injuries from 2003 to 2009. Injury/cyclist ratio was 1.32 in the historical group and 2.13 in those still active. Traumatic injuries increased from 39.5% (historical) to 53.9% (contemporary) (p<0.05). Severe traumatic lesions decreased from 49.9% in the historical group to 10.5% in the contemporary group (p<0.01). Patellofemoral pain decreased from 28.8% (historical) to 6.1% (contemporary) (p<0.01). Muscle injuries substantially increased from 13.4% to 44.9% (p<0.01). In the historical racers, the rates of risk for traumatic injury were 0.104 per year per cyclist, and 0.003 per 1 000 km of training and competition. These figures increased to 0.287 and 0.009 respectively in the contemporary group. In summary, contemporary professional road cyclists are exposed to double the risk of traumatic injuries than those competing in the 80s and early 90s. However, these lesions have less severity. Overuse injuries had a completely different clinical pattern, with the currently active cyclist exhibiting more muscle injuries and less tendinous lesions.

Musculoskeletal Injuries Related to Yoga: Imaging Observations

The purpose of this article is to describe the imaging appearances of musculoskeletal injuries related to yoga. We performed an automated search in the database of a large tertiary care center and conducted a retrospective analysis of the imaging findings in 38 patients over a 9-year period. The most frequently encountered musculoskeletal injuries were tendinous lesions, including tears of the supraspinatus, Achilles, and peroneus brevis tendons and fibrocartilaginous tears involving the medial meniscus, acetabular labrum, glenoid labrum, and lumbar disk with extrusion.