Hindfoot alignment measurements: rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs

Hindfoot alignment measurements should be performed on hindfoot alignment view radiographs using the medial or lateral calcaneal contour or on long axial view radiographs using the calcaneal axis. Interreader agreement of hindfoot alignment measurements is slightly better on long axial view radiographs than on hindfoot alignment view radiographs

Oedema and fatty degeneration of the soleus and gastrocnemius muscles on MR images in patients with Achilles tendon abnormalities

OBJECTIVE: The purpose of this study was to evaluate the frequency of oedema and fatty degeneration of the soleus and gastrocnemius muscles in patients with Achilles tendon abnormalities. METHODS: Forty-five consecutive patients (mean 51 years; range 14-84 years) with achillodynia were examined with magnetic resonance (MR) images of the calf. The frequency of oedema and fatty degeneration in the soleus and gastrocnemius muscles was determined in patients with normal tendons, tendinopathy and in patients with a partial tear or a complete tear of the Achilles tendon. RESULTS: Oedema was encountered in 35% (7/20) of the patients with tendinopathy (n = 20; range 13-81 years), and in 47% (9/19) of the patients with partial tears or complete tears (n = 19; 28-78 years). Fatty degeneration was encountered in 10% (2/20) of the patients with tendinopathy, and in 32% (6/19) of the patients with tears. The prevalence of fatty degeneration was significantly more common in patients with a partial or complete tear compared with the patients with a normal Achilles tendon (p = 0.032 and p = 0.021, respectively). CONCLUSION: Oedema and fatty degeneration of the soleus and gastrocnemius muscles are common in patients with Achilles tendon abnormalities

Closed suction drainage with or without re-transfusion of filtered shed blood does not offer advantages in primary non-cemented total hip replacement using a direct anterior approach.

The possibility to re-transfuse drained blood was not an argument for using drains and, accepting more thigh swelling, we stop to use drains in simple non-cemented primary THR using the direct anterior approach

Detection and quantification of glenohumeral joint effusion: reliability of ultrasound

OBJECTIVES: To evaluate reliability of ultrasound for detection and quantification of glenohumeral joint effusion. METHODS: With institutional review board approval and informed consent ultrasound of 30 consecutive patients before and after MR arthrography of the shoulder was performed. Presence and width of any anechoic collection was noted within various locations (biceps tendon sheath, subscapular recess (neutral position and internal rotation), posterior glenohumeral joint recess (neutral position and external rotation)). Injected fluid (8-12 ml) into the glenohumeral joint served as gold-standard. Widths of anechoic collections were correlated (Spearman rank correlation) with injected fluid. RESULTS: Glenohumeral anechoic collection was consistently seen in the posterior glenohumeral joint recess with the arm in external rotation (100%, 30/30), and in the biceps tendon sheath (97%, 29/30). Ultrasound was not sensitive at other locations (7%-17%). Mean width in anterior-posterior direction of anechoic collection in the posterior glenohumeral joint recess was 7 mm (range: 3-18 mm), 2 mm (range: 1-7 mm) in the biceps tendon sheath. Significant correlation (R = 0.390, p = 0.033) was found between width of anechoic collection and injected fluid in the posterior glenohumeral joint recess. CONCLUSIONS: Glenohumeral joint effusion can be detected and quantified most reliably in the posterior glenohumeral joint recess with the arm in external rotation

Synthetic-echo time postprocessing technique for generating images with variable T2-weighted contrast: diagnosis of meniscal and cartilage abnormalities of the knee

PURPOSE: To assess the feasibility and accuracy of a synthetic-echo time (TE) magnetic resonance (MR) postprocessing technique for the diagnostic evaluation of abnormalities of menisci and articular cartilage in the knee. MATERIALS AND METHODS: This study was approved by the institutional review board. Twenty-four patients (three women, 21 men; mean age, 44.8 years) gave informed written consent to prospectively undergo evaluation of their knees (10 left and 14 right knees) with standard sagittal intermediate-weighted (repetition time msec/TE msec, 2200/17) and fat-saturated T2-weighted (3600/88) fast spin-echo sequences. In addition, sagittal multiecho fast gradient-echo sequences were performed for the generation of synthetic-TE images with variable T2- or T2(*)-weighted contrast by using a newly developed synthetic-TE analysis tool that was incorporated directly into the picture archiving and communication system. Sensitivity, specificity, and accuracy values for detection of lesions in menisci and articular cartilage were calculated by using findings at surgery as reference standard. RESULTS: The standard intermediate-weighted and fat-suppressed T2-weighted MR sequences had overall sensitivity, specificity, and accuracy values of 100% and 100%, 88% and 93%, and 95% and 95% for the diagnosis of tears of medial and lateral menisci, respectively, as well as sensitivity, specificity, and accuracy values of 82%, 97%, and 95%, respectively, for articular cartilage defects. Corresponding sensitivity, specificity, and accuracy values for multiecho MR imaging with synthetic-TE MR image generation were 92% and 100%, 88% and 87%, and 90% and 90% for the diagnosis of tears of medial and lateral menisci, respectively, as well as sensitivity, specificity, and accuracy values of 70%, 99%, and 95%, respectively, for articular cartilage defects. CONCLUSION: For the evaluation of menisci and articular cartilage, images generated with the synthetic-TE technique are a potentially viable alternative to standard T2-weighted images obtained at different TEs. Furthermore, the synthetic-TE approach allowed assessment of abnormalities of menisci and articular cartilage with high sensitivity and specificity