Imaging features of Morel-Lavallée lesions

Objectives: To review the imaging characteristics of Morel-Lavallee lesions with both ultrasound and magnetic resonance imaging (MRI). Materials and Methods: We retrospectively analyzed 31 patients (mean age = 46 years), diagnosed with a Morel-Lavallee lesion, on ultrasound (n = 15) or MRI (n = 16). On ultrasound the echogenicity, internal septations, hyperechoic fat globules, compressibility and Doppler signal were evaluated. On MRI, T1-and T2-signal intensity, capsule presence, internal septations, enhancement, mass-effect and fluid-fluid levels were assessed. The MR images were classified according to the classification of Mellado and Bencardino. Results: Most of the lesions were situated peritrochanteric, around the knee or the lower leg. The majority of the lesions had a heterogeneous hypoechoic appearance with septations and intralesional fat globules. On MRI, most of the collections were hypointense on T1-weighted images and hyperintense on T2-weighted images. Half of the collections were encapsulated, and most collections demonstrated septations. The collections were classified as seroma (n = 10), subacute hematoma (n = 2) and chronic organizing hematoma (n = 5). Conclusion: Ultrasound is the imaging method of choice to diagnose Morel-Lavallee lesions. MRI can be of use in selected cases (extension in different compartments, large collections, superinfection). Characteristic imaging features include a fusiform fluid collection between the subcutaneous fat and the underlying fascia with internal septations and fat globules. On MRI, six types of ML lesion can be differentiated, with the seroma, the subacute hematoma, and the chronic organizing hematoma being the most frequently observed lesions

MR-Imaging of Meniscal Substitution

More than a century ago, the menisci were considered to be the functionless remains of a leg muscle. Gradually the usefulness and function of the meniscus was investigated and proven, and the link between total meniscectomy, radiographic osteoarthritis and reduced knee function was made. Subsequently, partial meniscectomy was introduced in the clinical practice. However, the frequency of symptomatic knee osteoarthritis was not substantially lowered. Therefore, meniscal repair was introduced for younger individuals with traumatic meniscus lesions with a good healing potential. Later on in the development process, the quest for meniscal replacement strategies arose. The introduction of allogenic, xenogenic and artificial materials followed in research and clinical settings. Nowadays, a lot of research is conducted on meniscal substitutes, because meniscal injuries are a very common problem in the general population. The imaging of the meniscus is running parallel to this evolution. With the development of magnetic resonance imaging (MRI), the meniscus could be perfectly visualized. A lot of studies were published on imaging of the normal meniscus, and subsequently meniscal pathology on MRI was investigated. In the current literature, a growing number of papers describe the MRI findings in artificial meniscus replacements

Imaging of sports lesions in soccer players

Soccer is one of the world’s most popular sports, but is physically demanding and acute and overuse injuries occur rather frequently. It is a typical low-extremity sport, with the lower limb region most frequently injured. Through a structured approach focused on injury epidemiology, relevant anatomy, mechanism, and appearance on medical imaging, the radiologist can gain familiarity with the common and important injuries experienced by soccer players and in turn assist the player and referring clinician towards the goal of appropriate treatment and timely return to play. This chapter reviews the most commonly observed and most important injuries in soccer players

Imaging of sports lesions in soccer players

Soccer is one of the world’s most popular sports, but is physically demanding and acute and overuse injuries occur rather frequently. It is a typical low-extremity sport, with the lower limb region most frequently injured. Through a structured approach focused on injury epidemiology, relevant anatomy, mechanism, and appearance on medical imaging, the radiologist can gain familiarity with the common and important injuries experienced by soccer players and in turn assist the player and referring clinician towards the goal of appropriate treatment and timely return to play. This chapter reviews the most commonly observed and most important injuries in soccer players

Graft extrusion in open vs arthroscopic meniscus: transplantation: a 1 year comparative study of 39 patients

Title: Graft Extrusion in Open vs Arthroscopic Meniscus Transplantation: A 1 Year Comparative Study of 39 patients. Purpose: to evaluate the radial displacement of meniscal allograft transplants (MATs) in patients operated with an open technique vs. an arthroscopic technique at 1 year postoperatively. Radial displacement or extrusion of the graft is frequently observed after meniscus transplantation. The hypothesis is that arthroscopically inserted MATs extrude less than open MATs and therefore have a more intra-articular position than open surgery transplants. Materials and Methods: 39 patients were included in the study: the first group of open surgery transplants consisted of 16 patients (10 lateral, 6 medial). The second group of arthroscopic transplants consisted of 21 patients (14 lateral, 7 medial). MR-images were taken one year post-surgery. The displacement, evaluated on 1,5T MR coronal images, was defined as the distance between the tibial plateau and the outer edge of the meniscus. Results: The radial displacement of lateral open surgery transplants (mean= 4,04 mm; SD= 1,46) is significantly larger (p < 0,05) than the displacement of arthroscopically implanted MATs (mean= 3,38 mm; SD= 0,85). The external displacement of medial open surgery transplants (mean= 4,71 mm; SD= 0,97) is significantly larger (p < 0,05) than the displacement of arthroscopically implanted MATs (mean= 2,36 mm; SD= 0,89). Conclusion: Graft position is influenced by the surgical technique; the radial displacement of arthroscopically implanted MATs is, both lateral and medial, significantly less than meniscal transplants implanted by open surgery. The clinical relevance remains to be determined

Subscapularis release in shoulder replacement determines structural muscular changes

Osteotomy of the lesser tuberosity in shoulder arthroplasty allows bony healing of the subscapularis tendon but does not prevent fatty degeneration in its muscle. Occurrence or increase in fatty degeneration may depend on the surgical technique. We (1) assessed fatty degeneration in the subscapularis muscle and its cross-sectional area after a C-block osteotomy of the lesser tuberosity with minimal mobilization of the subscapularis muscle, and (2) determined whether this technique had any adverse effect on function, fatty degeneration, and cross-sectional area of the subscapularis muscle. We retrospectively examined 36 patients with shoulder replacements who had C-block osteotomies. Constant-Murley scores and clinical signs of subscapularis insufficiency were recorded. We radiographically assessed prosthetic placement. On CT scans, lesser tuberosity healing, fatty degeneration, and cross-sectional area of the subscapularis muscle were determined. The minimum followup was 13 months (mean, 18 months; range, 13-33 months). The mean absolute Constant-Murley score was 71.2. Two patients had weakness of the subscapularis muscle without loss of active motion. All tuberosities healed anatomically. A normal glenohumeral relationship was found in all cases. Fatty degeneration was Grade 0 in 44%, Grade 1 in 39%, Grade 2 in 14%, and Grade 3 in 3%. The subscapularis muscular cross-sectional area decreased from 16.7 cm(2) preoperatively to 14.5 cm(2) postoperatively (13%). The C-block osteotomy with minimal dissection of the subscapularis is associated with a low incidence of fatty degeneration in the subscapularis muscle after shoulder arthroplasty although the muscular cross-sectional area of the subscapularis decreased. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence