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Chapala S, Papineni VRK, Shah AR, Ballal M, Iyengar KP, Botchu R. Painful Os Peroneum Syndrome Secondary to Hydroxyapatite Deposition Disease. Indian J Radiol Imaging 2025; 35:188-191. [PMID: 39697500 PMCID: PMC11651840 DOI: 10.1055/s-0044-1789190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024] Open
Abstract
Painful os peroneum syndrome (POPS) is one of the uncommon causes of lateral foot pain in orthopaedic practice. POPS encompasses a spectrum of pathologies such as an acute or a chronic fracture, peroneus longus tenosynovitis, and attrition or partial rupture of the peroneus longus tendon. Herein, we reported the first case of POPS secondary to hydroxyapatite deposition disease in a 32-year-old female patient. The clinical presentation, the role of radiological interventions, particularly ultrasound-guided barbotage in its diagnosis and effective management, is highlighted.
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Affiliation(s)
- Shashank Chapala
- Department of Radiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, Telangana, India
| | | | - Asad Rabbani Shah
- Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Moez Ballal
- Department of Orthopaedics, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Karthikeyan P. Iyengar
- Department of Orthopedics, Southport and Ormskirk Hospital, Southport, Mersey and West Lancashire Teaching Hospitals NHS Trust, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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Heitz PH, Miron MC, Beauséjour M, Hupin M, DiLiddo L, Jourdain N, Nault ML. Ultrasound Assessment of Ankle Syndesmotic Injuries in a Pediatric Population. Clin J Sport Med 2024; 34:83-90. [PMID: 37882722 DOI: 10.1097/jsm.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To determine sensitivity and specificity for anterior-inferior tibiofibular ligament (AiTFL) integrity and tibiofibular clear-space (TFCS) cut-off points for dynamic evaluation using ultrasound (US) in a pediatric population. DESIGN Prospective cohort study. SETTING Tertiary care university-affiliated pediatric hospital patients between the ages of 12 and 18 sustaining acute ankle trauma with syndesmotic injury. INTERVENTIONS Participants were assigned to the syndesmotic injury protocol that included a standardized MRI and US. MAIN OUTCOME MEASURES Anterior-inferior tibiofibular ligament integrity for static assessment and TFCS measurements for dynamic assessment on US. For dynamic assessment, the distance between the distal tibia and fibula was first measured in neutral position and then in external rotation for each ankle. The US results on AiTFL integrity were compared with MRI, considered as our gold standard. Optimal cut-off points of TFCS values were determined with receiver operating characteristics curve analysis. RESULTS Twenty-six participants were included. Mean age was 14.8 years (SD = 1.3 years). Sensitivity and specificity for AiTFL integrity were 79% and 100%, respectively (4 false negatives on partial tears). For dynamic assessment, the cut-off points for the differences in tibiofibular distance between the 2 ankles in 1) neutral position (TFCS N I-U ) and 2) external rotation (TFCS ER I-U ) were 0.2 mm (sensitivity = 83% and specificity = 80%) and 0.1 mm (sensitivity = 83% and specificity = 80%), respectively. CONCLUSIONS Static US could be used in a triage context as a diagnostic tool for AiTFL integrity in a pediatric population as it shows good sensitivity and excellent specificity.
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Affiliation(s)
- Pierre-Henri Heitz
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie-Claude Miron
- Department of Radiology, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Radiology, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Marie Beauséjour
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Sherbrooke, Université de Sherbrooke-Campus Longueuil, Longueuil, QC, Canada
| | - Mathilde Hupin
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | - Lydia DiLiddo
- Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Pediatrics, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
| | | | - Marie-Lyne Nault
- Department of Surgery, CHU Sainte-Justine, Montréal, QC, Canada
- Department of Surgery, Université de Montréal, Edouard-Montpetit, Montréal, QC, Canada
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
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Esparó J, Vega J, Cordier G, Johnson R, Dallaudière B, Gasol-Santa X, Dalmau-Pastor M. Anterior talofibular ligament's superior fascicle as a cause of ankle microinstability can be routinely identified by ultrasound. Knee Surg Sports Traumatol Arthrosc 2024; 32:352-360. [PMID: 38258974 DOI: 10.1002/ksa.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Chronic pain can affect up to 40% of patients after ankle inversion sprains. The current hypothesis to explain this high percentage of chronic pain is a partial/total rupture of anterior talofibular ligament (ATFL) superior fascicle, a structure that has recently been described as intra-articular and as having a different function than ATFL's inferior fascicle. This has created the need for diagnosing ATFL superior and inferior fascicles independently. Therefore, the objective of this study is to investigate if the ATFL's superior fascicle can be visualized on ultrasound, and to describe its ultrasonographic appearance. METHODS Twenty fresh-frozen ankle specimens were used in this 4-phases study. First, the specimens were scanned on US to identify what was believed to be ATFL's superior fascicle. Second, ATFL's superior fascicle was sutured under direct arthroscopic vision. Next, the specimens were scanned on US to obtain an image of the sutured structure. Finally, the specimens were dissected to confirm that the suture was indeed placed on ATFL's superior fascicle. RESULTS On the 20 specimens studied, full correlation was obtained between US, arthroscopic suture and specimen dissection. ATFL's superior fascicle US appearance is provided. CONCLUSION ATFL's superior fascicle can be visualized on US, which will allow to undergo diagnosis of isolated injuries to that fascicle, a common finding in ankle microinstability. The results of this study will facilitate the diagnosis of partial or complete rupture of ATFL's superior fascicle, likely increasing the amount of ankle microinstability diagnosis, impacting clinical management of ankle sprain consequences.
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Affiliation(s)
- Jordi Esparó
- Osteosport Clinic, Manresa, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Jordi Vega
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
| | - Guillaume Cordier
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Sport Surgery-Foot and Ankle, Clinique du Sport, Bordeaux-Merignac, Mérignac, France
| | - Rowena Johnson
- Fortius Clinic, London, UK
- Carnegie School of Sport, Leeds Beckett University, Headingley Campus, Leeds, UK
| | - Benjamin Dallaudière
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Mérignac, Mérignac, France
- Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, Place Amélie Léon Rabat, Bordeaux, France
| | | | - Miki Dalmau-Pastor
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
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Kandil NM, Hassan MAEF, Moharram AN, Saleh OAEFH, Hashem AB. Can ultrasound replace MRI in diagnosing causes of ankle impingement in different compartments? J Ultrasound 2023; 26:829-844. [PMID: 37526836 PMCID: PMC10632229 DOI: 10.1007/s40477-023-00803-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE This prospective study aims to determine the role of ultrasound (US) in diagnosing different types of ankle impingement due to osseous and soft tissue pathologies and to compare the results with magnetic resonance imaging (MRI), which is considered our gold standard. METHODS The study population included 90 patients with unilateral ankle pain who presented with symptoms and signs suggestive of ankle impingement. Their age ranged from 17 to 57 years, with a mean age of 33.7 years. Using US and MRI, our cases were classified into bony and soft tissue ankle impingement. They were further classified according to the anatomical compartments affected, into anteromedial, anterior, anterolateral, posteromedial, and posterior. RESULTS 90 patients were enrolled in this study: 51 males and 39 females. In our study, posterior ankle impingement was the commonest impingement type, while anteromedial ankle impingement was the rarest type, followed by posteromedial impingement. The accuracy of US in diagnosing osseous impingement was found to have the following: sensitivity 70.37%, specificity 100%, PPV 100%, NPV 75%, accuracy 84.31%, and p value < 0.001; meanwhile, the accuracy of US in diagnosing soft tissue impingement was found to have the following: sensitivity 83.33%, specificity 100%, PPV 100%, NPV 87.10%, accuracy 92.16%, and p value < 0.001. CONCLUSION US is a good diagnostic tool in bone and soft tissue impingements, with a significant p value of 0.001 for both. US cannot replace MRI as a diagnostic tool, but as a widely available imaging modality, it can save time and cost and allows dynamic imaging.
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Affiliation(s)
| | | | | | | | - Aya Bassam Hashem
- Radiology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E23-E35. [PMID: 37130137 DOI: 10.1002/jum.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
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Ahmad ZY, Rasiej MJ. Imaging of the Ankle Ligaments and Cartilage Injuries as an Aid to Ankle Preservation Surgery. Semin Ultrasound CT MR 2023; 44:319-331. [PMID: 37437970 DOI: 10.1053/j.sult.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Ankle sprains are among the most common musculoskeletal injuries and can lead to ankle ligament and cartilage injuries. Imaging plays an important role in differentiating ligament injuries from other causes of ankle pain such as fractures, osteochondral lesions or tendon injuries that helps guide further management. Chronic untreated ankle ligamentous and cartilage injuries can further progress to ankle osteoarthritis, hence the need for timely diagnosis and treatment. Surgical treatment is often required in patients not responding to conservative treatment and ranges from repair and reconstruction procedures for ligament injuries to arthroscopic debridement and repair procedures for cartilage injuries. Cartilage defects and deficiency may be augmented depending on the extent of cartilage loss and associated subchondral changes on MRI. Awareness of operative techniques utilized is essential to interpret imaging findings in postoperative settings.
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Affiliation(s)
- Zohaib Y Ahmad
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY.
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY
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Song JH, Moon JJ, Shin WJ, Ko KP. Use of a comprehensive systemic ultrasound evaluation in the diagnosis and analysis of acute lateral region ankle sprain. BMC Musculoskelet Disord 2023; 24:517. [PMID: 37353778 DOI: 10.1186/s12891-023-06642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/16/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND For the diagnosis of acute lateral ankle sprain, many clinicians use ultrasound; they typically focus on the lateral ligament complex, which is the most common site of lesions in ankle sprain. However, this approach risks missing other foot and ankle lesions. The present study aimed to provide and analyze the results of a new ultrasound method of diagnosis for acute lateral ankle sprain which can thoroughly investigate overall lesions of the foot and ankle. METHODS Retrospective cross-sectional cohort study of 123 patients who underwent diagnostic ultrasound within 1 week of acute lateral ankle injury was performed. Causes of ankle sprain, incidence and severity of each ligament injury, location of anterior talofibular ligament (ATFL) injury, accompanying ligament injury, and occult fracture were analyzed. RESULTS Among the 102 cases of ATFL injuries, 60 (58.5%) had islolated ATFL injury, 28 (27.5%) had accompanying calcaneofibular ligament injury (CFL), and 14 (13.7%) had accompanying midtarsal or syndesmosis injury. ATFL injuries occurred on the fibula attachment in 48 (47.1%) cases, ligament mid-substance in 24 (23.5%) cases, and talus attachment in 30 (29.4%) cases. Among the 165 lesions from 123 cases, injuries of the fourth or fifth dorsal tarsometatarsal (12 cases, 7.3%), bifurcate (11 cases, 6.7%), and anterior tibiofibular (11 cases, 6.7%) ligaments were not rare. CONCLUSION These findings suggest that an ultrasound examination involving investigation of the midtarsal joint and syndesmotic ligament, as well as the ATFL and CFL, is useful for comprehensive, systemic diagnosis of acute lateral ankle sprain.
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Affiliation(s)
- Jae Hwang Song
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - Jeong Jae Moon
- Department of Orthopedic Surgery, Changwon Hospital, Korea Worker's Compensation & Welfare Service, Gyeongnam, Republic of Korea
| | - Woo Jin Shin
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - Kwang Pyo Ko
- Hanmaeum Orthopedic Clinic, Daejeon, Republic of Korea.
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Koetser ICJ, Espinosa Hernández EA, Kerkhoffs PDGMMJ, Goedegebuure S, Smithuis FF, Maas PDM. Don't Miss Me: Midfoot Sprains, A Point-of-Care Review. Semin Musculoskelet Radiol 2023; 27:245-255. [PMID: 37230125 DOI: 10.1055/s-0043-1767766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.
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Affiliation(s)
- Inge C J Koetser
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Enrique A Espinosa Hernández
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Prof Dr Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centers (AUMC), Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), The Netherlands Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Simon Goedegebuure
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam University Medical Centers (AUMC), Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), The Netherlands Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Frank F Smithuis
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
| | - Prof Dr Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AUMC), Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences (AMS), Amsterdam Institute Sport Sciences (AISS), Amsterdam, the Netherlands
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do Amaral E Castro A, Godoy-Santos AL, Taneja AK. Advanced Imaging in the Chronic Lateral Ankle Instability: An Algorithmic Approach. Foot Ankle Clin 2023; 28:265-282. [PMID: 37137622 DOI: 10.1016/j.fcl.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Imaging examinations are a fundamental part of assessing chronic lateral ankle instability (CLAI). Plain radiographs are used in the initial examination, whereas stress radiographs can be requested to actively search for instability. Ultrasonography (US) and Magnetic Resonance Imaging (MRI) allow direct visualization of ligamentous structures, with the advantage of dynamic evaluation for US, and assessment of associated lesions and intra-articular abnormalities for MRI, which plays an essential role in surgical planning. This article reviews imaging methods to diagnose and follow up on CLAI, along with illustrative cases and an algorithmic approach.
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Affiliation(s)
- Adham do Amaral E Castro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Universidade Federal de São Paulo, Rua Napoleão de Barros, 800 - Vila Clementino - CEP 04024-002 - São Paulo, SP, Brasil
| | - Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Faculdade de Medicina, USP, R. Dr. Ovídio Pires de Campos, 333 - Cerqueira César, São Paulo - SP, 05403-010, Brasil
| | - Atul K Taneja
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, São Paulo - SP, 05652-900, Brasil; Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9316, USA.
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Omodani T, Takahashi K. Ultrasound findings of the deltoid ligament in patients with acute ankle sprains: A retrospective review. J Orthop Sci 2022:S0949-2658(22)00130-0. [PMID: 35691876 DOI: 10.1016/j.jos.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The deltoid ligament is a complex structure composed of multiple ligaments located on the medial side of the ankle joint that can be injured by ankle sprains. Although there have been previous reports on ultrasound imaging of the injured deltoid ligament, a systematic method for depicting each ligament component has not been established. This study aimed to clarify the ultrasound findings of the deltoid ligament in ankle sprains using a systematic scanning protocol. METHODS We examined the tenderness of the medial ankle and evaluated the ultrasound findings of the deltoid ligament in 169 sprained ankles with no fracture, within 3 days after injury. Observation and evaluation of the six components of the deltoid ligament were performed using a systematic scanning protocol with four probe positions. RESULTS Of the 169 ankles, 48 ankles had tenderness in the deltoid ligament. Ultrasonography confirmed deltoid ligament damage in 13 of these 48 ankles. Of the 13 ankles, 3 ankles had damages only in the superficial layer, 3 ankles only in the deep layer, and 7 ankles in both the superficial and deep layers. CONCLUSIONS We clarified the details of the damage pattern of the deltoid ligament in acute ankle sprains. It was possible to identify the superficial and deep layers of the ligament and to observe the damage pattern of each ligament component in detail, and it appeared that ultrasonography could be used as a tool to evaluate the damage pattern of the deltoid ligament in acute ankle sprains.
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Affiliation(s)
- Toru Omodani
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833, Hasama-cho, Funabashi, Chiba Prefecture 2740822, Japan; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Kenji Takahashi
- Sports Medicine & Joint Center, Funabashi Orthopaedic Hospital, 1-833, Hasama-cho, Funabashi, Chiba Prefecture 2740822, Japan
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Saijilafu, Li SY, Yu X, Li ZQ, Yang G, Lv JH, Chen GX, Xu RJ. Heel pain caused by os subcalcis: A case report. World J Clin Cases 2022; 10:5373-5379. [PMID: 35812669 PMCID: PMC9210887 DOI: 10.12998/wjcc.v10.i16.5373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/11/2021] [Accepted: 04/02/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The accessory bones are common bone variations around the feet and ankles, which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass, and most of them remain asymptomatic. Os subcalcis is an accessory bone at the plantar aspect of the calcaneus, which is located just posterior to the insertion of the plantar fascia. Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported. CASE SUMMARY A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years. X-ray, computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus, located at the insertion of the plantar fascia. He underwent surgical excision of the lesion. Microscopically the bony trabeculae were intermingled with fat and covered with cartilage. CONCLUSION This is a rare case with accessory os subcalcis leading to heel pain. It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.
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Affiliation(s)
- Saijilafu
- Department of Orthopaedics, Soochow University, Suzhou 215007, Jiangsu Province, China
| | - Suo-Yuan Li
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Xiao Yu
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Qiang Li
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Guang Yang
- Department of pathology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Jing-Huan Lv
- Department of pathology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Guang-Xiang Chen
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Ren-Jie Xu
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
- Department of Orthopaedics, the First Affiliated Hospital, Orthopaedic Institute, Soochow University, Suzhou 215000, Jiangsu Province, China
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Effect of Ligament Mapping from Different Magnetic Resonance Image Quality on Joint Stability in a Personalized Dynamic Model of the Human Ankle Complex. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background. Mechanical models of the human ankle complex are used to study the stabilizing role of ligaments. Identification of ligament function may be improved via image-based personalized approach. The aim of this study is to compare the effect of the ligament origin and insertion site definitions obtained with different magnetic resonance imaging (MRI) modalities on the mechanical behaviour of a dynamic model of the ankle complex. Methods. MRI scans, both via 1.5 T and 3.0 T, were performed on a lower-limb specimen, free from anatomical defects, to obtain morphological information on ligament-to-bone attachment sites. This specimen was used previously to develop the dynamic model. A third ligament attachment site mapping scheme was based on anatomical dissection of the scanned specimen. Following morphological comparison of the ligament attachment sites, their effect on the mechanical behaviour of the ankle complex, expressed by three-dimensional load–displacement properties, was assessed through the model. Results. Large differences were observed in the subtalar ligament attachment sites between those obtained through the two MRI scanning modalities. The 3.0 T MRI mapping was more consistent with dissection than the 1.5 T MRI. Load–displacement curves showed similar mechanical behaviours between the three mappings in the frontal plane, but those obtained from the 3.0 T MRI mapping were closer to those obtained from dissection. Conclusions. The state-of-the-art 3.0 T MRI image analysis resulted in more realistic mapping of ligament fibre origin and insertion site definitions; corresponding load–displacement predictions from a subject-specific model of the ankle complex showed a mechanical behaviour more similar to that using direct ligament attachment observations.
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Hosseinian SHS, Aminzadeh B, Rezaeian A, Jarahi L, Naeini AK, Jangjui P. Diagnostic Value of Ultrasound in Ankle Sprain. J Foot Ankle Surg 2022; 61:305-309. [PMID: 34565666 DOI: 10.1053/j.jfas.2021.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 02/03/2023]
Abstract
The present study aimed to evaluate the sensitivity and specificity of clinical tests and ultrasonography in detecting ankle ligament injuries. In this cross-sectional study, 105 patients with a history of ankle sprain were included. Ankle ligaments, including syndesmosis of ankle, as well as deltoid, calcaneofibular, anterior talofibular, and posterior talofibular ligaments were evaluated by clinical tests, ultrasonography, and magnetic resonance imaging. The sensitivity and specificity of ultrasound and clinical tests were assessed in normal, sprain, partial tear, and complete tear groups. The inter-observer reliability (Cohen's Kappa score) of the evaluated techniques with magnetic resonance imaging was assessed. Anterior drawer test showed a sensitivity and specificity of 81 and 80% in the detection of anterior talofibular ligament injuries, respectively. Ultrasonography showed 100% sensitivity and specificity in distinguishing normal anterior talofibular ligament from the torn or sprained ligament with a kappa value of 1. The sensitivity of ultrasonography in detecting normal calcaneofibular ligament and deltoid ligament was 93% and 90%, respectively. Ultrasonography was highly specific in detecting calcaneofibular ligament tear but it was not sensitive in this regard. Ultrasonography was proved reliable in determining the normal anterior talofibular ligament and calcaneofibular ligament from the torn or sprained ligament. Ultrasonography is an effective complementary tool for primary evaluation of ankle injuries, which leads to early diagnosis and efficient quality of care. Clinical tests are not reliable to rule out the ankle ligaments injury and the results should be interpreted with caution.
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Affiliation(s)
- Sayyed Hadi Sayyed Hosseinian
- Assistant Professor of Orthopedic Surgery, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Assistant Professor of Radiology, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amin Rezaeian
- Orthopedic Resident, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Associate Professor of Community Medicine, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Kasaeian Naeini
- Orthopedic Resident, Orthopedic Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Puria Jangjui
- Medical Student, Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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14
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Fenech M, Wylie B. Sonographic anatomy and imaging of the dorsal supportive ligaments of the Chopart joint complex. SONOGRAPHY 2022. [DOI: 10.1002/sono.12300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Michelle Fenech
- College of Clinical Sciences, School of Health, Medical and Applied Sciences CQUniversity Rockhampton Queensland Australia
| | - Bridie Wylie
- Qscan Radiology Clinics Brisbane Queensland Australia
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15
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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16
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Kauffmann P, Luhmann L, Alamé K, Schenck B, Bilbault P, Le Borgne P. L’entorse du médiopied (de Chopart). ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’entorse de Chopart est une lésion traumatique peu connue, sous-estimée et souvent confondue avec une entorse de cheville. Le traumatisme en inversion de la cheville, souvent accompagné d’une flexion plantaire forcée du pied, représente le mécanisme lésionnel le plus fréquent. Son diagnostic repose sur un examen clinique précis nécessitant une bonne connaissance anatomique. Les signes radiographiques sont indirects et souvent discrets. Il s’agit principalement d’arrachements osseux ou de lésions osseuses par impaction ; ils peuvent parfois d’emblée justifier d’un complément scanographique. L’échographie peut également être utile en première intention. A contrario, l’IRM est actuellement réservée aux difficultés diagnostiques. Le traitement de cette pathologie est essentiellement fonctionnel. Il faut cependant connaître les quelques indications pour un traitement orthopédique (immobilisation) comme la présence d’une lésion osseuse de grande taille. Le traitement chirurgical est quant à lui exceptionnel. L’instabilité calcanéocuboïdienne ainsi que l’arthrose du Chopart sont des complications possibles (à moyen ou long terme) mais peu fréquentes.
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17
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Bejarano-Pineda L, Guss D, Waryasz G, DiGiovanni CW, Kwon JY. The Syndesmosis, Part I: Anatomy, Injury Mechanism, Classification, and Diagnosis. Orthop Clin North Am 2021; 52:403-415. [PMID: 34538351 DOI: 10.1016/j.ocl.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle fractures are common injuries to the lower extremity with approximately 20% sustaining a concomitant injury to the syndesmosis. Although the deltoid ligament is not formally included in the syndesmotic complex, it plays an important role in the mortise stability. Therefore, its integrity should be always evaluated when syndesmotic injury is suspected. Given the anatomic variability of the syndesmosis between individuals, bilateral ankle imaging is recommended, especially in cases of subtle instability. Diagnostic tests that allow dynamic assessment of the distal tibiofibular joint in the 3 planes are the most reliable in determining the presence of syndesmotic injury.
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Affiliation(s)
- Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA
| | - John Y Kwon
- Foot & Ankle Research and Innovation Laboratory - Harvard Medical School, Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital - Newton-Wellesley Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA; Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 40 2nd Avenue Building 52, Suite 1150, Waltham, MA 02451, USA.
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18
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Abstract
Utilization of musculoskeletal ultrasound, in particular for sports medicine, has dramatically increased in recent years. Ultrasound is an important adjunct tool to physical examination and other imaging methods in the evaluation and management of the injured athlete. It offers unique advantages in specific clinical scenarios. Dedicated training and a standardized scanning technique are important to overcome the inherent operator dependence and avoid diagnostic pitfalls. Ultrasound guidance can also improve accuracy in targeted percutaneous injection therapies. This article reviews the general ultrasound appearance of muscle, tendon, ligament, and nerve abnormalities in the athlete with a focus on sport-specific injuries.
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19
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Basha MAA, Eldib DB, Zaitoun MM, Ghandour TM, Aly T, Mostafa S, Atta DS, Algazzar HY. The Added Diagnostic Value of the Bright Rim Sign to Conventional MRI Assessment of Anterior Talofibular Ligament Disruption. Acad Radiol 2021; 28:e247-e257. [PMID: 32534965 DOI: 10.1016/j.acra.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
RATIONALE AND OBJECTIVES The bright rim sign (BRS) was used as a reliable indicator of anterior talofibular ligament (ATFL) disruption beside other well-known diagnostic criteria. Although this sign can improve accuracy of conventional magnetic resonance imaging (MRI) in diagnosis of ATFL disruption, it was not adequately discussed in the literature. This study aimed to confirm the added diagnostic value of BRS to conventional MRI assessment of ATFL disruption. MATERIALS AND METHODS A prospective study included 62 patients (47 males and 15 females; mean age, 36.9 ± 12.1 years; range, 17-52 years) with clinically suspected ATFL disruption. All patients underwent MRI and arthroscopy of ankle. MRI images were evaluated for the presence of ligament disruption sign (LDS) and BRS. The patients were classified into 3 groups: group 1 included patients with acute lateral ankle ligament sprain; group 2 included patients with chronic ankle instability; and group 3 included patients with recurring ankle sprain. The diagnostic value of the BRS was evaluated using arthroscopy as reference standard. RESULTS The diagnostic value of both signs together increased overall sensitivity in detecting ATFL disruption to 86.7% compared to 60% when considering LDS alone (p < 0.0001). In group 1 and 3, the sensitivity increased when both signs were considered together compared to LDS alone (p = 0.004 and 0.025, respectively). In group 2, there was a trend toward significance in sensitivity when both signs were considered compared to LDS alone (p = 0.08). CONCLUSION BRS is a very helpful diagnostic sign in assessment of ATFL disruption when considered conjointly with the LDS.
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20
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Basha MAA, Eldib DB, Zaitoun MM, Ghandour TM, Aly T, Mostafa S, Atta DS, Algazzar HY. The Added Diagnostic Value of the Bright Rim Sign to Conventional MRI Assessment of Anterior Talofibular Ligament Disruption. Acad Radiol 2021; 28:e247-e257. [DOI: https:/doi.org/10.1016/j.acra.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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21
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Albano D, Bonifacini C, Zannoni S, Bernareggi S, Messina C, Galia M, Sconfienza LM. Plantar forefoot pain: ultrasound findings before and after treatment with custom-made foot orthoses. LA RADIOLOGIA MEDICA 2021; 126:963-970. [PMID: 33881714 PMCID: PMC8205886 DOI: 10.1007/s11547-021-01354-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/30/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE No prior studies investigated the role of ultrasound in the assessment of response of patients undergoing treatment of metatarsalgia with custom-made orthoses. Our aim was to describe ultrasound findings of patients with plantar forefoot pain treated with custom-made foot orthoses. METHODS Twenty patients (15 females; mean age: 62.6 ± 11 years) affected by metatarsalgia in 27/40 feet underwent clinical evaluation before, three months and six months after treatment with custom-made full foot insole with a support proximal and an excavation below the painful metatarsals. Ultrasound was performed before and three months after the use of orthoses to examine the presence of intermetatarsal/submetatarsal bursitis, metatarsophalangeal joints effusion, anterior plantar fat pad oedema, flexor tendinitis/tenosynovitis, and Morton's neuroma. Outcome measures were clinical response with Foot Function Index (FFI)/Visual Analogue Scale (VAS) and ultrasound features changes. RESULTS Median VAS and FFI before treatment were 8[5-8.5] and 45.85[32.4-59.4], respectively. After 3 and 6 months of insoles use, both median VAS (2.5 [0-5] and 0 [0-2.75], respectively) and median FFI (7.9 [3.95-20] and 0 [0-3.95], respectively) showed a significant reduction in pain and disability (p < .001). Before treatment, ultrasound revealed 22 intermetatarsal bursitis, 16 submetatarsal bursitis, 10 joint effusions, 20 fat pad oedema, 3 flexor tendinitis/tenosynovitis and 3 Morton's neuromas. After 3 months of treatment, a significant decrease of intermetatarsal bursitis (7, p < .001) was observed. No significant changes were observed in any other ultrasound parameters. CONCLUSION Ultrasound might be able to detect some imaging features associated with the response of forefoot pain to custom-made foot orthoses, especially intermetatarsal bursitis.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy.
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122, Milan, Italy.
| | - Carlo Bonifacini
- Foot and Ankle Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Stefania Zannoni
- Scuola di Specializzazione in Radiodiagnostica, Università Degli Studi di Milano, Milan, Italy
| | | | | | - Massimo Galia
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Dipartimento di Scienze Biomediche Per la Salute, Università Degli Studi di Milano, Milano, Italy
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22
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Gimber LH, Daniel Latt L, Caruso C, Nuncio Zuniga AA, Krupinski EA, Klauser AS, Taljanovic MS. Ultrasound shear wave elastography of the anterior talofibular and calcaneofibular ligaments in healthy subjects. J Ultrason 2021; 21:e86-e94. [PMID: 34258033 PMCID: PMC8264467 DOI: 10.15557/jou.2021.0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022] Open
Abstract
Aim of study Most sprained lateral ankle ligaments heal uneventfully, but in some cases the ligament’s elastic function is not restored, leading to chronic ankle instability. Ultrasound shear wave elastography can be used to quantify the elasticity of musculoskeletal soft tissues; it may serve as a test of ankle ligament function during healing to potentially help differentiate normal from ineffective healing. The purpose of this study was to determine baseline shear wave velocity values for the lateral ankle ligaments in healthy male subjects, and to assess inter-observer reliability. Material and methods Forty-six ankles in 23 healthy male subjects aged 20–40 years underwent shear wave elastography of the lateral ankle ligaments performed by two musculoskeletal radiologists. Each ligament was evaluated three times with the ankle relaxed by both examiners, and under stress by a single examiner. Mean shear wave velocity values were compared for each ligament by each examiner. Inter-observer agreement was evaluated. Results The mean shear wave velocity at rest for the anterior talofibular ligament was 2.09 ± 0.3 (range 1.41–3.17); and for the calcaneofibular ligament 1.99 ± 0.36 (range 1.29–2.88). Good inter-observer agreement was found for the anterior talofibular ligament and calcaneofibular ligament shear wave velocity measurements with the ankle in resting position. There was a significant difference in mean shear wave velocities between rest and stressed conditions for both anterior talofibular ligament (2.09 m/s vs 3.21 m/s; p <0.001) and calcaneofibular ligament (1.99 m/s vs 3.42 m/s; p <0.0001). Conclusion Shear wave elastography shows promise as a reproducible method to quantify ankle ligament stiffness. This study reveals that shear waves velocities of the normal lateral ankle ligaments increased with applied stress compared to the resting state.
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Affiliation(s)
- Lana H Gimber
- Department of VA - Menlo Park Campus, Uniformed Services University, National Teleradiology Program, United States
| | - L Daniel Latt
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine Banner-University Medical Center, United States
| | - Chelsea Caruso
- Department of Medical Imaging, The University of Arizona College of Medicine Banner-University Medical Center, United States
| | | | | | | | - Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona College of Medicine Banner-University Medical Center, United States
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Abstract
Although far less common than lateral ankle injuries, medial ankle sprains have been reported to result in significantly greater time lost and long-term disability when not diagnosed and treated accurately. Adequate diagnosis is paramount and the most important aspect is to determine whether the lesion is stable or unstable. Evidence confronting surgical versus conservative treatment in acute deltoid ligament lesions is largely anchored in the setting of ankle fractures. Ultimately treatment decisions rely on the clinical and imaging appraisal of each individual patient. This article discusses the isolated acute deltoid ligament impairment.
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Affiliation(s)
- Gastón Slullitel
- Foot and Ankle Surgery Department, J Slullitel Institute of Orthopaedics, San Luis 2534, Rosario, Santa Fe 2000, Argentina.
| | - Juan Pablo Calvi
- Foot and Ankle Surgery Department, J Slullitel Institute of Orthopaedics, San Luis 2534, Rosario, Santa Fe 2000, Argentina. https://twitter.com/pieijs
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24
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Bruns A, Möller I, Martinoli C. Back to the roots of rheumatology - Imaging of regional pain syndromes. Best Pract Res Clin Rheumatol 2020; 34:101630. [PMID: 33272828 DOI: 10.1016/j.berh.2020.101630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Musculoskeletal regional pain syndromes (RPS) often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can, in most cases, reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods, such as ultrasound (US) may support the clinical assessment. This paper reviews the underlying pathologies of some of the most frequently encountered RPS and the role of musculoskeletal US imaging for their diagnosis and treatment. If available, data on diagnostic accuracy and comparisons with gold standards are reported. The article stresses the importance of anatomical and sonoanatomical knowledge for the proper interpretation of the US images, points out the advantages and disadvantages of this imaging tool, and suggests the future research agenda.
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Affiliation(s)
- Alessandra Bruns
- Division of Rheumatology, Sherbrooke University, Sherbrooke, Canada.
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
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25
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Rein S, Houschyar KS, Sterling-Hauf T. Ultrasound Analysis of Lateral Ankle Ligaments in Functional Ankle Instability. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3228-3238. [PMID: 32933796 DOI: 10.1016/j.ultrasmedbio.2020.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
The anterior talofibular ligament and the calcaneofibular ligament were sonographically investigated in 16 patients with functional ankle instability (FAI) and 16 controls under neutral and standardized stress conditions of 15 kp with a TELOS device. Clinical investigation revealed a significantly higher rate of a positive anterior drawer and talar tilt (p <0.001, respectively), significantly increased supination (p = 0.047) of the right ankle joint and increased plantarflexion (p = 0.009) of the left ankle joint in the FAI group compared with controls. Significantly higher rates of inhomogeneity and hypo-echogenicity were sonographically observed in both ligaments in the FAI group (p < 0.05, respectively). The anterior talofibular ligament was significantly longer under stress conditions, and the calcaneofibular ligament was significantly longer under both neutral and stress conditions in the FAI group (p < 0.05, respectively). Peritendinous edema of the peroneal tendons was found in 22% of the FAI group and 6% of controls.
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Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Leipzig, Germany; Martin-Luther-University of Halle-Wittenberg, Halle-Wittenberg, Germany.
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Becciolini M, Bonacchi G, Stella SM, Galletti S, Ricci V. High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion. J Ultrasound 2020; 23:431-433. [PMID: 32248412 DOI: 10.1007/s40477-020-00455-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 12/26/2022] Open
Abstract
Syndesmotic injuries, also referred as high ankle sprains, may cause significant ankle instability and chronic pain. Ultrasound (US) is a well-proven imaging modality to evaluate the ligaments of the ankle, due to its high spatial resolution and the possibility to perform dynamic examinations. However, considering the syndesmosis complex, the sonographic appearance of the posterior inferior tibiofibular ligament (PITFL) is not well described in the pertinent literature and, to the best of our knowledge, we found no report of PITFL avulsion demonstrated at US, as in the case presented.
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Affiliation(s)
- Marco Becciolini
- Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy. .,Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy.
| | - Giovanni Bonacchi
- Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy.,Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy
| | - Salvatore Massimo Stella
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy
| | - Stefano Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy
| | - Vincenzo Ricci
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy.,Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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Prognostic factors of acute ankle sprain: Need for ultrasonography to predict prognosis. J Orthop Sci 2020; 25:303-309. [PMID: 31151752 DOI: 10.1016/j.jos.2019.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/04/2019] [Accepted: 04/24/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Ankle sprains are one of the most common musculoskeletal injuries. To guide management decisions, a clear insight into the relevant subgroups of patients with a potentially better or worse prognosis is important. This study aimed to evaluate injury severity, using ultrasonography (US), as a prognostic factor of acute ankle sprain and other possible factors including age, sex, body mass index (BMI), level of job activity, and level of sports activity. MATERIALS AND METHODS We retrospectively reviewed 28 patients with acute ankle sprain who reported at initial examination with an acutely twisted ankle. All patients had received a standard physical examination, radiography and standard ultrasound, to diagnose specific ligament injuries and their ankle sprain had been treated using standard conservative management. Various data including age, sex, BMI, level of sports activity, level of daily job activity, and final functional score (Foot and Ankle Outcome Scores, FAOS) were obtained. Mean comparison and correlations were used to assess risk factors. Risk factors associated with functional outcomes were evaluated using a multiple linear regression test. RESULTS At final follow-up as 1 year after injury, FAOS differed significantly for injury severity, age, and BMI. There were no significant differences in sex, job activity, and exercise levels. The factor most affecting FAOS for both pain (FAOS-Pain) and symptoms (FAOS-Sx) was the number of completely torn ligaments. Age was the most important factor affecting the FAOS-Daily Living Activity (ADL). BMI was the most important factor for sports activity level (FAOS-Sports). Age and the number of completely torn ligaments were both important to FAOS-Sports and quality of life (FAOS-QOL). CONCLUSION The severity of injury, defined using US, was a prognostic factor for long-term outcome following acute ankle sprain. Therefore, US imaging of acute ankle ligament injury may be important to predict prognosis of acute ankle sprain.
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28
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Rosa I, Rodeia J, Fernandes PX, Teixeira R, Saldanha T, Consciência JG. Ultrasonographic Assessment of Deltoid Ligament Integrity in Ankle Fractures. Foot Ankle Int 2020; 41:147-153. [PMID: 31597464 DOI: 10.1177/1071100719882679] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Regardless of fibular status, the presence of a superficial deltoid ligament disruption or a combination of deep and superficial deltoid ligament disruption is central to the decision-making process in treating ankle fractures. The aims of the present study were to test whether ultrasonography can assess deltoid ligament integrity and to determine its validity and reliability by comparing it with gravity stress radiography. METHODS A consecutive series of 81 eligible patients with a nondisplaced or minimally displaced fibula fracture identified on a standard radiograph were prospectively enrolled. All patients underwent gravity stress radiography and ultrasonography. Image analysis included the layer type, integrity, and tear site of the deltoid ligament. Ultrasound validity and intra- and interobserver reliability were assessed by the interpretations of the first author and an independent observer who were blinded to the results. RESULTS Of all patients, 64 (79.0%) had a deltoid ligament disruption; most of the tears were of both the superficial and deep layers, partial and proximal attachment tears, and only 8 (12.5%) were complete tears. Patients with an intact deltoid ligament had a mean medial clear space (MCS) value of 2.7 ± 0.5 mm, and those with deltoid ligament tears had a mean MCS value of 5.9 ± 3.4 mm (P < .001). In a comparison between ultrasonography and gravity radiography, we found a sensitivity of 100% versus 97%, a specificity of 90% versus 100%, a positive predictive value of 97% versus 100%, and a negative predictive value of 100% versus 90%, respectively. The intra- and interobserver reliability was evaluated as almost perfect in all conditions. In a comparison between ultrasonography and gravity radiography, we found a sensitivity of 100% versus 97%, a specificity of 90% versus 100%, a positive predictive value of 97% versus 100%, and a negative predictive value of 100% versus 90%, respectively. CONCLUSION Ultrasonography proved to be an accurate tool, allowing the identification of deltoid ligament disruption and the involved components in a more dynamic fashion. Its relative ease of use and lack of ionizing radiation make it a useful and confident technique that can be performed by an orthopedist. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Isabel Rosa
- Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.,NOVA Medical School/Faculty of Medical Sciences, Lisbon, Portugal
| | - Joaquim Rodeia
- Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | | | | | | | - José Guimarães Consciência
- Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.,NOVA Medical School/Faculty of Medical Sciences, Lisbon, Portugal
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Sonographic visibility of the main posterior ankle ligaments and para-ligamentous structures in 15 healthy subjects. J Ultrasound 2020; 24:23-33. [PMID: 31919812 DOI: 10.1007/s40477-019-00420-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023] Open
Abstract
The present article describes the ultrasound (US) appearance of ligaments and paraligamentous structures which are not included in standard US imaging of the ankle: the posterior inferior tibiofibular ligament (PITFL), the transverse tibiofibular ligament (TTFL), the posterior talofibular ligament (PTFL), the posterior intermalleolar ligament (PIL), the synovial recess (SR) of the posterior joint and the os trigonum (OT). Two skilled operators examined 15 ankles in 15 healthy volunteers. Correlation between thickness of the main ligaments and body mass index (BMI) was also analyzed. Compound and tissue harmonic imaging (THI) were carried out using 12-, 6-15- and 9-MHz linear probes. Exploration of the posterior ankle ligament complex is accurately described including correct ankle position, echogenicity, shape, direction and thickness. Both operators identified and measured the main ligaments (PITFL, TTFL and PTFL) in all volunteers (Intraclass Correlation Coefficient ranged from 0.8 to 1); both operators also detected SR and OT in 2/15 ankles and posterior intermalleolar ligament (PIL) in 5/15 ankles. Pearson's test showed a significant correlation (< 0.05) between TTFL thickness and BMI. Also, a dynamic study was carried out showing tension of the PTFL during dorsiflexion in 7/15 subjects. Our results highlight the potential role of accurate US imaging in detecting posterior ankle ligament involvement in acute and chronic traumas. To our knowledge, there are no previous articles in the literature dealing with this topic providing an accurate description of the US procedure, and in particular, no study has been carried out to identify OT.
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Ricci V, Özçakar L. From “Ultrasound Imaging” to “Ultrasound Examination”: A Needful Upgrade in Musculoskeletal Medicine. PAIN MEDICINE 2019; 21:1304-1306. [DOI: 10.1093/pm/pnz231] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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31
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Rossi F, Zaottini F, Picasso R, Martinoli C, Tagliafico AS. Ankle and Foot Ultrasound: Reliability of Side-to-Side Comparison of Small Anatomic Structures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2143-2153. [PMID: 30592321 DOI: 10.1002/jum.14911] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES In sonography of clinically relevant small structures of the ankle and foot, the healthy contralateral side can be used as a reference to identify subtle abnormalities. Intrasubject side-to-side variability must be minimal. The aim of this study was to assess the reliability of side-to-side sonographic evaluation of small structures of the ankle and foot. METHODS Thirty healthy volunteers were prospectively studied. Small structures of the ankle and foot were evaluated bilaterally by 2 musculoskeletal radiologists in separate sessions. The deep peroneal nerve, superior extensor retinacula, calcaneofibular ligament, superior peroneal retinacula, tibialis posterior tendon, tibial nerve, Achilles tendon, plantaris tendon, plantar fascia, and sural nerve were considered. To assess intra- and interreader agreements, 30 (100%) examinations were repeated. A nonparametric statistic was used. RESULTS Data were not normally distributed (P > .001). Intrareader agreement was k = 0.67 (95% confidence interval, 0.57-0.78) and interreader agreement was k = 0.73 (95% confidence interval, 0.68-0.77). The mean values and standard deviation for all the structures were 0.36 ± 1.85 mm. The overall coefficient of variation was 18.5%. The intraclass correlation coefficient was 0.93 (95% confidence interval, 0.92-0.94). CONCLUSIONS In ankle and foot sonography, the healthy contralateral side can be used as a reference during a real-time musculoskeletal ultrasound evaluation of small structures.
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Affiliation(s)
- Federica Rossi
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Federico Zaottini
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Riccardo Picasso
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Department of Radiology, Ospedale Policlinico San Martino, Genoa, Italy
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32
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Bashaeb MO, Mutala TM, Muriithi IM. Pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain at the department of diagnostic imaging, university of Nairobi. Pan Afr Med J 2019; 31:116. [PMID: 31037176 PMCID: PMC6462368 DOI: 10.11604/pamj.2018.31.116.14049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/12/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction the ankle joint is a frequently injured joint. It is also affected by inflammatory, infectious and tumoral lesions. Ultrasound is a safe and cost-effective imaging tool when evaluating the ankle joint, as most structures are superficial and accessible. The aim of the study was to determine the pattern of ultrasonographic findings of disorders of the ankle joint complex in patients presenting with ankle pain. Methods a total of 43 consecutive patients with ankle pain referred for an ankle radiograph or ankle ultrasound were examined. Statistical analysis was done using SPSS version 20. Results abnormalities were found in 60% of the examinations performed. The abnormalities were more common in female patients accounting for 61.4% of the abnormalities detected. The most common finding was synovial hypertrophy seen in 26% of the patients. Conclusion ankle ultrasound was able to identify a large number of pathologies. This demonstrates the usefulness of ultrasound in the evaluation of a patient with ankle pain.
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Affiliation(s)
- Muhammad Omar Bashaeb
- Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi, Nairobi, Kenya
| | - Timothy Musila Mutala
- Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi, Nairobi, Kenya
| | - Ian Mathenge Muriithi
- Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi, Nairobi, Kenya
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Alves T, Dong Q, Jacobson J, Yablon C, Gandikota G. Normal and Injured Ankle Ligaments on Ultrasonography With Magnetic Resonance Imaging Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:513-528. [PMID: 30099744 DOI: 10.1002/jum.14716] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 06/08/2023]
Abstract
Ultrasonography (US) has been increasingly used in the evaluation of ankle ligamentous injuries given its advantages as a dynamic, efficient, noninvasive, and cost-effective imaging method. Understanding the anatomy of the ankle ligaments is critical for correct diagnosis and treatment. This pictorial essay describes and illustrates the US scanning technique and potential pitfalls in evaluating the ankle ligaments and also provides an overview of the US appearance of normal and injured ankle ligaments with magnetic resonance imaging correlation. Highlighted structures include the lateral complex, medial/deltoid complex, spring (calcaneonavicular) ligament complex, and syndesmosis.
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Affiliation(s)
- Timothy Alves
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Qian Dong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Jon Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Corrie Yablon
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Girish Gandikota
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
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Singh K, Thukral CL, Gupta K, Singh A. Comparison of high resolution ultrasonography with clinical findings in patients with ankle pain. J Ultrason 2019; 18:316-324. [PMID: 30763016 PMCID: PMC6444321 DOI: 10.15557/jou.2018.0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis. Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis.
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Affiliation(s)
- Kunwarpal Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Chuni Lal Thukral
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Kamlesh Gupta
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Avtar Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
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Abstract
This article reviews the imaging aspects relevant to ligamentous instabilities of the foot and ankle with a focus on MRI and ultrasound imaging. A pictorial review of the anatomy of the medial and lateral ankle ligaments, syndesmosis, spring ligament, Lisfranc complex, hallux sesamoid complex, and lesser toe plantar plate as seen on MRI is presented. Selected cases of ligamentous pathology relevant to foot and ankle instability are presented. The value of imaging in the assessment of foot and ankle instability is reviewed.
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Affiliation(s)
- Peter Salat
- Department of Radiology, University of Calgary, 2500 University Drive Northwest, Calgary, Alberta T2N 1N4, Canada; Mayfair Diagnostics, 6707 Elbow Drive Southwest 132, Calgary, Alberta T2V 0E3, Canada.
| | - Vu Le
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, St. Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Mark E Cresswell
- Department of Radiology, St Paul's Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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36
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Döring S, Provyn S, Marcelis S, Shahabpour M, Boulet C, de Mey J, De Smet A, De Maeseneer M. Ankle and midfoot ligaments: Ultrasound with anatomical correlation: A review. Eur J Radiol 2018; 107:216-226. [PMID: 30173941 DOI: 10.1016/j.ejrad.2018.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/07/2018] [Accepted: 08/11/2018] [Indexed: 02/07/2023]
Abstract
We present a detailed overview of anatomical and US features of ankle and midfoot ligaments based on our own dissections and cadaver studies as well as US imaging in cadavers and volunteers. The ligament anatomy about the ankle and midfoot is complex. Most ligaments are superficial and hence very well accessible for US. US technique to obtain optimal visualization however is difficult and requires a learning curve. We discuss US technique in detail for each individual ligament. We divided the ligaments in different groups: tibiofibular ligaments, Bassett's ligament, lateral collateral ligament complex (anterior talofibular ligament, calcaneofibular ligament, lateral talocalcaneal ligament, posterior talofibular ligament), medial collateral ligament complex, spring ligament, Chopart joint ligaments (bifurcate ligament, dorsal talonavicular ligament, lateral calcaneocuboid ligament, long and short plantar ligaments), Lisfranc ligaments, sinus tarsi ligaments.
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Affiliation(s)
- Seema Döring
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Steven Provyn
- Department of Experimental Anatomy and ARTE, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stefaan Marcelis
- Department of Radiology, Sint Andries Ziekenhuis Tielt, Tielt, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Cedric Boulet
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Aron De Smet
- Department of Experimental Anatomy and ARTE, Vrije Universiteit Brussel, Brussel, Belgium
| | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium; Department of Experimental Anatomy and ARTE, Vrije Universiteit Brussel, Brussel, Belgium.
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Imaging of Chopart (Midtarsal) Joint Complex: Normal Anatomy and Posttraumatic Findings. AJR Am J Roentgenol 2018; 211:416-425. [PMID: 29927330 DOI: 10.2214/ajr.17.19310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective of this article is to review the normal anatomy and posttraumatic findings of the Chopart joint complex. Key imaging features of the normal ligaments and patterns of ligamentous and osseous injuries are discussed. CONCLUSION Traumatic midtarsal injuries, particularly midtarsal sprain, are often overlooked clinically and on imaging but are relatively common and typically are associated with inversion ankle injuries. Radiologists should be familiar with Chopart joint anatomy and the imaging features of midtarsal injuries because early diagnosis may help optimize clinical management.
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38
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Fischetti A, Zawaideh JP, Orlandi D, Belfiore S, SIlvestri E. Traumatic peroneal split lesion with retinaculum avulsion: Diagnosis and post-operative multymodality imaging. World J Radiol 2018; 10:46-51. [PMID: 29876022 PMCID: PMC5985235 DOI: 10.4329/wjr.v10.i5.46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability. The typical clinical presentation is retro-malleolar pain, in some cases associated with palpable swelling around the fibular malleolus, pain during activities and difficulty in walking. We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury. An early diagnosis allowed treating the injury and promptly resuming sport activity, after rehabilitation training. Surgical reconstruction key-points and post-surgical follow-up were also discussed. A late diagnosis would have caused a symptomatology worsening and an increased recovery time.
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Affiliation(s)
- Aldo Fischetti
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa 16100, Italy
| | - Jeries P Zawaideh
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa 16100, Italy
| | - Davide Orlandi
- Radiology Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| | - Stefano Belfiore
- Orthopedic and Trauma Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
| | - Enzo SIlvestri
- Radiology Department, Ospedale Evangelico Internazionale, Genova 16122, Italy
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Acute Fracture of the Anterior Process of Calcaneus: Does It Herald a More Advanced Injury to Chopart Joint? AJR Am J Roentgenol 2018; 210:1123-1130. [DOI: 10.2214/ajr.17.18678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Meyer NB, Jacobson JA, Kalia V, Kim SM. Musculoskeletal ultrasound: athletic injuries of the lower extremity. Ultrasonography 2018; 37:175-189. [PMID: 29794963 PMCID: PMC6044222 DOI: 10.14366/usg.18013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/14/2018] [Indexed: 12/23/2022] Open
Abstract
Athletic injuries of the lower extremities are commonly encountered in clinical practice. While some pathology can be diagnosed on physical exam, others are a clinical dilemma with nonspecific symptomatology. In these situations, ultrasound imaging can be utilized as an exceptional diagnostic tool, offering unique advantages over other imaging modalities. This article will review the imaging characteristics of commonly encountered athletic injuries of the lower extremity.
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Affiliation(s)
- Nathaniel B Meyer
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Vivek Kalia
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Sung Moon Kim
- Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
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Hetta WM, Niazi G. Concordance of US and MRI for diagnosis of ligamentous and tendinous injuries around the ankle. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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JOURNAL CLUB: MRI Evaluation of Midtarsal (Chopart) Sprain in the Setting of Acute Ankle Injury. AJR Am J Roentgenol 2018; 210:386-395. [DOI: 10.2214/ajr.17.18503] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chianca V, Albano D, Messina C, Midiri F, Mauri G, Aliprandi A, Catapano M, Pescatori LC, Monaco CG, Gitto S, Pisani Mainini A, Corazza A, Rapisarda S, Pozzi G, Barile A, Masciocchi C, Sconfienza LM. Rotator cuff calcific tendinopathy: from diagnosis to treatment. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:186-196. [PMID: 29350647 PMCID: PMC6179075 DOI: 10.23750/abm.v89i1-s.7022] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 12/15/2022]
Abstract
Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches. (www.actabiomedica.it)
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Möller I, Janta I, Backhaus M, Ohrndorf S, Bong DA, Martinoli C, Filippucci E, Sconfienza LM, Terslev L, Damjanov N, Hammer HB, Sudol-Szopinska I, Grassi W, Balint P, Bruyn GAW, D'Agostino MA, Hollander D, Siddle HJ, Supp G, Schmidt WA, Iagnocco A, Koski J, Kane D, Fodor D, Bruns A, Mandl P, Kaeley GS, Micu M, Ho C, Vlad V, Chávez-López M, Filippou G, Cerón CE, Nestorova R, Quintero M, Wakefield R, Carmona L, Naredo E. The 2017 EULAR standardised procedures for ultrasound imaging in rheumatology. Ann Rheum Dis 2017; 76:1974-1979. [PMID: 28814430 DOI: 10.1136/annrheumdis-2017-211585] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/24/2017] [Accepted: 07/17/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2001, the European League Against Rheumatism developed and disseminated the first guidelines for musculoskeletal (MS) ultrasound (US) in rheumatology. Fifteen years later, the dramatic expansion of new data on MSUS in the literature coupled with technological developments in US imaging has necessitated an update of these guidelines. OBJECTIVES To update the existing MSUS guidelines in rheumatology as well as to extend their scope to other anatomic structures relevant for rheumatology. METHODS The project consisted of the following steps: (1) a systematic literature review of MSUS evaluable structures; (2) a Delphi survey among rheumatologist and radiologist experts in MSUS to select MS and non-MS anatomic structures evaluable by US that are relevant to rheumatology, to select abnormalities evaluable by US and to prioritise these pathologies for rheumatology and (3) a nominal group technique to achieve consensus on the US scanning procedures and to produce an electronic illustrated manual (ie, App of these procedures). RESULTS Structures from nine MS and non-MS areas (ie, shoulder, elbow, wrist and hand, hip, knee, ankle and foot, peripheral nerves, salivary glands and vessels) were selected for MSUS in rheumatic and musculoskeletal diseases (RMD) and their detailed scanning procedures (ie, patient position, probe placement, scanning method and bony/other landmarks) were used to produce the App. In addition, US evaluable abnormalities present in RMD for each anatomic structure and their relevance for rheumatology were agreed on by the MSUS experts. CONCLUSIONS This task force has produced a consensus-based comprehensive and practical framework on standardised procedures for MSUS imaging in rheumatology.
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Affiliation(s)
- Ingrid Möller
- Department of Rheumatology, Instituto Poal de Reumatología, Barcelona, Spain
- Barcelona University, Barcelona, Spain
| | - Iustina Janta
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marina Backhaus
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - David A Bong
- Department of Rheumatology, Instituto Poal de Reumatología, Barcelona, Spain
- Barcelona University, Barcelona, Spain
| | - Carlo Martinoli
- Department of Radiology-III, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Emilio Filippucci
- Department of Rheumatology, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Lene Terslev
- Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | | | - Iwona Sudol-Szopinska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Imaging Diagnostic Department, Warsaw Medical University, Warsaw, Poland
| | - Walter Grassi
- Department of Rheumatology, Università Politecnica delle Marche, Ancona, Italy
| | - Peter Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George A W Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, The Netherlands
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Hôpital Ambroise Paré (APHP), Boulogne-Billancourt, France
- INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France
| | - Diana Hollander
- EULAR PARE Patient Research Partner, Amsterdam, The Netherlands
| | - Heidi J Siddle
- Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Gabriela Supp
- Joint and Bone Center for Diagnosis, Research, and Therapy of Musculoskeletal Disorders, Medical University of Vienna, Vienna, Austria
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Center for Rheumatology, Berlin, Germany
| | - Annamaria Iagnocco
- Dipartimento Scienze Cliniche e Biologiche - Reumatologia, Università degli Studi di Torino, Turin, Italy
| | - Juhani Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - David Kane
- Department of Medicine-Rheumatology, Trinity College, Dublin, Ireland
| | - Daniela Fodor
- Department of Internal Medicine, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Bruns
- Department of Rheumatology, University of Sherbrooke, Québec, Canada
| | - Peter Mandl
- Division of Rheumatology, 3rd Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Gurjit S Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | - Carmen Ho
- Rheumatology and Clinical Immunology Division, University of Hong Kong, Hong Kong SAR, China
| | - Violeta Vlad
- Department of Rheumatology, Sf. Maria Clinical Hospital, Bucharest, Romania
| | - Mario Chávez-López
- Department of Biomedical Research, Universidad Autónoma de Aguascalientes, Aguascalientes, México
| | - Georgios Filippou
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena, Italy
| | | | | | - Maritza Quintero
- Department of Rheumatology, Universidad de Los Andes, Mérida, Venezuela
| | - Richard Wakefield
- Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University, Madrid, Spain
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Cai Y, Li S, Chen S, Hua Y, Shan J. An Ultrasound Classification of Anterior Talofibular Ligament (ATFL) Injury. Open Orthop J 2017; 11:610-616. [PMID: 28979580 PMCID: PMC5620408 DOI: 10.2174/1874325001711010610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 07/21/2016] [Accepted: 07/23/2016] [Indexed: 12/26/2022] Open
Abstract
Background: To develop a classification of ATFL injury based on the ultrasonography. Methods: The ultrasound images of 560 cases that had chronic ankle instability were studied from May 2012 to May 2015. All the patients accepted ultrasonography to type the ATFL injury. Results: The ATFL injuries could be divided into six subtypes based on ultrasound imaging: I: Intact ligament; II: Injury at the fibular side; III:Injury at the talar side; IV: Tear at the midsubstance; V:Ligament absorbed; VI:Combined injury. Conclusion: Ultrasound could be used to evaluate and type the injury of ATFL. This kind of classification could be helpful in the preoperative decision of ATFL procedure.
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Affiliation(s)
- Yehua Cai
- Department of sonography, Huashan Hospital, Fudan University, Shanghai, China
| | - Shengkun Li
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jielin Shan
- Department of sonography, Huashan Hospital, Fudan University, Shanghai, China
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Messina C, Bignotti B, Tagliafico A, Orlandi D, Corazza A, Sardanelli F, Sconfienza LM. A critical appraisal of the quality of adult musculoskeletal ultrasound guidelines using the AGREE II tool: an EuroAIM initiative. Insights Imaging 2017; 8:491-497. [PMID: 28755330 PMCID: PMC5621989 DOI: 10.1007/s13244-017-0563-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Our aim was to evaluate the quality of published guidelines on musculoskeletal ultrasound (MSK-US) for adults. METHODS Between June and July 2016, we conducted an online search for MSK-US guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II tool. A fifth independent reviewer calculated scores per each domain and agreement between reviewers' scores using the intraclass correlation coefficient (ICC). RESULTS Five guidelines were included in this appraisal. They were published between 2001 and 2014. Our appraisal showed intermediate results, with four out of five guidelines scoring "average" as overall quality. Domain 1 (scope and purpose) achieved the highest result (total score = 71.1% ± 18.7%). Domain 6 (editorial independence) had the lowest score (total score = 26.3% ± 19.3%). Interobserver agreement was very good for all the evaluated guidelines (ICC ranged between 0.932 and 0.956). CONCLUSIONS Overall, quality of MSK-US guidelines ranges from low to average when evaluated using the AGREE II tool. The editorial independence domain was the most critical, thus deserving more attention when developing future guidelines. MAIN MESSAGES • Four of five guidelines on MSK-US had an average quality level. • Scope/purpose had the highest score (71.1% ± 18.7%). • Editorial independence had the lowest score (26.3% ± 19.3%). • Interobserver agreement was very good (ranges: 0.932-0.956).
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Affiliation(s)
- Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Bianca Bignotti
- Department of Health Sciences, University of Genova, Genoa, Italy
| | | | - Davide Orlandi
- Ospedale Evangelico Internazionale, Piazzale Gianasso 5, 16100, Genoa, Italy
| | - Angelo Corazza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy.
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McKiernan S, Fenech M, Fox D, Stewart I. Sonography of the ankle: The lateral ankle and ankle sprains. SONOGRAPHY 2017. [DOI: 10.1002/sono.12120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Tafur M, Rosenberg ZS, Bencardino JT. MR Imaging of the Midfoot Including Chopart and Lisfranc Joint Complexes. Magn Reson Imaging Clin N Am 2017; 25:95-125. [PMID: 27888854 DOI: 10.1016/j.mric.2016.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Following a brief description of the normal anatomy and biomechanics of the midfoot, this article focuses on MR imaging features of common osseous, tendon, and ligament abnormalities that affect the midfoot. Discussion of the anatomy and pathology affecting the Chopart and Lisfranc joint complexes, both of which play important roles in linking the midfoot to the hindfoot and the forefoot respectively, is also included.
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Affiliation(s)
- Monica Tafur
- Joint Department of Medical Imaging, University of Toronto, 399 Bathurst Street, 3rd Fl Room 3MC-410, Toronto, Ontario M5T 2S8, Canada
| | - Zehava Sadka Rosenberg
- Department of Radiology, NYU School of Medicine, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
| | - Jenny T Bencardino
- Department of Radiology, NYU School of Medicine, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
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49
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Gitto S, Messina C, Mauri G, Aliprandi A, Sardanelli F, Sconfienza LM. Dynamic high-resolution ultrasound of intrinsic and extrinsic ligaments of the wrist: How to make it simple. Eur J Radiol 2016; 87:20-35. [PMID: 28065372 DOI: 10.1016/j.ejrad.2016.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/28/2016] [Accepted: 12/01/2016] [Indexed: 01/29/2023]
Abstract
Wrist ligaments are crucial structures for the maintenance of carpal stability. They are classified into extrinsic ligaments, connecting the carpus with the forearm bones or distal radioulnar ligaments, and intrinsic ligaments, entirely situated within the carpus. Lesions of intrinsic and extrinsic ligaments of the wrist have been demonstrated to occur largely, mostly in patients with history of trauma and carpal instability, or rheumatoid arthritis. Ultrasound allows for rapid, cost-effective, non-invasive and dynamic evaluation of the wrist, and may represent a valuable diagnostic tool. Although promising results have been published, ultrasound of wrist ligaments is not performed in routine clinical practice, maybe due to its technical feasibility regarded as quite complex. This review article aims to enlighten readers about the normal sonographic appearance of intrinsic and extrinsic carpal ligaments, and describe a systematic approach for their sonographic assessment with detailed anatomic landmarks, dynamic manoeuvres and scanning technique.
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Affiliation(s)
- Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Giovanni Mauri
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy; Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141 Milano, Italy
| | - Alberto Aliprandi
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Servizio di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy; Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy
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50
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Omar H, Saini V, Wadhwa V, Liu G, Chhabra A. Spring ligament complex: Illustrated normal anatomy and spectrum of pathologies on 3T MR imaging. Eur J Radiol 2016; 85:2133-2143. [PMID: 27776669 DOI: 10.1016/j.ejrad.2016.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 11/30/2022]
Abstract
The spring (plantar calcaneonavicular) ligament complex connects the calcaneus and navicular bone of the foot and serves as the primary static stabilizer of the medial longitudinal arch of the foot. In this article, we describe the normal anatomy of the spring ligament complex, illustrate 3T magnetic resonance imaging appearances in its normal and abnormal states, and discuss the pathological associations with relevant case examples.
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Affiliation(s)
- Hythem Omar
- Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Vikram Saini
- Center for Infection and Inflammation Imaging Research, Johns Hopkins University, Baltimore, MD, United States
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - George Liu
- Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Avneesh Chhabra
- Musculoskeletal Radiology, UT Southwestern Medical Center, Dallas, TX, United States.
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