Faculty Bibliography

Ulnar collateral ligament (UCL) reconstruction is now being performed more commonly and on younger patients than in prior decades. As a result, radiologists will increasingly be asked to evaluate elbow imaging of patients presenting with pain who have had UCL reconstruction. It is essential for radiologists to understand the normal and abnormal imaging appearances after UCL reconstruction and ulnar nerve transposition, which is also commonly performed in overhead-throwing athletes. Doing so will allow radiologists to provide accurate interpretations that appropriately guide patient management.

OBJECTIVE:To describe the clinical presentation of arterial pseudoaneurysms following total knee arthroplasty (TKA) and their diagnostic imaging features on ultrasound and magnetic resonance angiography (MRA) in 7 patients. MATERIALS AND METHODS/METHODS:A search of our radiology report database from 2007 to 2017 yielded 7 patients with a pseudoaneurysm diagnosed by imaging after TKA. Clinical notes and imaging were reviewed. RESULTS:All 7 patients were male and ranged in age from 53 to 68 (mean 61) years. All patients presented with a painful swollen knee and hemarthrosis within the first month following surgery. Five patients presented after primary TKA. One patient presented after explantation for septic arthritis and another after partial synovectomy for septic arthritis without explantation. Ultrasound identified the pseudoaneurysm as a hypoechoic or hyperechoic mass with a "yin-yang" appearance of turbulent arterial flow and associated complex joint effusion. On MRA, the pseudoaneurysm was a mass next to a parent artery showing avid contrast enhancement in the arterial phase that persisted into the venous phase and washed out in the late venous phase. Six pseudoaneurysms arose from lateral geniculate arteries and 1 from a medial geniculate artery. There were no popliteal artery pseudoaneurysms. Five patients were treated endovascularly, 1 patient thrombosed without intervention, and 1 patient was treated with open surgery. CONCLUSION/CONCLUSIONS:Pseudoaneurysm is a potential source of a painful swollen knee with hemarthrosis or a drop in hematocrit after TKA and can be identified with either ultrasound or MRA.

Scurvy is a rare disease in developed nations. In the field of pediatrics, it primarily is seen in children with developmental and behavioral issues, malabsorptive processes, or diseases involving dysphagia. We present the case of an otherwise developmentally appropriate 4-year-old boy who developed scurvy after gradual self-restriction of his diet. He initially presented with a limp and a rash and was subsequently found to have anemia and hematuria. A serum vitamin C level was undetectable, and after review of the MRI of his lower extremities, the clinical findings supported a diagnosis of scurvy. Although scurvy is rare in developed nations, this diagnosis should be considered in a patient with the clinical constellation of lower-extremity pain or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and anemia. This case highlights the importance of carefully assessing a child's dietary and developmental status at well-child visits, which can help avoid a more invasive workup.

Various pathologic conditions extending from the lumbar and pelvic regions to the lower leg may manifest as foot drop, or weakness of ankle dorsiflexion. Potential causes of foot drop include L5 radiculopathy, lumbosacral plexopathy, sciatic neuropathy, and peroneal neuropathy. Although the first-line test in lesion localization is most commonly electrodiagnostic testing, MR neurography has emerged as a useful tool to verify lesion site, to accurately characterize the cause of the neuropathy, and to guide patient treatment. MR neurography, when tailored and focused, can help overcome potential pitfalls in clinical and electrodiagnostic evaluation and is commonly performed in the authors' practice. MR neurography studies are protocoled in advance after careful review of clinical notes and electrodiagnostic findings and often after discussion with the referring clinician. Radiologists who interpret MR neurography studies should have a sound understanding not only of peripheral nerve anatomy and common pathologic conditions, but also of the clinical and electrodiagnostic evaluation performed in patients with foot drop. In this way, the radiologist can actively guide the referring clinician in ordering the most appropriate imaging examination, efficiently reaching the correct diagnosis, and deciding appropriate treatment.

Recently, there has been a renewed interest in primary repair of proximal anterior cruciate ligament (ACL) tears. Magnetic resonance imaging (MRI) plays an important role in preoperative patient selection and in postoperative ligament assessment. Knowledge of the imaging factors that make patients candidates for primary ACL repair, namely proximal tear location and good tissue quality, can help radiologists provide information that is meaningful for surgical decision making. Furthermore, an understanding of the surgical techniques can prevent misinterpretation of the postoperative MRI. This article reviews preoperative MRI characterization of ACL injuries, techniques of arthroscopic primary ACL repair surgery and examples of postoperative MRI findings.

Individuals reporting high group cohesion are less likely to discontinue participation in group exercise programs. A validated measure of group cohesion, the Physical Activity Group Environment Questionnaire (PAGEQ), is untested in older men. The PAGEQ was administered to, and questions about demographics and frequency and duration of participation were asked of, the Walk A Mile or More (WAMM) exercise group, which was composed of U.S. military Veterans. Forty participants (mean age = 62 years, 77.5% male) completed surveys. Cronbach's alpha for the overall PAGEQ was 0.976. Although no significant relationship was found between group cohesion scores and frequency of attending WAMM sessions, there was a trend for individuals who had participated for a longer time to report more group cohesiveness, particularly regarding the task (i.e., exercise) itself. The PAGEQ was easily administered and internally consistent in this group of older men, and provides a useful benchmark for future gerontological researchers. [Journal of Gerontological Nursing, 42(8), 18-23.].