Faculty Bibliography

PURPOSE/OBJECTIVE:To review adverse events and outcomes at least 1 year postoperatively from Bridge enhanced ACL restoration (BEAR) in the first 100 subjects of the Bridge registry, a postcommercialisation prospective cohort. METHODS:Consecutive BEAR patients were invited to enroll in the Bridge registry. Technique modifications, adverse events and reoperations were recorded. Physical examinations and patient reported outcomes (International Knee Documentation Committee [IKDC], knee injury and osteoarthritis outcome score [KOOS], Marx and return to sport index [RSI]) were reported at 0, 6, 9 and 12 months. RESULTS:Of the 100 subjects, 94 enrolled postoperatively. Four exited the study. Mean follow up was 15.3 ± 4.7 months. The mean age was 31.3 ± 14.3 years. 67% were female. Classic and modified techniques were each used in 50 cases. The rates of adverse events and reoperations at 1 year were: one deep venous thrombosis, two meniscal injuries without anterior cruciate ligament (ACL) retear and eight reoperations (one debridement, two manipulations, three suture removals, one partial lateral meniscectomy and one medial meniscus repair). Adverse events between 1 and 2 years included one recurrent ACL tear with associated meniscus tears, two meniscal injuries without ACL tear, and one isolated ACL tear. Overall reoperation rate was 8.3% (8/96) at 1 year and 11.5% (11/96) at final follow-up, with 0% ACL retear at 1 year and 2.1% (2/96) ACL retear at final follow-up. Mean IKDC, Marx and RSI scores at 12 months were (N = 79), respectively 82.7 ± 14.6, 7.5 ± 5.36 and 66.6 ± 24.06. Mean KOOS pain, function daily living and function sports and recreational activities were: 92.7 ± 8.6, 96.7 ± 6.0 and 82.0 ± 18.5. Lachman (N = 75) was 0-2 mm in 80.0% (60/75) and 3-5 mm in 20.0% (15/75). Pivot shift (N = 73) was negative in 90.4% (66/73), grade 1 in 8.2% (6/73) and grade 2 in 1.4% (1/73) at 12 months. CONCLUSION/CONCLUSIONS:The rates of adverse events of BEAR with and without modification are low at 1 year. Excellent stability and ROM are attained at 1 year. CLINICAL RELEVANCE/CONCLUSIONS:BEAR has promising results in postcommercial utilization and is as an alternative to reconstruction. LEVEL OF EVIDENCE/METHODS:Level II cohort study.

As Crohn disease treatment rapidly evolves, imaging has a critical role in treatment response assessment and clinical decision making. Therapy is often "top down," with the most powerful and potent therapies selected first. Disease activity assessment remains multifactorial, integrating source data from biomarkers, symptoms, endoscopy, and imaging. The "treat-to-target" approach also integrates these markers to escalate, de-escalate, or switch therapies. Given the transmural nature of Crohn disease, endoscopic mucosal healing (ie, the current treatment target) may not be sufficient evidence of remission, and imaging assessment of transmural healing could prove a better predictor of treatment response and long-term patient outcomes. Quantitative imaging methods have been developed to standardize treatment response assessment, including emerging radiologic techniques such as contrast-enhanced US, T1 mapping at MRI, standardized stricture assessment, and velocity-encoded phase contrast imaging. Morphologic changes of resolving inflammation at imaging may lag behind clinical response, and complete normalization of inflamed bowel segments may occur infrequently. In these cases, evaluating changes in bowel motility may be may be more helpful for detection of early treatment response. The radiologist is critical in the assessment of Crohn disease, providing insight into disease management and endoscopically occult and subclinical inflammation. The goal of this article is to highlight the role of imaging in driving management of Crohn disease, including endoscopically occult and subclinical disease, transmural healing, and treatment decision making in patients undergoing biologic therapies. ^©RSNA, 2026 See the invited commentary by Srinivasan and Taylor in this issue.

BACKGROUND:Simultaneous bilateral total knee arthroplasty (BTKA) is avoided due to higher perioperative risk, favoring staged procedures. This study evaluated how the interval between staged TKAs affects patient-reported outcome measures (PROMs) and compared complications between the first and second procedures. METHODS:We retrospectively reviewed patients undergoing primary, elective, staged, BTKAs at a high-volume academic center between 2011 and 2024. Intra- and perioperative data and complications were compared between the surgeries. Patients were stratified by interval: less than three months ("extremely short waiters"), three to six months, six to nine months, nine to 12 months, one to two years, two to five years, and greater than five years. The PROMs were compared across these groups. A total of 4,210 patients underwent 8,420 staged, BTKAs at a mean 21.4-month interval. The most common intervals were six to nine months (27.4%) and nine to 12 months (21.1%). RESULTS:Patients were more likely to return to the emergency department (22 versus 16, P = 0.030) and be readmitted (48 versus 26, P = 0.113) after the second surgery, primarily due to infection. Revision rates did not differ. "Extremely short waiters" had the greatest improvement in Patient-Reported Outcomes Measurements Information System Pain Intensity and interference scores nine months after the second TKA (change 13.4 and 15.1, P < 0.001). At three months following the second surgery, those who waited three to six months had the largest Knee Injury and Osteoarthritis Outcome Score for Joint Replacement score improvement (change 23.7, P = 0.004). At one year after the second surgery, "extremely short waiters" again showed the greatest reduction in Patient-Reported Outcomes Measurements Information System Pain Intensity (change 10.5, P = 0.007) and Interference (change 11.3, P < 0.001). CONCLUSIONS:The interval between surgeries significantly impacted PROMs, with shorter intervals associated with better pain relief and functional recovery. Surgical timing should be tailored to individual patient goals and recovery trajectories.

Artificial intelligence (AI) has progressed from technical research to routine clinical use, reaching an inflection point where technological capabilities may exceed current regulatory and oversight frameworks. These systems are becoming more complex, progressing from narrow, task-specific algorithms to foundation models and early agentic prototypes. This progression has redistributed risk, responsibility, and clinical judgment, requiring radiologists and health care leaders to understand how policy choices affect patient safety and clinical innovation advancement. This special report provides a roadmap for aligning policy with clinical practice through a practical, lifecycle-based framework centered on patient safety. Translational bialignment is a concept that pairs regulatory science requirements (what AI systems should deliver to clinicians and patients) with implementation science capabilities (what institutions should provide for safe deployment of AI). This framework addresses the full AI lifecycle, from data stewardship and model development to validation, deployment, and monitoring, and articulates shared responsibilities for vendors, institutions, and clinicians grounded in trustworthy AI principles. The analysis focuses on U.S. regulatory frameworks, particularly Food and Drug Administration policies governing medical AI, with relevant highlights from international approaches. Concrete opportunities for radiologists to engage in policy formation, participate in oversight, and collaborate with industry and policymakers are provided to help shape a trustworthy and sustainable AI ecosystem. The alignment of policy, practice, and patient safety will enable medical AI to have a lasting impact on clinical care and public trust. The analysis and recommendations provided represent the authors' perspectives and do not necessarily reflect the official positions of the Radiological Society of North America. Keywords: Artificial Intelligence, Food and Drug Administration, Health Policy, Implementation Science, Large Language Models, Machine Learning, Patient Safety, Regulatory Science, Translational Bialignment © RSNA, 2026.

While there have been great advancements in total knee arthroplasty (TKA) over the past 50 years, anterior knee pain (AKP) remains the most common concern among patients postoperatively. Despite exhausting evidence supporting no clinical difference in AKP with resurfaced vs. unresurfaced patellae in TKA, 87% of TKAs are resurfaced in the United States, compared with 2% in other countries. These large practice variations underscore a lack of consensus regarding the role of the patella and the approach to the anterior compartment of the knee in TKA. The aim of this review was to go beyond patellar resurfacing and describe the effects that surgical technique and implant design may have on AKP in current TKA.

OBJECTIVE:To evaluate cannabidiol (CBD) in pediatric patients with autism spectrum disorder (ASD), fluent verbal language and an estimated full-scale IQ of 80 or above. BACKGROUND:Preliminary evidence suggests CBD may ameliorate challenges associated with ASD. Whether CBD benefits pediatric ASD without accompanying intellectual or language impairment remains unknown. METHODS:, 100 mg/mL) at 3, 6, or 9 mg/kg/day using a Bayesian optimal interval dosing design. The primary endpoint was the CBD dose associated with the highest response rate (i.e., Clinical Global Impression Scale-Improvement [CGI-I] score = 1 or 2) on a target symptom domain designated individually based on informant report, standardized scales, and clinical observation. Secondary endpoints were effect sizes of changes from baseline in measures assessing ASD core and associated symptoms, and global functioning. Adverse events (AEs) were assessed weekly. Plasma CBD levels and clinical labs were obtained at the final visit. RESULTS:= 1.36, 95% CI [0.78-1.93]).Of 222 reported AEs, 27 unique AEs were considered treatment-related. Most AEs (93%) were mild and expected (82%); none was severe. The most frequent related AEs were increased salivation (30%), increased sleep duration (39%), sleepiness/sedation (26%), increased dream activity (35%), and polyuria (22%). Vital signs, physical exams, weight, liver function tests, and complete blood counts were unaffected. CBD plasma levels did not correlate with response. CONCLUSIONS:In this preliminary study, CBD was well tolerated; AEs were mild-moderate. Mean SRS2-T and subscores decreased significantly with large effect sizes, shifting from the severe to the moderate range. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov Identifier NCT03900923.

KEY POINTS/CONCLUSIONS:In this cohort study of 720,348 adults referred for kidney transplantation from 2014 to 2025, only 48% were evaluated and 19% were waitlisted. Progression from referral to evaluation, waitlisting and kidney transplantation was limited by individual, center-level, and geographic factors. Some centers evaluated and waitlisted patients at rates far below the national average, and low-volume centers had lower rates of transplantation. BACKGROUND:Kidney transplantation is a cost-effective, lifesaving treatment of kidney failure, compared with dialysis. Unfortunately, most patients with kidney failure never undergo transplantation. METHODS:Using Epic Cosmos electronic health record data on all patients referred for kidney transplantation from 2014 to 2025, we assessed the stage-specific progression and attrition in the process of evaluation, waitlisting, and kidney transplantation. Center-level and individual (socioeconomic, geographic, and insurance status) factors associated with access to evaluation, waitlisting, and kidney transplantation were characterized using modified Poisson regression. RESULTS:Among 720,348 referred candidates, the median age was 55 years (interquartile range [IQR], 42-64); 47% of patients were White, 52% were male, and 87% were English speaking. Eighty-five percent of patients lived in urban areas. Of the referred candidates, 48% initiated evaluation, 19% were waitlisted, and 10% ultimately underwent transplantation. Among the referred patients who initiated evaluation, the median (IQR) time to evaluation initiation was two (1-4) months after referral; among the patients who were waitlisted, the median (IQR) time to waitlisting was four (2-9) months after evaluation initiation. Patients who were never married (0.94; 95% confidence interval [CI], 0.93 to 0.94), had severe obesity (0.70; 95% CI, 0.69 to 0.72), or were from rural zip codes (relative risk, 0.98; 95% CI, 0.97 to 1.00) were less likely to initiate evaluation. Low-volume centers had lower relative rates of transplantation (0.92; 95% CI, 0.88 to 0.96). In centers with documentation for nonprogression to evaluation, reasons for removal included not meeting criteria/not a candidate (18%), patient decision (13%), unable to contact (12%), death (4%), and financial/insurance complications (7%). CONCLUSIONS:Our study shows substantial attrition before kidney transplant waitlisting.

BACKGROUND:Delayed abdominal wound healing remains a common complication following abdominally based autologous breast reconstruction. We hypothesized that the type of umbilical inset incision impacts the incidence of delayed wound healing due to differential disruption of abdominal wall vascularity, particularly in the infraumbilical region. METHODS:A retrospective review was conducted of all patients undergoing abdominally based autologous breast reconstruction at a single center between 2014 and 2021. The primary outcome was delayed abdominal wound healing, classified as major (requiring readmission or reoperation), minor (managed with outpatient care, antibiotics, or debridement), or both. Umbilical inset incision type was evaluated as a predictor using univariate and multivariate analysis. RESULTS:. The most used umbilical incision was an elliptical incision (193, 40%) followed by vertical (141, 29%), inverted-U (30, 6%), other (39, 8%), and unknown (81, 17%). Abdominal wound healing complications occurred in 63 (13%) patients. The incidence of abdominal wound healing complications was lowest with elliptical incisions (p < 0.001). In a multivariate regression model controlling for age, BMI, diabetes, smoking history, and flap weight, umbilical incision predicted abdominal wound healing complications, with inverted-U and vertical incisions conferring higher odds of abdominal wound healing complications (OR 5.9, 95% CI [1.6, 20.8] and OR 4.6, 95% CI [2.0, 11.4], p < 0.05) as compared to elliptical incisions. CONCLUSION/CONCLUSIONS:Abdominal wall vascularity likely plays a critical role in donor site healing following autologous reconstruction. In this large cohort, inverted-U and vertical umbilical inset incisions were associated with the highest rates of wound healing complications.

Recurrent patellar instability is a complex condition influenced by both soft tissue insufficiency and a spectrum of bony abnormalities. Although medial patellofemoral ligament reconstruction is the cornerstone of treatment, it may not address all contributing factors-particularly in patients with malalignment, trochlear dysplasia, or abnormal patellar height. This study explores the indications, techniques, and outcomes of adjunctive bony procedures including tibial tubercle osteotomy, trochleoplasty, and derotational distal femoral osteotomies. Ultimately, the goal is to integrate soft tissue and bony procedures in a patient-specific manner to reduce recurrence and preserve long-term joint function. This synthesis aims to offer an up-to-date framework for approaching a challenging condition with growing treatment complexity.