Faculty Bibliography

BACKGROUND:Magnetic resonance imaging (MRI) is an integral component of the treatment algorithm for proximal hamstring avulsion injuries. OBJECTIVE:The purpose of this study was to survey orthopedic surgeons and musculoskeletal radiologists on the reporting and analysis of proximal hamstring avulsions on MRI. METHODS:Two online surveys were developed to evaluate musculoskeletal radiologists' and orthopedic surgeons' perceptions of MRI-reporting for proximal hamstring avulsion injuries. Each survey was designed to provide information on physicians' best practices with respect to four primary questions (1) ischial tuberosity landmark determination (2) difficulties associated with measuring tendon retraction, (3) important ancillary findings, and (4) perceived clinical impact of measured retraction. Descriptive statistics were calculated for all categorical variables, which were reported as frequencies with percentages. Chi-squared test was utilized to compare rates of responses between surgeons and radiologists. Statistically significant differences were analyzed with post-hoc Fisher's exact tests; p < 0.05 considered statistically significant. RESULTS:218-Musculoskeletal radiologists and 33-orthopedic surgeons responded to their respective surveys. There were statistically significant differences with responses to two of the questions asked in both surveys; (1) in cases of complete hamstring avulsion (avulsion of both the semimembranosus and conjoint tendon), which arrow represents the tendon gap measurement used for planning surgery? p = 0.028; (2) in cases of avulsion of only the conjoint tendon, which arrow represents the tendon gap measurement used for planning surgery? p = 0.013. Post-hoc testing demonstrated that for either partial or complete hamstring avulsions, more surgeons use the conjoint tendon origin to measure tendon retraction than radiologists (p < 0.05 for both). Significantly more radiologists use the semimembranosus origin to measure hamstring retraction for partial or complete hamstring tears (p < 0.05 for both). However, for each of these questions, both radiologists and surgeons most frequently stated that the conjoint tendon landmark should be used for surgical planning. CONCLUSION/CONCLUSIONS:Musculoskeletal radiologists and orthopedists frequently utilize the conjoint tendon origin as an anatomic landmark for measuring complete and partial proximal hamstring avulsion injuries; though, orthopedists are more likely to utilize this landmark. Additionally, the broad surface area of the ischial tuberosity may lead to variability in measurement. CLINICAL IMPACT/CONCLUSIONS:Standard landmarks at the ischial tuberosity and/or detailed descriptions of tendon retractions would improve communication between radiologists and surgeons for proximal hamstring avulsions.

Diagnostic musculoskeletal imaging represents a large economic expenditure within the health care system. Cost-effectiveness analysis can identify the most efficient use of imaging resources, but the literature is not well summarized. The purpose of this study was to summarize the existing literature on this topic and identify areas for future research. A systematic review of the literature was performed for 1995 - 2020. Data was extracted and summarized from those studies meeting inclusion criteria including publication and analysis characteristics and clinical topics. The search found 27 studies meeting inclusion criteria of which 16 (59%) were published in the last 5 years. Studies were clustered around specific topics with 21 (78%) of studies analyzing either osteoporosis screening (n = 9, 33%), cancer imaging (n = 4, 15%), inflammatory arthritis (n = 4, 15%), or spinal trauma (n = 4, 15%). Only 4 studies (15%) were published in radiology journals. Although 12 studies (44%) had a radiologist author, only 8 (30%) had a radiologist as first or senior author. Existing cost-effectiveness analyses in musculoskeletal radiology are clustered around a small number of topics and few studies are led by radiologists. Future research should target under-represented clinical topics and radiologists should actively pursue involvement in this field to apply their unique expertise and understanding of imaging.

This study aimed to describe patterns of imaging utilization after resection of extremity soft tissue sarcoma in the United States, assess for potential disparities, and evaluate temporal trends. A retrospective cohort study using a national database of private payer claims data was performed to determine the utilization rate of extremity and chest imaging in a 5-year postoperative follow-up period for patients with extremity soft tissue sarcoma treated between 2007 and 2019. Imaging utilization was assessed according to patient demographics (age, sex, race and ethnicity, and region of residency), calendar year of surgery, and postoperative year. Associations of demographic variables with imaging use were assessed using chi-square tests, trends in imaging use were analyzed using the Cochran-Armitage trend test or linear regression, and associations of postoperative year with imaging use were evaluated with the Pearson Correlation coefficient. A total of 3707 patients were included. Most patients received at least 1 chest (74%) and extremity (53%) imaging examination during their follow-up period. The presence of surveillance imaging was significantly associated with age (P < 0.0001) and region (P = 0.0029). Over the study period, there was an increase in use of extremity MRI (P < 0.05) and ultrasound (P < 0.01) and chest CT (P < 0.0001) and a decrease in use of chest radiographs (P < 0.0001). Imaging use declined over postoperative years (decrease by 85%-92% from year 1-5). In conclusion, the use of surveillance imaging varied according to patient demographics and has increased for extremity MRI and ultrasound and chest CT over the study period.

OBJECTIVE:To compare MRI with 3D reconstructions and 3D-CT with respect to assessment of glenoid wear in osteoarthritic shoulders. METHODS:3D reconstructions were generated for CT and MR (utilizing the Dixon technique) imaging performed on 29 osteoarthritic shoulders. Two reviewers independently performed glenoid morphometric measurements and evaluated glenoid erosion. Mean differences between the two modalities were calculated. Inter-observer agreement was calculated using kappa coefficient. RESULTS:The combined mean absolute difference (bias) in glenoid version between 3D-CT and 3D-MRI was 2.7° ± 1.6° (range 0.15-7.85, P value = 0.7). The combined mean absolute difference in glenoid inclination between 3D-CT and 3D-MRI was 6.8° ± 4.1° (range 0.8°-15.75°, P value = 0.17). No significant inter-reader variation in glenoid version and inclination measurements on 3D-CT and 3D-MRI was found (P > 0.05). The inter-reader reliability for both CT and MRI was high for Walch grading of glenoid bone loss (κ = 1, κ = 0.81, respectively). CONCLUSIONS:3D-MRI is comparable to 3D-CT with respect to axial glenoid bone loss, as measured by glenoid version. However, for coronal bone loss estimation, measured by glenoid inclination, 3D-CT remains the gold standard. Thus, 3D-MR can be used as an alternative for preoperative assessment of glenoid version in arthritic shoulders.

Following anterior shoulder instability surgery, patients may present with new or recurrent symptoms. Postoperative imaging, including MR imaging, may be obtained for these patients to assess the integrity of the repaired tissues and orthopedic fixation hardware or grafts. Familiarity with different operative techniques and their expected normal appearances and complications helps in the appropriate interpretation of these imaging studies. This article provides an overview of the current treatment guidelines and surgery options for patients with anterior shoulder instability and reviews the normal and abnormal postoperative imaging appearances of the shoulder joint after treatment with the most common surgical stabilization techniques.

OBJECTIVE:To determine the rate of infection in patients with suspected hip septic arthritis who underwent image-guided aspiration (IHA) resulting in dry-tap, diagnostic value of subsequent lavage and re-aspiration, and if pre-aspiration MRI can help prevent a dry tap. MATERIALS AND METHODS/METHODS:Retrospective review between 2010 to 2020 identified native hip (NH) and total hip arthroplasty (THA) patients who had a dry-tap following aspiration for suspected infection or periprosthetic joint infection (PJI). Serology tests, lavage/re-aspiration volumes, and aspirate cell-count/culture were assessed. On pre-aspiration MRI, presence/grade of joint effusion (JE), pseudocapsule dehiscence (PD), extraarticular fluid and sinus-tract were recorded. RESULTS:Out of 215 included dry-taps, 185 (86.0%) were non-infected and 30 (13.9%) infected. In subgroup analysis, 64/71(90.1%) NH and 121/144(84.0%) THA dry-taps were non-infected. Pre-aspiration MRI of THA group with dry-tap showed significant findings; PD with extraarticular fluid (8/12, 66.7%) and sinus tract (7/12, 58.3%) were higher in the infected compared to non-infected group (5/42, 11.9% and 0/42, 0.0%) (both p < 0.001). Among THA group, polymorphonuclear-leukocytes > 80% was present in 8/9 (88.9%) of infected versus 4/28 (14.3%) non-infected group (p < 0.001). Multivariable regression showed PD (p = 0.005) and JE (p = 0.042) being significant independent predictors of PJI, similarly the elevated CRP (p = 0.044) and JE (p = 0.017). CONCLUSION/CONCLUSIONS:Majority of patients suspected of hip joint infection with dry-tap were non-infected. Synovial PMN% following lavage maintains high sensitivity for detection of PJI. In patients with THA, PD and subsequent extraarticular collection can be associated with dry-tap therefore, pre-aspiration MRI can help determine their presence and plan the aspiration.

Purpose/UNASSIGNED:To investigate the variance in 90-day complication, emergency department (ED) visit, revision, and readmission rates between the Latarjet procedure (LP) performed as a primary procedure for the treatment of recurrent shoulder instability associated with critical levels of glenohumeral bone loss and the LP performed as a salvage surgical procedure after failed arthroscopic instability repair (FAIR). Methods/UNASSIGNED:< .05. Results/UNASSIGNED:The final sample sizes consisted of 54 patients in the LP-PBL group and 23 patients in the LP-FAIR group. In the postoperative period, 4 complications were observed in the first 90 days. These included complex regional pain syndrome (n = 1) and superficial wound dehiscence (n = 1) in the LP-PBL cohort. Superficial suture abscess (n = 1) and audible crepitation (n = 1) were observed in the LP-FAIR cohort. There was 1 secondary intervention (arthroscopic debridement) in the LP-FAIR cohort. No statistically significant difference in complication rates, ED visits or admissions, or secondary procedures was found between the LP-PBL and LP-FAIR groups. Conclusions/UNASSIGNED:The results of this study indicate that the 90-day complication, ED visit, revision, and readmission rates after open LP are low irrespective of the extent of glenoid or bipolar bone loss and history of arthroscopic instability repair. Level of Evidence/UNASSIGNED:Level III, retrospective cohort study.

The posteromedial and posterolateral corners of the knee are important areas to consider when assessing the patient with a possible knee injury. An understanding of the anatomy, associated biomechanics, and typical injury patterns in these regions will improve the value that the radiologist interpreting the MRIs brings to this patient population.