Introduction. Magnetic resonance arthrogram (MRA) is the investigation of choice in young adults with symptoms of femero acetabular impingement. The aim of the study is to assess the accuracy of MRA when correlated with surgical findings on hip arthroscopy. Materials and Method. Between June 2007 and January 2014, 136 patients had MRA followed by subsequent arthroscopy at our institution. The radiology information system was used to gather MRA data. All scans were reported by a consultant radiologist with a specialist interest in musculoskeletal radiology. Patient records were reviewed to gather surgical data. Assessment was made of labral injury, Camshaft (CAM) or Pincer lesion and degeneration of the cartilage. Results. Mean age at MRA was 34.5 years with a 2.5:1 female to male ratio. For labral pathology sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89, 100, 100 and 22% respectively. For CAM (62, 80, 79 and 64% respectively) and Pincer lesions (15, 84, 81 and 18% respectively). MRA was specific for picking up Grade 3/4 degenerate changes in the articular cartilage (92.2%) but was not as sensitive (60%), PPV 55 and NPV 94. Conclusion. These findings demonstrate that MRA is a sensitive and specific imaging modality for assessing the labrum and articular surface, but not as good for assessing CAM and Pincer lesions. This could be due to the static nature of the MRA or a lack of firm definition as to what constitutes a CAM or Pincer lesion leading to under reporting. This maybe better assessed with plane X ray or Computed tomography with 3 dimensional reconstruction. Further to this it would be interesting to combine the plane X ray and MRA finding and see if sensitivity and specificity was improved

To the best of our knowledge, this prospective study is the first to investigate the prevalence of acetabular labrum tears in athletes presenting with groin pain. Eighteen consecutive athletes who presented to our sports clinic with groin pain, underwent Magnetic Resonance Arthrography (MRA). Presence or absence of acetabular labrum tears, were reported on by a Consultant Radiologist, who has an interest in musculoskeletal radiology. In 4 out of 18 athletes with groin pain (22.2%), the Magnetic Resonance Arthrography demonstrated the presence of acetabular labrum tear. Two underwent hip arthroscopy and treatment. Acetabular labrum tears can be a common cause of groin pain in athletes. Sports clinicians have to be well aware of the condition. Magnetic resonance arthrography of the hip can be a valuable tool in diagnosing this pathology

MRI arthography (MRA) is commonly used in the investigation of shoulder instability. However many surgeons are now using CT arthography (CTA) as their primary radiological investigative modality. They argue that CTA is cheaper, and give satisfactory soft tissue images in the “soft tissue window” mode. They believe that CTA give superior images when looking at bone loss and bony defects, and as such is more useful in deciding whether a patient requires an open procedure or not. In this study we aimed to compare the results of MRA and CTA in the investigation of shoulder instability. We reviewed the operative and arthographic findings in all patients who had surgery for shoulder instability in our unit over a 4 year period. We compared the results of the arthograms with the definitive findings found at the time of surgery. All arthograms were performed by standard techniques and were reported by musculoskeletal radiology consultants. All surgery was performed by experienced consultant shoulder surgeons. In total 48 CTAs and 50 MRAs were performed. We found that there was no significant difference between the two wrt sensitivity (p=0.1) and specificity (p=0.4) when looking at labral pathology. However CTA was more sensitive at picking up bony lesions (p< 0.05). This study supports the view that CT arthography is the superior radiological modality in identifying pathology when investigating patients with shoulder instability. It is cheaper and better tolerated by patients than MRA and gives useful information on whether a patient needs an open or arthroscopic stabilisation procedure

Incidence of pars defect associated with idiopathic scoliosis has been reported as 6% based on roentgenographic evaluation in previous studies. (Fisk et al, 1978). We aim to present our results in an MRI based study. 224 patients of adolescent idiopathic scoliosis (AIS) who had an MRI scan over a period of three years (2006-2008), performed either as a preoperative investigation or due to other symptoms were reviewed. All MRI scans were reviewed by two experienced musculoskeletal radiology consultants independently. Among 224 patients 13 (5.8%) patients were found to have pars defect. Mean age-group of patients were (19 years, range-11-40). 84.6% (n=11) patients were female and 15.3% patients were male. There was varying severity of curve patterns. We have noted two lumbar/thoraco-lumbar curves (Lenke 5), King Type I-6, King Type II-2 and three King Type III curves. All scoliotic deformities were non-structural. Bilateral pars defect was noted in nine (69%) patients. Previous studies (Fisk et al, 1978; Mau H 1981) have described the incidence of pars defect as approximately 6.2%. Recent studies have emphasized use of MRI to diagnose pars defect based on signal changes in the pedicle (Sairyo et al.). Our study reveals the incidence of pars defect in AIS to be 5.8 % based on MRI diagnosis which does not seem to be different to previous roentgenographic studies

Incidence of pars defect associated with idiopathic scoliosis has been reported as 6% based on roentgenographic evaluation in previous studies. (Fisk et al, 1978). We aim to present our results in an MRI based study. Methods: 229 patients of adolescent idiopathic scoliosis (AIS) who had an MRI scan over a period of three years (2006–2008), performed either as a preoperative investigation or due to other symptoms were reviewed. All MRI scans were reviewed by two experienced musculoskeletal radiology consultants independently. Results: Among 229 patients 18 (7.86%) patients were found to have pars defect. Mean age-group of patients were (19 years, range-11–40). Male -5 (27.7%), female- 13(72.2%). There was varying severity of curve patterns, major thoracic curve-10, major lumbar curve-4, mild thoracic curve-3 and mild lumbar curve in one. Bilateral pars defect was noted in 14 (77.8%) patients. Discussion: Previous studies (Fisk et al, 1978; Mau H 1977) have described the incidence of pars defect as approximately 6.2%. Recent studies have emphasized use of MRI to diagnose pars defect based on signal changes in the pedicle (Sairyo et al, 2009). Our study reveals the incidence of pars defect in AIS to be 7.86 % based on MRI diagnosis which does not seem to be different to previous roentgenographic studies. Conflicts of Interest: none. Source of Funding: none

Incidence of pars defect associated with idiopathic scoliosis has been reported as 6% based on roentgenographic evaluation in previous studies. (Fisk et al, 1978). We aim to present our results in an MRI based study. Methods: 229 patients of adolescent idiopathic scoliosis (AIS) who had an MRI scan over a period of three years (2006–2008), performed either as a preoperative investigation or due to other symptoms were reviewed. All MRI scans were reviewed by two experienced musculoskeletal radiology consultants independently. Result. Among 229 patients 18 (7.86%) patients were found to have pars defect. Mean age-group of patients were (19 years, range-11–40). Male-5 (26.3%), female- 4(73.6%). Majority of the patients with were females (72.2%). There was varying severity of curve patterns, major thoracic curve-10, major lumbar curve-4, mild thoracic curve-3 and mild lumbar curve in one. Bilateral pars defect was noted in 14 (77.7%) patients. Discussion. Previous studies (Fisk et al, 1978; Mau H 1977) have described the incidence of pars defect as approximately 6.2%. Recent studies have emphasized use of MRI to diagnose pars defect based on signal changes in the pedicle (Jon R. Davids et al, 2004). Our study reveals the incidence of pars defect in AIS to be 7.86 % based on MRI diagnosis which does not seem to be different to previous roentgenographic studies

Purpose of Study. To identify the degree of morphological change achievable following the Bereiter trochleoplasty and to establish whether these results are comparable with functional outcomes. Methods. Seventeen consecutive patients (19 knees) with patellar instability secondary to trochlear dysplasia underwent trochleoplasty, of which 12 knees (12 patients) were radiologically evaluated pre- and post surgery using axial CT and MRI imaging. Their mean age at time of surgery was 28.1 years (15 to 44). The mean follow-up was 2.2 years (0.5 to 5). The following four radiological outcomes were used: trochlear depth (TD), transverse patellar shift (TPS), lateral patellar inclination angle (LPIA) and sulcus angle (SA). All knees were assessed post-operatively using MRI. The axial CT images were reformatted which allowed for direct comparison with MRI. Each knee was radiologically evaluated twice by a senior musculoskeletal radiology consultant to increase data accuracy and assess for intra-observer reliability using the intraclass correlation coefficient (ICC). Functional outcomes consisted of the KOOS, Lysholm, Kujala and Tegner scores. Results. The ICC for all four radiological outcomes revealed high intra-observer reliability (0.89-0.92) suitable for clinical application. The results clearly show an increase in TD and TSP with median differences of 4mm (0.5-5) and 5.5mm (1.75-10) respectively. Decreases in SA and LPIA were observed with median differences of 14° (12.75-23) and 10.5° (7-21.75) respectively. These morphological changes resulted in improved patellar stability as exemplified by no re-dislocations and excellent functional outcomes: KOOS score 89.59 (81.97 to 93.36), Lysholm 97.5 (91.75 to 100), Kujala 93 (88.75-96.5) and Tegner Activity Scale increased from level 1 to 4 (p = 0.0002). Conclusion. This evaluation has shown the Bereiter trochleoplasty improves the radiological appearance of trochlear dysplasia close to normal in the proximal trochlea leading to improved patellofemoral congruency and excellent functional outcomes

Aims

Large acetabular bone defects encountered in revision total hip arthroplasty (THA) are challenging to restore. Metal constructs for structural support are combined with bone graft materials for restoration. Autograft is restricted due to limited volume, and allogenic grafts have downsides including cost, availability, and operative processing. Bone graft substitutes (BGS) are an attractive alternative if they can demonstrate positive remodelling. One potential product is a biphasic injectable mixture (Cerament) that combines a fast-resorbing material (calcium sulphate) with the highly osteoconductive material hydroxyapatite. This study reviews the application of this biomaterial in large acetabular defects.

Aims

The frequency of severe femoral retroversion is unclear in patients with femoroacetabular impingement (FAI). This study aimed to investigate mean femoral version (FV), the frequency of absolute femoral retroversion, and the combination of decreased FV and acetabular retroversion (AR) in symptomatic patients with FAI subtypes.

Objectives

Little is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA.