Publications by authors named "Erin F Alaia"

18 Publications

  • Page 1 of 1

Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications.

Am J Sports Med 2021 04 26;49(5):1152-1159. Epub 2021 Feb 26.

NYU Langone Health, New York, New York, USA.

Background: The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity.

Purpose: To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation.

Study Design: Descriptive laboratory study.

Methods: Axial, non-fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity.

Results: Of the 13 study participants, mean age was 38.77 years, and mean body mass index was 25.58. Five participants were female, and 5 left and 8 right elbow MRI scans were reviewed. The GWE-PIN was significantly greater in supination (mean ± SD, 16.01 ± 2.9 mm) compared with pronation (13.66 ± 2.5 mm) ( < .005). The mean CSP-PIN was significantly greater in supination (16.20 ± 2.8 mm) compared with pronation (14.18 ± 2.4 mm) ( < .013).The mean PPT-PIN was significantly greater in supination (9.00 ± 3.0 mm) compared with both pronation (1.96 ± 1.2 mm; < .001) and neutral (4.73 ± 2.6 mm; < .001). The mean BTP-PIN was 20.54 ± 3.0, 20.81 ± 2.7, and 20.35 ± 2.9 mm in pronation, neutral, and supination, respectively, which did not significantly differ between positions. In supination, the proximal, midportion, and distal measurements of BTP-PIN did not significantly differ. The proximal PPT-PIN distance (9.08 ± 2.9 mm) was significantly greater than midportion PPT-PIN (5.85 ± 2.4 mm; < .001) and distal BTP-PIN (2.27 ± 1.8 mm; < .001).

Conclusion: This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach.

Clinical Relevance: When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.
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http://dx.doi.org/10.1177/0363546521992120DOI Listing
April 2021

Distal posterolateral corner injury in the setting of multiligament knee injury increases risk of common peroneal palsy.

Knee Surg Sports Traumatol Arthrosc 2021 Feb 9. Epub 2021 Feb 9.

New York University Langone Orthopedic Hospital, 333 East 38th Street, New York, NY, 10016, USA.

Purpose: The purpose of this study was to identify if the location of posterolateral corner (PLC) injury was predictive of clinical common peroneal nerve (CPN) palsy.

Methods: A retrospective chart review was conducted of patients presenting to our institution with operative PLC injuries. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. A fellowship-trained musculoskeletal radiologist reviewed the PLC injury and categorized it into distal, middle and proximal injuries with or without a biceps femoral avulsion. The CPN was evaluated for signs of displacement or neuritis.

Results: Forty-seven operatively managed patients between 2014 and 2019 (mean age-at-injury 29.5 ± 10.7 years) were included in this study. Eleven (23.4%) total patients presented with a clinical CPN palsy. Distal PLC injuries were significantly associated with CPN palsy [9 (81.8%) patients, (P = 0.041)]. Nine of 11 (81.8%) patients with CPN palsy had biceps femoral avulsion (P = 0.041). Of the patients presenting with CPN palsy, only four (36.4%) patients experienced complete neurologic recovery. Three of 7 patients (43%) with an intact CPN had full resolution of their clinically complete CPN palsy at the time of follow-up (482 ± 357 days). All patients presenting with a CPN palsy also had a complete anterior cruciate ligament (ACL) rupture in addition to a PLC injury (P = 0.009), with or without a posterior cruciate ligament (PCL) injury. No patient presenting with an isolated pattern of PCL-PLC injury (those without ACL tears) had a clinical CPN palsy.

Conclusion: Distal PLC injuries have a strong association with clinical CPN palsy, with suboptimal resolution in the initial post-operative period. Specifically, the presence of a biceps femoris avulsion injury was highly associated with a clinical CPN palsy. Additionally, CPN palsy in the context of PLC injury has a strong association with concomitant ACL injury. Furthermore, the relative rates of involvement of the ACL vs. PCL suggest that specific injury mechanism may have an important role in CPN palsy.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-021-06469-zDOI Listing
February 2021

Distal biceps femoris avulsions: Associated injuries and neurological sequelae.

Knee 2020 Dec 15;27(6):1874-1880. Epub 2020 Nov 15.

NYU Langone Health, United States of America.

Background: The aim of this study was to describe associated injuries in cases of distal biceps femoris avulsions (DBFA) as well as the incidence of neurological injury and radiographic abnormalities of the common peroneal nerve (CPN).

Methods: A retrospective chart review was conducted of patients presenting to our office or trauma center with DBFA injuries. Demographic data was obtained as well as mechanism of injury. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. The CPN was evaluated for signs of displacement or neuritis.

Results: Sixteen patients were identified (mean age-at-injury 28.6 years, 87.5% male) with DBFA. Three patients (18.8%) sustained their injuries secondary to high energy trauma while 13 (81.3%) had injuries secondary to lower energy trauma. Nine patients (56.3%) initially presented with CPN palsy. All patients presenting with CPN palsy of any kind were found to have a displaced CPN on MRI and no patient with a normal nerve course had a CPN palsy.

Conclusions: This case series demonstrates a strong association between DBFA and CPN palsy as well as multi-ligamentous knee injury (MLKI). These injuries have a higher rate of CPN palsy than that typically reported for MLKI. Furthermore, these findings suggest that CPN displacement on MRI may be a clinically significant indicator of nerve injury. LOE: IV.
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http://dx.doi.org/10.1016/j.knee.2020.07.085DOI Listing
December 2020

Impact on Participants of Family Connect, a Novel Program Linking COVID-19 Inpatients' Families With the Frontline Providers.

J Am Coll Radiol 2021 02 5;18(2):324-333. Epub 2020 Oct 5.

Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York.

Purpose: With clinical volumes decreased, radiologists volunteered to participate virtually in daily clinical rounds and provide communication between frontline physicians and patients with coronavirus disease 2019 (COVID-19) and their families affected by restrictive hospital visitation policies. The purpose of this survey-based assessment was to demonstrate the beneficial effects of radiologist engagement during this pandemic and potentially in future crises if needed.

Methods: After the program's completion, a survey consisting of 13 multiple-choice and open-ended questions was distributed to the 69 radiologists who volunteered for a minimum of 7 days. The survey focused on how the experience would change future practice, the nature of interaction with medical students, and the motivation for volunteering. The electronic medical record system identified the patients who tested positive for or were suspected of having COVID-19 and the number of notes documenting family communication.

Results: In all, 69 radiologists signed or cosigned 7,027 notes. Of the 69 radiologists, 60 (87.0%) responded to the survey. All found the experience increased their understanding of COVID-19 and its effect on the health care system. Overall, 59.6% agreed that participation would result in future change in communication with patients and their families. Nearly all (98.1%) who worked with medical students agreed that their experience with medical students was rewarding. A majority (82.7%) chose to participate as a way to provide service to the patient population.

Conclusion: This program provided support to frontline inpatient teams while also positively affecting the radiologist participants. If a similar situation arises in the future, this communication tool could be redeployed, especially with the collaboration of medical students.
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http://dx.doi.org/10.1016/j.jacr.2020.08.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534665PMC
February 2021

Does Magnetic Resonance Imaging After Diagnostic Ultrasound for Soft Tissue Masses Change Clinical Management?

J Ultrasound Med 2020 Oct 14. Epub 2020 Oct 14.

Department of Radiology, New York University Langone Medical Center, New York, New York, USA.

Objectives: To evaluate whether a follow-up magnetic resonance imaging (MRI) scan performed after initial ultrasound (US) to evaluate soft tissue mass (STM) lesions of the musculoskeletal system provides additional radiologic diagnostic information and alters clinical management.

Methods: A retrospective chart review was performed of patients undergoing initial US evaluations of STMs of the axial or appendicular skeleton between November 2012 and March 2019. Patients who underwent US examinations followed by MRI for the evaluation of STM lesions were identified. For inclusion, the subsequent pathologic correlation was required from either a surgical or image-guided biopsy. Imaging studies with pathologic correlations were then reviewed by 3 musculoskeletal radiologists, who were blinded to the pathologic diagnoses. The diagnostic utility of MRI was then assessed on the basis of a 5-point grading scale, and inter-reader agreements were determined by the Fleiss κ statistic.

Results: Ninety-two patients underwent MRI after US for STM evaluations. Final pathologic results were available in 42 cases. Samples were obtained by surgical excision or open biopsy (n = 34) or US-guided core biopsy (n = 8). The most common pathologic diagnoses were nerve sheath tumors (n = 9), lipomas (n = 5), and leiomyomas (n = 5). Imaging review showed that the subsequent MRI did not change the working diagnosis in 73% of cases, and the subsequent MRI was not considered to narrow the differential diagnosis in 68% of cases. There was slight inter-reader agreement for the diagnostic utility of MRI among individual cases (κ = 0.10) between the 3 readers.

Conclusions: The recommendation of MRI to further evaluate STM lesions seen with US frequently fails to change the working diagnosis or provide significant diagnostic utility.
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http://dx.doi.org/10.1002/jum.15529DOI Listing
October 2020

Three-dimensional MRI Bone Models of the Glenohumeral Joint Using Deep Learning: Evaluation of Normal Anatomy and Glenoid Bone Loss.

Radiol Artif Intell 2020 Sep 9;2(5):e190116. Epub 2020 Sep 9.

Department of Radiology, Hospital do Coração (HCOR) and Teleimagem, Rua Desembargador Eliseu Guilherme 53, 7th Floor, São Paulo, SP, Brazil 04004-030 (T.C.R.); Department of Radiology, NYU Langone Medical Center, New York, NY (C.M.D., E.F.A., S.G.); Department of Radiology, McGill University Health Centre, Montreal, Canada (N.G.); and Department of Radiology, New York University School of Medicine, New York, NY (J.S.B., J.D.).

Purpose: To use convolutional neural networks (CNNs) for fully automated MRI segmentation of the glenohumeral joint and evaluate the accuracy of three-dimensional (3D) MRI models created with this method.

Materials And Methods: Shoulder MR images of 100 patients (average age, 44 years; range, 14-80 years; 60 men) were retrospectively collected from September 2013 to August 2018. CNNs were used to develop a fully automated segmentation model for proton density-weighted images. Shoulder MR images from an additional 50 patients (mean age, 33 years; range, 16-65 years; 35 men) were retrospectively collected from May 2014 to April 2019 to create 3D MRI glenohumeral models by transfer learning using Dixon-based sequences. Two musculoskeletal radiologists performed measurements on fully and semiautomated segmented 3D MRI models to assess glenohumeral anatomy, glenoid bone loss (GBL), and their impact on treatment selection. Performance of the CNNs was evaluated using Dice similarity coefficient (DSC), sensitivity, precision, and surface-based distance measurements. Measurements were compared using matched-pairs Wilcoxon signed rank test.

Results: The two-dimensional CNN model for the humerus and glenoid achieved a DSC of 0.95 and 0.86, a precision of 95.5% and 87.5%, an average precision of 98.6% and 92.3%, and a sensitivity of 94.8% and 86.1%, respectively. The 3D CNN model, for the humerus and glenoid, achieved a DSC of 0.95 and 0.86, precision of 95.1% and 87.1%, an average precision of 98.7% and 91.9%, and a sensitivity of 94.9% and 85.6%, respectively. There was no difference between glenoid and humeral head width fully and semiautomated 3D model measurements ( value range, .097-.99).

Conclusion: CNNs could potentially be used in clinical practice to provide rapid and accurate 3D MRI glenohumeral bone models and GBL measurements. © RSNA, 2020.
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http://dx.doi.org/10.1148/ryai.2020190116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529433PMC
September 2020

Fibular Tip Periostitis: New Radiographic Sign, Predicting Chronic Peroneal Tendon Subluxation/Dislocation in the Setting of Pes Planovalgus.

AJR Am J Roentgenol 2020 Sep 16. Epub 2020 Sep 16.

Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health.

Tearing of the superior peroneal retinaculum (SPR) is a known cause of peroneal tendon subluxation/dislocation (PTS). However, with the exception of cortical avulsions at its fibular attachment, SPR injury and subsequent PTS are typically radiographically occult. Evaluate the previously undescribed association between radiographic fibular tip periostitis and MRI evidence of PTS, in patients with hindfoot valgus. 35 patients with radiographic fibular tip periostitis and 35 age- and sex-matched controls without periostitis, were selected out of 220 consecutive patients with hindfoot valgus and both ankle radiographs and MRIs. Studies were retrospectively assessed by two musculoskeletal radiologists in consensus, and two additional blinded, independent radiologists for presence of PTS, sub-fibular impingement, and hindfoot valgus angle measurement. Inter-observer agreement and accuracy, sensitivity, and specificity for detecting fibular periostitis, PTS, and sub-fibular impingement were measured. Fischer-exact, Mann-Whitney, kappa coefficients, and intra-class correlation tests were performed. Both consensus and two independent readers' interpretations showed that PTS was significantly greater in subjects with periostitis (62.9%, 65.7% and 85.7%, respectively) compared to those without (5.7%, 0% and 14.3%, respectively) (p<0.001); periostitis was specific and highly sensitive for predicting PTS. Sub-fibular impingement was also statistically higher in the periostitis group compared to the one without (p<0.001). Hindfoot valgus angle was statistically higher in the periostitis group compared to the control group, (p = 0.010 to 0.002) and among subjects with PTS compared to those without (p = 0.002 to <0.001). The blinded readers reached substantial or near perfect agreement for all imaging interpretations (82.9-95.7% concordance rate, κ= 0.66-0.91). Radiographic fibular tip periostitis, in patients with hindfoot valgus, can be a predictor of PTS, and may also suggest advanced hindfoot valgus and sub-fibular impingement. These radiographic associations should be recognized by the radiologist and MRI may be recommended as clinically indicated. Chronic, undiagnosed PTS can be a persistent cause of lateral ankle pain, leading to further degeneration and the possibility of complete peroneal tendon tears. Distal fibular periostitis in patients with hindfoot valgus can be a reliable radiographic indicator of this entity and may suggest the presence of sub-fibular impingement.
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http://dx.doi.org/10.2214/AJR.20.23964DOI Listing
September 2020

Anterior Shoulder Instability in the Aging Population: MRI Injury Pattern and Management.

AJR Am J Roentgenol 2021 Feb 24:1-8. Epub 2021 Feb 24.

Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E. 17th St, 6th Fl, New York, NY 10003.

Literature on glenohumeral dislocations has focused on younger patient populations because of high recurrence rates. However, the spectrum of injuries sustained in younger versus older patient populations is reported to be quite different. The purpose of this article is to describe MRI findings and management of anterior shoulder instability in the aging (≥ 60 years) population. Shoulder MRI examinations of anterior glenohumeral dislocations in patients 40 years old and older were subdivided into groups younger than 60 years old or 60 years old and older and reviewed by two musculoskeletal radiologists for a Hill-Sachs lesion, other fracture, glenoid injury, capsulolabral injury, rotator cuff tear, muscle atrophy, and axillary nerve injury. Fischer exact test and logistic regression was evaluated for significant differences between cohorts, and interreader agreement was assessed. Surgical management was recorded, if available. A total of 104 shoulder MRI examinations (age range, 40-79 years; mean age, 58.3 years; 52 women, 52 men) were reviewed (54 examinations < 60 years; 50 examinations ≥ 60 years). Acute high-grade or full-thickness supraspinatus (64.0% vs 37.0%; = .001), infraspinatus (28.0% vs 14.8%; = .03), and subscapularis (22.0% vs 3.7%; = .003) tears were more common in the group 60 years old and older. Hill-Sachs lesions were more common in the younger group (81.5% vs 62.0%; = .046). Greater tuberosity fractures were seen in 15.4% of the overall cohort, coracoid fractures in 4.8%, and acute axillary nerve injuries in 9.6%. Interreader concordance was 88.5-89.4% for rotator cuff tears and 89.4-97.1% for osseous injury. In the group younger than 60 years old, 11 of 37 subjects (29.7%) had rotator cuff repair and 11 of 37 (29.7%) had labral repair, whereas 17 of 36 (47.2%) of the older group underwent rotator cuff repair, six of 36 (16.7%) underwent reverse shoulder arthroplasty, and six of 36 (16.7%) underwent labral repair. Radiologists should have a high index of suspicion for acute rotator cuff tears in anterior shoulder instability, especially in aging populations. Greater tuberosity or coracoid fractures and axillary nerve injury occur across all ages, whereas Hill-Sachs injuries are more common in younger patients. Acute high-grade or full-thickness rotator cuff tears are seen with higher frequency in older populations after anterior glenohumeral dislocation. Osseous and nerve injuries are important causes of patient morbidity that if not carefully sought out may be overlooked by the interpreting radiologist on routine imaging.
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http://dx.doi.org/10.2214/AJR.20.24011DOI Listing
February 2021

Using Deep Learning to Accelerate Knee MRI at 3 T: Results of an Interchangeability Study.

AJR Am J Roentgenol 2020 12 14;215(6):1421-1429. Epub 2020 Oct 14.

Facebook Artificial Intelligence Research, Menlo Park, CA.

Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. Our goal was to use DL to accelerate MRI to allow a 5-minute comprehensive examination of the knee without compromising image quality or diagnostic accuracy. A DL model for image reconstruction using a variational network was optimized. The model was trained using dedicated multisequence training, in which a single reconstruction model was trained with data from multiple sequences with different contrast and orientations. After training, data from 108 patients were retrospectively undersampled in a manner that would correspond with a net 3.49-fold acceleration of fully sampled data acquisition and a 1.88-fold acceleration compared with our standard twofold accelerated parallel acquisition. An interchangeability study was performed, in which the ability of six readers to detect internal derangement of the knee was compared for clinical and DL-accelerated images. We found a high degree of interchangeability between standard and DL-accelerated images. In particular, results showed that interchanging the sequences would produce discordant clinical opinions no more than 4% of the time for any feature evaluated. Moreover, the accelerated sequence was judged by all six readers to have better quality than the clinical sequence. An optimized DL model allowed acceleration of knee images that performed interchangeably with standard images for detection of internal derangement of the knee. Importantly, readers preferred the quality of accelerated images to that of standard clinical images.
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http://dx.doi.org/10.2214/AJR.20.23313DOI Listing
December 2020

Shoulder MR Imaging and MR Arthrography Techniques: New Advances.

Magn Reson Imaging Clin N Am 2020 May 19;28(2):153-163. Epub 2020 Feb 19.

Department of Radiology, Musculoskeletal Division, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, A21, Cleveland, OH 44195, USA.

MR imaging is the standard diagnostic modality that provides a comprehensive and accurate assessment for both osseous and soft-tissue pathologic conditions of the shoulder. This article discusses standard MR imaging and arthrography protocols used routinely in clinical practice, as well as more innovative sequences and reconstruction techniques, facilitated by the increasing availability of high-field-strength magnets and multichannel phased array surface coils and incorporation of artificial intelligence. These exciting innovations allow for a more detailed and diagnostic imaging assessment, improvements in image quality, and more rapid image acquisition.
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http://dx.doi.org/10.1016/j.mric.2019.12.001DOI Listing
May 2020

Radiographic features and complications following coracoclavicular ligament reconstruction.

Skeletal Radiol 2020 Jun 11;49(6):955-965. Epub 2020 Jan 11.

Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E. 17th Street, 6th Floor, New York, NY, 10003, USA.

Objective: To report radiographic features and complications of coracoclavicular ligament reconstruction and the association of radiographic features with symptomatology.

Materials And Methods: Retrospective picture archiving and communication system query (1/2012-8/2018) identified subjects with prior coracoclavicular ligament reconstruction. Post-operative radiographs were reviewed with attention to the following: (1) acromioclavicular alignment, (2) coracoclavicular width, (3) distal clavicular osteolysis, (4) osseous tunnel widening, and (5) hardware complication or fracture. Medical records were reviewed to determine purpose of imaging follow-up (symptomatic versus routine). Statistical analysis determined associations between binary features and outcomes, and inter-reader agreement.

Result: Review of 55 charts identified 32 subjects (23 male, 9 females; age range 24-64; imaged 1-34 months following surgery) meeting inclusion criteria. Loss of acromioclavicular reduction was the most common imaging finding (n = 25, 78%), with 76% progressing to coracoclavicular interval widening. Distal clavicular osteolysis was seen in 21 cases (66%) and was significantly associated with loss of acromioclavicular joint reduction (p = 0.032). Tunnel widening occurred in 23 patients (82%) with more than one follow-up radiograph. Six (19%) had hardware complication or fracture. No radiographic feature or complication had significant correlation with symptomatology (p values 0.071-0.721). Inter-reader agreement was moderate to substantial for coracoclavicular interval widening and hardware complication, fair to substantial for tunnel widening, and fair to moderate for loss of acromioclavicular reduction and distal clavicular osteolysis.

Conclusion: Loss of acromioclavicular joint reduction, coracoclavicular interval widening, distal clavicular osteolysis, and tunnel widening are common radiographic features after coracoclavicular ligament reconstruction; however, they do not necessarily correlate with symptomatology.
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http://dx.doi.org/10.1007/s00256-020-03375-2DOI Listing
June 2020

Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation.

Magn Reson Imaging Clin N Am 2019 Nov 26;27(4):701-719. Epub 2019 Aug 26.

Department of Radiology, Division of Musculoskeletal Radiology, NYU Langone Health, 301 East 17th Street, 6th Floor, New York, NY 10003, USA; Department of Orthopaedic Surgery, Division of Musculoskeletal Radiology, NYU Langone Health, 301 East 17th Street, 6th Floor, New York, NY 10003, USA. Electronic address:

The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
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http://dx.doi.org/10.1016/j.mric.2019.07.001DOI Listing
November 2019

Stener-Like Lesions of the Superficial Medial Collateral Ligament of the Knee: MRI Features.

AJR Am J Roentgenol 2019 12 28;213(6):W272-W276. Epub 2019 Aug 28.

Department of Orthopaedic Surgery, Sports Surgery Division, NYU Langone Health/NYU Langone Orthopedic Hospital, New York, NY.

To listen to the podcast associated with this article, please select one of the following: iTunes or Google Play. The purpose of this article is to describe Stener-like lesions of the superficial medial collateral ligament (sMCL) of the knee, which, to our knowledge, have not yet been reported in the radiologic literature. This lesion, defined as a distal tear with interposition of osseous or soft-tissue structures between the ligament and its tibial attachment, often requires surgical intervention. Knee MRI examinations of grade 3 sMCL tears were identified via a search of department imaging and orthopedic case files of medial collateral ligament (MCL) tears for the period of January 2010-April 2017 using the keywords "complete MCL tear" or "near complete MCL tear." Two musculoskeletal radiologists reviewed the MRI examinations. The location of the sMCL tear, presence of a Stener-like lesion, associated ligamentous injuries, and surgical findings were recorded. Review of 65 knee MRI examinations identified 20 cases of distal tibial grade 3 sMCL tear. Of the distal tears, 12 (60%) were Stener-like lesions and six (30%) were borderline lesions. Of these 18 cases, 14 (78%) were associated with multiligament knee injury and nine (50%) underwent MCL repair or reconstruction. Ten of the 12 (83%) Stener-like lesions were displaced superficial to the pes anserinus and two (17%) were entrapped, one in a reverse Segond fracture and one in the femorotibial compartment. Stener-like lesions represent a high percentage of tibia-sided sMCL avulsions, are found most often with pes anserinus interposition, and are frequently associated with multiligamentous injury, suggesting high-energy trauma. MRI diagnosis is important because interposition preventing anatomic healing and potential secondary valgus instability often prompt surgical intervention.
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http://dx.doi.org/10.2214/AJR.19.21535DOI Listing
December 2019

Normal Anatomy and Traumatic Injury of the Midtarsal (Chopart) Joint Complex: An Imaging Primer.

Radiographics 2019 Jan-Feb;39(1):136-152. Epub 2018 Nov 30.

From the Department of Radiology, Musculoskeletal Division, NYU Langone Orthopedic Hospital, 301 E 17th St, 6th Floor, New York, NY 10003 (W.R.W., E.F.A., Z.S.R.); Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland (A.H.); and Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (M.T.).

The midtarsal (Chopart) joint complex consists of the talonavicular and calcaneocuboid joints and their stabilizing ligaments. Detailed assessment of this complex at MRI can be challenging owing to frequent anatomic variation and the small size of the structures involved. Nevertheless, a wide spectrum of pathologic conditions affect the joint complex, and its imaging evaluation deserves more thorough consideration. This review focuses on MRI evaluation of normal ligamentous anatomy and common variations about the Chopart joint, presenting practical imaging tips and potential diagnostic pitfalls. Imaging findings across a spectrum of traumatic Chopart joint injuries are also reviewed, from midtarsal sprains to Chopart fracture-dislocations. Midtarsal sprains-commonly associated with ankle inversion injuries-are emphasized, along with their often predictable radiographic and MRI injury patterns. Online DICOM image stacks are available for this article. RSNA, 2018.
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http://dx.doi.org/10.1148/rg.2019180102DOI Listing
March 2020

Acute Fracture of the Anterior Process of Calcaneus: Does It Herald a More Advanced Injury to Chopart Joint?

AJR Am J Roentgenol 2018 May 23;210(5):1123-1130. Epub 2018 Mar 23.

1 Radiology Department, NYU Langone Medical Center, 301 E 17th St, 6th Fl, New York, NY 10003.

Objective: Injuries at the calcaneocuboid and talonavicular joint have been described as two distinct, unrelated entities in the radiology literature. Our purpose was to assess the coexistence of these injuries using radiography and MRI and to correlate our findings with radiologic and clinical diagnoses.

Materials And Methods: Twenty-one patients with injury at the anterior calcaneal process on radiographs or MR images were retrospectively assessed for concomitant injury at the talonavicular joint. Radiologic and clinical diagnoses and treatment were documented. McNemar and kappa statistics were calculated; p values < 0.05 were considered statistically significant.

Results: Radiographic and MRI rates of detection of injuries across the Chopart joint were statistically different. Calcaneocuboid avulsion fractures were evident on 48% of radiographs and 100% of MR images (p = 0.001). Talonavicular joint injuries were evident on 38% of radiographs and 76% of MR images (p = 0.008). Concomitant injury at both joints was evident on 14% of radiographs and 76% of MR images (p < 0.0001). Interrater agreement was 0.488-0.637 and 0.286-0.364 for talonavicular and 0.144-0.538 and 0.976-1 for calcaneocuboid injuries on radiography and MRI, respectively. Sixty percent of calcaneocuboid fractures were prospectively missed on radiography (none on MRI), whereas 38% and 25% of talonavicular findings were missed on radiography and MRI, respectively. Sixty percent of injuries were clinically misdiagnosed as ankle sprains. Chopart joint injury was never mentioned in prospective clinical or imaging diagnoses.

Conclusion: Calcaneocuboid and talonavicular injuries commonly coexist. Radiographs underestimate severity of injury; MR images show more subtle abnormalities. Lack of mention of Chopart joint injury clinically and on imaging reports underlies the need for greater familiarity with this entity.
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http://dx.doi.org/10.2214/AJR.17.18678DOI Listing
May 2018

JOURNAL CLUB: MRI Evaluation of Midtarsal (Chopart) Sprain in the Setting of Acute Ankle Injury.

AJR Am J Roentgenol 2018 Feb 7;210(2):386-395. Epub 2017 Nov 7.

1 Department of Radiology, Musculoskeletal Division, NYU Langone Medical Center, 301 E 17th St, 6th Fl, New York, NY 10003.

Objective: This study determined the frequency and MRI appearance of osseous and ligamentous injuries in midtarsal (Chopart) sprains and their association with ankle sprains after acute ankle injuries. Prospective diagnosis of and interobserver agreement regarding midtarsal injury among musculoskeletal radiologists were also assessed.

Subjects And Methods: Two cohorts with ankle MRI were identified via a digital PACS search: patients who had undergone MRI within 8 weeks after ankle injury and control subjects who had not sustained ankle trauma. Studies were retrospectively reviewed in consensus as well as independently, assessing ligamentous and osseous injury to the Chopart joint (calcaneocuboid and talonavicular joints) and associated lateral collateral and deltoid ligamentous injury. Interobserver agreement was calculated, and prospective radiology reports were reviewed to determine the musculoskeletal radiologist's familiarity with Chopart joint injury.

Results: MR images of control subjects (n = 16) and patients with ankle injury (n = 47) were reviewed. The normal dorsal calcaneocuboid and calcaneocuboid component of bifurcate ligaments were variably visualized; the remaining normal ligaments were always seen. Eleven patients (23%) had midtarsal ligamentous and osseous injury consistent with midtarsal sprain (eight acute or subacute, one probable, and two old). Six (75%) of eight acute or subacute cases had coexisting lateral collateral ligament injury. Eighty-nine percent of osseous injuries were reported prospectively, but 83% of ligamentous injuries were missed. Substantial interobserver agreement was achieved regarding diagnosis of midtarsal sprain.

Conclusion: Midtarsal sprains are commonly associated with acute ankle injury and with ankle sprains. Presently, midtarsal sprains may be underrecognized by radiologists; thus, greater familiarity with the MRI spectrum of ligamentous and osseous injuries at the Chopart joint is important for accurate diagnosis and clinical management.
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http://dx.doi.org/10.2214/AJR.17.18503DOI Listing
February 2018

Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI.

Knee Surg Sports Traumatol Arthrosc 2018 Sep 2;26(9):2826-2834. Epub 2017 Nov 2.

Department of Orthopedic Surgery, Sports Medicine Division, NYU Langone Orthopedic Hospital, New York, NY, USA.

Purpose: The purpose of the current study was to evaluate the short-term results of meniscal root repair surgery, assessing clinical and radiographic outcomes, utilizing MRI to assess root healing and extent of post-operative extrusion.

Methods: This was a single-center, retrospective study evaluating patients who had undergone a medial meniscus posterior root repair using a transtibial pullout technique with two locking cinch sutures. Demographic data were collected from patient charts. Clinical outcomes were assessed with pre- and post-operative IKDC and Lysholm scores. Pre-op scores were taken at the patients' initial clinical visit, mean 1.55 months prior to surgery (± 1.8 months, min 0.3, max 7.3). Radiographic outcomes were assessed with MRI evaluation of root healing, meniscal extrusion, and cartilage degeneration using ICRS criteria. Tunnel placement was evaluated and compared to the anatomic footprint.

Results: Eighteen patients (47.2 years ± 11.9) were evaluated at mean follow-up of 24.9 months (± 7.2, min 18.4, max 35.6). The IKDC score significantly increased from 45.9 (± 12.6) pre-operatively to 76.8 (± 14.7) post-operatively (p < 0.001). Lysholm scores also increased from 50.9 (± 7.11) to 87.1 (± 9.8) (p < 0.001). Mean tunnel placement was 5.3 mm (± 3.5, range 0-11.8) away from the anatomic footprint. Mean extrusion increased from 4.74 mm (± 1.7) pre-operatively to 5.98 (± 2.8) post-operatively (p < 0.02). No patients with > 3 mm of extrusion on pre-operative MRI had < 3 mm of extrusion on post-operative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades worsened significantly (p < 0.02 and p < 0.01, respectively). On MRI, one root appeared completely healed, 16 partially healed, and one not healed.

Conclusion: Patients treated with the transtibial suture pull-out technique with two locking cinch sutures had improved clinical outcomes, but only partial healing in the majority of cases, increased extrusion, and progression of medial compartment cartilage defect grade on follow-up MRI. Patients should be counseled that although clinical outcomes in the short term may be optimistic, long-term outcomes regarding progression to degenerative arthritis may not be as predictable.

Clinical Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-017-4755-8DOI Listing
September 2018