Publications by authors named "Mary K Jesse"

14 Publications

  • Page 1 of 1

The Everted Acetabular Labrum: Patho-anatomy, Magnetic Resonance Imaging and Arthroscopic Findings of a Native Variant.

Arthroscopy 2021 May 4. Epub 2021 May 4.

University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, U.S.A.. Electronic address:

Purpose: The purpose of this study was to introduce a native labral variant, the everted acetabular labrum, and to describe the patho-anatomy, magnetic resonance imaging and magnetic resonance arthrogram (MRI/MRA) characteristics and the arthroscopic findings in this condition.

Methods: All primary hip arthroscopy procedures performed by the senior author between June 2013 and January 2020 were reviewed retrospectively. An everted acetabular labrum was identified as a segment of labrum that lacked apposition to the femoral head with the hip off traction. All everted labra were treated with labral advancement and repair with or without augmentation or reconstruction. The labrum-to-femoral head distance was measured in 3T MRI/MRA at the 1-2 o'clock position. A random selection of 38 hips without an everted labrum served as controls to compare radiographic parameters.

Results: A total of 68 hips were identified as having an everted labrum during the study period (mean age, 29.1 years), and 55 hips had advanced imaging available for review. MRI/MRA scans revealed the everted labrum to have a triangular shape in 17 hips (31%) and a blunted/round shape in 38 hips (69%), which differed significantly from controls (triangular 25/38 [66%], blunted 13/38 [34%], P < 0.001). The average labrum-to-femoral head distance was 1.4 mm for everted labra versus 0.0 mm for controls (P < 0.0001) and the mean labral lengths and widths were significantly shorter than those of controls (both P < 0.01). Of the hips, 8 underwent labral reconstruction or augmentation, and 61 underwent labral advancement/repair.

Conclusion: The everted acetabular labrum is a native variant that is identifiable during hip arthroscopy by assessing the labral seal off traction. Preoperative MRI/MRA findings can be highly predictive of an everted labrum. Surgical treatment includes labral advancement and repair or reconstruction to restore contact between the labrum and the femoral head.

Level Of Evidence: III, retrospective comparative study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2021.04.038DOI Listing
May 2021

Radiculopathy Following Vertebral Body Compression Fracture: The Role of Percutaneous Cement Augmentation.

Pain Physician 2020 06;23(3):315-324

University of Colorado, Aurora, Colorado.

Background: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure.

Objectives: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes.

Study Design: Retrospective cohort study.

Setting: Interventional pain practice in a tertiary care university hospital.

Methods: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient's relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.).

Results: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location.

Limitations: This retrospective study used an electronic chart review of clinicians' notes to determine the presence of radiculopathy and their relative improvement following the procedure.

Conclusions: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure.

Key Words: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2020

Plantar Flexion-Induced Entrapment of the Dorsalis Pedis Artery in a Teenaged Cross-Country Runner.

Ann Vasc Surg 2021 Jan 22;70:213-218. Epub 2020 Apr 22.

Department of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address:

Background: Symptomatic peripheral artery disease of the lower extremity rarely affects young adults and, when present, typically has a nonatherosclerotic etiology. Anatomical variants have manifested as symptomatic foot ischemia in four cases in the literature. We describe the case of a 17-year-old girl presenting with foot pain upon plantar flexion due to dynamic dorsalis pedis (DP) artery entrapment by fibrous bands and the extensor hallucis brevis (EHB) tendon.

Methods: The patient was a 17-year-old girl who presented with right foot pain upon plantar flexion, which resolved upon returning to the neutral position. The potential site of compression was identified on MRI where the DP artery ran deep to the EHB tendon near the first and second tarsometatarsal joints. On diagnostic arteriogram, there was notching of the dorsalis pedis over the talus bone. The dorsalis pedis Doppler signal was obliterated upon plantar flexion. A longitudinal incision was made over the artery in the area of compression. The flexor retinaculum was incised. Abnormal fibrous bands were identified, which were lysed anterior to the artery. The EHB tendon was released and transferred distally to the extensor hallucis longus tendon.

Results: A completion angiogram showed a persistently patent dorsalis pedis artery with plantar flexion. She was discharged one day postoperatively without issues. On follow-up, the patient was ambulatory with complete resolution of her pain. Arterial duplex demonstrated normal velocities through the dorsalis pedis in all positions.

Conclusions: Symptomatic peripheral artery disease is a rare presentation in young adults and is usually due to nonatherosclerotic pathophysiology. We present a rare case of dorsalis pedis artery entrapment syndrome. Given the mechanical nature of obstruction, surgical correction was an effective treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2020.03.045DOI Listing
January 2021

Transpedicular-Transdiscal Cement Augmentation Treatment of Thoracolumbar Fusion Proximal Junctional Failure.

Int J Spine Surg 2019 Oct 31;13(5):470-473. Epub 2019 Oct 31.

University of Colorado, Aurora, Colorado.

Background: Long instrumented fusions for adult deformity have a proximal junction kyphosis rate between 20% and 40%. When symptomatic, proximal junctional failure (PJF) often requires revision surgery and is associated with significant morbidity. Vertebral cement augmentation (VCA) has been used for prophylaxis against PJF but has not been previously described as treatment after onset of PJF has occurred. We describe a series of patients with PJF of long posterior spinal fusions that were treated at our institution using a novel VCA technique.

Methods: Three patients with PJF above thoracolumbopelvic fusions were retrospectively reviewed following treatment with transpedicular-transdiscal VCA. The medical record was reviewed for demographic data, outcomes scores, and radiographic images.

Results: Mean age was 69.3 years. Mean follow-up was 13.3 months. Mean preprocedure visual analog scale score was 8.67, and postprocedure visual analog scale score was 4.00. Mean preprocedure sagittal balance was 9.7 cm, and postprocedure sagittal balance was 5.8 cm. No patients required revision surgery for PJF in the follow-up period.

Conclusions: Transpedicular-transdiscal VCA treatment for PJF is safe and may have the potential to prevent the need for revision surgery.

Level Of Evidence: 4.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14444/6062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6833968PMC
October 2019

Distal Adductor Longus Avulsion: A Technique for Successful Repair.

Arthrosc Tech 2019 Jun 23;8(6):e617-e622. Epub 2019 May 23.

Department of Orthopedic Surgery and Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, U.S.A.

Strains of the adductor muscle are common among athletes, but avulsion at its insertion is rare. Likewise, the diagnosis and management of distal ruptures of the adductors are infrequently reported in the literature. Presented here are the common presenting clinical findings of chronic distal adductor longus tendon ruptures and a description of how these can be successfully treated with a previously undescribed surgical technique. Preoperative and postoperative magnetic resonance imaging can be compared for verification of successful surgical repair. Also reviewed are common sports and mechanisms that elicit this injury pattern, adductor longus muscle function, relevant surgical anatomy, and treatment strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eats.2019.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6624124PMC
June 2019

Increased Prevalence of Femoroacetabular Impingement in Patients With Proximal Hamstring Tendon Injuries.

Arthroscopy 2019 05 12;35(5):1396-1402. Epub 2019 Apr 12.

Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.. Electronic address:

Purpose: To determine the prevalence of clinically diagnosed femoroacetabular impingement (FAI) in a consecutive series of patients presenting with proximal hamstring tendon injury and to correlate this with pelvic anatomic factors.

Methods: The prevalence of clinically symptomatic cam-, pincer-, and mixed-type and overall FAI was calculated among a consecutive series of patients presenting to a hip preservation clinic with a confirmed clinical and radiographic diagnosis of proximal hamstring tendon injury between 2012 and 2017. The presence of a cam lesion was determined by an alpha angle > 50° on radiographs and computed tomography radial sequences of the head-neck junction and a femoral head-neck offset ratio < 0.18. Clinical diagnoses of osseous impingement were determined according to accepted pathomorphologic signs and measurements. A diagnosis of FAI was confirmed by imaging findings of acetabular overcoverage for pincer-type FAI and the presence of an anterior or lateral cam lesion for cam-type FAI.

Results: Overall, 120 hips in 97 patients (mean age, 45 years) were included in this study. A clinical diagnosis of FAI was noted in 70.8% of hips (pincer-type 9.2%, cam-type 40.8%, mixed-type 20.8%), an approximate 2- to 7-fold increased prevalence in comparison with the general population from prior studies.

Conclusions: The prevalence of FAI is high in patients with symptomatic proximal hamstring tendon pathology. Because FAI results in restriction of hip range of motion and altered pelvic tilt, future studies are warranted to investigate whether the presence of FAI acts as a predisposing factor for injury to the hamstring muscle complex.

Level Of Evidence: Level IV, case series.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2018.11.037DOI Listing
May 2019

Combined Lateral Osseolabral Coverage Is Normal in Hips With Acetabular Dysplasia.

Arthroscopy 2019 03 4;35(3):800-806. Epub 2019 Feb 4.

Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.

Purpose: To compare the lateral osseolabral coverage between groups of patients with different degrees of acetabular bony coverage using a magnetic resonance imaging parameter known as the combined lateral center-edge angle (cLCEA).

Methods: The cLCEA was measured among a consecutive series of patients presenting to a dedicated hip preservation surgeon with a magnetic resonance imaging scan. The cLCEA was measured using a coronal T1 or proton density image and was defined as the angle subtended by (1) a line through the center of the femoral head and orthogonal to the transverse line passing through the teardrops of both hips and (2) an oblique line drawn from the center of the femoral head to the free edge of the lateral acetabular labrum. The average difference between the lateral center-edge angle (LCEA) and the cLCEA was calculated and compared between groups based on acetabular bony coverage: dysplasia (LCEA <20°), borderline dysplasia (LCEA 20°-24.9°), normal coverage (LCEA 25°-39.9°), and overcoverage (LCEA ≥40°).

Results: In total, 341 patients (386 hips) were included. There were no significant differences in cLCEA between hips with normal acetabular coverage and dysplasia (P = .10) or borderline dysplasia (P = .46). Despite the large difference in mean LCEA between dysplasia (14.8° ± 3.9°) and acetabular overcoverage (43.1° ± 2.8°), the mean cLCEA values exhibited only a modest difference (44.7° ± 4.9° vs 52.7° ± 4.5°, respectively). Concordantly, hips with dysplasia exhibited the largest difference between mean LCEA and cLCEA (delta = 29.9° ± 4.7°) and hips with acetabular overcoverage had the smallest difference between measures (9.6° ± 5.2°).

Conclusions: With decreasing acetabular bony coverage, there is increasing labral size such that the total osseolabral coverage, measured by the combined LCEA, remains equivalent between hips with normal acetabular coverage versus dysplasia.

Level Of Evidence: Level III, retrospective comparative study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.arthro.2018.10.133DOI Listing
March 2019

Upsloping lateral sourcil: a radiographic finding of hip instability.

J Hip Preserv Surg 2018 Dec 1;5(4):435-442. Epub 2018 Dec 1.

Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA.

While radiographic findings of frank hip dysplasia are well defined, there is a lack of diagnostic criteria for patients with radiographically 'normal' hips who have borderline morphologic deficits and clinical instability. In this study, we aim to define and validate a new radiographic finding associated with hip instability known as the upsloping lateral sourcil (ULS). Patients (316) were reviewed for lateral center edge angles, generalized joint laxity assessed with the Beighton Hypermobility Score and the presence of the ULS. The ULS was defined as a caudal-to-cranial inclination of the middle-to-far lateral aspect of the acetabular sourcil with loss of the normal lateral acetabular concavity. The prevalence of the ULS correspondingly increased with the degree of under-coverage as defined by LCEA. Within the normal coverage group, hips with a ULS had smaller LCEAs than those without ULS (29° versus 32°,  < 0.001). Among hips with a ULS, 59.00% had generalized joint laxity. The association between the ULS finding and generalized joint laxity was statistically significant ( < 0.01). The ULS is seen with higher prevalence in patients with clinical hip laxity and radiographically decreasing LCEA and may serve as an adjunctive finding in patients presenting with hip pain and instability. The ULS may help to characterize patients with borderline hip dysplasia and laxity that fall outside conventional imaging criteria for dysplasia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jhps/hny042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328756PMC
December 2018

The Anteroposterior Pelvic Radiograph: Acetabular and Femoral Measurements and Relation to Hip Pathologies.

J Bone Joint Surg Am 2018 Jan;100(1):76-85

Departments of Orthopedics (K.L.W. and O.M.-D.) and Radiology (M.K.J.), University of Colorado School of Medicine, Aurora, Colorado.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2106/JBJS.17.00500DOI Listing
January 2018

Postoperative Imaging in the Setting of Hip Preservation Surgery.

Radiographics 2016 Oct;36(6):1746-1758

From the Department of Musculoskeletal Imaging and Intervention (M.K.M., C.D.S., M.K.J., P.A.L., J.A.F.) and Department of Sports Medicine (O.M.D.), University of Colorado School of Medicine, Aurora, Colo.

Osteoarthritis of the hip remains a prevalent disease condition that influences ever-changing treatment options. Procedures performed to correct anatomic variations, and, in turn, prevent or slow the progression of osteoarthritis, are aptly referred to as types of hip preservation surgery (HPS). Conditions that predispose individuals to femoroacetabular impingement (FAI), including pincer- and cam-type morphology, and hip dysplasia are specifically targeted in HPS. Common surgical interventions include acetabuloplasty, osteochondroplasty, periacetabular osteotomy (PAO), and derotational femoral osteotomy (DFO). The radiologist's understanding of the surgical approach, pre- and postoperative imaging findings, and common complications of HPS are paramount to providing value to the patient and surgeon. Acetabuloplasty and osteochondroplasty are performed to address pincer- and cam-type morphology in patients with FAI. With both of these HPS techniques, the goal is to restore the normal morphology by resecting excess bone in the acetabulum or femoral head or neck. As a result, a frequently encountered complication is incomplete or excessive resection. Excessive resection can predispose the patient to dislocation in the case of acetabuloplasty and fracture in the case of osteochondroplasty. Iatrogenic injury to adjacent structures such as the ischiofemoral ligament and acetabular cartilage also may occur. Although rare, especially when an arthroscopic approach is used, avascular necrosis remains a risk. Femoral head undercoverage in hip dysplasia is corrected by using PAO, which may be performed as the sole procedure or in conjunction with DFO. Incomplete or excessive rotation during surgery can result in postprocedural complications. As with any orthopedic procedure involving osteotomy, nonhealing is a risk. Iatrogenic injury in the form of fracture or hardware failure also may be seen. RSNA, 2016.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1148/rg.2016160021DOI Listing
October 2016

Introduction of a virtual workstation into radiology medical student education.

AJR Am J Roentgenol 2015 Mar;204(3):W289-92

1 All authors: Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO 80045.

OBJECTIVE. This article describes the creation of a virtual workstation for use by medical students and implementation of that workstation in the reading room. CONCLUSION. A radiology virtual workstation for medical students was created using OsiriX imaging software to authentically simulate the experience of interacting with cases selected to cover important musculoskeletal imaging diagnoses. A workstation that allows the manipulation and interpretation of complete anonymized DICOM images may enhance the educational experience of medical students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.14.13180DOI Listing
March 2015

Discography with epidural contrast extravasation along an exiting nerve root.

Spine J 2015 Apr 25;15(4):782. Epub 2014 Nov 25.

Department of Orthopedic Surgery, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO 80045, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.spinee.2014.10.030DOI Listing
April 2015

Magnetic resonance imaging of cystic adnexal lesions during pregnancy.

Curr Probl Diagn Radiol 2008 Jul-Aug;37(4):139-44

Department of Radiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA.

Management of cystic adnexal lesions diagnosed during pregnancy is a challenging issue for obstetricians. The range of treatment options changes from immediate surgery to close follow-up. This pictorial essay illustrates the magnetic resonance imaging findings of various cystic adnexal lesions in pregnant patients. Magnetic resonance imaging may help in better characterization of some of the cystic adnexal lesions diagnosed during pregnancy without exposing the fetus to ionizing radiation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1067/j.cpradiol.2007.08.002DOI Listing
August 2008

Magnetic resonance imaging of the chest, abdomen, and pelvis in the evaluation of pregnant patients with neoplasms.

Am J Perinatol 2007 Apr;24(4):243-50

Department of Radiology, The University of Texas Medical Branch, Galveston, Texas 77555-0709, USA.

This article illustrates the magnetic resonance (MR) technique and MR imaging (MRI) findings of various neoplasms in chest, abdomen, and pelvis in pregnant patients. MRI can provide useful information about characterization and staging of maternal neoplasms without exposing the fetus to ionizing radiation and can be considered as a first-line cross sectional imaging method as an adjunct to ultrasonography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-2007-973444DOI Listing
April 2007