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OBJECTIVE: The current trends in anterior cruciate ligament (ACL) reconstruction aim not only to restore the position and footprint of the native ACL, but also its shape and biomechanical function. The objective of our study was to determine whether the in vivo shape of the healed graft differs from the native ACL. PATIENTS AND METHODS: We performed bilateral MRI examinations on patients with successful unilateral ACL reconstruction for an average period of 3 years. The imaging acquisitions were performed using 1.5T field strength and T2 FSE axial oblique sequence at 2 mm spacing.We than averaged the ratio between the maximum width and thickness as well as the surface area in pixels using ImageJ (National Institutes for Health) and compared it with the native ACLs using the paired t-test. RESULTS: For both quadrupled hamstrings and B-PT-B neoligaments, the mid-portion area was significantly higher (p < 0.001) than the native contralateral ACL: 41.82/31.39 mm2 and 37.05/32.08 mm2, respectively. The surface area of the neoligaments mid-portion was on average 33.23% higher than the native ACL for the quadrupled hamstrings and 15.49% for the B-PTB, respectively. The native contralateral ACL was also significantly thinner throughout the mid-portion (p < 0.001) than both B-PT-B and quadrupled hamstrings neoligaments, with a widththickness ratio of 2.57 vs 1.97 and 2.57 vs 1.39, respectively. CONCLUSIONS: Our study showed that, several years after successful anatomic single bundle ACL reconstruction using an ipsilateral autograft, the mid-portion shape and cross-sectional area are not restored compared to the uninjured contralateral knee. This effect was more prevalent with hamstrings and less prominent when B-PT-B were used. [ABSTRACT FROM AUTHOR]

Introduction: There is a growing body of literature separately linking lumbar spinal stenosis (LSS) with various factors such as paravertebral muscle (PVM) impaired function/morphology, lordosis or BMI. However, their interplay is yet to be known. The present study aims to investigate the relationship between PVM morphology, BMI and lumbar lordosis in a population with a surgical indication for LSS., Materials and Methods: A cross-sectional retrospective study was conducted on a group of 122 patients diagnosed with LSS in a hospital setting and scheduled for spine surgery. Epidemiological data and body mass index (BMI) were gathered. The cross-sectional area of the psoas muscle (rCSA) at the L4-L5 disc level on preoperative axial T2 MRI was measured. Fat infiltration of the anterior (APVM) and posterior paravertebral muscles (PPVM) was evaluated according to Goutallier classification while the severity of lumbar stenosis was staged according to Schizas criteria. Lumbar lordosis was measured on sagittal MRI using Cobb's angle method. The presence of the "rising psoas" sign was also noted. Statistical analysis of the data was performed using Pearson and Spearman correlations., Results: Statistical analysis revealed a moderate correlation between the severity of LSS and BMI (p = 0.001), and fatty infiltration of paravertebral muscles (p = 0.000, p = 0.000). Adjusting for age, gender, and BMI resulted in a low correlation (p = 0.003, p = 0.045), rCSA correlated negatively with age, gender, and lordosis. BMI had a low positive correlation with lumbar lordosis (p = 0.006), severity (p = 0.001), number of levels (p = 0.005) and PPVM (p = 0.031)., Conclusions: This study highlighted the relationship between PVM morphology and the severity of radiological signs in patients with LSS undergoing spine surgery and found a correlation independent of age, gender, and BMI. BMI was also shown to correlate with the severity after controlling for age and gender. rCSA has limited use in evaluating the severity of LSS., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Chest computed tomography (CT) has played a valuable, distinct role in the screening, diagnosis, and follow-up of COVID-19 patients. The quantification of COVID-19 pneumonia on CT has proven to be an important predictor of the treatment course and outcome of the patient although it remains heavily reliant on the radiologist's subjective perceptions. Here, we show that with the adoption of CT for COVID-19 management, a new type of psychophysical bias has emerged in radiology. A preliminary survey of 40 radiologists and a retrospective analysis of CT data from 109 patients from two hospitals revealed that radiologists overestimated the percentage of lung involvement by 10.23 ± 4.65% and 15.8 ± 6.6%, respectively. In the subsequent randomised controlled trial, artificial intelligence (AI) decision support reduced the absolute overestimation error (P < 0.001) from 9.5% ± 6.6 (No-AI analysis arm, n = 38) to 1.0% ± 5.2 (AI analysis arm, n = 38). These results indicate a human perception bias in radiology that has clinically meaningful effects on the quantitative analysis of COVID-19 on CT. The objectivity of AI was shown to be a valuable complement in mitigating the radiologist's subjectivity, reducing the overestimation tenfold.Trial registration: https://Clinicaltrial.gov . Identifier: NCT05282056, Date of registration: 01/02/2022., (© 2023. The Author(s).)

Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19., Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: "lung ultrasound", "sonography", "newborn", "neonate", and "COVID-19'., Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper., Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.

Purpose: Long time recognized as a cause of lumbar stenosis, degenerative spondylolisthesis has an evolution in interrelation with sagittal balance. This study aimed to assess the role of ALIF in correcting the sagittal balance in patients with degenerative spondylolisthesis., Material and Methods: Twenty patients aged between 47 and 70 years were operated between July 2011 and September 2014 for degenerative spondylolisthesis by ALIF. The pre-operative and post-operative valid standing full spine radiographs were reviewed retrospectively. Clinical and radiological evaluations were conducted pre-operatively and postoperatively at one year and five years., Results: Lumbar lordosis (LL) was measured to 41.16 ± 14.25° pre-operatively and 47.27 ± 11.25° post-operatively (p > 0.05). At one year was 49.76 ± 13.31° and at five years 46.93 ± 9.26° (p > 0.05). Mean gain of lordosis after ALIF at index level was calculated to 8 ± 1.6° [4-12°]., Conclusions: ALIF offers a good reduction of the slipped vertebra providing good conditions for fusion and is an efficient surgical technique to recreate the sagittal spine balance.

Introduction: Idiopathic pulmonary fibrosis (IPF) is the most common and severe form of idiopathic interstitial pneumonia, accounted for 20% of cases of interstitial lung disease (ILD). In this study, we sought to compare the lung changes of IPF using a lung ultrasound (LUS) protocol of 12 zones with "current standard" high resolution computed tomography (HRCT) diagnostic method and overlap it with the functional pulmonary test as a complete clinical and imaging evaluation., Methods: Thirty-one patients were included in the study and performed HRCT and pulmonary functional tests (PFT). A 12-lung zones' LUS protocol was used and compared with HRCT and PFT., Results: The HRCT total fibrotic score had a correlation coefficient of 0.454 (P < 0.005) with predicted FVC and 0.713 with predicted DLCO (P < 0.001). Both the median of the number of B-lines and the average of the thickness of the pleural line obtained in the LUS assessment had a positively and statistically significant correlation with the HRCT fibrotic score P < 0.001. The pleural thickness of 2.4 mm is the cut-off value of the mild form of fibrosis with a sensitivity of 0.958 and a specificity of 0.994., Conclusion: B-lines and the average thickness of the pleural line as LUS markers of the fibrotic interstitial syndrome are highly and positively correlated with HRCT score, FVC and DLCO. LUS as a complementary method in the clinical management of IPF could be used more often by skilled clinicians to assess patients in terms of possible diagnosis and monitoring of IPF., (© 2019 John Wiley & Sons Ltd.)

Background: Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm., Method: We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult., Results: The majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %)., Conclusion: Occult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.

Introduction: Unstable pelvic ring disruptions have been associated with high rates of morbidity. Accurate reduction with fixation diminishes pain, permits early patient mobility, and allows the pelvic ring to improve functional outcome., Material and Methods: This was a retrospective study, whereby 30 polytrauma hospitalized patients were included, with unstable pelvic lesions stabilized with an external fixator as a mean of temporary or definitive fixation. Data collected for these sample were: age, sex, cause of trauma, type of pelvic lesion, associated lesions (ISS score), pelvic stabilization methods, and functional outcome. There were 17 male subjects (57%) and 13 female subjects (43%), with a mean age of 42.5 years (range 18-62 years). According to Tile classification, the unstable pelvic ring lesions prevailed; 60 % of patients were type C while three patients with type C instability had associated acetabular fractures, and 40% had type B rotational instability. Stabilization was achieved using an external fixator in 16 patients; in 14 patients the anterior ring fixation was used with an external fixator combined with posterior stabilization using percutaneous sacroiliac screws. The pelvic stabilization using the external fixator was later replaced with plates and screws (ORIF) in four patients. Follow-up at one, three, six and 12 months postoperatively was based on the Majeed functional score and radiographic assessment., Results: Eighteen patients (78%) had an excellent Majeed functional score, four patients had a good score, and only one patient had a fair functional outcome. Malunions were recorded in four patients with Tile C that were stabilized only by external fixation, and superficial pin track infection occurred in three patients. Within the studied group seven deaths have been recorded (23%) in patients with extremely severe associated injuries (ISS over 50), this being the decisive factor that determined the unfavourable evolution in six patients., Conclusions: The external fixation stabilizes the anterior pelvic ring lesions and it can be combined with the posterior stabilization using percutaneous sacro-iliac screws in case of associated lesions of the posterior ring. The external fixator is very useful especially in the acute phase, acquiring an acceptable reduction and an adequate stability in the partially unstable lesions (Tile B) and also reduces the pelvic volume and bleeding, being considered essential within the resuscitation protocols. The external fixator can be used as a permanent stabilization method when it guarantees a satisfying reduction.