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Subchondral insufficiency fracture of the knee (SIFK) is a potentially devastating disorder that may progress rapidly to osteoarthritis with articular surface collapse. It should be suspected in the appropriate clinical setting, as in early stages it is usually indistinct on initial plain radiographs and magnetic resonance imaging is required for a definitive diagnosis. Outcome of SIFK depends on several factors, including the initial subchondral fracture size, patient BMI, degree of osteopenia, as well as early diagnosis and initial treatment. The purpose of this paper is to review the clinical presentation, pathophysiology, image findings, complications and outcome of SIFK., (© The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Purpose: To retrospectively compare the diagnostic performance of 1.5- and 3.0-T magnetic resonance (MR) imaging protocols for evaluating the articular cartilage of the knee joint in symptomatic patients., Materials and Methods: This HIPAA-compliant study was performed with a waiver of informed consent from the institutional review board. The study group consisted of 200 symptomatic patients undergoing MR examination of the knee at 1.5 T (61 men, 39 women; mean age, 38.9 years) or 3.0 T (52 men, 48 women; mean age, 39.1 years), who also underwent subsequent arthroscopic knee surgery. All MR examinations consisted of multiplanar fast spin-echo sequences with similar tissue contrast at 1.5 and 3.0 T. All articular surfaces were graded at arthroscopy by using the Noyes classification system. Three musculoskeletal radiologists retrospectively and independently graded all articular surfaces seen at MR imaging by using a similar classification system. The sensitivity, specificity, and accuracy of the 1.5- and 3.0-T MR protocols for detecting cartilage lesions were determined by using arthroscopy as the reference standard. The z test was used to compare sensitivity, specificity, and accuracy values at 1.5 and 3.0 T., Results: For all readers combined, the respective sensitivity, specificity, and accuracy of MR imaging for detecting cartilage lesions were 69.3%, 78.0%, and 74.5% at 1.5 T (n = 241) and 70.5%, 85.9%, and 80.1% at 3.0 T (n = 226). The MR imaging protocol had significantly higher specificity and accuracy (P < .05) but not higher sensitivity (P = .73) for detecting cartilage lesions at 3.0 T than at 1.5 T., Conclusion: A 3.0-T MR protocol has improved diagnostic performance for evaluating the articular cartilage of the knee joint in symptomatic patients when compared with a 1.5-T protocol., (RSNA, 2009)

Purpose: To determine if overhead-throwing athletes with internal impingement pain and internal rotation deficit have thickening of the posterior inferior labrocapsular complex on MR arthrogram images., Materials and Methods: This study was approved and a waiver of consent granted by our institutional review board. Twenty-six overhead-throwing athletes with internal impingement pain and internal rotation deficit, and 26 controls who had undergone MR arthrograms, were retrospectively examined. The MR studies were combined and read in a blind fashion. On an axial image through the posteroinferior glenoid rim, the readers measured the labral length, capsule-labrum length, and the posterior recess angle. A t-test was used to determine statistical significance., Results: The mean labral length was 4.9 mm [standard deviation (SD) 1.4 mm] for the controls, and 6.4 mm (SD 1.6 mm) for the athletes (P = 0.001). The mean capsule-labrum length was 5.4 mm (SD 2.1 mm) for the controls, and 8.8 mm (SD 2.9 mm) for the athletes (P < 0.001). The mean posterior recess angle measured 65 degrees (SD 27 degrees) for the controls and 94 degrees (SD 38 degrees) for the athletes (P = 0.002)., Conclusions: Overhead-throwing athletes with internal impingement pain and internal rotation deficit tend to have a thicker labrum and a shallower capsular recess in the posterior inferior shoulder joint than do non-overhead-throwing athletes. In many, the posteroinferior capsule is also thickened. These MR findings should alert the radiologist to closely inspect the posterior cuff and posterosuperior labrum for the tears associated with internal impingement.

Purpose: The purpose of this study was to evaluate the prevalence of articular cartilage lesions and meniscal tears on magnetic resonance imaging (MRI) scans in the knees of asymptomatic male professional basketball players., Type of Study: A retrospective review., Methods: Twenty players (40 knees) met the inclusion criteria of being signed by a National Basketball Association team and passing their preseason physical examination. All included athletes were assessed for the presence of articular cartilage lesions, meniscal pathology, and the presence of effusions., Results: The overall prevalence of articular cartilage lesions on MRI was 47.5% in our study group. There were trochlear groove articular lesions in 25%. The lateral femoral condyle was involved in 2.5% of all knees. The medial femoral condyle was affected in 10% of all knees. The lateral tibial plateau showed articular cartilage lesions in 5%. The patella had articular cartilage lesions in 35%. The overall prevalence of various grade meniscal lesions was 20% on MRI. Medial intra-meniscal signals accounted for 87.5% and 12.5% on the lateral side., Conclusions: The results of our study show an equal to or higher prevalence of meniscal lesions in male professional basketball players than previously reported in the literature. We found a large number of patella-femoral articular cartilage lesions in our study population of male professional basketball players. These athletes perform at the highest demand level, which indicates that the presence of these lesions did not cause any symptoms., Level of Evidence: Level IV, case series.

Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical entities treated by orthopedic surgeons with arthroscopic surgery. Preoperatively, magnetic resonance imaging (MRI) is now standard in confirming knee pathology, particularly detecting pathology less evident with history and physical examination alone. The radiologist's MRI interpretation becomes essential in evaluating intra-articular knee structures. Typically, the radiologist that interprets the MRI does not have the opportunity to view the same pathology arthroscopically. Thus, the purpose of this article is to illustratively reconcile what the orthopedic surgeon sees arthroscopically with what the radiologist sees on magnetic resonance imaging when viewing the same pathology. Correlating virtual and actual images can help better understand pathology, resulting in more accurate MRI interpretations. In this article, we present and review a series of MR and correlating arthroscopic images of ACL tears, meniscal tears, chondral lesions, and intra-articular masses and cysts. Short teaching points are included to highlight the importance of radiological signs and pathological MRI appearance with significant clinical and arthroscopic findings. [ABSTRACT FROM AUTHOR]

Management of isolated grade III medial collateral ligament injuries is controversial, as both nonoperative and operative management can result in return to play. However, operative management is recommended in elite athletes who have a grade III injury with distal avulsion. We present a standardized rehabilitation protocol in a case series of 7 National Collegiate Athletic Association Division I American football athletes who sustained grade III distal medial collateral ligament tears that were repaired operatively, with emphasis on return to play. Median time to surgery was 4 days (range = 2–67 days). Median time from surgery to noncontact drills was 120.5 days (range = 104–168 days), and median time from surgery to full-contact sport was 181 days (range = 139–204 days). All athletes returned to play at their preinjury level of competition. Our study highlighted how operative management with a standardized rehabilitation protocol can be applied to Division I football players and result in safe return to play. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a documented increase in the number of professional baseball players on the disabledlist and the total number of days on the disabled list. Pitchers account for the largest number of disabled list reports.Purpose: To examine the relationship between magnetic resonance imaging (MRI) findings in asymptomatic professional pitchersand subsequent time on the disabled list (DL).Study Design: Cohort study (Prognosis); Level of evidence, 2.Methods: A total of 21 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization underwentpreseason MRIs of their dominant shoulder from 2001 to 2010. Asymptomatic was defined as no related DL stays in the 2 seasonsbefore the MRI. These studies were reevaluated by a fellowship-trained musculoskeletal radiologist who was blinded topatient name, injury history, and baseball history. A second investigator who was blinded to the MRI results collected demographicdata, total career number of innings pitched, and any subsequent DL reports for each subject.Results: The mean age at the time ofMRI was 29.04 years (range, 20-39 years). Eleven of 21 pitchers had a rotator cuff tear (RCT): 9had an articular surface tear (AST), and 2 had a full-thickness rotator cuff tear (FTT). Ten had superior labral anterior posterior (SLAP)tears, and 13 had either anterior or posterior labral tears. There was a statistically significant relationship between the number ofinnings pitched and presence of an RCT (AST + FTT). The mean number of career innings pitched by those with an RCT was1014 compared with a mean of 729 innings pitched in pitchers without an RCT (P<.01). In addition, the number of career inningspitched was moderately correlated with presence of RCT (r = 0.46) and presence of superior and anterior/posterior labral tears(r = 0.43). There were no statistically significant findings between any single preseason MRI finding and subsequent time on the DL.Conclusion: The MRI findings in asymptomatic MLB pitchers do not appear to be related to near future placement on the DL.However, there was a significant difference in numbers of innings pitched between pitchers who had an RCT and those whodid not and a moderate correlation between innings pitched and the presence of RCT as well as the presence of labral lesions.This finding supports the notion that RCT and labral injury in pitchers may result from repetitive overhead motion with subsequentstrain on the rotator cuff tendons and glenoid labrum. Asymptomatic shoulder lesions in professional baseball pitchers appear tobe more frequent than previously thought. [ABSTRACT FROM AUTHOR]

Background: Shoulder injuries are the fourth most common musculoskeletal injury encountered in American football players. There is little information in the literature on the role of playing position in the type of shoulder injuries seen. Hypothesis: There is a high prevalence of shoulder injuries in elite collegiate American football players, with type of injury varying by playing position. Study Design: Cohort study (prevalence); Level of evidence, 3. Methods: A total of 336 elite collegiate American football players were invited to the National Football League Combine for physical testing and medical evaluation. Current and historical data were evaluated for the purpose of this study, and all players underwent radiographic examinations, including plain radiographs and/or magnetic resonance imaging when necessary. All shoulder pathological conditions and shoulder surgical procedures were recorded. Players were categorized by position for the analysis of position-specific trends. Results: Of the players, 50% had a history of shoulder injuries, with a total of 226 shoulder injuries (1.3 injuries per player injured); 56 players (34%) had a total of 73 surgeries. The most common injuries were acromioclavicular separation (41%), anterior instability (20%), rotator cuff injury (12%), clavicle fracture (4%), and posterior instability (4%). The most common surgeries performed were anterior instability reconstruction (48%), Mumford/Weaver-Dunn surgery (15%), posterior instability surgery (10%), and rotator cuff surgery (10%). Shoulder injuries were more common in quarterbacks and defensive backs. Surgery was more common in linebackers or linemen. A history of anterior instability was more common in defensive players, with surgery required 76% of the time. Linemen had more rotator cuff injuries and posterior instability than players in other positions. Conclusion: Shoulder injuries are common injuries in elite collegiate football players, with one-third undergoing surgical procedures. There are definitive trends in the types of injuries per player position. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the prevalence of articular cartilage lesions and meniscal tears on magnetic resonance imaging (MRI) scans in the knees of asymptomatic male professional basketball players. Type Of Study: A retrospective review. Methods: Twenty players (40 knees) met the inclusion criteria of being signed by a National Basketball Association team and passing their preseason physical examination. All included athletes were assessed for the presence of articular cartilage lesions, meniscal pathology, and the presence of effusions. Results: The overall prevalence of articular cartilage lesions on MRI was 47.5% in our study group. There were trochlear groove articular lesions in 25%. The lateral femoral condyle was involved in 2.5% of all knees. The medial femoral condyle was affected in 10% of all knees. The lateral tibial plateau showed articular cartilage lesions in 5%. The patella had articular cartilage lesions in 35%. The overall prevalence of various grade meniscal lesions was 20% on MRI. Medial intra-meniscal signals accounted for 87.5% and 12.5% on the lateral side. Conclusions: The results of our study show an equal to or higher prevalence of meniscal lesions in male professional basketball players than previously reported in the literature. We found a large number of patella-femoral articular cartilage lesions in our study population of male professional basketball players. These athletes perform at the highest demand level, which indicates that the presence of these lesions did not cause any symptoms. Level Of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]