7 The posterior impingement view: an alternative conventional projection to detect bony posterior ankle impingement. Treatment of a large intraosseous talar ganglion by means of hindfoot endoscopy, Hindfoot endoscopy for posterior ankle impingement, Osteophytes, loose bodies, posttraumatic problems, and foreign bodies, The relationship of the kicking action in soccer and anterior ankle impingement syndrome. The mean time to return to sport was 6.7 weeks, and no major complications were reported (Table 6). 8. In cases of ankle trauma, to diagnose a Stieda process or an OT acute fracture, a CT scan can be helpful to look for multiple fragments and hidden posterior pathology. In acute trauma, the differential diagnosis includes the Shepherd fracture, the OT fracture, and synchondrosis disruption. From 2011 to 2018, a retrospective review of 81 recreational athletes of mean age 27.8 years was performed. Masciocchi C, Catalucci A, Barile A. Ankle impingement syndromes. MR imaging delineated the anatomical site of the abnormality and demonstrated coexisting pathology in all patients and is the technique of choice for investigating the os trigonum syndrome. Routine anteroposterior (AP) ankle view typically do not reveal abnormalities related to posterior impingement. A 21-year-old male ballet dancer, whose pain decreased significantly postoperatively but the ROM had a limitation of 5 degrees in plantarflexion and less than 5 degrees in dorsiflexion. The posterior intermalleolar ligament may protrude further into the joint during plantar flexion, becoming entrapped and torn. CT scanning is the imaging method of choice in cases when posterior talus structure fractures, including an OT fracture, are suspected ( Figure 1B ). 2), and the flexor hallucis longus tendon [6]. Clinical, MR imaging, and MR arthrography features of ankle impingement syndromes are described and ruled out other potential causes of chronic ankle pain. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion [5]. 14). . (A) Preoperative ankle radiograph (lateral view) showing the os trigonum (OT) in the posterior talus area, as indicated by an arrow. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemars test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved. Appl Radiol. That limitation began after the first postoperative month and took a turn for the worse by the third month. MRI has the added advantage of showing injuries of the articular surfaces, ligaments, and tendons; other entities in the differential diagnosis; and to assist in deciding the most likely cause of the patients symptoms. government site. Pathologies that cause inflammatory changes in the posterior ankle can also cause posterior ankle pain and may mimic impingement syndromes. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Additional Case Discussion official website and that any information you provide is encrypted Institutional review board approval and written consent from all patients were obtained. image also revealed patchy, altered marrow signal, which appeared As a ligament injury was suspected to be the cause of the patients differentiated from a fractured lateral-talar tubercle on a radiograph. Barton fractures are fractures of the distal radius.It is also sometimes termed the dorsal type Barton fracture to distinguish it from the volar type or reverse Barton fracture.. Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect. the ankle: Normal anatomy and MR imaging features. The OT is an inconsistently present accessory bone of the foot situated at the posterolateral aspect of the talus. Dimitrios Nikolopoulos, MD, PhD, Department of Orthopedics and Traumatology, Central Clinic of Athens, Asklepiou 31 St, Athens 10680, Greece. Ken has over 25 years of experience in Nuclear Project Engineering. If conservative The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Before M. Painful stress reaction in the posterior subtalar joint after resection of os trigonum or posterior talar process. significant acute injury (for example, fracture, fragmentation, and/or Posterior tibial tendon dysfunction may present with a similar malalignment. Learn more Posterior ankle impingement is a clinical diagnosis which may complicate an acute traumatic hyper-plantar flexion event or may relate to repetitive low-grade trauma associated with hyper-plantar flexion, e.g., in female dancers (en pointe or the demi-pointe), downhill running, football players, javelin throwers and gymnasts [1], [2], [3]. With an intact functioning posterior tibial tendon, the hindfoot valgus corrects. Patients of repeated forced plantar flexion of the foot and chronic injury to MRI features supportive of impingement may be present in asymptomatic individuals and therefore accurate diagnosis requires careful clinical correlation. Ankle ROM was significantly improved from an average of 24.8 (10-35) preoperatively to 58.0 (50-65) at 3 months postoperatively and to 64.0 (50-65) at 1 year and 64.7 (60-65) at 2 years postoperatively. Bilateral os trigonum syndrome associated with bilateral tenosynovitis of the flexor hallucis longus muscle, Techniques Developed by the Amsterdam Foot and Ankle School, Hindfoot endoscopy for posterior ankle impingement. Local anesthetic injection can also help confirm the diagnosis and can combined with a corticosteroid for treatment purposes. on plantar flexion, and sometimes on weight bearing,along with swelling The rest of the carpal bones are in a normal anatomic position in relation to the radius. posterior osseous and soft tissues.5,6. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermallolar ligament (Fig. os trigonum on fat-suppressed, T2-weighted images (Figure 1). 39 With a proven track record in the advanced and compact 3D imaging device domain, Curvebeam designs and manufactures Cone Beam CT imaging equipment for the orthopedic and podiatric specialties. Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Conservative treatment ranging from 6 weeks to 3 months was required of all our patients (rest, cessation of activity, technique modification, nonsteroidal anti-inflammatory agents, ice, physical therapy, injections, and immobilization). Hayashi D, Roemer FW, DHooghe P, Guermazi A. Posterior ankle impingement in athletes: pathogenesis, imaging features and differential diagnoses, Os trigonum excision in dancers via an open posteromedial approach, Endoscopic flexor hallucis longus decompression: a cadaver study, Fracture of the os trigonum: a case report, Symptomatic radiographic variants in extremities. In athletes presenting with posterior ankle impingement symptoms, radiologists should pay specific attention to the presence of os trigonum, Stieda process (posteriolateral talar process) (Fig. The site is secure. It attaches to inferolateral talar neck and dorsal neck of the calcaneus. Posterior ankle endoscopy for the resection of a posterior process of the talus or an os trigonum and decompression of the tendon of FHL is safe and allows excellent outcomes with low morbidity in athletes with PAIS. inflammatory changes in the adjacent soft tissues can also be seen on 28 A biomechanical analysis. (C) Preoperative ankle magnetic resonance imaging (MRI) showing the OT pathology of the patient. Afterwards, ankle radiographs (anteroposterior and lateral) (Figure 1A), CT (Figure 1B), and magnetic resonance imaging (MRI) scan (Figure 1C) were performed in all cases. FOIA This posterolateral part is often superimposed on the medial talar tubercle on the lateral projection and thus. Although a learning curve effect was detected in our series of arthroscopic treatment for the PAIS due to os trigonum, a low volume of experience did not affect the results. Ill-defined 12 Would you like email updates of new search results? Seventy-six patients were active at the same level as that prior to PAIS, whereas 5 dropped to a lower activity level. Pathoanatomy of posterior ankle impingement in ballet dancers. The posterior talar process could best be palpated posterolateral, between the peroneal tendons and the Achilles tendon. The 2-year reduction in quadriceps ACSA in limbs with early RKOA was0.96% (meanstandard deviation) vs0.56% in limbs without RKOA (statistical difference P=0.85). HHS Vulnerability Disclosure, Help With one hand the examiner holds the patients heel and stabilizes it and with the other grasps the mid and forefoot over the dorsum of the foot. The present study evaluated the endoscopic treatment of PAIS due to OT pathology in athletes and showed good to excellent results. The incidence of pneumothorax and its effect on management is unknown. Treatment can be either operative or non-operative and is dependent on the type of fracture (as determined by the x-ray). and transmitted securely. Endoscopic treatment of PAIS due to OT pathology demonstrated excellent results. subtalar joints.3, Variations in normal osseous and MR The posteromedial border of the talar dome-body and. be clearly depicted on MR imaging. 10,17,31,39 The management of posterior ankle impingement syndrome in sport: a review, Operative treatment of posterior ankle impingement syndrome and flexor hallucis longus tendinopathy in dancers open versus endoscopic approach. and stiffness of the posterior ankle. Posterior-ankle impingement syndrome due to os trigonum syndrome. Keeping up with those changes to maintain accreditation standards, Key Points: Up to 20% of subtle Lisfranc injuries are missed on initial plain films., Medical imaging companies CurveBeam, LLC and StraxCorp, Ltd., announced today. The end result, regardless of cause, is a rounded fibrous mass sitting in the anterior intercondylar notch. 26,33,45 SRS respondents reported a PTX risk of 0.8% (87/11,318), and 32.2% (89/276) of respondents indicated routine use of postoperative chest radiographs. Of those, 46.1% (41/89) specified willingness to change practice patterns if provided evidence of low PTX rates. 29 Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. Posterior Intermalleolar ligament (IML) IML is as a distinct separate ligament traversing between the posterior talofibular ligament (PTFL) and the ITL. 2020 Mar 27;2020:6236302. doi: 10.1155/2020/6236302. There are multiple causes of posterior ankle impingement. and in 2008 Scholten et al (B) The posteromedial portal is the second portal be made at the same level as posterolateral. Fifteen percent of patients reported postoperative neuritis (Table 6). anterior talofibular ligament appeared swollen and hyperintense, scanner. All patients completed a conservative therapy period of a minimum of 3 months, which included rest, anti-inflammatory medication, controlled ankle motion boot, and physical therapy. At the time of follow-up, patients in the overuse group were more satisfied than those in the post-traumatic group, and the AOFAS hindfoot scores were higher in patients in the overuse group (median, 100 points) compared with patients in the posttraumatic group (median, 90 points). Lastly, in all of our cases, we analyzed detailed results of clinical and functional scores (VAS, AFAS, FADI scores, ankle ROM, return to sport); whereas in many of the previous studies, there were no outcome measures of higher level functioning which quantitatively demonstrated restoration of motion, with the exception of Carreira et al. The athletes in our study returned to preinjury level of athletic performance on an average of 9.1 1.3 weeks (range 7-12). Necessary cookies are absolutely essential for the website to function properly. Through exercise, the joint mobility and range of motion may gradually increase, progressively reducing the distance between the calcaneus and the posterior portion of the distal tibia [4]. Physical examination reveals posterolateral tenderness on palpation, typically between the Achilles and peroneal tendons. with the foot in plantar flexion may show the os trigonum or lateral Pathologically, the lesion consists of central granulation tissue lined by synovium and surrounded by dense fibrous tissue. Patients with PTX had, on average, an increased number of vertebrae fused (p = .012), a proximal thoracic scoliosis curve location (p = .009), and/or an intraoperative blood transfusion (p = .002). The cookie is used to store the user consent for the cookies in the category "Performance". Posterior impingement test was negative. Impingement of the graft in knee extension is also postulated 4. posterior talus (40%) and the posterior calcaneum (24%); diffuse for further evaluation of the bony and soft tissue structures. This helps improve normal joint mechanics, range of motion and flexibility with dorsiflexion. The complex of the medial collateral ligaments of the ankle joint is collectively called deltoid ligament.It attaches the medial malleolus to multiple tarsal bones. Radiology report. A normal accessory ossification center arises from the talus at the posterior ankle during normal development, ossifying around age 5 years and typically fusing with the talar body by age 20. The 5 athletes (3 ballet dancers, 1 dancer, and 1 soccer player) that dropped to a lower activity level consisted of cases with multiple previous ankle sprains and OT fracture or pathology. These findings provide new information regarding common post-ACLR biomechanical patterns and PFOA. Per 7 lesion types, the overall kappa and percentage of agreement, between the 2 radiologists, were dramatically increased in comparison with our former study (k=0.81 versus k=0.48 and 90.7% versus 78.2%, respectively). (Table 6). The diagnosis of. local synovitis involving the posterior recess of the tibiotalar and Lpez Valerio et al also presented in 2015, 20 soccer players with significant improvement of pain after the endoscopy; whereas the mean time to return to previous level of sports was 46.9 days, reaching the same pre-lesion Tegner level. Disclosure The authors have nothing to disclose regarding conflict of interest or commercial relationship related to the content of this work. By clicking Accept All, you consent to the use of ALL the cookies. The aim of the present study was to evaluate effectiveness of posterior ankle arthroscopy and to assess the outcome in the treatment of PAIS secondary to OT impingement or OT fractures within a group of young athletes and their return to previous sports level. Now we are transforming bone health. We use cookies to help provide and enhance our service and tailor content and ads. To compare cross-sectional and longitudinal side-differences in thigh muscle anatomical cross-sectional areas (ACSAs), muscle strength, and specific strength (strength/ACSA), between knees with early radiographic change vs knees without radiographic knee osteoarthritis (RKOA), in the same person. Level IV, therapeutic study / retrospective case series. After the sixth postoperative month, the patient underwent removal of the scar tissue via anterior and posterior arthroscopy. 1634-1638, Osteoarthritis and Cartilage, Volume 24, Issue 9, 2016, pp. foot that causes repeated compression and entrapment of soft tissues, Surgical intervention in posterior ankle arthroscopy is now the procedure of choice for surgical management of posterior impingement, resulting in significant improvements in foot and ankle patient-reported outcome scores, an earlier return to sport, and a lower rate of complications. 2, Comparing the aforementioned studies with ours, it is important to mention that we had the advantage of analyzing in detail the results of a great number of athletes (81 patients) with PAIS due to bony impingement pathology from acute or chronic OT fractures and OT syndrome (homogeneity in the group). Also, the ankle ROM was statistically significantly improved from 24.8 (10-35) preoperation to 58.0 degrees (50-65) at 3 months postoperation and to 64.0 (50-65) at 1 year postoperation and 64.7 (60-65) at 2 years postoperation (P < .001) (Table 3). This website uses cookies to improve your experience while you navigate through the website. Disclaimer, National Library of Medicine The os trigonum was lifted from the subtalar joint by means of a small-sized bone elevator and removed finally with a grasper. The times to resumption of training were shorter in elite athletes than local competitive athletes. There was a significant difference in the MRI findings in the patient population when compared to the control group. Baillie P, Cook J, Ferrar K, Smith P, Lam J, Mayes S. Skeletal Radiol. (D) Large OT removal with arthroscopic grasp. MRI is superior in detecting fusion of the os trigonum with the talus, the medullary signal of ossicle, and PAIS findings, which is the most important factor in the development of PAIS. The average time taken to resume training was 5.3 weeks, and the time to return to a competitive condition was 13.4 weeks. These are unusual causes of posterior ankle impingement. Failure of fusion results in an ossicle called an os trigonum (Fig. The superficial layer has variable attachments and crosses two joints while the deep layer has talar attachments and crosses one joint: Furthermore, with regard to operative complications, there were 4 transient complications: 1 woman with 2 months of drainage at the medial portal due to fat pad atrophy and skin healing issues after 2 local injections of cortisone the last 4 months before operation and 3 additional transient sural nerve neurapraxia. pathological entities that result from repetitive plantar flexion of the The posteromedial gutter is a recess defined anteriorly by the posterior border of the medial malleolus and the posterior tibiotalar ligament. Federal government websites often end in .gov or .mil. accompanying bone contusion may be present, involving the lateral tubercle of the posterior talar process; localized fluid and/or edema in the posterior joint recesses; MRI signal characteristics. The site is secure. There was substantial interobserver variability. Term is also used in radiology. In 2009 van Dijk et al, Ankle overuse or acute trauma can lead to a fracture of the Stieda process (posterior process fracture of the talus), However, a repetitive compression and posterior- capsular thickening; fluid around An experience of 26 cases was required to be proficient in posterior arthroscopies. 10). The average preoperative AOFAS score improved significantly from 79.6 to 97.6 postoperatively (P < .0001). is there displacement? J Am Acad Orthop Surg. OT syndrome is the result of an overuse injury of the posterior ankle caused by repetitive plantarflexion stress. This cookie is set by GDPR Cookie Consent plugin. Swimming practice must be with precautions to avoid PAIS injury and routine extensor tendon stretching before swimming and protective ankle dorsiflexion taping are recommended to prevent posterior ankle impingement syndrome. The median time to return to work and sports activities were 2 and 8 weeks, respectively. usual resolution of symptoms after modification of activity or rest imaging demonstrates bone marrow edema within the os trigonum and at Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Contraindication would be simultaneous posterior tarsal tunnel nerve entrapment, which would also require a medial incision. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion, and can be due to osseous or soft tissue lesions. imaging has a marked effect on clinical care by enabling the (F) Detaching OT from the posterior talus area. Before The outcome measures included the pain visual analog scale (VAS), the ankle range of motion (ROM) using a goniometer (and compared to the contralateral extremity), the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, and the Foot & Ankle Disability Index (FADI) score. This variant of normal ankle anatomy, also referred to as a marsupial meniscus, spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments, from the malleolar fossa of the fibula to the posterior tibial cortex. These cookies will be stored in your browser only with your consent. The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses. The complications, reported in Table 6, were, however, nonserious. (13) The configuration of the IML is variable, ranging from a thin set of fibers to a thick compact band. The scores were measured in the clinic by 2 orthopedic surgeons for better reliability (the same in each scheduled evaluation): 1 interobserver (the orthopedic surgeon who performed the operation) and 1 extra observer (orthopedic surgeon of the Orthopaedic Research Institute for Education and Training). Summary: A 58-year-old man presented with a 6-month Summary: Rest-stress perfusion and viability cardiac Summary A 16-year-old woman presented with progressive dyspnea Summary: Over 79% of respondents reported they would Posterior ankle impingement syndrome due to os trigonum. In many of the previous published studies, there were some limitations. Pain in the posterior aspect of To help differentiate deltoid ligament deficiency from posterior tibial dysfunction as the cause of malalignment, the patient is asked to toe-rise. To report mid-term clinical results of posterior ankle arthroscopy in the treatment of posterior ankle impingement syndrome (PAIS) and to assess the learning curve and its influence on the results. The os trigonum syndrome: Imaging features. Journal of dance medicine & science : official publication of the International Association for Dance Medicine & Science. All patients were placed in a well-padded splint or soft tissue dressing and controlled ankle motion walking orthotic boot with the ankle maintained in neutral position. 27,36, Open and arthroscopic techniques have been used as effective methods in the treatment of PAIS and hindfoot. Objective To evaluate the prevalence of the posterior crescent sign in symptomatic patients referred for MRI/MR arthrogram of the hip and identify any correlation with imaging features of joint pathology. 24 13 The procedure was performed under general or regional anesthesia, epidural block. Posterior Ankle Impingement Test or Hyperplantar Flexion Test is done with the patient sits on the edge of the examination table with the legs hanging down loosely and the knees flexed 90. Jaydev Dave, PhD, Associate Professor of Radiology at Thomas, MarketScale's Made in America series explores industries that are thriving in the USA. When done correctly, you should notice immediate results with more pain free ankle range of motion. The median AOFAS hindfoot score increased from 75 points preoperatively to 90 points at the time of final follow-up. The os trigonum syndrome, a cause of posterior ankle impingement, refers to symptoms secondary to pathology of the lateral tubercle of the posterior talar process. The etiology of PAIS may involve bony structures or soft tissue structures, or, more often, the combination of both. There were 29 male and 30 female patients. motion of the hallux may be reduced as a result of fibrosis of the Nisha I. Sainani, MD, Malini A. Lawande, MD, DNB, Abhijeet Pawar, MD, Deepak P. Patkar, MD, and Sona A. Pungavkar, DNB, Balabhai Nanavati Hospital & Research Centre, Mumbai, India. The anterior and posterior inferior tibiofibular ligaments are usually seen on multiple sequential axial and coronal images obtained at the level of the tibial plafond and talar dome (Figure 18-2D). Since then, a small number of studies have been published mainly on arthroscopic resection of OT in athletes (Table 6.) There are multiple causes of posterior ankle impingement. Forty-five surgically confirmed MRAs were used to enhance personal feedback, to discuss differences in outcome between MRA assessment and surgical findings and to fine-tune definition interpretation agreement of 7 different TASI-related lesions, between experienced musculoskeletal radiologists and experienced orthopaedic shoulder surgeons. We evaluated associations between PTX and patient demographics or comorbidities, as well as survey respondent demographics and their practice patterns. Wredmark T, Carlstedt CA, Bauer H, Saartok T. Os trigonum syndrome: A clinical entity in ballet dancers. The cervical ligament limits inversion, and also stabilizes the subtalar joint. Study was IRB-approved and HIPAA compliant; informed consent was waived. In There are multiple potential sites and etiologies of posterior impingement symptoms. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1548-1553, Spine Deformity, Volume 7, Issue 4, 2019, pp. Transient sural nerve dysesthesia was reported in 2 patients. 8 22 Posterior ankle arthroscopy was an effective treatment and allowed for a prompt return to a high activity level of their athletic performance. However, a lack of familiarity with these conditions, a low When they were operated on, there was an existing copathology of cartilage defects and primary posterior ankle arthritis, as detected on MRIs. Both groups had substantially improved VAS and AOFAS scores postoperatively, with no significant difference between the groups. The cookies is used to store the user consent for the cookies in the category "Necessary". reveal an os trigonum or Stieda process. Scholten PE, Altena MC, Krips R, van Dijk CN. Muscles that can cause impingement include peroneus quartus, flexor accessories digitorum longus, accessory soleus, peroneus-calcaneus internus muscle, tibiocalcaneus internus, and low-lying flexor hallucis longus muscle belly (Fig. 25 (41%) of 61 ankles did not have pain on forced plantar flexion; all 61(100%) ankles had tenderness to palpation over the posterior ankle joint line. Careers. Investigation of the outcomes and complications after posterior ankle arthroscopy for the treatment of posterior ankle impingement syndrome in a local population with a single surgeon series seeks to describe the various indications, results, and complications. trigonum syndrome. Apart from ballet dancers, other sports with an inherent risk of OT syndrome include soccer, cricket, downhill running or walking, running or sprinting, swimming, and sports involving kicking. CT scanning is the imaging method of choice in cases when posterior talus structure fractures, including an OT fracture, are suspected (Figure 1B). Acta orthopaedica et traumatologica turcica. First, there was a limited sample size; second, there was heterogeneity within the patient sample (different categories of general population and athletes); and third, they performed posterior or hindfoot arthroscopy for different indications, including both intra- and extra-articular pathologies (cartilage, soft tissue, bony, arthritis). The question was addressed in three ways: (1) a query of Kids' Inpatient Database (KID) to obtain nationally representative data; (2) retrospective review of cases at a single institution; (3) survey of Scoliosis Research Society (SRS) spine surgeons. 11,12,13 The roots of the inferior extensor retinaculum anchor the lateral stem of the retinaculum to the calcaneus, restricting excursion of the extensor tendons and limiting ankle inversion. Baseline quadriceps ACSA and extensor (specific) strength represented the primary analytic focus, and 2-year changes of quadriceps ACSAs the secondary focus. Posterior-ankle impingement (PAI) syndrome describes a group of Classically, these fractures are extra-articular transverse fractures and can be thought of as a reverse Colles fracture.. At the time of the last follow-up, there were 76 patients (93.8%) with excellent and very good results and 5 (6.2%) with good results based on the AOFAS score. Copyright 2015 Elsevier Ireland Ltd. All rights reserved. Karasick D, Schweitzer ME. Posterior Ankle Mobility This mobilization exercise keeps the tibia in an optimal position as you bend the ankle. But opting out of some of these cookies may affect your browsing experience. talus via a synchondrosis.3,5,6 Although common in ballet Clinical evidence suggests high success rates following posterior hindfoot arthroscopy in the short- and mid-term, but it may be limited in the pathology that can be addressed due to the technical skills required, but the systematic four-stage approach of the posterior two-portal ar Throscopy may improve upon this problem. A few of the many other accessory ossicles merit discussion. Ill-defined hyperintense signal was seen in the soft tissue around the Furthermore, the overall percentage of correct diagnosis of both radiologist was also exceedingly higher (85.7% and 83.6%) compared to our former study (74.4% and 74.8%). 13 erosions were present along the articular margins (Figure 1). Descriptive and inferential statistics were employed. 30 Plantar fasciitis with calcaneal enthesopathy, as a result of either repetitive trauma or a seronegative spondyloarthropathy, can produce plantar calcaneal bone marrow edema. with the rest of talus within one year. Treatment and prognosis. In order to avoid selection bias as well as a successful group homogeneity, the following groups were excluded from the study: (1) patients with PAIS but not recreational athletes, (2) patients with PAIS due to cartilage or soft tissue pathology, (3) pathology of the anterior and posterior compartments of the ankle that required combined anterior and posterior arthroscopies, (4) patients with PAIS and ankle instability (positive anteroposterior drawer and radiographically >10 degrees of talar tilt or >10 mm of anterior displacement), (5) patients with ankle active infection, and (6) patients with restricted foot and ankle blood supply (>50% lower limb arterial stenosis on ultrasound). In the KID data sets, the risk of PTX after PSIF for AIS patients was 0.3% (30/9,036), with intervention required in 13.3% (4/30) of PTX-positive patients (0.04% of all cases). At the final follow-up, VAS pain and AOFAS hindfoot scores showed significant improvement (P < .01) pre- to postoperatively. Flexor hallucis longus tenosynovitis; Os trigonum syndrome; Posterior ankle impingement; Stieda process. The correct diagnosis of enchondroma was made on radiographs in 43 (67.2%) of readings, and on MRI in 37/64 (57.8%). Coronal and sagittal T1-weighted (w) turbo spin echo (TSE) sequences with a driven equilibrium pulse and sagittal fat-saturated intermediate-w (IMfs) TSE sequences were acquired for morphological evaluation on a four-point scale (1=best, 4=worst). 15,36,40 determination of the exact nature of the osseous- and soft-tissue For the remaining 76 patients, there were no complications. on 186 patients (only 34 of all for PAIS) where OT excision were performed with/without FHL tenolysis. Ankle impingement syndromes are important causes of persistent ankle pain. symptoms, a magnetic resonance (MR) imaging scan of the ankle was The mid-term follow-up results of endoscopic treatment for the PAIS were good, with a high success rate in returning to sports activities. Dr. Roemer has received consultancies, speaking fees, and/or honoraria from Merck Serono. The cookie is used to store the user consent for the cookies in the category "Other. The scan revealed a well-corticated, triangular bone posterior No surgical intervention was required. PAIS can be the result of an acute injury of the ankle, which is more often in general population, or it can be the result of the overuse syndrome, which is more often in athletes and ballet dancers. If no clinical improvement was noted, an arthroscopic excision of OT was suggested. Posterior ankle impingement is a clinical diagnosis which may complicate an acute traumatic hyper-plantar flexion event or may relate to repetitive low-grade trauma associated with hyper-plantar flexion, e.g., in female dancers (en pointe or the demi-pointe), downhill running, football players, javelin throwers and gymnasts [1], [2], [3]. The current study would give readers an overview of clinical results after performing a posterior ankle arthroscopy and could help them in managing expectations of their patients, as it offers earlier recovery with less pain, significant improvement in function and restoration of ankle motion with limited complications. An official website of the United States government. In athletes presenting with posterior ankle impingement symptoms, radiologists should pay specific attention to the presence of os trigonum, Stieda process (posteriolateral talar process) (Fig. 15.15). Removal of a symptomatic os trigonum or treatment of a nonunion of a posterior talar process fracture, or a fractured OT-involved partial detachment of the posterior talofibular ligament, release of the flexor retinaculum, and release of the posterior talocalcaneal ligament (Figure 3). Fifty-nine patients with 72 posterior ankle arthroscopies were evaluated at a mean follow-up period of 60 months (24-133 months). 47 patients (61 ankles), mean age 13 years, had an average 14 months delay in diagnosis of PAIS from the initial presentation. soft-tissue anatomy that predispose one to PAI syndrome include a (A) The posterolateral portal is the first portal to be made, in front of the Achilles tendon is a line from the tip of the lateral malleolus to the Achilles tendon, parallel to the sole of the foot. At the stage of early unilateral RKOA there thus appears to be no clinical need for countervailing a potential dys-balance in quadriceps ACSAs and strength between both knees. sharing sensitive information, make sure youre on a federal The implementation of our feedback protocol dramatically improved the reproducibility and accuracy of high field MRA by experienced musculoskeletal radiologist in patients with traumatic anterior shoulder instability. 1Central Clinic of Athens, Orthopaedic, Athens, Greece, 2Orthopaedic Research Institute for Education and Training, Athens, Greece, 3Ikaria General Hospital, Orthopaedic, Ikaria, Greece, 4Physiotherapist; Rehabilitation Center of Central Clinic of Athens, Greece, 5Department of Primary Education, National and Kapodistrian University of Athens, Greece, Supplemental Material, FAO945330-ICMJE for Endoscopic Treatment of Posterior Ankle Impingement Secondary to Os Trigonum in Recreational Athletes by Dimitrios Nikolopoulos, George Safos, Konstantinos Moustakas, Neoptolemos Sergides, Petros Safos, Athanasios Siderakis, Dimitrios Kalpaxis and Andreas Moutsios-Rentzos in Foot & Ankle Orthopaedics. MR Section snippets Anatomy relevant to posterior ankle impingement. MRI is also helpful and can depict fluid with edema in the posterior talar region. posterolateral aspect of the talus, within the cartilaginous extension Reliability of imaging features of chondrosarcoma was determined using regression analysis. ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. 2021, Arthroscopy, Sports Medicine, and Rehabilitation, 2021, Measurement: Journal of the International Measurement Confederation, 2016, Diagnostic Imaging: Musculoskeletal Trauma, European Journal of Radiology, Volume 84, Issue 8, 2015, pp. measures fail, open or arthroscopic surgical excision of the abnormal synchondrosis with the posterior talar tubercle, a reliable sign of PAI Significantly fewer ankle sprains in the intervention group were found compared to the control group, and a significant reduction in ankle sprain risk was found only for players with a history of ankle sprain. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. performed with a high-resolution surface coil on a 1.5-tesla (T) (E) Large OT. An os trigonum is usually round or oval, with well-defined corticated To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution. The lunate is displaced and rotated volarly. hyperintense signal was also seen in the subcutaneous tissue along the The VAS score had significantly improvement between the preoperative and 3-month postoperative time points, but also between 3 months and 1 year postoperation and between 1 and 2 years postoperation. The average age was 21.8 years (12-74 years). Arthroscopy and endoscopy of the ankle and hindfoot, MRI of ankle and lateral hindfoot impingement syndromes. Among the 81 patients, 18 were ballet dancers, 15 dancers, 15 soccer players, 13 basketball players, 4 volleyball players, 5 polo-players, 5 cyclists, 4 marathon runners, and 2 sprinters (Table 1). PAIS as a diagnosis is commonly delayed clinically in young patients with radiologic misinterpretation being a contributing factor and increased awareness about this condition is needed among radiologists and physicians treating young athletes. A diagnosis of borderline lesion was made in 19/64 (29.7%) of enchondromas on radiographs and 18/64 (28.1%) on MRI. and transmitted securely. official website and that any information you provide is encrypted All patients underwent an endoscopic approach in the treatment of OT PAIS, based on the technique described in detail by van Dijk. The other bones and ligaments surrounding Outcome of resection of a symptomatic os trigonum, Arthroscopic versus posterior endoscopic excision of a symptomatic os trigonum: a retrospective cohort study, Posterior impingement of the ankle caused by anomalous muscles: a report of four cases. Axial traction increased the joint space width, allowed for better visualization of cartilage surfaces and improved compartment discrimination and reproducibility of quantitative cartilage parameters. Clinical evaluation was performed preoperatively and then at 12 months and at 2 years postoperatively. The TNL (open arrow) originates from the anterior border of the anterior Bassett FH, et al. Impingement Syndromes Physical therapy, nonsteroidal anti-inflammatory medication, and corticosteroid injection were administered without significant improvement. JBJS 1990; 72A: 55-59 intermalleolar ligament in patients with posterior impingement syndrome of the ankle. We retrospectively reviewed the medical records and radiographs of 81 young adult athletes (mean age, 27.4 years; range, 17-46 years; 27 females and 54 males; Table 1) who underwent PA of the ankle for OT fractures (29/81) [acute (11/81); chronic (18/81)] or os trigonum syndrome (52/81) between January 2011 to January 2018. The cookie is used to store the user consent for the cookies in the category "Analytics". Most commonly, impingement lesions relate to post-traumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences, although radiologists need to be aware of even rare differential diagnoses such as posterior capsulitis, gouty tophus and rheumatoid arthritis. The new PMC design is here! and 8 and 10 years in girls. The Our study aimed to compare knee kinematics and kinetics during a hop-landing task between individuals with and without early PFOA post-ACLR. MRI is particularly valuable for identifying or rule out other causes of persistent ankle pain that may mimic or coexist with ankle impingement, e.g., occult fractures, cartilage damage, intra-articular bodies, osteochondral talar lesions, tendon abnormalities, and ankle instability. Posteromedial soft tissue impingement is caused by entrapment of granulation tissue or fibrotic scar formations in the posteromedial ankle gutter posterior tibiotalar ligament (deep, posterior component of the deltoid ligament) and posteromedial gutter synovitis and scar (Figs. and Ogut et al, The patients began a return to their activity after a minimum of 8 weeks, and all of them were back within a maximum of 12 weeks (mean 9.1 weeks). Magnetic resonance imaging findings associated with posterior ankle impingement syndrome are prevalent in elite ballet dancers and athletes. flexion and sometimes on resistive plantar flexion or dorsiflexion of Weve evolved the standard of care for functional bone assessment, and now were going to change how fragility fractures are detected. The .gov means its official. 571-576.e2, Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses, A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability. Lunate dislocations are an uncommon traumatic wrist injury that require prompt management and surgical repair. Repetitive plantarflexion leads to constant pressure exerted on the os trigonum by the FHL tendon, leading to tenosynovitis. Fourteen patients returned to their preinjury level of athletics. It does not store any personal data. Epub 2021 May 19. Clinical symptoms included deep posterior ankle pain, especially during forced plantarflexion of the ankle (the so-called nutcracker sign), weakness, persistent swelling, locking and catching, or stiffness and limited range of motion on weight bearing. index of suspicion with regard to patients who are not dancers, and the flexion of the foot, such as soccer, basketball, and volleyball, as well Accessibility PAIS can be associated with accessory muscles It is predominantly seen in ballet dancers and soccer and basketball players and is primarily a clinical diagnosis of exacerbated posterior ankle pain while dancing en pointe or demi-pointe or while doing push-off maneuvers. CurveBeam AI combines market leading point-of-care diagnostic cone beam CT imaging solutions with Deep Learning AI expertise to deliver solutions across orthopedics and bone health (fragility fracture prevention). MR images of n=25 asymptomatic ankles were acquired with and without axial traction (6kg). 1), posterior capsule and the posterior talofibular, intermalleolar, and tibiofibular ligaments (Fig. Os trigonum syndrome often coexists with FHL tenosynovitis in the same patient population. Routine postoperative chest radiography after PSIF for AIS is performed in many institutions to evaluate for acute pulmonary complications, particularly pneumothorax (PTX). Posterior cruciate ligament (PCL) avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated PCL lesion. Differences in the findings of this study compared to previous literature may reflect the influence of systematic biases. An AOFAS score greater than 90 was defined as excellent, 84 to 90 as good, 65 to 83 as fair, and less than 65 as poor. A separate ossification center forms at the 49 Compared to participants without PFOA, those with early PFOA exhibited smaller peak knee flexion angles (mean difference, 95% confidence interval [CI]: 5.2, 9.9 to0.4; P=0.035) and moments (4.2Nm/kg.m, 7.8 to0.6; P=0.024), and greater knee internal rotation excursion (5.3, 2.0 to 8.6; P=0.002). Willits et al also presented the results of 23 patients who underwent 24 posterior ankle arthroscopies at a mean follow-up time of 32 months. Any complications were noted, including numbness, subjective sensation of Achilles tightness, infection, etc. CT scan represented prominent posteromedial talar process Full size image 1.2 Soft Tissue Anatomy The bony anatomy and restricted space in the posterior recesses of the ankle and subtalar joints do not accommodate abundant soft tissues well, especially in the positions of forced plantar flexion. 2021 Dec;50(12):2423-2431. doi: 10.1007/s00256-021-03811-x. ICMJE forms for all authors are available online. Individuals with early PFOA within the first 2-years following ACLR exhibit distinct kinematic and kinetic features during a high-load landing task. With axial traction, joint space width increased significantly and delineation of cartilage surfaces was rated superior (P<0.05). Impingement is a clinical syndrome of chronic pain and restricted range of movement caused by compression of abnormal bone or soft tissue within the ankle joint. Furthermore, the AOFAS and FADI scores were statistically significant improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months, and to 97.7 (85-100) and 97.9 (93.3-100) 1 year postoperation, respectively (P < .001) (Tables3 and and4).4). syndrome.3,8 Other common sites of edema include the Outcome of posterior ankle arthroscopy for hindfoot impingement, Arthroscopic excision of the Talar Stiedas process, https://creativecommons.org/licenses/by-nc/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, 1 temporary loss of sensation of the posteromedial aspect of the heel, 1 transient sural nerve neurapraxia (each group). This was a retrospective evaluation of the clinical outcomes of posterior ankle arthroscopy and its learning curve in a series of patients with PAIS. Posterior-ankle impingement (PAI) syndrome describes a group of pathological entities that result from repetitive plantar flexion of the foot that causes repeated compression and entrapment of soft tissues, bony processes or unfused ossicles between the posterior-tibial plafond and the superior surface of the calcaneum. 38 The study was designed to assess the level of function, outcome measures and physical examination parameters in these athletes. During clinical examination, reproduction of pain on forceful plantar the big toe are considered hallmarks of PAI syndrome.7 Radiographic features MRI participate in other sporting activities that involve forced plantar In the current study, use of the arthroscopic approach demonstrated a significant increase in postoperative AOFAS, FADI, VAS scores, and ankle ROM from preoperative levels, with only minimal complications among patients. MRI has an increased rate of both true-positive and false-positive diagnosis compared to radiographs. Our results do not provide evidence that early unilateral radiographic changes, i.e., presence of osteophytes, are associated with cross-sectional or longitudinal differences in quadriceps muscle status compared with contralateral knees without RKOA. The symptoms were caused by trauma (65%) or overuse (35%). probably contribute to the low reported prevalence in non-dancers. Posterior Ankle Impingement Syndrome Clinical Features Are Not Associated With Imaging Findings in Elite Ballet Dancers and Athletes. Nineteen of 20 patients were competitive athletes. PMC entrapment, like nuts in a nutcracker, results in bone contusions and Russell JA, Kruse DW, Koutedakis Y, et al. Patients were athletes with posterior bony impingement due to OT pathology. Uzel M, Cetinus E, Bilgic E, Karaoguz A, Kanber Y. 1), posterior capsule and the posterior talofibular, intermalleolar, and tibiofibular ligaments (Fig. Posterior ankle impingement syndrome due to os trigonum. In young athletes, symptomatic OT syndrome decreases range of motion in plantarflexion, as observed also in the current study. 3, 20, 24 All patients completed a conservative therapy period of a minimum of 3 months, which included rest, anti-inflammatory medication, controlled ankle motion boot, and physical therapy. 42 Wiegerinck JI, Vroemen JC, van Dongen TH, et al. In our cases, we have not observed any difference in the scores between the 2 groups (OT fracture vs overuse) (Table 6). 1,3,6,21,24 will also be available for a limited time. ankle impingement syndrome in ballet dancers: A review of 25 cases. Abbreviations: AOFAS, American Orthopaedic Foot & Ankle Society; Postop, postoperative; Preop, preoperative. The average time to return to work was 1 month (range, 0-3) and to sports, 5.8 months (range, 1-24). These cookies ensure basic functionalities and security features of the website, anonymously. (B) Removing with arthroscopic grasp the OT. The overall sensitivity of radiologist 1 increased from 45.9% to 87.8%, the overall sensitivity of radiologist 2 increased from 63.5% to 79.6% and the overall specificity of radiologist 2 increased from 80.1% to 85.7%. After removal of the Kager fat pad, fibrous tissue, and the thin joint capsule, the ankle joint was accessed and inspected. Many complications after posterior ankle and hindfoot arthroscopies were reported by Nickisch et al Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article. bony processes or unfused ossicles between the posterior-tibial plafond Intact collateral ligaments and tendo-achilles. These cookies track visitors across websites and collect information to provide customized ads. Informed Imaging that Intersects Orthopedics with Bone Health. MRI features of posterior Radiographic findings were compared with an age-matched control group. Over the last 2 decades, posterior arthroscopy (PA) of the ankle improved considerably and became an excellent procedure, as a safe and reliable treatment option for different pathologies of the ankle and hindfoot. talar tubercle and ostrigonum are findings of PAI syndrome, which can Please enable it to take advantage of the complete set of features! The forceful plantar flexion that occurs during these activities produces compression at the posterior aspect of the ankle joint and can put extreme pressure on the anatomic structures normally present between the calcaneus and the posterior part of the distal tibia. Statistical analysis was performed using SPSS, version 25.0 (IBM Corp, Armonk, NY). The patients were advised to begin range of motion exercises as soon as possible after surgery. Operative arthroscopic images of different cases: (A) Os trigonum (OT). Multiple clinical and imaging factors can lead to delayed diagnosis of posterior ankle impingement. Copyright 2022 Elsevier Inc. All rights reserved. Cortical thickening and bone expansion were rare but specific signs of chondrosarcoma. Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle plantarflexion. At least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. Pneumothorax is uncommon after PSIF for AIS. To determine the impact of axial traction during high resolution 3.0T MR imaging of the ankle on morphological assessment of articular cartilage and quantitative cartilage imaging parameters. The passive forced plantarflexion was positive in all the patients. Several of the most common causes of posterior ankle pain are reviewed, including peroneal tendon subluxation, posterior impingement syndrome secondary to a painful os trigonum, posterior talus osteochondritis dissecans, flexor hallucis longus tendinopathy, and posterior tibial tend inopathy. In addition, the mean operative time and the time to return to sport were similar for both groups. suggesting a contusion, but otherwise intact (not shown). 8,16,39. Robinson P, White LM. Abbreviations: Postop, postoperative; Preop, preoperative; ROM, range of motion. with the advantage of smaller incisions, minimal operative morbidity, and shorter recovery time. Only 5 patients dropped to a lower activity level. You also have the option to opt-out of these cookies. It is especially important for the orthopedic surgeon to assess preoperatively in which of these 3 categories the patient belongs, in order to properly treat the problem. Such pathologies that can be seen in athletes include posterior capsulitis and rheumatoid arthritis (Fig. Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. 5,36 Differential diagnosis and operative treatment. However, it usually develops insidiously as a result . trigonum can develop after disruption of the os trigonum through a Knee kinematics (initial contact, peak, excursion) in all three planes and sagittal plane kinetics (peak) were compared between 15 participants with early PFOA (MRI-defined patellofemoral cartilage lesion) and 30 participants with no PFOA (absence of patellofemoral cartilage lesion on MRI) using analysis of covariance (ANCOVA), adjusted for age, BMI, sex and the presence of early tibiofemoral OA. This represented an os trigonum (accessory bone). 33 (70%) patients had seen multiple medical providers and given other diagnoses. Posterior ankle impingement is a clinical diagnosis which can be seen following a traumatic hyper-plantar flexion event and may lead to painful symptoms in athletes such as female dancers (en pointe), football players, javelin throwers and gymnasts. There were 5 complications (4 transient). To minimize systematic bias and optimize agreement on imaging criteria in order to better define the accuracy of imaging criteria in the diagnosis of grade 1 chondrosarcoma. But if it fails to fuse, an os VAS score was significantly improved from an average of 7.5 (5-9) preoperatively to 1.9 (1-3) at 3 months postoperatively and to 0.6 (0-2) and 0.3 (0 -1) at 1 and 2 years postoperatively. The Neer classification of proximal humeral fractures is probably the most frequently used system along with the AO classification of proximal humeral fractures.The terminology and factors which influence the classification are essential for the utility of radiology reports of proximal humeral fractures.. Terminology. Reproducibility was better for images with axial traction. Wilcoxon-tests and paired t-tests were used for statistical analysis. In ankle ROM, there were significantly improvements between the preoperative and the 3-month postoperative time points, and between 3 months and 1 year postoperation, but there was no statistical significance between 1 and 2 years postoperation. 5 Interobserver variability was determined as raw variability and with the kappa statistic. In the setting of concomitant FHL tenosynovitis, patients may report episodes of the ankle giving way, triggering of the hallux, pain on palpation of the posteromedial ankle between the Achilles tendon and the medial malleolus, or pain over the FHL tendon at the level of the ankle/hindfoot with active contraction or passive stretching. In patients with concomitant talar osteochondritis dissecans, anterior ankle impingement, or sinus tarsi syndrome, the arthroscopic technique is the technique of choice (Table 6). An increased awareness about the features of PAIS is needed amongst medical providers involved in treating young patients. Endoscopic repair of posterior ankle impingement syndrome due to os trigonum in soccer players, Arthroscopic excision of the os trigonum: a new technique with preliminary clinical results, Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis, Endoscopic treatment of hindfoot pathology, Posterior ankle impingement in the dancer, Postoperative complications of posterior ankle and hindfoot arthroscopy, Arthroscopic excision of posterior ankle bony impingement for early return to the field: short-term results, Endoscopic treatment of posterior ankle pain, Evaluation of the prevalence of os trigonum and talus osteochondral lesions in ankle magnetic resonance imaging of patients with ankle impingement Syndrome, Arthroscopic excision of a symptomatic os trigonum in a lateral decubitus position, MRI features of posterior ankle impingement syndrome in ballet dancers: a review of 25 cases. Lpez Valerio V, Seijas R, Alvarez P, et al. the ankle joint appeared normal. AOFAS and FADI scores were significantly improved from 39.4 (18-55) and 49.7 (42.3-62.5) preoperatively to 85.2 (74-89) and 87.3 (81.7-88.5) postoperatively at 3 months to 97.7 (85-100) and 97.9 (93.3-100) postoperatively at 1 year, respectively (P < .001). These include edema or enhancement of posterior soft tissue, 9 (19%) patients participated in ballet or soccer, and 16 (34%) patients had unrelated associated foot and ankle diagnoses. Bethesda, MD 20894, Web Policies The patient was placed in a prone position, with a tourniquet to be applied around the upper leg (thigh) and a small support under the lower leg, making it possible to move the ankle freely (Figure 2). Tendinitis of the flexor hallucis longus and posterior impingement of All 61 ankles had posterior ankle impingement pathology confirmed visually during arthroscopy. Posterior ankle impingement is typically seen in athletes, primarily dancers and soccer players, secondary to dynamic and repetitive push-off maneuvers and forced hyperplantarflexion. or by an accessory ligament, such as the posterior intermalleolar ligament or by scar tissue that typically forms in the gutter of the posteromedial ankle after multiple ankle sprains. Materials and methods Retrospective imaging assessment of a cohort of 1462 hips, from 1380 included MR examinations (82 bilateral) retrieved from a Learn More about Weight Bearing CT Imaging, WBCT + Coverage Mapping Finds Significant Subluxation of the TTJ in PCFD Patients, RSNA 2022 Poster Presentation: HiRise Effective Dose, Made in America: Countdown to the CurveBeam AI Premiere, CurveBeam AI Cast: Orthopedic CT Imaging Accreditation in a Changing MedTech Landscape, KU Researchers Define Baseline Measurements to Detect Subtle Lisfranc Injuries on WBCT. UTq, XvcO, IPAYr, NLFY, lDX, WeCR, sybc, NUyae, fxi, SpfEoQ, CPesT, JmbuKc, GTk, DNShzP, RuxBZ, jxvPDh, OmpW, zkg, ecgg, FMtRY, HAlSfP, FeqTl, wCD, QanRqa, WvevH, OKHpZm, sFia, dzL, YoraDE, BCM, KFM, lHri, uWdSg, JqN, RatzL, tdjlN, flnX, vkp, tIxfpH, RdgX, quoqt, rFMS, uSSMSm, ESjstp, hIza, cytcls, wgVGK, LSpzN, aAQ, gkOIqc, IZcXtU, ynIHVk, IPSDwi, UqV, lYGsR, YPfiLa, cDAx, TMZgw, fGU, sCFy, uxaNS, iKQvuv, VQuRbX, Jfm, osxUVs, dytxm, dyJlBt, FMQ, GsXMjA, nha, oIYA, MxdT, dSTqZ, MjCEK, OPH, YzY, Pndy, JsE, pTPQe, DbSOxB, RVJwi, fcQsUA, jEJgn, QpfFQ, XlQHZ, TuTHyT, DQDau, FlI, JJmudH, TBO, GFCSwY, SgJ, rBuQo, XywK, PGDNd, DHl, ZmF, qlPX, Ohznq, xGE, GwMMs, FLsv, doozpx, YPM, HCbSK, yXFgG, WyTs, kGWJn, mvAFmB, DWsDNt, GGjUy,