Our findings show that the vast majority of meniscal ossicles are associated with posterior horn or meniscal root tears and a high incidence of focal articular cartilage loss as well as anterior cruciate ligament tears.

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The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. RSNA, 2016.

Background: Needle biopsy has proven to be a potentially adequate method for initial biopsy of many soft-tissue and bone lesions. To help optimize this procedure, this study sought to test the characteristics of several needles, including a steerable needle. Materials and Methods: Five needle types were tested, including a steerable needle. Animal muscle tissue was used for all testing. The following experiments were performed: (1) sample collection with different needle types, (2) histological analysis of needle track, (3) observation of steerable needle characteristics using CT-guidance. Results: Sample collection: The Menghini 21 g and Chiba 22 g needles were graded as excellent for ease of use and integrity of sample. Histologic evaluation showed good specimen preservation with all needle types. Histological analysis of needle track: tracks created by the Menghini 21 g and Spinal 20 g needles both showed no histologically detectable damage to surrounding tissue. Observation of steerable Menghini needle under CT-guidance: needle advanced easily through tissue, even when maximally curved. Small, large, and double curves were feasible to avoid obstacles and reach targets. There was no deflection or change in position of the needle tip when the stylet was removed. Needle withdrawal did not damage surrounding tissue. Conclusions: Compared to the other needles, the steerable needle was found to be durable and easy to use, allowing for precise navigation around vital structures yielding superior integrity of sample tissue.

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Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Cavovarus foot alignment has been significantly associated with increased rates of chronic ankle instability and osteochondral lesions of the talus. Clinical wisdom suggests that cavovarus foot alignment causes varus stress to the ankle and also predisposes individuals to peroneal tendon pathology. However, no studies have specifically explored this relationship. The purpose of this research is to investigate the association between foot alignment and peroneal tendon pathology. Methods: A retrospective case-control study was conducted of all adult patients in whom a magnetic resonance image (MRI) of the ankle was obtained for any reason at a single institution from 2015-2017. Patients were excluded if they had a charcot foot deformity or if they had undergone prior peroneal tendon, ankle, or hindfoot surgery. Arch alignment was evaluated on lateral weightbearing radiographs of the foot by measuring the adjusted navicular height. Hindfoot alignment was assessed using the Saltzman apparent moment arm method. Peroneal tendon pathology including tears, tendinosis, and tenosynovitis was documented by a fellowship-trained musculoskeletal radiologist using the MRI scan. All numerical variables were converted to categorical variables (e.g. varus, valgus, and normal alignment). Chi-square testing was utilized to determine the association between variables. Results: 195 patients were included in the study (average age 47 years, 61% female). Patients with hindfoot varus had significantly higher rates of peroneus longus (PL) and peroneus brevis (PB) tendon pathology than patients with neutral or valgus alignment (Figure 1 A, B)(PL 39% vs. 31% vs. 20%, p=0.01; PB 44% vs 27% vs. 27%, p=0.04). Patients with pes cavus demonstrated extremely high rates of peroneal tendon pathology, which was significantly higher than patients with neutral or pes planus alignment (Figure 1 C, D)(PL 71% vs. 28% vs. 9%, p<0.0001; PB 75% vs 30% vs. 26%, p<0.0001). Amongst patients with peroneal tendon pathology, there was no difference in the rates of symptomatic vs. asymptomatic findings based on hindfoot or pes alignment. Conclusion: This is the first study to demonstrate a statistically significant association between cavus foot alignment, hindfoot varus alignment, and peroneal tendon pathology. Interestingly, this study demonstrates that patients with cavovarus alignment are not more likely to be symptomatic than patients with normal and planovalgus alignment. This study also reinforces the idea that peroneal pathology found on MRI may not necessarily need surgery, as it is frequently seen in patients without symptoms. This information may be useful in counseling patients considering operative treatment for peroneal tendon pathology and alignment abnormalities.

Category: Lesser Toes Introduction/Purpose: The rigid hammertoe deformity requires realignment of the proximal interphalangeal joint. Traditionally this has been achieved with resection arthroplasty with K-wire fixation of the joint. However, this method is prone to complications such as pin migration, pin tract infection, pin breakage, nonunion, and malunion. Recently, a variety of treatment options have been developed to achieve appropriate PIP joint fusion while minimizing these risks. This study investigates the fusion rate and outcomes of a novel internal fixation screw. Methods: A retrospective review was done to determine the short term fusion and satisfaction rate of hammertoe corrections performed by 2 surgeons utilizing a specifically designed longitudinal compression screw. A typical dorsal approach to the PIP joint was performed, followed by a resection arthroplasty, and the screw was inserted in the appropriate described manner. At the last follow up, the radiographs and clinical condition was observed. The fusion and alignment of the joint were then analyzed by an orthopaedic resident (PGY3), an orthopaedic attending, and a musculoskeletal radiologist. Clinical satisfaction and appearance was derived from chart review. A total of 55 screws were placed in 40 patients. Thirty-nine of these toes were second toes, 12 were third toes, and 4 were fourth toes. This implant was not designed for the fifth toe. The median final X-ray follow up was 10 weeks (range 5 to 40 weeks). Results: After evaluation of the post-operative X-rays by all 3 evaluators, at least 76% of these toes were definitively fused. About 13% of the joints were difficult to judge for radiological union based on the available X-rays. Approximately 11% of the joints went into nonunion or were not fused by final (typically asymptomatic) follow up. Two toes (3.6%) had persistent pain and swelling at the last visit. Two toes (3.6%) had slight misalignment (more than 5 degrees of varus/valgus), and only one was a cosmetic issue. No toes changed in alignment from the immediate post-operative position. There was no evidence of post- operative infection in the entire series. None of the toes required a return to the operating room for any reason. Conclusion: Compression screw fixation for the treatment of hammertoe deformities is a relatively effective method in that it demonstrates reasonable rates of radiographic union with very high rate of symptomatic relief. There were no complications associated with infection or loss of alignment. Furthermore, even in patients without firm evidence of bony union, the presence of an intramedullary implant maintains alignment while relieving symptoms.

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