The presence of a triticeous cartilage is common and of variable appearance. As the clinical and surgical significance of this anatomic structure may be misinterpreted, it is important for imaging interpreters to be familiar with this seldom-recognized anatomic structure and recognize its variable appearance on cross-sectional imaging to avoid a misdiagnosis.

Background: Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates. Purpose: To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent isolated ACL reconstruction between August 2013 and December 2019 were identified. No patient had had Kaplan fiber (KF) injury identified on the initial reading of the MRI scan or at the time of surgery. Preoperative knee MRI scans (minimum 1.5 T) were reviewed and injuries to the proximal and distal KFs were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (the lateral joint line and the lateral femoral epicondyle) were measured. Additional radiological findings, including bleeding, lateral femoral notch sign, and bone marrow edema (BME), were identified to detect correlations with KFC injury. Results: The intact KFC could reliably be identified by all 3 reviewers (85.9% agreement; Kappa, 0.716). Also, 53% to 56% of the patients with initially diagnosed isolated ACL ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8%, and 43.3% by the first, second, and third reviewers, respectively) than injuries to the proximal KFs (35.6%, 47.1%, and 45.2% by the first, second, and third reviewers, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries ( P = .023). Additionally, there was a positive correlation between distal KF injuries and lateral tibial plateau BME ( P = .035), but no associations were found with the lateral femoral notch sign or other patterns of BME, including pivot-shift BME. Conclusion: KF integrity and injury can be reliably detected on routine knee MRI scans. Also, 53% to 56% of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as ACL injuries diagnosed by current routine MRI examination protocols may come with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL graft failure or reoperation rates, significant improvements in preoperative diagnostic imaging are required to determine the exact injury pattern and to assist in surgical decision making.

Overall microbiologic yield of repeat CT-guided biopsy for patients with suspected infectious spondylodiscitis was low at 14.3%; however, a higher yield was identified in patients who were younger in age and not exposed to pre-biopsy antibiotics.

No abstract

Juvenile xanthogranuloma (JXG) is a disorder of non-Langerhans cell histiocytosis that usually displays as a self-limiting course in children. Rare systemic involvement implies poor prognosis. Although conventional and spectroscopic magnetic resonance imaging (MRI) findings of JXG in CNS have been described, diffusion imaging of intracranial JXG has not been reported. Our case report is the first manuscript to describe diffusion restriction of a cerebral lesion seen in the setting of JXG. Since diffusion restriction has not been described in the setting of JXG but it is more commonly associated with infectious cerebral abscess, this finding has had significant impact in the management. Central nervous system (CNS) lesion of our patient has also had additional imaging features similar to typical infectious cerebral abscess. Extensive work-up has been unrevealing any infectious source. Patient has had biopsy proven peripheral sterile abscesses. After extensive discussion with the family, brain biopsy is deferred. Intravenous steroid therapy is initiated in intensive care setting. All of the lesions have gradually responded to steroid therapy. CNS lesion has taken the longest time to clear.

No abstract

:The meniscus is an organized collection of fibrocartilaginous tissue that is located between the femoral condyles and the tibial plateau of the knee which primarily assists with load transmission. The complex composition of articulating soft-tissue structures in the knee causes the menisci to become a common source of injury, especially in the realm of athletic trauma. Magnetic resonance imaging (MRI) has become the imaging modality of choice for evaluating patients with suspected meniscal pathology because of its numerous advantages over plain radiographs. Most forms of meniscal tears have classic MRI findings and are used in correlation with physical examination findings to confirm or rule out a diagnosis. These imaging findings are referred to as signs and have been well studied, and the associated eponyms for each sign are well published throughout the literature. This article will review and describe a unique selection of meniscal pathology as visualized by MRI that is more commonly published in musculoskeletal radiology literature when compared with orthopedics and sports medicine literature.

Imaging of the anterolateral ligament of the knee: The MR(eye) sees what the brain knows. Arthroscopy. 2018;34(9):2739-2742. 15. Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY Study Randomized Clinical Trial.