No abstract

Three groups of top level female gymnasts of preelite, elite, national and Olympic caliber were studied without regard to back pain or injury. These athletes were compared to a similar group of national caliber female swimmers. Magnetic resonance imaging scans of each participant were used to document disk or bony abnormalities. The relationship between magnetic resonance imaging findings and age, height, weight, previous injuries, back symptoms, and hours of training per week each year was examined. Nine percent of preelite (1/11), 43% of elite (6/14), and 63% of Olympic level (5/8) gymnasts had spine abnormalities; 15.8% of all swimmers had spine abnormalities. Average hours of training per week and age were found to be associated with abnormalities seen on magnetic resonance imaging. Increased intensity and length of training correlated with previous data that suggests the female gymnast is prone to spine injuries.

Magnetic resonance imaging (MRI) is an accepted non-invasive modality for evaluation of soft tissue pathology without exposure to ionizing radiation. Current applications demonstrate excellent visualization of the anatomy and pathology of various organs. Preliminary studies in the knee reveal fine resolution of anatomy and pathology involving the meniscus. The purpose of this study is to determine a prospective correlation between MRI scans and actual meniscal pathology as documented at the time of arthroscopy. MRI scans were obtained in 155 patients, on 156 knees (one patient with bilateral scans), with 86 patients (87 knees) eventually undergoing diagnostic and operative videoarthroscopy performed by the same surgeon (DWJ). All images were obtained on the same high-resolution 1.5 Tesla GE Signa Magnetic Resonance Scanner with the same radiologist performing all readings (PEB). The knees were studied in the coronal and sagittal plane using a spin echo sequence and 5 mm slice thicknesses. The menisci were described as having Grade 1, 2, or 3 changes, with Grade 3 reserved for complete tears. Using arthroscopy as the diagnostic standard, the accuracy of MRI in diagnosing medial and lateral meniscal tears was 93.1% and 96.6%, respectively with a Grade 3 MRI reading. For tears of the ACL, the accuracy was 96.6% as confirmed at arthroscopy. Five tears of the PCL were also documented by MRI and correlated with clinical evaluation. Other abnormalities seen were articular cartilage and osteochondral defects, bone tumors, tibial plateau fractures, Baker's cysts, and meniscal cysts. The MRI scan is a highly accurate, noninvasive modality for documentation of meniscal pathology as well as cruciate ligament tears in the knee.

The authors of the present study believe that all health care professionals who care for the spine will find this nomenclature valuable in communicating with each other, in writing medical reports, in presenting reports at meetings, or in writing scientific articles.

During the course of MRI examinations of the knee for possible internal derangement, the hip for avascular necrosis, and the shoulder for rotator cuff tears, we have encountered many examples of unsuspected fractures of the tibial plateau, femoral condyles, pelvis, hip and proximal humerus. These fractures were either radiographically inapparent or demonstrated very subtle abnormalities that were missed on prospective interpretation. In addition, a large number of patients have been found to demonstrate evidence of intraosseous trabecular disruption, or edema and hemorrhage of medullary bone, or stress type injuries, all of which are radiographically occult. The clinical significance of these osseous abnormalities varies and is dependent upon the degree of injury. It is believed that an awareness of these osseous abnormalities will improve the accuracy of MRI interpretation, will heighten an appreciation of the subtle radiographic abnormalities that may be present, and will improve patient evaluation and management.