Background: Synovial inflammation is associated with pain severity in patients with knee osteoarthritis (OA). The aim here was to determine in a population with knee OA, whether synovial tissue from areas associated with pain exhibited different synovial fibroblast subsets, compared to synovial tissue from sites not associated with pain. A further aim was to compare differences between early and end-stage disease synovial fibroblast subsets. Methods: Patients with early knee OA (n = 29) and end-stage knee OA (n = 22) were recruited. Patient reported pain was recorded by questionnaire and using an anatomical knee pain map. Proton density fat suppressed MRI axial and sagittal sequences were analysed and scored for synovitis. Synovial tissue was obtained from the medial and lateral parapatellar and suprapatellar sites. Fibroblast single cell RNA sequencing was performed using Chromium 10X and analysed using Seurat. Transcriptomes were functionally characterised using Ingenuity Pathway Analysis and the effect of fibroblast secretome on neuronal growth assessed using rat DRGN. Findings: Parapatellar synovitis was significantly associated with the pattern of patient-reported pain in knee OA patients. Synovial tissue from sites of patient-reported pain exhibited a differential transcriptomic phenotype, with distinct synovial fibroblast subsets in early OA and end-stage OA. Functional pathway analysis revealed that synovial tissue and fibroblast subsets from painful sites promoted fibrosis, inflammation and the growth and activity of neurons. The secretome of fibroblasts from early OA painful sites induced greater survival and neurite outgrowth in dissociated adult rodent dorsal root ganglion neurons. Interpretation: Sites of patient-reported pain in knee OA exhibit a different synovial tissue phenotype and distinct synovial fibroblast subsets. Further interrogation of these fibroblast pathotypes will increase our understanding of the role of synovitis in OA joint pain and provide a rationale for the therapeutic targeting of fibroblast subsets to alleviate pain in patients.

Numerous corticosteroid preparations are available, but the type and dose administered is frequently at the discretion of the clinician. This is often based on anecdotal evidence and experience rather than formal clinical guidelines. In order to better understand current practice, we anonymously surveyed 100 members of the British Society of Skeletal Radiologists. The results of the survey demonstrated the arbitrary use of all types of steroid preparation at different anatomical locations. In this article, we review the commonly used corticosteroids and propose a guideline to help practitioners decide on the type and dose of steroid depending on the treatment location.

BackgroundThe relationship between hamstring muscle injuries (HMIs) that involve the intramuscular tendon and prolonged recovery time and increased reinjury rate remains unclear in elite footballers.ObjectiveTo determine the association of time to return to full training (TRFT) and reinjury of HMIs using the British Athletic Muscle Injury Classification (BAMIC) and specific anatomical injury location in elite-level football players.MethodsThe electronic medical records of all players at an English Premier League club were reviewed over eight consecutive seasons. All players who sustained an acute HMI were included. Two experienced musculoskeletal radiologists independently graded each muscle using the BAMIC, categorised each injury location area (proximal vs middle vs distal third and proximal vs distal tendon) and reported second muscle involvement. TRFT and reinjury were recorded.ResultsOut of 61 HMIs, the intramuscular tendon (BAMIC ‘c’) was involved in 13 (21.3%). HMI involving the intramuscular tendon (‘c’) had a mean rank TRFT of 36 days compared with 24 days without involvement (p=0.013). There were 10 (16.4%) reinjuries with a significant difference of 38.5% reinjury rate in the group with intramuscular tendon injury (‘c’) and 12.5% in the group without (p=0.031). TRFT and reinjury involving a second muscle was statistically significantly higher than without. Most of the HMIs to the biceps femoris with reinjury (5 out of 9) were in the distal third section related to the distal tendon site involving both the long and short head.ConclusionTRFT in HMI involving the intramuscular tendon (‘c’) of the Biceps femoris is significantly longer with significantly higher reinjury rate compared with injuries without, in elite football players. The finding that most reinjures of the biceps femoris occurring in the distal third muscle at the distal tendon site, involving both the long and short head, merits further investigation.

Symptomatic calcific discitis has been reported in the paediatric population but is a rare entity in adults with only eight cases reported in the English literature. We present a case of adult calcific discitis presenting with acute onset back pain. Radiographs and CT demonstrated central T11-T12 disc calcification with diffuse marrow oedema on subsequent MRI. The patient was referred to our spinal oncology unit due to the extensive marrow oedema as a possible underlying primary bone tumour. Review of the CT confirmed an end-plate defect with herniated calcific nucleus pulposus with no underlying bone lesion. Features were in keeping with acute calcific discitis. The patient was treated symptomatically and made an uneventful recovery. We discuss the characteristic imaging features seen on radiograph, CT and MRI and review the current literature. Calcific discitis is a self-limiting pathology requiring symptomatic management only. Radiologists need to be aware of this rare entity as it can occur in adults and may be mistaken for a more sinister pathology such as infective discitis or a bone tumour and lead to further unnecessary imaging or invasive procedures.

Background:Over the years, there has been a tremendous increase in the use of fluoroscopy in orthopaedics. The risk of contracting cancer is significantly higher for an orthopedic surgeon. Hip and spine surgeries account for 99% of the total radiation dose. The amount of radiation to patients and operating surgeon depends on the position of the patient and the type of protection used during the surgery. A retrospective study to assess the influence of the radiation exposure of the operating surgeon during fluoroscopically assisted fixation of fractures of neck of femur (dynamic hip screw) and ankle (Weber B) was performed at a district general hospital in the United Kingdom.Materials and Methods:Sixty patients with undisplaced intertrochanteric fracture were included in the hip group, and 60 patients with isolated fracture of lateral malleolus without communition were included in the ankle group. The hip and ankle groups were further divided into subgroups of 20 patients each depending on the operative experience of the operating surgeon. All patients had fluoroscopically assisted fixation of fracture by the same approach and technique. The radiation dose and screening time of each group were recorded and analyzed.Results:The radiation dose and screening time during fluoroscopically assisted fixation of fracture neck of femur were significantly high with surgeons and trainees with less than 3 years of surgical experience in comparison with surgeons with more than 10 years of experience. The radiation dose and screening time during fluoroscopically assisted fixation of Weber B fracture of ankle were relatively independent of operating surgeon's surgical experience.Conclusion:The experience of operating surgeon is one of the important factors affecting screening time and radiation dose during fluoroscopically assisted fixation of fracture neck of femur. The use of snapshot pulsed fluoroscopy and involvement of senior surgeons could significantly reduce the radiation dose and screening time.

Whilst compression by a ganglion in the Guyon's canal is rare but well recognized, a feature of both of our cases was the rapid progression and severe nature of the compressive symptoms and signs. This is in contrast to the more typical features of compressive neuropathy and should alert the clinician to the possible underlying cause of compression. Early decompression has the potential to promote a complete recovery.

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PURPOSE. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury METHODS. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/ disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. RESULTS. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76-1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non-type-A knees (p=0.023). CONCLUSION. Dejour type-A trochlear dysplasia was associated with ACL injuries.