Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2003
Purpose: The purpose of this study was to show that magnetic resonance imaging (MRI) can accurate... more Purpose: The purpose of this study was to show that magnetic resonance imaging (MRI) can accurately and noninvasively evaluate the articular cartilage overlying osteochondral lesions of the talus, using arthroscopy as the standard, and provide information about lesion stability. A classification system applicable to both MRI and arthroscopy is proposed. Type of Study: Retrospective review with MRI and arthroscopy correlation. Methods: A retrospective analysis involving 26 men and 28 women who underwent MRI of the ankle and in whom arthroscopy had been performed. The talar dome cartilage was evaluated using the following grading system: 0, normal cartilage; 1, abnormal signal but intact; 2, fibrillation or fissures not extending to bone; 3, flap present or bone exposed; 4, loose undisplaced fragment; 5, displaced fragment. There was a history of trauma in 80% of cases. Results: At surgery, 14 ankle joints had intact cartilage and 40 showed osteochondral lesions. MRI correctly identified all 40 osteochondral lesions and all 14 normal ankles. MRI correctly graded 33 of 40 (83%) of the osteochondral lesions using the described 5-point scale. Of the remaining 7 lesions, all were identified within 1 grade. Collapsing all grades into disease-negative status (grades 0 and 1) and disease-positive status (grades 2, 3, 4, and 5) yielded sensitivity of 95%, specificity of 100%, negative predictive value of 88%, and positive predictive value of 100%. Conclusions: This study shows that MRI can be used to evaluate the articular cartilage covering osteochondral lesions of the talus with a high degree of accuracy and thus may aid in identifying patients who would benefit from definitive arthroscopic treatment.
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2005
Purpose: Traditional imaging techniques have limited ability to detect subtle chondral and labral... more Purpose: Traditional imaging techniques have limited ability to detect subtle chondral and labral injuries of the hip. We performed a retrospective review of patients who underwent magnetic resonance imaging (MRI) of the hip and subsequent hip arthroscopy in order to evaluate the ability of optimized, noncontrast MRI to identify tears of the acetabular labrum and defects in articular cartilage. Type of Study: Retrospective review of a consecutive sample. Methods: Between January 1997 and July 2000, 92 patients had MRI of the hip, followed by arthroscopic surgery of that hip by 1 of 2 surgeons (R.B., D.E.P.). Two musculoskeletal MR radiologists blinded to the initial MRI and surgical findings, independently interpreted the studies, looking for the location and degree of articular cartilage and acetabular labral pathology. Results: Of the 92 patients studied, each of 2 radiologists correctly identified 83 (94%) and 84 (95%) of the 88 labral tears present at surgery, respectively. There was 92% interobserver agreement on the MRI studies. For articular cartilage defects on the femoral head and acetabulum, there was good agreement (92% and 86% within 1 grade) between MRI and surgical grading and between the 2 MR readers (kappa of 0.8 for femoral head cartilage and 0.7 for acetabular cartilage). Conclusions: This study shows that noncontrast MRI of the hip, using an optimized protocol, can noninvasively identify labral and chondral pathology. Such information may facilitate deciding which patients warrant surgical intervention, thus preserving hip arthroscopy as a therapeutic tool. Level of Evidence: Level II, Development of Diagnostic Criteria Study.
Our objective was to describe the sonographic appearance of the gluteus medius and minimus tendon... more Our objective was to describe the sonographic appearance of the gluteus medius and minimus tendons in normal subjects, and to illustrate the spectrum of sonographic findings in gluteus tendinopathies. Sonography was performed in 20 asymptomatic volunteers. Seventy-five consecutive patients (59 women, 16 men; mean age 57.1 years) presented with pain and point tenderness over the greater trochanter. There were 43 right hips and 32 left hips. Ten patients provided a history of a traumatic incident with subsequent symptoms (mean duration 3.2 months). All patients underwent sonography to assess the site and severity of injury, and to discriminate tendinosis from partial and complete tear. Calcific foci, bony change, and fluid in the trochanteric bursae were noted. Twenty-two patients subsequently underwent surgery. Fifty-three (53 of 75) patients showed sonographic evidence of gluteus medius tendinopathy. Twenty-eight patients were thought to have tendinopathy without discrete tear. Sixteen patients had partial tears and 9 full-thickness tears. Gluteus minimus tendinopathy was detected in 10 of 75 patients. Foci of tendinopathy and partial tears were more common in the deep and anterior portions of the gluteus medius tendon attachment. Eight patients had fluid pooling in the trochanteric bursae. Findings were confirmed in 22 patients at surgery. Sonography can identify gluteus medius and minimus tendinopathy and provides information about the severity of the disease.
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2003
Purpose: The purpose of this study was to show that magnetic resonance imaging (MRI) can accurate... more Purpose: The purpose of this study was to show that magnetic resonance imaging (MRI) can accurately and noninvasively evaluate the articular cartilage overlying osteochondral lesions of the talus, using arthroscopy as the standard, and provide information about lesion stability. A classification system applicable to both MRI and arthroscopy is proposed. Type of Study: Retrospective review with MRI and arthroscopy correlation. Methods: A retrospective analysis involving 26 men and 28 women who underwent MRI of the ankle and in whom arthroscopy had been performed. The talar dome cartilage was evaluated using the following grading system: 0, normal cartilage; 1, abnormal signal but intact; 2, fibrillation or fissures not extending to bone; 3, flap present or bone exposed; 4, loose undisplaced fragment; 5, displaced fragment. There was a history of trauma in 80% of cases. Results: At surgery, 14 ankle joints had intact cartilage and 40 showed osteochondral lesions. MRI correctly identified all 40 osteochondral lesions and all 14 normal ankles. MRI correctly graded 33 of 40 (83%) of the osteochondral lesions using the described 5-point scale. Of the remaining 7 lesions, all were identified within 1 grade. Collapsing all grades into disease-negative status (grades 0 and 1) and disease-positive status (grades 2, 3, 4, and 5) yielded sensitivity of 95%, specificity of 100%, negative predictive value of 88%, and positive predictive value of 100%. Conclusions: This study shows that MRI can be used to evaluate the articular cartilage covering osteochondral lesions of the talus with a high degree of accuracy and thus may aid in identifying patients who would benefit from definitive arthroscopic treatment.
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2005
Purpose: Traditional imaging techniques have limited ability to detect subtle chondral and labral... more Purpose: Traditional imaging techniques have limited ability to detect subtle chondral and labral injuries of the hip. We performed a retrospective review of patients who underwent magnetic resonance imaging (MRI) of the hip and subsequent hip arthroscopy in order to evaluate the ability of optimized, noncontrast MRI to identify tears of the acetabular labrum and defects in articular cartilage. Type of Study: Retrospective review of a consecutive sample. Methods: Between January 1997 and July 2000, 92 patients had MRI of the hip, followed by arthroscopic surgery of that hip by 1 of 2 surgeons (R.B., D.E.P.). Two musculoskeletal MR radiologists blinded to the initial MRI and surgical findings, independently interpreted the studies, looking for the location and degree of articular cartilage and acetabular labral pathology. Results: Of the 92 patients studied, each of 2 radiologists correctly identified 83 (94%) and 84 (95%) of the 88 labral tears present at surgery, respectively. There was 92% interobserver agreement on the MRI studies. For articular cartilage defects on the femoral head and acetabulum, there was good agreement (92% and 86% within 1 grade) between MRI and surgical grading and between the 2 MR readers (kappa of 0.8 for femoral head cartilage and 0.7 for acetabular cartilage). Conclusions: This study shows that noncontrast MRI of the hip, using an optimized protocol, can noninvasively identify labral and chondral pathology. Such information may facilitate deciding which patients warrant surgical intervention, thus preserving hip arthroscopy as a therapeutic tool. Level of Evidence: Level II, Development of Diagnostic Criteria Study.
Our objective was to describe the sonographic appearance of the gluteus medius and minimus tendon... more Our objective was to describe the sonographic appearance of the gluteus medius and minimus tendons in normal subjects, and to illustrate the spectrum of sonographic findings in gluteus tendinopathies. Sonography was performed in 20 asymptomatic volunteers. Seventy-five consecutive patients (59 women, 16 men; mean age 57.1 years) presented with pain and point tenderness over the greater trochanter. There were 43 right hips and 32 left hips. Ten patients provided a history of a traumatic incident with subsequent symptoms (mean duration 3.2 months). All patients underwent sonography to assess the site and severity of injury, and to discriminate tendinosis from partial and complete tear. Calcific foci, bony change, and fluid in the trochanteric bursae were noted. Twenty-two patients subsequently underwent surgery. Fifty-three (53 of 75) patients showed sonographic evidence of gluteus medius tendinopathy. Twenty-eight patients were thought to have tendinopathy without discrete tear. Sixteen patients had partial tears and 9 full-thickness tears. Gluteus minimus tendinopathy was detected in 10 of 75 patients. Foci of tendinopathy and partial tears were more common in the deep and anterior portions of the gluteus medius tendon attachment. Eight patients had fluid pooling in the trochanteric bursae. Findings were confirmed in 22 patients at surgery. Sonography can identify gluteus medius and minimus tendinopathy and provides information about the severity of the disease.
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Papers by David Connell