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BACKGROUND Arthroscopy is the established 'gold standard' diagnostic investigation for detection of shoulder disorders. We aimed to compare the diagnostic accuracy of arthroscopy with magnetic resonance arthrography (MRA) for detection of shoulder disorders. METHODS Patients who underwent arthroscopy by a single surgeon and preoperative MRA between February 2011 and March 2012 for shoulder instability were identified. MRAs were reported by experienced musculoskeletal radiologists. Labral tears, anterior labral tears, superior labral anterior posterior (SLAP) lesions, posterior labral tears, rotator-cuff tears (RCTs), osteoarthritis, loose bodies and Hill-Sachs lesions were identified. Sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio and negative likelihood ratio were calculated. RESULTS A total of 194 patients were identified. The sensitivity and specificity for anterior labral tears was 0.60 and 0.92, SLAP lesions was 0.75 and 0.81, posterior labral tears was 0.57 and 0.96, any labral tear was 0.87 and 0.76, Hill-Sachs lesions was 0.91 and 0.91, RCTs was 0.71 and 0.86, osteoarthritis was 0.72 and 0.95, and loose bodies was 0.22 and 0.96, respectively. The positive predictive value and negative predictive value for anterior labral tears were 0.88 and 0.71, SLAP lesions was 0.64 and 0.88, posterior labral tears was 0.74 and 0.45, any labral tear was 0.89 and 0.71, Hill-Sachs lesions was 0.66 and 0.98, RCTs was 0.47 and 0.95, osteoarthritis was 0.70 and 0.95, and loose bodies was 0.27 and 0.95, respectively. CONCLUSIONS MRA has high diagnostic accuracy for labral tears and Hill-Sachs lesions, but whether MRA should be the first-line imaging modality is controversial.

Purpose: To evaluate the types of synovial condromatosis (SC) of tempromandibular joint (TMJ) on MRI and their potential aggressive behavior., Methods: 144 patients with pure SC of TMJ were included in. On MRI, 3 types of the lesion included loose body, homogeneous mass, and mixture of both loose body and homogeneous mass. Bony evaluations included 4 stages of erosion: without erosion, chondral breakdown, bony absorption and bony perforation., Results: 47 (32.6%) cases were categorized in the type of loose body, 71 (49.3%) cases in the type of homogeneous mass, and 26 (18.1%) cases in the type of mixture. 80% of bony perforation belonged to the type of homogeneous mass and 20% belonged to the type of mixture. 2 patients were found recurrence., Conclusion: The types of homogeneous mass and mixture of both on MRI were more aggressive. Homogeneous mass with bony erosion on MRI had potential recurrence., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Sudden and intermittent locking of the elbow joint is a com- mon complaint among patients who commonly demonstrate degenerative changes in the elbow. Common causes of elbow locking include acute trauma, osteochondritis dessicans, synovial chondromatosis, and osteoarthritis. Two cases involving patients with symptoms of elbow locking secondary to reasons other than loose bodies within the joint are presented: a synovial cyst within the posterior aspect of the elbow, specifically within the olecranon fossa causing their painful symptoms of locking. These cases present unique features in the diagnostic approaches of elbow locking due to the unexpected association with synovial cysts. We believe that these findings can shed new light on the pathogenesis of this disease.

Foot and ankle injuries are common in sport. Although many available imaging techniques can be useful in identifying and classifying injuries, magnetic resonance imaging (MRI) provides high levels of sensitivity and specificity for articular and soft-tissue injuries. Arthroscopic and minimally invasive treatment techniques for foot and ankle injuries are rapidly evolving, minimizing morbidity and improving postoperative rehabilitation and return to play. Correlation between MRI and surgical findings can aid in both accessing and treating pathologic processes and structures., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objectives: Research diagnostic criteria for temporomandibular disorders (RDC/TMDs) were proposed in 1992 with the aim of standardizing and testing methods for diagnosing TMDs. RDC/TMDs have so far been lacking standardized methods for imaging and criteria for imaging diagnosis of disorders of the temporomandibular joint (TMJ). Criteria for disorders of the TMJ have recently been proposed for MRI. The aim of this study was to publish MR images of the TMJ on the web and to test the agreement of five observers using the criteria., Methods: 20 cases of MRI of the TMJ were published on the web together with the criteria. The MR images were taken in closed and open mouth positions, and sagittal and coronal views. Five observers diagnosed disc position, disc shape, joint effusion and loose calcified bodies in the TMJ., Results: In all cases except one, three or more observers agreed upon the diagnosis. All agreed on whether a loose calcified body was present or not. The second best agreement was obtained for disc position in the sagittal view, where all observers agreed in 16 of the 20 cases. For disc position in the coronal view and the evaluation of the disc shape, observer agreement was lower., Conclusion: Criteria were useful in order to standardize and simplify evaluation and thereby probably increase the diagnostic outcome among different observers for MRI of the TMJ. We recommend that the criteria be used internationally to facilitate comparisons between different studies.

The number of elbow arthroscopies and indications for the procedure have increased significantly since the advent of modern elbow arthroscopy in the 1980s. In addition to the patient history, physical examination, and plain radiography, MRI is an important tool for the clinician in diagnosing several pathologies within and around the elbow. Understanding the pathophysiology and clinical presentation and being familiar with the MRI characteristics of a variety of elbow conditions will assist the physician in making an accurate diagnosis and help guide appropriate treatment.

We herein present a case of radial wrist pain following trauma. Magnetic resonance imaging showed a large area of abnormal soft tissue in the scapho-trapezial joint. The patient was treated successfully by complete resection of the soft tissue. The soft tissue was diagnosed to be synovial fringe based on a histological study. Synovial fringe is frequently reported as a cause of knee and elbow pain, however, it is a rare cause of wrist pain at the scapho-trapezial joint.

Disorders of the hip joint can be physically disabling for the patient and a diagnostic challenge for the physician. Advances in imaging the hip with MRI can help the physician determine a more specific diagnosis for patients with acute or chronic hip pain. MRI and particularly magnetic resonance arthrography have helped raised awareness of nonarthritic hip problems and have made the diagnosis of hip problems much easier. Intra-articular and extra-articular processes can be evaluated with MRI; multiple sequences are available to increase the sensitivity and specificity for detecting specific pathology around the hip. Because the hip is a deep joint within a large soft-tissue envelope, MRI more precisely delineates the sources of hip pain by evaluating the soft tissues and ligamentous structures around the hip. It is helpful to understand the role of MRI in evaluating common pathologic conditions within the hip joint, including labral tears, chondral lesions, loose bodies, tears of the ligamentum teres, femoral acetabular impingement, developmental dysplasia of the hip, and pigmented villonodular synovitis. Hip arthroscopy, a less invasive technique for treating hip problems, has also contributed to the rapid growth of interest in this area of orthopaedic surgery. Hip arthroscopy can be used to evaluate disorders in the intra-articular region (central and peripheral compartments) and periarticular region (iliopsoas bursa and tendon disorders) as well as those in the peritrochanteric region.

Fractures of the calcaneus generally occur in the setting of high-energy trauma, resulting in complex, three-dimensionally oriented fracture patterns. Surgical treatment is typically indicated for displaced intra-articular fractures, permitting restoration of calcaneal height, width and overall morphology, in addition to the posterior facet articular surface where possible, and enabling late in situ arthrodesis as a means of salvage in the event of post-traumatic arthritis. The present article briefly discusses our preferred methods for the management of calcaneal fractures. An English full text version of this article is available at SpringerLink as supplemental.

Since synovial chondromatosis (SC) clinically mimics symptoms of internal derangements of the TMJ, the diagnostic value of MRI and CT, overlooked for years, is discussed in the presented case. Multiple amorphous calcifications in the left infratemporal fossa and upper synovial compartment of the TMJ were detected on the CT and MRI scans. The patient underwent open TMJ arthrotomy and removal of 15 calcified loose bodies. SC may be diagnosed radiographically when sclerosis of the glenoid fossa, soft tissue edema, and intraarticular radio-opaque loose bodies are detected. Advanced imaging of the TMJ, such as MRIs and CTs, are indispensible methods to obtain differential diagnoses for long-standing suspicious pathologies of the temporomandibular joint.

Synovial chondromatosis of the ankle is a rare condition, particularly secondary chondromatosis. In view of a possible traumatic pathogenesis, chondromatosis should be kept in mind in daily trauma and orthopedics practice. Diagnostic imaging gives a first indication. The key to differentiating between the primary and secondary forms is histological identification. This case shows the necessity of exact differentiation, even in cases of a causal link with a specific injury.

The patient was a 52-year-old woman who visited our hospital for the chief complaint of a strange sensation in the left temporomandibular joint region on February 22, 1992. On the first examination, crepitus was heard, but no disturbance of mouth opening was noted. On panoramic radiography, radiopaque bodies were present in the left temporomandibular joint region, diagnosed as synovial chondromatosis. Course observation without active treatment was selected. Calcified bodies were noted on the lateral side directly below the left temporomandibular articular tubercle on the first computed tomography image performed in December 1998. Reportedly, this lesion grows slowly, but the lesions started to enlarge at a specific time point during the 17-year follow-up in this patient, showing the necessity of long-term follow-up by imaging even though no quality-of-life reduction or subjective symptom is observed., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Meniscal ossicles are an unusual finding and a rare cause for knee pain. They are often initially diagnosed as a loose body, chondrocalcinosis or meniscal calcification within the knee joint. Few cases have been reported in the literature. We present a case of a meniscal ossicle with an associated femoral cartilage lesion in a healthy 26-year-old male professional soccer player who presented with swelling and pain. The purpose of this article is to discuss the origins, radiological features, clinical symptoms and prognosis of meniscal ossicles., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Derangements of the soft tissues within the ankle joint are associated with a wide variety of pathophysiology, and typically can be classified as secondary to traumatic injury, rheumatic disease, or congenital lesions. Patients often present with persistent pain, swelling, and limitations on function, usually focused on the anterior aspect of the joint. Evaluation should be guided by a detailed history and physical examination, followed by clinical, laboratory, and imaging studies as indicated. The pathophysiology, diagnosis, and management of these conditions will be the focus of this article., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Athletic injuries in or around the hip in the adolescent athlete encompass possible causes such as a single, traumatic event to those of repetitive microtrauma. The injuries may involve the bone or the soft tissues, with former involving the epiphysis, apophysis, metaphysis, or diaphysis, whereas the latter includes muscles and tendons. With the improvements in surgical technique and instrumentation for hip arthroscopy and the development of magnetic resonance arthrography, clinicians have been able to diagnose and treat labral tears, hip instability, snapping hip, loose bodies, chondral injuries, and femoroacetabular impingement. The clinician needs to consider acquired conditions that may have coincidentally become apparent as a result of the adolescent's participation in an organized sports program. These include slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, and pathologic lesions and fractures. This study reviews the more common acute and chronic overuse injuries in or around the hip in the adolescent athlete and discusses hip injury prevention in this active patient population.

Elbow injuries in the pediatric and adolescent population represent a spectrum of pathology that can be categorized as medial tension injuries, lateral compression injuries, and posterior shear injuries. Early and accurate diagnosis can improve outcomes for both nonoperative and operative treatments. Prevention strategies are important to help reduce the increasing incidence of elbow injuries in youth athletes., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to investigate the correlations between spur severity, clinical characteristics, and articular cartilage lesions in patients with anterior bony impingement., Methods: The study included 57 ankles in 57 patients (48 male and 9 female patients; age range, 15 to 59 years) who had undergone a spur resection for anterior impingement. We excluded spurs in patients with osteoarthritis with joint space narrowing. Spur severity was classified by use of the McDermott scale. The correlations between spur severity, clinical characteristics, and articular cartilage lesions were evaluated. Differences in the mean lengths of the tibial spurs were examined according to the presence or absence of tram-track lesions, spur fragmentation, and loose bodies., Results: The duration of pain, degree of sports activity, and presence of mechanical instability showed no relation to spur severity. Of the ankles, 28 (49.1%) were grade 1, 1 (1.8%) was grade 2, and 28 (49.1%) were grade 3. Cartilage lesions were present in 46 ankles (80.7%). Spur severity was correlated with the degree of cartilage lesions (Spearman rho = 0.30, P = .02). Grade 3 ankles had more spur fragmentation than grade 1 or 2 ankles. The mean length of the tibial spurs with tram-track lesions or spur fragmentation was longer than that without these lesions., Conclusions: The results suggest that cartilage lesions are present even in ankles with small spurs and that the degree of cartilage lesions increases as spurs become larger., Level of Evidence: Level IV, therapeutic case series., (Copyright (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose was to evaluate the effect of fixation of detached free fragments of osteochondritis dissecans (OCD) (International Cartilage Repair Society OCD IV) on not only the clinical outcome, including functional and radiographic assessment, but also postoperative second-look arthroscopic and histologic evaluation., Methods: Nine International Cartilage Repair Society OCD IV fragments were fixed with bioabsorbable pins made of poly-L-lactic acid after curettage of the bed and bone grafting. In 4 cases with severe cartilage damage in the fragments, after resection of the damaged part, trimmed fragments were fixed and osteochondral autologous transplantation was performed to cover the remaining defects. The follow-up period was at least 2 years (range, 2 to 3 years). Lysholm score and computed tomography (CT)/magnetic resonance imaging (MRI), second-look arthroscopy, and biopsy findings were examined postoperatively., Results: All patients ultimately could return to previous sports activity, and the mean postoperative Lysholm score was 97 (range, 90 to 100). At 6 months, CT/MRI scans showed complete union and smooth continuity of articular surface in all cases. Second-look arthroscopy in 7 cases showed that fixed fragments were stable and that there were no progressive degenerative changes in the cartilage. Postoperative histologic examination in 4 cases showed almost normal cartilage from surface to bottom in terms of viability and quality. In addition, new bone trabeculae were covering dead bone trabeculae, which is called creeping substitution., Conclusions: Our study shows good short-term clinical results, as well as confirmation of healing on CT/MRI and second-look arthroscopy., Level of Evidence: Level IV, therapeutic case series., (Copyright (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Synovial osteochondromatosis is a rare condition, found mainly in larger joints, where as it is particularly rarer in small joints especially the metatarsophalangeal joint. We report the case of a 45-year-old man with primary synovial osteochondromatosis in the first metatarsophalangeal joint. Following surgical intervention, the diagnosis was confirmed with histological examination. The patient had successful management and is completely symptom free on 12-month review. A summary of the case and review of the current literature with the incidence of this condition and risks involved are discussed., (Copyright 2008 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to investigate on hip pathology found at hip arthroscopy in Australian Football League (AFL) players and describe our current treatments and outcomes., Methods: From 2003 to 2008, 24 consecutive AFL players (27 hips) had arthroscopic hip surgery by use of the lateral position. Patients were assessed preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS) and postoperatively with a satisfaction survey., Results: All hips were available for review. The mean duration of follow up was 22 months (range, 6 to 60 months). The mean age was 22 years (range, 16 to 29 years). The mean body mass index was 24 points (range, 21 to 26 points). The mean traction time was 21 minutes (range, 11 to 60 minutes). The most common pathology was a rim lesion, affecting 93% of cases. Microfracture was performed in 22%. Synovitis was found in 70%, and this was most commonly associated with a rim lesion. Labral pathology was present in 33%, the most common of which was labral separation. On the femoral side, 81% had cam impingement and underwent a femoral neck ostectomy. Rim lesions and labral pathology were the most commonly associated lesions. Also seen were loose os acetabuli in 7% and loose bodies in 7%. The former were associated with labral tears and required repair. The MHHS and NAHS improved in all patients postoperatively, and they maintained their improvement from 1 year up to 4 years. In all but 1 case, the players returned to playing at the AFL level and were satisfied with their outcome., Conclusions: Using hip arthroscopy, we have observed high satisfaction levels and return to preinjury levels of play in all but 1 case. Postoperative hip scores (MHHS and NAHS) have improved significantly, and this improvement has been maintained for up to 4 years., Level of Evidence: Level IV, therapeutic case series., (Copyright (c) 2010 Arthroscopy Association of North America. All rights reserved.)

Background: Chondral lesions, peroneal tendon tears, and other disorders in patients with chronic ankle instability may not be detected by preoperative MRI. Also, MRI often is obtained and interpreted at the referring institution, leading to variability in reading., Questions/purposes: We assessed the accuracy of the radiologists' and orthopaedic surgeon's reading of preoperative MRI for diagnosing ankle lesions in patients with ankle instability warranting surgery., Patients and Methods: We retrospectively reviewed 133 patients who underwent 135 surgeries for lateral ankle ligament reconstruction with concomitant ankle arthroscopy and who had preoperative MRI., Results: We found 72 associated lesions in 66 of the 135 surgeries, including 38 chondral injuries, 18 peroneus brevis tears, seven loose bodies, and nine other miscellaneous abnormalities. Eliminating eight lesions for which the decision to operate was not based on operative findings, there were 127 surgeries with 64 associated lesions that required intraoperative confirmation or were detected intraoperatively. In the original reports, the radiologists identified 39% (15) of the chondral injuries, 56% (10) of the peroneal tears, and 57% (four) of the loose bodies. Radiologists' MRI sensitivity for detecting lesions was 45%. The attending surgeon identified 47% (18) of the chondral injuries, 89% (16) of the loose bodies, 71% (five) of the peroneus brevis tears, and the posterior talus process lesion, with a sensitivity of 63%., Conclusions: Our data suggest orthopaedic surgeons should review preoperative MRIs and also suggest the sensitivity of MRI may not be adequate to detect lesions in these patients before surgery., Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Purpose: The purpose of this study was to develop and validate a model predicting whether patients would have shorter-than-typical or longer-than-typical recoveries after hip arthroscopy for labral tears., Methods: We retrospectively reviewed 268 cases of hip arthroscopy implemented between 2000 and 2007 by 2 orthopaedic surgeons at our institution. The development cohort consisted of patients with magnetic resonance angiography-identified labral tears and a history and physical examination consistent with either labral pathology or loose bodies. Univariate analysis targeted preoperative patient characteristics correlated with the risk of longer-than-typical recoveries. Multivariate logistic regression was applied to generate an algorithm predicting risk of longer-than-typical recovery based on baseline characteristics. The algorithm was tested in the validation sample of 52 patients who were treated in 2007 and was found to be valid., Results: Five predictors for longer-than-typical recovery were identified: Workers' Compensation status, female gender, use of pain medications, presence of a limp, and presence of a lateral labral tear. The multivariate algorithm was developed and successfully validated., Conclusions: This study identifies many new predictors of recovery, and it also corroborates those that have already been identified. The 5 predictors for longer-than-typical recovery identified by our validated multivariate algorithm were Workers' Compensation status, female gender, use of pain medications, presence of a limp, and presence of a lateral labral tear., Level of Evidence: Level IV, therapeutic case series., (Copyright 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a benign lesion characterized by the formation of metaplastic cartilaginous nodules. SC of the TMJ usually only affects the superior joint compartment of the TMJ. The authors report a rare case of SC of the TMJ affecting the inferior and superior joint compartments., (Copyright 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The authors report a case of an undiagnosed Kocher-Lorenz fracture in a 12-year-old adolescent. The Kocher-Lorenz type fracture involves a superficial osteochondral shell of the capitellum with little underlying bone. Three years after trauma, the patient still complained of throbbing and occasional elbow pain. Radiographic examination revealed a large intra-articular bone fragment mimicking the shape of a "second radial head", between the lateral condyle's ossification center and the radial head. Surgical treatment by fragment excision was performed. Eight years postoperatively, the patient had fully recovered with complete relief of pain. The patient demonstrated full range of motion in all planes. The authors offer a review of the literature on this rare fracture which diagnosis is often delayed., (2009 Published by Elsevier Masson SAS.)

This case shows a typical presentation of an osteochondrosis dissecans lesion on the capitellum, with associated intra-articular loose bodie(s), diagnosed on plain film. Osteochondrosis dissecans (OCD) is a rather common entity. Mostly the knee joint is involved. Only 5% of OCD lesions occur in the elbow joint. Possible causes of osteochondrosis dissecans include (repetitive) trauma (e.g. in throwing sports or gymnastics), ischemia, ossification defects, and genetic factors. Conventional radiography mostly has a low sensitivity to detect OCD lesions, and is often normal in early stages. CT is more sensitive to detect intra-articular loose bodies. MRI detects very early stages of OCD and radiographically occult lesions that may not be evident on CT.

Graft fixation in anterior cruciate ligament (ACL) reconstruction is commonly performed with bioabsorbable devices. This article presents a case of a broken bioabsorbable tibial interference screw (Gentle Threads; Biomet, Warsaw, Indiana) that presented as an intra-articular loose body 4 months after ACL reconstruction with posterior tibialis tendon allograft. A 19-year-old man presented with symptoms of pain and catching for 1 week but reported no history of trauma. The broken screw tip was identified on magnetic resonance imaging examination, and the remaining screw appeared to be overinserted into the tibia. During arthroscopic removal, a 10-mm screw tip was found in the lateral gutter. The ACL graft was found to be well fixed, but small areas of chondral damage were found in the patellofemoral and medial compartment. The patient's symptoms resolved postoperatively. To our knowledge, this is the earliest report of a broken bioabsorbable interference screw and only the second report of subsequent chondral injury due to intra-articular migration. Although rare, late breakage and intra-articular migration of bioabsorbable interference screws should be considered during the postoperative evaluation of any patient with pain or mechanical symptoms, regardless of trauma. This case also supports the importance of both measurement of tibial tunnel length and inspection of the intercondylar notch following interference screw insertion. Orthopedic surgeons performing ACL reconstruction must be aware of this possible complication and its potential for devastating chondral injury.

Aim: Describe the technique of the elbow arthroscopy and discuss their indications through a series of 12 cases and a review of the literature., Methods: We report a retrospective study of a short series of 12 cases of elbow arthroscopy performed on 4 years. The indications of this technique were loose bodies in 7 cases, parcellar displaced fracture of radial head in 3 cases, fracture of coronoid process in one case and osseous impingement in one case., Results: We have noted no complications and at a mean follow up of 18 months (6 to 40 months) our results were almost satisfactory., Conclusion: Elbow arthroscopy is an effective but delicate technique. Its indications are not frequent. They are dominated by loose bodies.

Arthroscopy of the elbow was originally considered to be an unsafe procedure because of the small size of the elbow joint capsule and its proximity to several crucial neurovascular structures. Over the past decade, however, the procedure has become safer and more effective. These improvements can be attributed to a better understanding of elbow anatomy and of the disorders about the elbow as well as to advances in arthroscopic equipment and surgical technique. The most common indications for elbow arthroscopy include removal of loose bodies, synovectomy, débridement and/or excision of osteophytes, capsular release, and the assessment and treatment of osteochondritis dissecans. More recent advances have expanded the indications of elbow arthroscopy to include fracture management (eg, radial head fractures) and the treatment of lateral epicondylitis.

We report a case of synovial chondromatosis of the temporomandibular joint in which both joint compartments were affected. Because of the important involvement of the medial aspect of the joint, arthrotomy was done with arthroscopic assistance.

The aim of this study was to investigate temporomandibular joint (TMJ) pain and magnetic resonance imaging characteristics in 104 TMJs with and 58 without degenerative changes of the condyle, such as osteophytes, erosion, avascular necrosis, subcondral cyst and intra-articular loose bodies. TMJ images were also assessed for flattening, retropositioning and hypomobility of condyle and disc displacement. Comparison of the TMJ side-related data showed a significant relationship between disc displacement without reduction (DDwoR) and the presence of degenerative bony changes (p=0.00). Flattening, retropositioning and hypomobility of condyle showed no significant difference in relation to the presence or absence of degenerative bony changes. Retropositioning of the condyle was significantly associated to disc displacement with reduction (DDwR) (p=0.00), while condylar hypomobility was significantly more frequent in TMJ with DDwoR (p<0.05). Independent of the presence or type of DD, TMJ pain was more frequent in the presence of degenerative bony changes. When considering only DDwR, TMJ pain was significantly associated to a degenerative condition (p=0.03). When there were no degenerative bony changes, TMJ pain was significantly more frequent in DDwoR (p=0.04). Despite the present findings, the absence of symptoms in some patients with condylar bony changes suggests that the diagnosis of osteoarthritis should be established by evaluation of magnetic resonance images in association with clinical examination.

Synovial chondromatosis is a rare disease with an unknown etiology, and can be defined as a synovial process characterized by the formation of metaplastic cartilaginous foci inside the connective tissue of articular surfaces. The disease is classified as primary or secondary. The cause of primary disease is unknown, but its pathogenesis involves the development of chondroid foci in synovial membranes. Secondary disease is caused by synovial tissue pathophysiologies, such as, trauma or infection, adjacent to an involved joint. Plain radiographs reveal multiple calcific nodules in glenohumeral joints. However, X-ray diagnosis is often delayed and extremely difficult when the disease is not calcified. Magnetic resonance imaging (MRI) and computed tomography are helpful. For treatment, open or arthroscopic synovectomy and loose body removal are recommended. The authors experienced a rare case of radiologically non-visible synovial chondromatosis, which was viewed as the cause of postoperative residual pain and limitation of motion in a young male with open capsular shift. This case report is presented to emphasize the role of arthroscopy and MRI in the early diagnosis and treatment of synovial chondromatosis.

Clear indications have been recognised for arthroscopic surgery of the elbow since the 1980s. Good indications are loose bodies, mild or moderate restriction of the range of movement and early stages of rheumatoid arthritis. Cartilage diseases such as Panner disease or focal radial chondropathy can be treated by arthroscopic debridement and microfracturing. Impingement syndromes affecting the lateral compartment of the joint respond well to resection of synovial plicae. The technical demands of endoscopic arthrolysis procedures for joints with mild or moderate restriction of range of movement are extremely heavy; only experienced surgeons should operate on such patients. Arthroscopy of the elbow joint should be carried out only by operators who have already gained experience in other joints, because of the close relations of nerves and vessels in the elbow. A rigorous standard should be followed in planning the procedure and in creation of the portals and performance of the diagnostic round-up in the joint, to make it possible to work purposefully and quickly, and thus with minimum complications.

Objective: To assess the specificity and sensitivity of MR arthrography of the hip in comparison with arthroscopy for the evaluation of intra-articular loose bodies., Design: Over a 3-year period, 81 consecutive patients underwent a total of 82 hip arthroscopies by a single orthopedic surgeon for intractable hip pain. Of the 82 arthroscopies, 70 had pre-operative MR arthrograms. Of these, 57 were available for retrospective review, after which they were compared with the operative notes of the subsequent arthroscopies., Results: Of 82 arthroscopies 16 (20%) demonstrated intra-articular loose bodies, while, in the study group, nine of 57 had loose bodies (16%). There was a total of seven discordant cases (five false negatives and two false positives). The sensitivity of MR arthrography for detection of intra-articular loose bodies was 44%, while the specificity was 96%., Conclusion: While the specificity of MR arthrography for the detection of intra-articular loose bodies was high (96%), the sensitivity was not nearly as good (44%).

Localized pigmented villonodular synovitis (LPVS) is widely accepted to frequently develop symptoms resembling internal derangement in the knee, including limitation of motion and episodes of giving way and locking. We report the case of a 31-year-old man with LPVS displaying an unusual presentation. After sustaining a twisting injury to the knee, he suffered constant but subtle knee discomfort, sudden attacks of pain and a feeling of a loose body. Arthroscopic examination 1 month after injury revealed a freely mobile tumor in the supra-patellar pouch that was not pedunculated and displayed no soft tissue attachments to the synovium. Histological findings for the tumor were consistent with a diagnosis of LPVS. This case illustrates that LPVS may present with symptoms of a loose body after trauma to the knee.

Giant bursitis with rice bodies is an important clinical entity recognized in rheumatoid arthritis. Usually the bursitis is connected to a joint space. In this unusual case of a giant bursitis of the shoulder/neck region, no connection to a joint could be found. The bursitis lays directly on a rib. The clinical and radiological findings are presented and this special case is discussed in comparison to the literature.

Various causes have been reported for cystic lesions arising from the cruciate ligaments. We present a case of synovial chondromatosis that involved the posterior cruciate ligament and was treated by an arthroscopic posterior-posterior triangulation method. We recommend that synovial chondromatosis be considered in the differential diagnosis of cystic lesions of the cruciate ligaments. Lesions involving the posterior aspect of the posterior cruciate ligament, as in the presented case, can be accessed via the standard anterior arthroscopic portals. However, scattered synovial chondromatosis masses located in the posterolateral compartment are difficult to access via anterior portals. We suggest that the arthroscopic posterior-posterior triangulation technique may be useful for the management of such cases.

Synovial chondromatosis of the temporomandibular joint (TMJ) is relatively rare. An unusual case with extension through the glenoid fossa and into the middle cranial fossa is reported. Invasion of the infratemporal fossa and the middle cranial fossa was seen on both computed tomography and magnetic resonance imaging. Complete removal of the loose bodies with excision of the affected synovium is the accepted treatment of synovial chondromatosis. A conservative approach should be followed while trying to eliminate any remaining lesion in the infratemporal fossa and the middle cranial fossa. An overview of previously reported cases of synovial chondromatosis with cranial extensions is also presented.

Knee joint is the most common site of synovial chondromatosis with the prevalence in middle-aged male. The following is the description of a 14-year-old girl presented with a knocking sensation during the motion of her joint, which is a less common occurrence at her age. Loose bodies in the left knee joint were excised as much as possible with arthroscopy. The patient was asymptomatic when moving her knee after arthroscopic synovialectomy and removal of the loose bodies. In spite of the less possibility of malignant transformation of synovial chondromatosis, long-term follow-up is still recommended in this 14-year-old girl due to the supposed genetic abnormalities.

The case presented is that of a 23-year-old man suffering from osteochonditis dissecans (OCD) of the medial femoral condyle, in whom a free piece of cartilage had separated off and there was a large osteochondral defect despite numerous operations. After refixation of the fragment failed, an autologous chondrocyte transplantation (ACT) was performed using the sandwich technique. Three years after the operation the patient is very satisfied with the result. The radiological findings show stable repair of the bony and cartilaginous defect area. This case report shows that ACT is a valid method for the treatment of large osteochondral defects even after several previous failed operations. The low donor site morbidity is an important advantage over other methods, such as transplantation of osteochondral plugs.

We will report on a case with a large intra-articular loose body in the metacarpophalangeal (MP) joint of the middle finger in a 30-year-old-male, which was mimicking a calcified tumourous lesion adjacent to the palmar side of the metacarpal head. It was easily removed through the palmar approach.

Osteochondritis dissecans (OCD) is a disease of unknown etiology, characterized by separation of necrotic bone from its bony bed. While the juvenile form seen in patients with open physes has a 60-90% rate of spontaneous resolution, the adult form has virtually no chance of spontaneous healing. Plain X-rays are sufficient for the diagnosis, and magnetic resonance imaging (MRI) is essential for evaluation of disease progression and/or healing. The clinical correlation of MRI criteria defined in recent years to determine stability of the lesion is high. Juvenile OCD can be treated conservatively if there are no signs of instability on magnetic resonance images. Adult patients or unstable lesions in children should be treated surgically. For stable lesions, arthroscopic antegrade perforation is indicated to increase vascularity and stimulate healing. Unstable or displaced lesions should be treated with debridement, internal fixation, and cancellous bone grafting. Although cannulated metal screws are the most widely used implants for internal fixation, biodegradable implants have also been utilized in recent years. Loose fragments that are too deformed to be internally fixed should be removed and cartilage reconstruction techniques should be employed for the remaining crater. Long-term results of loose body removal alone are unsatisfactory. Modern cartilage restoration techniques are technically demanding due to the large, deep, and unconfined nature of the defect in the femoral condyle.

We reviewed consecutive patients undergoing hip arthroscopy for loose bodies after sustaining hip dislocations and fracture-dislocations not requiring open fracture management. Eleven patients were identified, all with intra-articular loose bodies diagnosed by computed tomography. After 3 weeks, all patients underwent hip arthroscopy in which loose bodies were removed and labral pathology debrided. No patient developed any of the complications (avascular necrosis, heterotopic ossification, nerve injury) associated with hip arthrotomy. Arthroscopic treatment of intraarticular loose bodies after hip dislocations and fracture-dislocations allows excellent joint visualization for loose body removal and labral tear diagnosis and treatment.