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Introduction: Foot-ankle offset (FAO) is a three-dimensional (3D) biometric measurement of hindfoot alignment (HA) measured on images from weight-bearing computed tomography (WBCT). Our aim was to investigate its distribution in a large cohort of patients, hypothesizing that threshold FAO values in valgus or varus could be identified as markers for increased risk of associated pathologies., Materials and Methods: Prospective, monocentric, level II study including 125 subjects (250 feet) undergoing bilateral WBCT [58.4% female; mean age, 54 years (18-84)]. Patients were clinically assessed and pathologies were classified according to anatomic location (valgus- or varus associated). HA was measured using FAO on 3D datasets and tibio-calcaneal angles (TCA) on two-dimensional Saltzman-El-Khoury views. Threshold FAO values and area under the receiver operating characteristics curve (AUC) were calculated for predicting increased risk of medial or lateral pathologies., Results: Mean FAO was 1.65% ± 4.72 and mean TCA was 4.15° ± 7.67. Clinically, 167 feet were normal, 33 varus and 50 valgus with FAO values of 1.71% ± 3.16, - 4.96% ± 5.30 and 5.79% ± 3.77, respectively. Mean FAO was 0.99% ± 3.26 for non-pathological feet, - 2.53% ± 5.05 for lateral and 6.81% ± 2.70 for medial pathologies. Threshold FAO values of - 1.64% (51.4% sensitivity, 85.1% specificity, AUC = 0.72) and 2.71% (95% sensitivity, 82.8% specificity, AUC = 0.93) best predicted the risk of lateral and medial pathology, respectively., Conclusion: Patients with FAO between - 1.64% and 2.71% had the least risk of degenerative foot and ankle pathology. This interval could be considered a target for patients undergoing realignment procedures., Clinical Relevance: A "safe zone" for Foot Ankle Offset was described between - 1.64% and 2.71%, for which the risk of foot and ankle pathologies is lower., Level of Evidence: II-Diagnostic study., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Cone-beam scanners (CBCT) enable CT to be performed under weight-bearing - notably for the foot and ankle. The technology is not new: it has been used since 1996 in dental surgery, where it has come to replace panoramic X-ray. What is new is placing the scanner on the ground, so as to have 3D weight-bearing images, initially of the foot and ankle, and later for the knee and pelvis. This saves time, radiation and money. It is now increasingly used, but is unfortunately limited by not having specific national health insurance cover in France, and by the psychological reticence that goes with any technological breakthrough. A review of the topic is indispensable, as it is essential to become properly acquainted with this technique. To this end, we shall be addressing 5 questions. What biases does conventional radiography incur? Projecting a volume onto a plane incurs deformation, precluding true measurement. Conventional CT is therefore often associated with an increased dose of radiation. What is the impact of CBCT on radiation dose, costs and the care pathway? The conical beam turns around the limb (under weight-bearing if so desired) in less than a minute, making the radiation dose no greater than in standard X-ray. What does the literature have to say about CBCT, and what are the indications? CBCT is indicated in all foot and ankle pathologies, and indications now extend to the upper limb and the knee, and will soon include the pelvis. How are angles measured on this 3D technique? The recently developed concept of 3D biometry uses dedicated software to identify anatomic landmarks and automatically segment the bones, thereby enabling every kind of measurement. What further developments are to be expected? CBCT may become indispensable to lower-limb surgical planning. Artificial Intelligence will reveal novel diagnostic, prognostic and therapeutic solutions. LEVEL OF EVIDENCE: V; expert opinion., (Copyright © 2020. Published by Elsevier Masson SAS.)

Purpose: To compare the contribution of various radiographic projections in the evaluation of impingement syndrome and rotator cuff tears. Materials and method. We realized a prospective study in 53 patients with suspected rotator cuff tear, evaluated by plain radiographs and arthrography (gold standard). 31 patients were men and 22 were women (mean age 51 years). In all patients, anteroposterior radiograph, strict anteroposterior straight-beam decubitus view and anteroposterior radiograph during Leclercq's maneuver of the affected shoulder were obtained. The population was divided into three groups: group 1: normal arthrography (n=19), group 2: isolated supraspinatus tendon tear (n=23), group 3: rupture of the supraspinatus and infraspinatus tendons (n=11). The acromio-humeral space was measured on all these views and differences between the three groups were statistically analyzed., Results: There is a significant statistical difference between the height of the acromio-humeral space found in patients with isolated tear of the supraspinatus tendon and those with a tear extending to the infraspinatus tendon (p=0.0001). The ROC methodology showed a better accuracy of the strict anteroposterior straight-beam decubitus view in cases of wide ruptures of the rotator cuff, and this for a selected threshold value of 6 mm., Conclusion: Strict anteroposterior straight-beam decubitus view, seems to be easy to realize, cheap, reproducible and very powerful in the preoperative assessment of patients with suspected rotator cuff tendon tear. It allows an excellent visualization of the acromioclavicular joint.

Objective: We performed this study to define the normal patterns of the glenohumeral joint with kinematic MR imaging in healthy volunteers., Subjects and Methods: Twenty healthy volunteers (39 shoulders) were studied with a 1.5-T imager. Successive fast low-angle shot images (75/11 [TR/TE], 15 degrees flip angle) were obtained in the axial plane from full internal to full external rotation at the superior, middle, and inferior glenoid levels., Results: The free margin of the anterior labrum was seen to be slightly mobile and its base was always fixed. The anterior labrum showed changes in shape and signal intensity during internal rotation (54%). The posterior labrum remained motionless in 97% of patients and no shape or signal-intensity changes were noted during internal rotation. The anterior joint capsule was taut during external and internal rotation, exhibited a slack pattern in 51% of patients, and a folded pattern in 14% of patients., Conclusion: Kinematic MR imaging, which permits dynamic evaluation of the various anatomic components that may be involved in shoulder instability, also provides information on the labrocapsular ligamentous complex.

Purpose: To define the normal patterns of gleno-humeral joint, with kinematic MR imaging in asymptomatic volunteers., Material and Method: Twenty asymptomatic volunteers (39 shoulders) were studied with a 1.5 Tesla imager. Successive acquisitions Flash (99, 18, 15 degrees) were obtained in the axial plane, from full internal to full external rotation, at the superior, mid and inferior glenoid level., Results: Free edge of the anterior labrum was noted slightly mobile, its base was always immobile. The anterior labrum exhibited modification of shape and increased signal intensity in internal rotation (54%). The posterior labrum remained motionless in 97% and neither shape or signal intensity changes were noted in internal rotation. Inferior labro-capsular ligamentous complex was visualised in all cases. The anterior capsular joint was taut in external rotation and exhibited a slack (51%) or folded (13.5%) pattern during internal rotation., Conclusion: Kinematic MR imaging allows a dynamic assessment of the different anatomic components which may be implicated in shoulder instability. It provides information about the labro-capsular ligamentous complex.

Massive osteolysis of Gorham is a clinical, radiographic, and histologic entity characterized by histologically benign vascular proliferation involving bone associated with extensive osteolysis. We present CT and MRI findings of the disease and serial radiography following the progressing bone destruction.

Forty cases of foraminal (28) and lateroforaminal (12) herniated discs treated either by nucleolysis (N.L.) or percutaneous automated nucleotomy (P.A.N.) were investigated over a period of 12 months or more. The group of patients treated with P.A.N. (15 males, 5 females) with a mean age of 41.8 years, had severe radicular pain in 25% of cases, caused by foraminal (15 cases) and lateroforaminal (5 cases) herniated discs which were predominantly located at the L4-L5 level (12 cases). The group of patients treated with N.L. (13 M, 7 F) with a mean age of 50.3 years complained of severe radicular pain in 65% of cases, caused by foraminal (13 cases) and lateroforaminal (7 cases) disc herniations evenly distributed over the last three mobile segments. The overall results obtained with N.L and P.A.N. showed a 67.5% success rate. The best results were obtained in cases of cruralgia with severe radicular pain caused by foraminal herniated disc at the L3-L4 or L4-L5 levels. A significantly better result was obtained in the group of patients treated by N.L. (80% success rate) than in the group of patients treated by P.A.N. (p < 0.04).

The purpose of this study was to determine magnetic resonance imaging (MRI) features of osteoid osteomas and to evaluate the place of MRI in the diagnostic workup of suspected osteoid osteoma by comparing its diagnostic value with that of computed tomography (CT). Nine patients with radioclinical features highly suggestive of osteoid osteoma were investigated using bone scintigraphy, CT scan and MRI. MRI sequences were weighted for T1 (TR: 500 ms-TE: 34 ms), T2 (TR:2000 ms-TE:50-100 ms) and T1 after intravenous injection of gadolinium-DTPA contrast material. The appearance of the nidus and surrounding area were analyzed, as well as the accompanying inflammatory reaction involving the bone marrow, soft tissues or synovium. All patients had surgical treatment. Clinical recovery was achieved in every case. Histological studies confirmed the diagnosis of osteoid osteoma in 7 patients. In two cases, histological confirmation was not obtained and the exact nature of the lesion therefore remained in doubt, although clinical and scintigraphic findings as well as the subsequent course were consistent with the diagnosis of osteoid osteoma. In 5 cases, MRI proved inferior to CT scan for detecting the nidus. MRI disclosed edema of the bone marrow not seen on CT scan sections in 5 cases, edema of the soft tissues in three cases, and synovitis with joint effusion in one patient with an epiphyseal osteoid osteoma. At present, MRI plays only an ancillary role in the diagnosis of osteoid osteoma, which rests on the concomitant use of bone scintigraphy and CT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

Taenia saginata is a parasite of the gastrointestinal tract which is often encountered in France. Its responsibility in the occurrence of pulmonary eosinophilic infiltrates is only exceptionally suspected. We report a case of Loeffler's syndrome most probably caused by Taenia saginata. This case illustrates the diagnostic problems encountered to determine the responsibility of this cestode.