A head-to-head comparison of high-frequency ultrasound and magnetic resonance imaging for preoperative assessment of ATFL tears and concomitant CFL injuries

Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps pathologies - a prospective study.

OBJECTIVE To validate the diagnostic properties of orthopedic tests and qualitative and quantitative high-resolution ultrasound-based (HRUS) assessments in the diagnosis of long head of the biceps tendon (LHBT) pathologies. DESIGN Single blind prospective study evaluating orthopedic tests and HRUS diagnostic performances compared to surgery. SETTING Hospital orthopaedic department. PARTICIPANTS Seventy-one adults scheduled for open or arthroscopic shoulder surgery were included within six weeks of their scheduled surgery. INTERVENTION Participants underwent a preoperative clinical examination, including the Speed's, O'Brien's, Uppercut, and Yergason's tests, and palpation of the bicipital groove, as well as both qualitative and quantitative HRUS evaluation of the LHBT. Afterwards, the LHBT was evaluated during surgery to confirm the diagnosis, with the surgeon blinded from the clinical and HRUS examination. MAIN OUTCOME MEASURE(S) Diagnostic properties were determined for 1) each individual orthopedic test and combinations of tests, 2) qualitative HRUS data alone and in combination with orthopedic tests, and 3) quantitative HRUS data. A receiver operating characteristic (ROC) curve was used to assess the ability of quantitative HRUS to discriminate the presence of LHBT tendinopathy. RESULTS The overall diagnostic performance of the orthopedic special tests was low. Qualitative HRUS exhibited promising diagnostic properties for identifying full-thickness tears (Sensitivity 63%, Specificity 86%) and LHBT dislocation/subluxation (Sensitivity 38%, Specificity 81%). However, combining qualitative HRUS with orthopedic tests and participant age yielded the best properties (i.e., improvement in sensitivity and specificity across all LHBT diagnoses). The diagnostic performance of quantitative HRUS varied depending on the cut-off values used; the best results observed using a maximal surface area greater than 21 mm² (Sensitivity 55%, Specificity 86%). CONCLUSION Qualitative HRUS shows promising diagnostic potential but should be used in conjunction with orthopedic tests. Further research is needed to validate these preliminary results and refine the pathological cut-offs values of quantitative HRUS assessments.

Analysis of Pre- and Postoperative Magnetic Resonance Imaging and Functional Status in Anterior Talofibular Ligament Injury Managed with Arthroscopic Modified Broström Procedure

The arthroscopic modified Broström procedure (aMBP) with internal bracing has become an increasingly favored surgical option for managing anterior talofibular ligament (ATFL) injuries, particularly due to its potential to expedite return to daily activities and sports. However, the intrinsic quality of the ATFL and surrounding tissue remains a critical prognostic factor for successful anatomic repair. Magnetic resonance imaging (MRI) offers a noninvasive and powerful tool for evaluating ATFL integrity and associated intra-articular pathology. In particular, T2-weighted MRI signal intensity has been shown to correlate inversely with ligament biomechanical strength. This study aimed to examine the relationship between MRI-based ligament characteristics and postoperative clinical outcomes in patients undergoing aMBP for ATFL injury. A retrospective analysis was conducted on 100 patients with confirmed ATFL injuries who underwent aMBP with internal bracing. Preoperative and 6-month postoperative MRI scans of the injured ankle were reviewed. Functional assessment was performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score at baseline, 2 months, and 6 months postoperatively. ATFL morphology was categorized as wavy-shape or discontinuity on preoperative MRI. Radiographic parameters, including talar tilt angle and anterior talar translation, were also evaluated. Both morphological groups demonstrated statistically significant postoperative improvements in AOFAS scores, talar tilt angles, and anterior talar translation ( P <.05). At 6 months postoperatively, all repaired ATFLs exhibited a continuous linear band structure on MRI, and 64.9% (63 of 97) demonstrated low signal intensity on T2-weighted sequences. The continuity group had a significantly higher prevalence of low signal intensity compared to the discontinuity group (80.9% vs. 50.0%, P < 0.05). aMBP with internal bracing effectively improved functional and radiological outcomes across all morphological subtypes. However, better preoperative ATFL morphology exhibited more favorable postoperative MRI characteristics, suggesting a higher capacity for biological healing and ligament maturation.

Magnetic Resonance Imaging Evaluation of Meniscal Ramp Lesions and their Association with Anterior Cruciate Ligament Injury Severity: A Retrospective Observational Study.

The strong association with ACL injury and having a potentially important role in knee stabilisation, their injuries need to be given due importance by radiologists and should not be underreported.

Role of Direct MRI Arthrography by Combined Distal Radioulnar and Radiocarpal Compartment Contrast Injection Over Conventional MRI in Detection and Differentiation of Triangular Fibrocartilage Complex Injuries.

Impact of MRI on the management of CT-defined AO spine A/B thoracolumbar fractures.

OBJECTIVES To assess the added value of emergency spine MRI compared with CT alone in patients with AO Spine A/B thoracolumbar trauma without neurological deficit, focusing on clinical management. MATERIALS & METHODS This retrospective single-center study included consecutive trauma patients who underwent both CT and spine MRI between November 2023 and October 2025. CT served as the index test and MRI as the adjunct modality for fracture characterization and posterior ligamentous complex (PLC) assessment. MRI was performed according to an indication-driven institutional protocol. Changes in treatment strategy (conservative, minimally invasive, invasive) before versus after MRI were analyzed. Paired Wilcoxon signed-rank, McNemar, and symmetry tests were used as appropriate. Agreement was assessed using Cohen's κ. Predictors of MRI-driven management change were explored using Fisher's exact test and multivariable logistic regression. RESULTS A total of 158 patients were included (114 men; mean age, 35.8 ± 12.4 years; range 18-59). MRI detected a higher number of fractured vertebrae than CT (2.2 ± 1.8 vs. 1.5 ± 1.0; p < 0.001). MRI led to a change in treatment strategy in 19 patients (12%), predominantly reflecting escalation of care (p < 0.001). Management change was driven by MRI-detected PLC injury in 17 patients (partial in 8, complete in 9), by occult spinal cord injury without clinical translation in 2 patients, and by both mechanisms simultaneously in 4 patients. AO Spine fracture classification changed after MRI in 39 patients (25%), reflecting substantial overall agreement between MRI and CT (κ = 0.64; p < 0.001). MRI identified significantly more posterior ligamentous complex injuries (AO Spine type B) than CT when comparing fracture classification (48 vs. 16 patients; p < 0.001) and dedicated PLC status assessment (48 vs. 13 patients; p < 0.001). No CT-based variable remained independently associated with management change after adjustment. CONCLUSION In selected patients with neurologically intact thoracolumbar trauma, emergency spine MRI modified therapeutic management in 12% of cases, primarily by revealing posterior ligamentous complex injuries and occult spinal cord findings not apparent on CT. These results support an indication-driven rather than systematic use of MRI.

MRI Utilization in Acute Ankle Inversion Injuries: Indications and Optimal Timing

MRI performed after initial symptom improvement yields greater diagnostic accuracy and reduces unnecessary ED imaging and should be selectively reserved for cases with persistent clinical suspicion on physical examination or when results may alter management.