Primary repair of the anterior cruciate ligament (ACL) is being performed increasingly in the treatment of acute proximal ACL ruptures. Advantages of ACL repair over surgical reconstruction with a tendon graft include preservation of the anatomy and proprioceptive function of the native ACL, and therefore, faster rehabilitation. The addition of an internal brace protects the repair during ACL healing and can increase the success rate of the procedure. Given this evolution of ACL surgical treatment, radiologists should be familiar with the new repair techniques and their appearances on postoperative imaging. In this article, we describe two different surgical techniques for primary ACL repair, dynamic intraligamentary stabilisation and internal brace ligament augmentation, and provide an overview of the normal and abnormal appearances after this type of repair at magnetic resonance imaging (MRI) follow-up.

OBJECTIVE:To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma.MATERIALS AND METHODS:Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared.RESULTS:Fracture detection on CBCT increased by 35% and 37% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236% and 185%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT.CONCLUSION:CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.

Poster: ECR 2014 / C-1412 / Cone Beam Computed Tomography: Clinical Applications in Musculoskeletal Imaging. by: E. De Smet1, G. De Praeter1, K. L. Verstraete2, F. M. H. M. Vanhoenacker3; 1Duffel/BE, 2Ghent/BE, 3Antwerp, Ghent, Mechelen/BE

Poster: ESSR 2014 / P-0101 / Imaging in spinal trauma: current concepts and pictorial review by: E. De Smet, F. M. H. M. Vanhoenacker, P. M. Parizel; Antwerp/BE

21st Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR), Riga, Latvia, June 26–28, 2014

Background Peroneal nerve lesions are not common and are often exclusively assessed clinically and electromyographically. Methods On a routine MR examination without dedicated MR-neurography sequences the peroneal nerve can readily be assessed. Axial T1-weighted sequences are especially helpful as they allow a good differentiation between the nerve and the surrounding fat. Results The purpose of this article is to review the normal anatomy and pathologic conditions of the peroneal nerve around the knee. Conclusion In the first part the variable anatomy of the peroneal nerve around the knee will be emphasized, followed by a discussion of the clinical findings of peroneal neuropathy and general MR signs of denervation. Six anatomical features may predispose to peroneal neuropathy: paucity of epineural tissue, biceps femoris tunnel, bifurcation level, superficial course around the fibula, fibular tunnel and finally the additional nerve branches. In the second part we discuss the different pathologic conditions: accidental and surgical trauma, and intraneural and extraneural compressive lesions. Teaching Points • Six anatomical features contribute to the vulnerability of the peroneal nerve around the knee. • MR signs of muscle denervation within the anterior compartment are important secondary signs for evaluation of the peroneal nerve. • The most common lesions of the peroneal nerve are traumatic or compressive. • Intraneural ganglia originate from the proximal tibiofibular joint. • Axial T1-weighted images are the best sequence to visualise the peroneal nerve on routine MRI.

A 46-year-old woman presented to our department with persistent low back pain, which increased by back flexion and was released by flexion. On clinical examination, localized midline lumbar tenderness was noted.

The purpose of the Journal of the Belgian Society of Radiology is the publication of articles dealing with diagnostic and interventional radiology, related imaging techniques, allied sciences, and continuing education