PURPOSE:Anterior cruciate ligament (ACL) injuries are increasing in children and adolescents and reconstruction (ACLR) is now frequently performed in this population. Paediatric patients remain at higher risk of reinjury, possibly due to delayed graft remodelling. The current study aims to compare magnetic resonance imaging (MRI)-based graft remodelling between paediatric and adult populations at 1 year postoperatively. METHODS:We conducted a single-centre comparative pilot study including a prospectively collected cohort of 52 paediatric and 59 adult patients undergoing ACLR with a semitendinosus autograft folded in four (ST4) without additional lateral extra-articular tenodesis (LET). MRI was performed at 12 months postoperatively. Graft maturation was assessed using the signal-to-noise quotient (SNQ) and Howell scores. Tibial tunnel widening (TTW) and patient-reported outcome measures (PROMs) were also collected. RESULTS:The mean adjusted SNQ was significantly higher (p < 0.001) in paediatric patients (5.1; 95% confidence interval [CI] [4.3-5.9]) than in adults (1.5; 95% CI [0.9-2.2]), indicating slower remodelling. The Howell classification confirmed less mature grafts in children, with a predominance of Grade II. TTW was observed in similar proportions in both groups. PROMs were favourable and comparable in both groups. One paediatric patient experienced a graft rupture at 6 months, following premature return to pivoting sport. CONCLUSION:At 1-year post-ACLR, paediatric patients show delayed graft remodelling compared to adults. This slower biological incorporation may contribute to higher reinjury rates in young athletes and supports the need for prolonged rehabilitation and careful return to high-risk sports. LEVEL OF EVIDENCE:Level II.

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is increasingly performed in children and adolescents, yet mid- to long-term graft ligamentization remains poorly understood. Purpose: To characterize the magnetic resonance imaging (MRI) evolution of ACL grafts in pediatric patients between 2 and 5 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: The authors included 50 pediatric patients undergoing transphyseal ACLR with a semitendinosus tendon autograft folded in 4 without additional lateral extra-articular tenodesis to evaluate the evolution of ACL graft ligamentization over 5 years using quantitative (signal-to-noise quotient, SNQ) and qualitative (Howell grading) MRI criteria. The SNQ was measured in intra-articular and intra-tibial graft regions. Tibial tunnel widening (TTW) and its relation to graft signal were also assessed. MRI scans were performed at 6, 12, 24, and 60 months postoperatively. Results: Sixteen patients completed a 60-month follow-up. The median intra-articular SNQ peaked at 12 months, decreased by 24 months (median, 3), and finally stabilized, with no significant change at 60 months (median, 2.8; P = .999). Similar trends were observed for intra-tibial SNQ with no significant difference between 24 and 60 months ( P = .09). SNQ scores were compared using Wilcoxon signed-rank tests. Howell grading improved mainly within the first 24 months and remained stable thereafter, with Grade 1 or 2 in most grafts at final follow-up. TTW peaked at 6 months and gradually decreased. Conclusion: ACL graft ligamentization progresses primarily in the late first 2 years, followed by a subsequent plateau up to 5 years postoperatively.

Background:Growth-related complications are a concern in skeletally immature patients undergoing anterior cruciate ligament reconstruction (ACLR). Reported outcomes of growth disturbances following ACLR in this population are heterogeneous. Purpose:We hypothesized that transphyseal ACLR performed with a standardized technique results in mild radiological, but clinically non-significant growth disturbances. Methods:This single-center study prospectively enrolled 50 patients with open growth plates undergoing transphyseal ACLR. Magnetic resonance imaging of the operated knee was performed preoperatively and at 6, 12, 24, and 60 months postoperatively. Growth-related outcomes included tibial and femoral physeal-diaphyseal angles in coronal and sagittal planes, Harris growth arrest line deviation, focal physeal bone bridge formation, physeal violation by tunnels, skeletal maturity, and premature physeal closure. Growth disturbances were also evaluated clinically. Results:Sixteen patients completed the 60-month follow-up. Eighty-seven point five percent had reached skeletal maturity by then. Physeal-diaphyseal angles remained stable over time, with no significant differences between preoperative and 60-month measurements (medial tibial physeal angle, p-value = 0.20; lateral femoral physeal angle, p-value = 0.91; posterior tibial physeal angle, p-value = 0.16; posterior femoral physeal angle, p-value = 0.30). Angular deviations (≥ ±5°) were identified in 37.5% of cases, but were minimal (max -6° and + 5°) and clinically insignificant. Bone bridges were observed in three patients (18.8%) and resolved spontaneously. No premature physeal closure or Harris growth arrest line deviation was identified. Mean physeal violation was minimal. Significance of Study:This study supports the safety of transphyseal ACLR in skeletally immature patients. Conclusions:Transphyseal ACLR in skeletally immature patients appears to be associated with minimal physeal injury and a low risk of clinically relevant growth disturbances. Level of Evidence:IV, Retrospective case series of prospectively enrolled patients.

Introduction L’objectif de cet article est de proposer une aide pour la description d’un rachis traumatique en TDM. Données récentes Chez l’adulte, la TDM est l’examen de première intention. Les différentes classifications lésionnelles du rachis sont développées, selon l’étage atteint, avec une confrontation entre les descriptions historiques et modernes de l’AOSpine. Un compte rendu radiologique idéal est fourni avec six éléments clés. Un algorithme décisionnel est proposé pour définir la stabilité du rachis. Conclusion Cet article propose une aide utile au quotidien pour la description des atteintes traumatiques du rachis.

A machine learning algorithm using radiologic features from structured reports accurately classified focal bone lesions; Bone Tumor Imaging Reporting and Data System 2.0 was proposed to categorize model outputs into clinically meaningful malignancy risk classes.

Le recours à une imagerie après chirurgie de l’épaule doit être justifié, non systématique et apporter un véritable bénéfice pour le patient. Actuellement, il n’existe pas de consensus sur les indications d’imagerie pour les patients présentant une bonne évolution postopératoire, sans complications et avec de bons résultats fonctionnels. En cas d’évolution non favorable, les indications sont plus claires. La radiographie conventionnelle reste incontournable qui, combinée à l’échographie, constitue le socle de première intention. Les techniques d’imagerie de seconde intention, comme le scanner ou l’IRM, sont choisies en fonction du type de chirurgie réalisée, du contexte clinique du patient et des questions posées par le chirurgien à visée diagnostique et/ou thérapeutique. Le scanner, bien que facilement accessible, implique une irradiation « maîtrisée » et est susceptible de générer des artéfacts avec les implants métalliques. L’IRM, qui offre une excellente visualisation des tissus mous et ce sans irradiation, peut aussi présenter des risques d’artéfacts, bien que des avancées technologiques récentes aient atténué ce problème. L’arthroscanner est couramment utilisé en France, tandis que l’arthro-IRM, bien qu’efficace, reste insuffisamment demandée. La scintigraphie garde des indications très limitées. La réalisation d’une échographie nécessite une formation spécifique et une courbe d’apprentissage. Elle peut être précieuse dans les mains d’un chirurgien orthopédiste formé, utilisée comme un prolongement de l’examen clinique et appelée échoscopie. Cependant, un radiologue spécialisé musculosquelettique peut fournir un diagnostic dynamique souvent supérieur à celui d’une imagerie statique en coupe. Ainsi, toute demande d’imagerie devrait être le fruit d’une collaboration entre chirurgiens et radiologues, adaptée aux ressources disponibles, pouvant varier sur le territoire de santé. Niveau de preuve V : avis d’expert.

The use of imaging after shoulder surgery should be considered carefully and should provide a real benefit for the patient. It is not a routine request. Currently, there is no consensus on imaging indications for patients showing good postoperative progress, without complications and with satisfactory functional outcomes. In cases of unfavorable progress, the indications are clearer. Conventional radiography remains essential, and when combined with ultrasound, forms the first-line approach. Second-line imaging techniques, such as CT scans or MRI, are selected based on the type of surgery performed, the patient's clinical context, and the diagnostic and/or therapeutic questions the surgeon is addressing. In France, CT scans, although easily accessible, involve "controlled" radiation exposure and can produce artifacts with metallic implants. MRI, which provides excellent visualization of soft tissues without radiation, can also present a risk of artifacts, although recent technological advances have mitigated this issue. CT arthrography is commonly used in France, whereas MRI arthrography is underutilized, despite being effective. Scintigraphy has very limited indications. Performing an ultrasound exam requires specific training and has a learning curve. It can be valuable in the hands of a trained orthopedic surgeon, used as an extension of the clinical examination and referred to as "echoscopy". However, a specialized musculoskeletal radiologist can often provide a more accurate dynamic diagnosis compared to static cross-sectional imaging. Thus, any imaging request should result from collaboration between surgeons and radiologists, and be tailored to the available resources, which can vary across different healthcare regions. LEVEL OF EVIDENCE: V: expert opinion.

Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease­–related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.

IntroductionLes études basées sur l’imagerie par microscanner sont nombreuses, mais les rares études sur le parenchyme pulmonaire utilisent un protocole long et compliqué pour éviter le collapsus alvéolaire. L’objectif de notre étude était de tester un protocole simple et reproductible pour obtenir des images du parenchyme pulmonaire par microscanner. Notre objectif secondaire était de tester s’il était possible de différencier une alvéolite oedème d’une alvéolite hémorragique.Matériel et méthodesTreize fragments de parenchyme pulmonaire provenant de cas de pendaison ont été sélectionnés après analyse microscopique : quatre avec une alvéolite hémorragique, quatre avec une alvéolite oedémateuse et cinq sans aucune lésion. Chaque fragment a été fixé dans du formol à 4 % puis congelé avec de la carboglace. Les prélèvements congelés ont été scannés par microscanner avec une résolution spatiale de 20 μm et une dimension caractéristique de voxels de 20,16 μm. Pour les analyses qualitatives et quantitatives, nous avons utilisé les logiciels XnView, Avizo, Quant 3D et ImageJ.RésultatsGrâce à la congélation, le parenchyme pulmonaire ne s’est pas affaissé pendant l’acquisition des images. Seuls les poumons normaux étaient distinguables des poumons hémorragiques ou oedémateux. Parmi les paramètres étudiés, seuls la porosité et le rapport volume de la paroi alvéolaire/volume total du parenchyme étaient intéressants, reflétant le remplissage de la lumière alvéolaire par l’œdème ou l’hémorragie et l’épaississement de la paroi alvéolaire par la congestion.ConclusionNotre protocole simple permet des acquisitions par microtomographie satisfaisantes. Les analyses quantitatives sont prometteuses et laissent entrevoir la possibilité d’établir un diagnostic d’asphyxie.

The assessment of chemotherapy response in osteosarcoma (OS), based on the average percentage of viable cells, is limited, as it overlooks the spatial heterogeneity of tumor cell response (foci of resistant cells), immune microenvironment, and bone microarchitecture. Despite the resulting positive classification for response to chemotherapy, some patients experience early metastatic recurrence, demonstrating that our conventional tools for evaluating treatment response are insufficient. We studied the interactions between tumor cells, immune cells (lymphocytes, histiocytes, and osteoclasts), and bone extracellular matrix (ECM) in 18 surgical resection samples of OS using multiplex and conventional immunohistochemistry (IHC: CD8, CD163, CD68, and SATB2), combined with multiscale characterization approaches in territories of good and poor response (GRT/PRT) to treatment. GRT and PRT were defined as subregions with <10% and >10% of viable tumor cells, respectively. Local correlations between bone ECM porosity and density of immune cells were assessed in these territories. Immune cell density was then correlated to overall patient survival. Two patterns were identified for histiocytes and osteoclasts. In poor responder patients, CD68 osteoclast density exceeded that of CD163 histiocytes but was not related to bone ECM load. Conversely, in good responder patients, CD163 histiocytes were more numerous than CD68 osteoclasts. For both of them, a significant negative local correlation with bone ECM porosity was found (P < ,01). Moreover, in PRT, multinucleated osteoclasts were rounded and intermingled with tumor cells, whereas in GRT, they were elongated and found in close contact with bone trabeculae. CD8 levels were always low in metastatic patients, and those initially considered good responders rapidly died from their disease. The specific recruitment of histiocytes and osteoclasts within the bone ECM, and the level of CD8 represent new features of OS response to treatment. The associated / (2024) prognostic signatures should be integrated into the therapeutic stratification algorithm of patients after surgery. (c) 2024 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

L’objectif de notre étude était de mettre en évidence les facteurs de risque préopératoires qui influencent l’évaluation subjective postopératoire des patients après une réparation de la coiffe des rotateurs (RCR) et de déterminer si cette satisfaction est corrélée à la cicatrisation du tendon. Certains facteurs préopératoires influencent l’évaluation subjective du patient, évaluée par le score SSV (Subjective Shoulder Value) en postopératoire, avec une corrélation satisfaction-cicatrisation tendineuse. Avec un âge moyen de 60,6 ans (40–72), 102 patients ayant subi une RCR arthroscopique ont été inclus rétrospectivement. Le score SSV préopératoire était inférieur ou égal à 50 % pour tous les patients. Il y avait un suivi clinique et radiologique avec une évaluation échographique de la cicatrisation tendineuse 6 mois après l’intervention par des radiologues ostéoarticulaires. Nous avons divisé les patients en 2 groupes en utilisant un SSV postopératoire de 85 % comme seuil ; 55 patients dans le groupe S Satisfait (SSV > 85 %) ; et 47 patients dans le groupe NS Non Satisfait (SSV < 85 %). En analyse multivariée, les facteurs de risque préopératoires de mauvais SSV postopératoire après RCR étaient : le tabagisme (−8,41 (−13,64 ; −3,17) p = 0,002), l’infiltration graisseuse (−3,65 (−6,24 −1,06) p = 0,006) et l’accident de travail (−19,15 (−24,04 ; −14,27) p < 0,001). Lorsque les patients n’étaient pas en accident du travail, plus leur score SSV avant la chirurgie était faible, plus leur score SSV postopératoire était élevé. Pour les patients en accident du travail, plus le SSV était élevé avant l’opération, moins le SSV était élevé après l’opération. La classification échographique postopératoire de cicatrisation tendineuse selon Sugaya n’a pas influencé le score SSV (p = 0,15). Le tabagisme, l’infiltration graisseuse et les patients en accident du travail sont des facteurs de moins bons résultats subjectifs évalués par le patient grâce au score SSV. La cicatrisation du tendon n’a pas influencé le score SSV et l’évaluation subjective du patient. IV, étude de cohorte.

Introduction: To highlight the preoperative risk factors that influence postoperative patient satisfac-tion following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing.Hypothesis: Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing.Methods: With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radio-logical follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV > 85%); and 47 patients in the second group (SSV < 85%).Results: In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use [-8.41 (-13.64; -3.17) p = 0.002], fatty infiltration [-3.65 (-6.24 -1.06) p = 0.006] and work-ers compensation [-19.15 (-24.04; -14.27) p < 0.001]. When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p = 0.15)Conclusions: Smoking, fatty infiltration and patients in workers compensation are factors of poorer sub-jective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction.Level of evidence: IV, cohort study.(c) 2022 Elsevier Masson SAS. All rights reserved.

Purpose or Learning Objective: The extensor carpi ulnaris (ECU) can be the site of a rare and probably underestimated tendinopathy: stenosing tenosynovitis. We observed several cases of stenosing tenosynovitis of the ECU with an epicenter located distal to the ulnar groove and styloid, at the level of the ulnocarpal joint, by thickening of the extensor retinaculum.

La complexité anatomique de l’articulation coxo-fémorale rend son analyse IRM difficile. Il est donc nécessaire d’adapter le protocole à la symptomatologie du patient. Le protocole de base doit comporter des séquences axiales T1 et coronales STIR avec un grand champ de vue, puis des séquences centrées sur l’articulation symptomatique avec un petit champ de vue, idéalement 3D T1 et 3D densité de protons, avec saturation de graisse. Pour ces séquences, il faut privilégier le spin écho qui permet une meilleure analyse du cartilage. En fonction de l’indication, il est parfois nécessaire d’ajouter à ce protocole une injection intraveineuse de produit de contraste, une opacification articulaire ou des séquences sagittales T2. Complexity of the hip joint anatomy makes its MRI analysis difficult. It is therefore required to adapt the protocol to the patient's. The basic protocol must include T1-weighted axial and coronal STIR sequences with a large field of view. Other sequences focused on the symptomatic hip with a small field of view, ideally 3D T1 and 3D proton-density fat saturation are also performed. These sequences should ideally be performed in spin echo, which provides a better cartilage analysis. Depending on indication, additional sequences can be sometimes useful such as T1-weighted imaging after intravenous injection of Gadolinium, or a joint opacification or T2-weighted sagittal sequences.

• Hospitalized patients with COVID-19 during the second wave were older and had more comorbidities. • Use of invasive mechanical ventilation was less frequent. • Mortality rate was similar to that of the first wave, which may be explained by the different demographic characteristics of the patients in the second wave.

ABSTRACT Treatment with asfotase alfa has transformed the prognosis of hypophosphatasia in children and improves the bone and muscle signs in adults. The doses used in adults are the same as in children, whereas bone remodeling is different between them. We report on the cases of two patients treated with 1 mg/kg/day of asfotase alfa who developed spinal cord compression from spinal ossifications during treatment. The first patient, 50 years old, presented after 2 years of treatment with quadraparesis secondary to an increase in ossifications of the cervical vertebral ligaments. The neurological damage was resolved after laminectomy, and the patient was then treated for 18 months with doses of 80 mg per week, without recurrence of the bone and muscle signs. The second patient, 26 years old, 78 kg, developed pain and cervical stiffness with pyramidal tract irritation secondary to ossifications of the vertebral ligaments. This improved with a reduction of doses to 80 mg/week, which then, after 6 months of follow‐up, enabled maintained improvement of the bone and muscle pain that was initially obtained. To our knowledge, these are the first reported cases of increased spinal ligamentous ossifications with neurological complications. Biological monitoring in adults does not seem to enable asfotase alfa doses to be adjusted. The levels of serum alkaline phosphatase (ALP) while on the recommended treatment of 1 mg/kg/day are significantly supraphysiological (5000 to 20,000 IU) and the assays of pyrophosphate and pyridoxal phosphate are not correlated with clinical efficacy. In both of our patients, the treatment with 80 mg of asfotase alfa per week, which was proposed after the occurrence of spinal complications, seemed as effective, after a follow‐up of 18 months and 6 months, as the initial treatment for improving the bone and muscle signs, and could be provided as “attack” doses after healing of the pseudoarthroses. © 2021 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.