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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article reviews the conventional magnetic resonance imaging features of common, sports-related shoulder pathology, as well as of MRI of a normal ACL graft reconstruction and a graft failure. Also discussed are the indications and technique for shoulder magnetic resonance arthrography for evaluating the shoulder labroligamentous complex.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eshoulder \u0026amp; elbow conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehip \u0026amp; knee conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esports medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emagnetic resonance imaging\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ELaura W. Bancroft, MD, University of Central Florida College of Medicine, Tallahassee, and Florida State University College of Medicine, Orlando, Florida, USA, reviewed the conventional magnetic resonance imaging (MRI) features of common, sports-related shoulder pathology.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ERotator cuff tears may be either partial or full thickness and involve the supraspinatus tendon. Partial-thickness tears mostly occur on the articular surface (70%) and appear as fraying of an intact tendon. They can be either rim-rent tears or partial articular-sided tears, and they are often overlooked on MRI scans. Bursal surface and interstitial or intrasubstance tears account for the remaining partial-thickness rotator cuff tears. Partial-thickness rotator cuff tears are seen on MRI as increased signal intensity on the articular or bursal side of the tendon and tendon thinning.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EFull-thickness tears are complete and often seen as a hole in the tendon, or complete detachment of the tendon from the humeral head. A rotator cuff tear MRI report should describe which rotator cuff tendons are torn, the size and degree of the tear, whether it involves the articular or bursal surface, the degree of retraction, the quality of tendinous remnant, and whether muscular atrophy is present.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003ERotator cuff tears can be accompanied by a split or tear in the subscapularis tendon and subluxation of the biceps tendon. Biceps tendon dislocation is associated with superior labral tear anterior-to-posterior (SLAP) lesions. Failure to diagnose this type of tendon tear preoperatively has been implicated in subcoracoid impingement after shoulder dislocation as well as failed rotator cuff repair. Biceps tendon pathology can be isolated or in conjunction with biceps pulley and subscapularis tears.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EA SLAP tear or lesion is associated with damage to the superior area of the glenoid labrum. SLAP tears or lesions can be type I (frayed and degenerative superior labrum at the biceps\u2013labral complex), type II (avulsion of the superior labrum and biceps anchor; long head of the biceps attachment onto the supraglenoid tubercle is not disrupted), type III (bucket-handle tear through the superior labrum and intact biceps anchor), or type IV (bucket-handle tear of the superior labrum and extension into the biceps tendon).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ECommon sports-related injuries seen in children include Little Leaguer\u0027s shoulder (epiphysiolysis) and superior labral injuries, which are due to the high rotational and repetitive nature of the forces placed on the shoulder during the throwing motion [May MM, Bishop JY. \u003Cem\u003EPediatr Radiol.\u003C\/em\u003E 2013]. Little Leaguer\u0027s shoulder is described as tenderness over the proximal humerus physis, fragmentation of the lateral (LAT) metaphysis, sclerosis, cystic changes, and demineralization. Labral tears may involve any portion of the labrum and may be associated with paralabral cyst formation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThere are \u0026gt; 200 000 anterior cruciate ligament (ACL) injuries and 100 000 reconstructions each year in the United States that are commonly associated with sports. Lynne S. Steinbach, MD, University of California San Francisco, San Francisco, California, USA, described MRI of a normal ACL graft reconstruction and a graft failure.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EBefore deciding to perform an ACL reconstruction, an MRI evaluation is helpful to reveal the anatomy and type of tear (partial thickness, isolated bundle, full thickness, and secondary signs). The condition of the proximal and distal attachments and ACL bundles (anteromedial and posterolateral) should be included in the assessment. Routine sagittal imaging and oblique planes or isometric volume imaging may be used for further delineation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EPartial tears are recognized as having one or more of the following features: (1) high T2 signal, thinning; (2) abnormal orientation; and (3) abnormal morphology on the MRI scan. A full-thickness tear may show discontinuity of fibers, increased T2 signal, abnormal orientation, detachment at insertion sites, and\/or effusion in \u0026gt; 75% of cases.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe mechanisms of ACL injury include internal rotation and valgus stress, hyperextension, and varus stress with external rotation. One of the sequelae of a valgus injury with ACL tear is impaction of the bone and cartilage overlying the LAT femoral condylopatellar sulcus (notch), which causes injuries seen on MRI including a deep LAT femoral notch sign along with abnormal signal in the marrow and occasional overlying cartilage loss. This is seen in approximately 10% of ACL tears.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EChronic ACL tears are often difficult to distinguish from an intact ACL because edema and increased signal intensity are not seen on T2-weighted images \u0026gt; 6 months following injury. Sometimes, the ACL looks completely normal. It may be thickened. It can also attach to the posterior cruciate ligament or have abnormal angulation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EACL reconstruction is best performed with autograft (bone\u2013patellar tendon\u2013bone graft or distal hamstring tendons) or allograft. Graft failure can be the result of poor surgical technique, failure of graft incorporation, errors in rehabilitation, new trauma, or graft tearing. Hardware complications include bone graft\u2013screw migration, screw impingement on the graft, pin or screw failure, or dislodged screws.\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EBruce B. Forster, MD, MSc, University of British Columbia, Vancouver, British Columbia, Canada, reviewed the indications and technique for shoulder magnetic resonance arthrography (MRA), the most sensitive and specific imaging test for evaluating the shoulder labroligamentous complex.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EDr Forster recommends MRA over conventional MRI for shoulder pain in athletes and patients aged \u0026lt; 40 years as these patients are more likely to have clinically occult instability. Age is important because the stabilizing function of the shoulder transfers from labra to cuff as we age; thus, older patients with instability are more likely to have rotator cuff tears [Rowan KR et al. \u003Cem\u003EClin Rad.\u003C\/em\u003E 2004]. In addition, clinical [Norregaard J et al. \u003Cem\u003EAnn Rheum Dis.\u003C\/em\u003E 2002] and sonographic diagnoses of labral injury have low accuracy when compared with MRA.\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EMRA is better than 3T MRI for diagnosing labral tears in the shoulder, particularly for tears of the anterior labrum [Major NM et al. \u003Cem\u003EAJR Am J Roentgenol.\u003C\/em\u003E 2011], and it can discriminate normal variants such as a sublabral foramen or Buford complex with a high degree of accuracy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EMRA of the shoulder in patients in the abduction external rotation position improves detection of Perthes lesions.\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EWhen interpreting a shoulder MRA, it is important to have a solid knowledge of both the normal anatomy and these normal variants (which also include the superior sublabral recess). Dr Forster recommends concentrating on the anterior labrum below the 3-o\u0027clock arthroscopic position and checking morphology of the gadolinium-enhanced MRI signal for superior labrum abnormalities. He concluded by recommending using a simplified 5-step approach to interpret a shoulder MRA (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16397\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16397\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16397\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-19\u0022 class=\u0022first-child\u0022\u003EFive-Step Checklist\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/53\/2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlry2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}