Charles Ho - Academia.edu (original) (raw)

Papers by Charles Ho

Cartilage, 2013

Objective: Before quantitative imaging techniques can become clinically valuable, the method, and... more Objective: Before quantitative imaging techniques can become clinically valuable, the method, and more specifically, the regions of locating and reporting these values should be standardized toward reproducibility comparisons across centers and longitudinal follow-up of individual patients. The purpose of this technical note is to describe a rigorous and reproducible method of locating, analyzing, and reporting quantitative MRI values in hip articular cartilage with an approach that is consistent with current orthopedic literature. Design: To demonstrate this localization and documentation, 3 patients (age, 23 ± 5.1 years; 2 males, 1 female) who presented with symptomatic mixed-type femoroacetabular impingement (α angle, 63.3° ± 2.1°; center edge angle, 39° ± 4.2°) were evaluated with T2-mapping at 3 T MRI prior to hip arthroscopy. Manual segmentation was performed and cartilage of the acetabulum and femur was divided into 12 subregions adapted from the geographic zone method. Bone landmarks in the acetabulum and femur, identifiable both in arthroscopy and MR images, were manually selected and the coordinates exported for division of cartilage. Results: Mean T2 values in each zone are presented. Conclusions: The current work outlines a standardized system to locate and describe quantitative mapping values that could aid in surgical decision making, planning, and the noninvasive longitudinal follow-up of implemented cartilage preservation and restoration techniques.

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 18, 2015

To develop a simplified method to define a clinically relevant subregion in the course of arthros... more To develop a simplified method to define a clinically relevant subregion in the course of arthroscopic treatment of femoroacetabular impingement (FAI) using T2 mapping in patients and asymptomatic volunteers. Additionally, we sought to compare the lateral and medial subregion values in asymptomatic volunteers and in patients presenting with FAI. Finally, we wanted to investigate possible associations between patients' T2 mapping values and demographic variables-i.e., alpha angle, age, sex, and body mass index (BMI). Twenty-five asymptomatic volunteers and 23 consecutive symptomatic patients with FAI (cam or mixed type) were prospectively enrolled and evaluated with a sagittal T2 mapping sequence. The weight-bearing region of the acetabular and femoral cartilage was manually segmented and divided into medial and lateral subregions. Median T2 values were determined, and patient characteristics were assessed as potential predictors of T2 values. T2 values in the lateral portion of ...

The American journal of sports medicine, 2015

The tibial tubercle-trochlear groove (TTTG) distance is used to quantify the degree of lateraliza... more The tibial tubercle-trochlear groove (TTTG) distance is used to quantify the degree of lateralization of the patellar tendon insertion on the tibial tubercle relative to the deepest part of the trochlear groove. Disagreement exists as to whether the TTTG distance measured on computed tomography (CT) and magnetic resonance imaging (MRI) can be considered equivalent. To compare TTTG distance as measured on axial CT and MRI and to investigate the potential effect of patient positioning between modalities. Cohort study (diagnosis); Level of evidence, 3. Patients who received both CT and MRI of the same knee for any indication from August 2010 to April 2014 were included in this study. The TTTG distances were measured twice by 2 raters in a randomized order, with at least 30 days between ratings to minimize recall bias. Inter- and intrarater reliability of CT and MRI measurements and intermethod reliability were assessed with intraclass correlation coefficients (ICCs). Bland-Altman plots...

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014

The purpose of this study was to determine the accuracy of 3-Tesla magnetic resonance imaging (MR... more The purpose of this study was to determine the accuracy of 3-Tesla magnetic resonance imaging (MRI) in detecting ligamentum teres (LT) lesions in patients before they undergo hip arthroscopy for the treatment of femoroacetabular impingement. From 2010 to 2011, data were prospectively collected on all patients presenting for treatment of hip pain. All patients underwent MRI followed by arthroscopic surgery. A radiologist prospectively documented MRI findings, and the surgeon recorded the findings at arthroscopy. Radiologic and surgical data included classification of the LT as not torn, hypertrophic, partially torn, or completely torn. All MR images were read by a single radiologist, and all surgery was performed by a single surgeon. Arthroscopy was considered the diagnostic gold standard. One hundred forty-two patients with a mean patient age of 35 years (range, 19 to 73 years) met the inclusion criteria. Only one complete LT tear was found in the study. The accuracy of MRI for the ...

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 14, 2015

Scapular incongruity has been described as a contributing factor to the development of snapping s... more Scapular incongruity has been described as a contributing factor to the development of snapping scapula syndrome (SSS). The purpose of this retrospective case-control study was to determine the association between scapula bony morphology on magnetic resonance imaging (MRI) and the diagnosis of SSS. Bony morphologies of the scapula were evaluated on MRI scans of 26 patients with SSS and 19 patients with non-SSS pathologies. The medial scapula corpus angle (MSCA) was measured on axial MRI sequences. Scapulae were categorized as straight, S shaped, or concave. Two independent observers performed the measurements. Interobserver and intraobserver agreements of MSCA measurements were determined with intraclass correlation coefficients. Axial scapula bony morphology identified 28 scapulae of the straight type, 14 S-shaped scapulae, and 5 concave scapulae. All 5 concave scapulae had confirmed SSS. Measurement of the MSCA showed excellent interobserver agreement of 0.80 (95% confidence inter...

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014

The purpose of this study was to determine whether outcomes after hip arthroscopy were different ... more The purpose of this study was to determine whether outcomes after hip arthroscopy were different based on femoral version. The inclusion criteria were diagnosis of femoroacetabular impingement (FAI) based on clinical examination and/or imaging findings and preoperative measurement of femoral version by magnetic resonance imaging. For this study, the definition of FAI was a positive impingement sign, a positive flexion-abduction-external rotation examination finding, or radiographic signs of impingement. A query of a prospective data registry identified 180 patients who matched the inclusion and exclusion criteria. Group 1 had version of less than 5° (n = 48), group 2 had version of 5° to 15° (n = 84), and group 3 had version greater than 15° (n = 48). The mean age of the patients was 35 years (range, 18 to 61 years). On radiographic examination, the mean alpha angle for all patients' injured hips was 63° (range, 42° to 88°). The mean center-edge angle was 30° (range, 20° to 43°), and mean femoral version was 9.9° (range, -16° to 29°). There was no significant difference in age, alpha angle, or center-edge angle among the 3 version groups. A significant difference in psoas release procedures (psoas impingement) was seen with increasing femoral version. The mean follow-up period was 30 months (range, 18 to 47 months). Patient-reported functional outcomes were not statistically different among the groups. Patient-reported functional outcomes after hip arthroscopy for labral tears and FAI were not different based on femoral version in this population. Although some differences were observed regarding intraoperative findings, these also did not result in differences in patient outcomes reported at a mean follow-up of 2 years. Level IV, therapeutic case series.

Foot & ankle international, Jan 24, 2014

Talar chondral defects can be a source of persistent ankle pain and disability. If untreated, the... more Talar chondral defects can be a source of persistent ankle pain and disability. If untreated, there is an increased risk of osteoarthritis. The purpose of our study was to determine diagnostic accuracy of 3T MRI in detecting Outerbridge grades 3 and 4 articular cartilage lesions of the talus in a clinical setting, utilizing a standardized clinical MRI protocol. Patients who had a 3T ankle MRI and subsequent ankle surgery, by a single surgeon, were included in this study. MRI exams were performed 180 days or less before surgery. Seventy-nine ankles in 78 patients (mean age of 42.3 years) were included in this study. Mean body mass index was 26.3. A standard clinical MRI exam was performed on a 3T MRI scanner. Mean days from MRI to surgery was 39 days. All MRI exams were read and findings recorded by a musculoskeletal radiologist. Arthroscopic examination was performed by a single orthopaedic surgeon. Detailed arthroscopic findings and demographic data were collected prospectively and...

Veterinary Radiology & Ultrasound, 2009

Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. ... more Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. Horses underwent magnetic resonance (MR) imaging of both front feet. All abnormalities were characterized and the most severe abnormality identified, if possible. Abnormal signal intensity in the navicular bone was the most severe abnormality in 24 (33%) horses. Pathologic change in the deep digital flexor tendon was the most severe abnormality in 13 (18%) horses. Pathologic change in the collateral sesamoidean ligament was the most severe abnormality in 11 (15%) horses. Pathologic change in the distal sesamoidean impar ligament was the most severe abnormality in seven (10%) horses. Multiple abnormalities were observed in 13 (18%) horses in which an abnormality that was more severe than the others could not be determined. Abnormalities were not observed in the navicular bone or its supporting soft tissues in four (5%) horses. Fifty-six horses had abnormalities that were most severe in one limb; in 52 (93%) horses, the most severe abnormalities were in the foot of the most lame limb. In 7% (4/56) of horses, the most severe findings were in the opposite limb, and in 16 horses, the findings on both limbs were similar. MR imaging is a useful technique for evaluating horses with navicular syndrome and can differentiate between multiple abnormalities. This provides a more specific diagnosis which affects further treatment of the horse. Pathologic changes in different locations in the foot can cause similar clinical signs that, before MR imaging, were categorized as one syndrome.

Veterinary Radiology & Ultrasound, 2007

Injury to the oblique and straight distal sesamoidean ligaments is becoming recognized as a more ... more Injury to the oblique and straight distal sesamoidean ligaments is becoming recognized as a more common cause of lameness in horses than was previously thought. The purpose of this study was to review the magnetic resonance (MR) imaging findings of 27 horses affected with desmitis of the oblique and/or straight distal sesamoidean ligament and determine long-term prognosis for horses with this diagnosis. Imaging was performed with horses in right lateral recumbency in a high-field 1 T magnet. All horses had lameness localized to the digit or metacarpophalangeal/metatarsophalangeal joint region with diagnostic local anesthetic blocks. Ten horses had forelimb lameness and 17 horses had hind limb lameness. MR imaging revealed abnormalities in the oblique distal sesamoidean ligaments in 18 horses, in the straight distal sesamoidean ligament in three horses, and in both the oblique and straight distal sesamoidean ligament in six horses. Treatment consisted of a 6-month rest and rehabilitation program in all horses. The digital flexor tendon sheath was injected with methylprednisolone acetate and hyaluronic acid in 22 horses to decrease inflammation in the injured ligaments before starting the rest and rehabilitation program. Two horses had ligament splitting performed, one in the oblique distal sesamoidean ligament and one in the straight distal sesamoidean ligament. MR imaging is an effective method for diagnosing injury to the oblique and straight distal sesamoidean ligaments in horses. Treatment, primarily a 6-month rest and rehabilitation program, allowed 76% of the horses to successfully resume performance.

Veterinary Radiology & Ultrasound, 2007

Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal m... more Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal metacarpal or metatarsal region have not been described. To accomplish that, the medical records of 45 horses evaluated with MR imaging that had lameness localized to either the proximal metacarpal or metatarsal region were reviewed. Abnormalities observed in the proximal suspensory ligament or the accessory ligament of the deep digital flexor tendon included abnormal high signal, enlargement, or alteration in shape. Twenty-three horses had proximal suspensory ligament desmitis (13 hindlimb, 10 forelimb). Sixteen horses had desmitis of the accessory ligament of the deep digital flexor tendon. One horse had desmitis of the proximal suspensory ligament and the accessory ligament of the deep digital flexor tendon on the same limb and one horse had desmitis of the proximal suspensory ligament on one forelimb and desmitis of the accessory ligament of the deep digital flexor tendon on the other forelimb. Four horses did not have abnormalities in the proximal suspensory ligament or accessory ligament of the deep digital flexor tendon. Eighty percent of horses with forelimb proximal suspensory ligament desmitis and 69% of horses with hindlimb proximal suspensory ligament desmitis returned to their intended use. Sixty-three percent of horses with desmitis of the accessory ligament of the deep digital flexor tendon were able to return to their intended use. MR imaging is a valuable diagnostic modality that allows diagnosis of injury in horses with lameness localized to the proximal metacarpal and metatarsal regions. The ability to accurately diagnose the source of lameness is important in selecting treatment that will maximize the chance to return to performance.

Sports Health: A Multidisciplinary Approach, 2013

This report presents 2 cases of subtle injuries to the subtalar joint, specifically, osteochondra... more This report presents 2 cases of subtle injuries to the subtalar joint, specifically, osteochondral defects of the middle facet of the talus and concomitant involvement of the middle talocalcaneal articulation sustained while snowboarding. The 3T magnetic resonance image revealed fracture of the lateral talar process with osteochondral lesions of the middle talocalcaneal articulation. This injury can lead to severe and chronic disability if undetected and could ultimately end athletic participation prematurely.

The American Journal of Sports Medicine, 2006

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 29, 2015

The purpose of this study was to determine whether there is an association between the critical s... more The purpose of this study was to determine whether there is an association between the critical shoulder angle (CSA) and rotator cuff tears (RCT) as well as osteoarthritis (OA), and to compare the reproducibility and accuracy of CSA values as measured with radiograph and MRI. Based on a pre hoc power analysis, three independent reviewers measured CSAs for three groups of 10 age-matched patients each (RCT group, OA group, and non-RCT/non-OA group) using radiographs and MRIs. Inter- and intra-observer agreements of CSAs were determined with intraclass correlation coefficients. ANOVA analysis was performed. Interobserver and intra-observer agreements on radiographs were 0.87 (95 % CI 0.78-0.93) and 0.91 (95 % CI 0.82-0.96), respectively. Significant differences in mean CSAs by radiographs were found between the groups (RCT 37.3° ± 2.6°; OA 28.7° ± 2.2°; non-RCT/non-OA 32.7° ± 2.5°; p < 0.001). CSAs obtained from MRI scans had interobserver agreement of 0.62 (95 % CI 0.43-0.78) and i...

Cartilage, 2013

Objective: Before quantitative imaging techniques can become clinically valuable, the method, and... more Objective: Before quantitative imaging techniques can become clinically valuable, the method, and more specifically, the regions of locating and reporting these values should be standardized toward reproducibility comparisons across centers and longitudinal follow-up of individual patients. The purpose of this technical note is to describe a rigorous and reproducible method of locating, analyzing, and reporting quantitative MRI values in hip articular cartilage with an approach that is consistent with current orthopedic literature. Design: To demonstrate this localization and documentation, 3 patients (age, 23 ± 5.1 years; 2 males, 1 female) who presented with symptomatic mixed-type femoroacetabular impingement (α angle, 63.3° ± 2.1°; center edge angle, 39° ± 4.2°) were evaluated with T2-mapping at 3 T MRI prior to hip arthroscopy. Manual segmentation was performed and cartilage of the acetabulum and femur was divided into 12 subregions adapted from the geographic zone method. Bone landmarks in the acetabulum and femur, identifiable both in arthroscopy and MR images, were manually selected and the coordinates exported for division of cartilage. Results: Mean T2 values in each zone are presented. Conclusions: The current work outlines a standardized system to locate and describe quantitative mapping values that could aid in surgical decision making, planning, and the noninvasive longitudinal follow-up of implemented cartilage preservation and restoration techniques.

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 18, 2015

To develop a simplified method to define a clinically relevant subregion in the course of arthros... more To develop a simplified method to define a clinically relevant subregion in the course of arthroscopic treatment of femoroacetabular impingement (FAI) using T2 mapping in patients and asymptomatic volunteers. Additionally, we sought to compare the lateral and medial subregion values in asymptomatic volunteers and in patients presenting with FAI. Finally, we wanted to investigate possible associations between patients' T2 mapping values and demographic variables-i.e., alpha angle, age, sex, and body mass index (BMI). Twenty-five asymptomatic volunteers and 23 consecutive symptomatic patients with FAI (cam or mixed type) were prospectively enrolled and evaluated with a sagittal T2 mapping sequence. The weight-bearing region of the acetabular and femoral cartilage was manually segmented and divided into medial and lateral subregions. Median T2 values were determined, and patient characteristics were assessed as potential predictors of T2 values. T2 values in the lateral portion of ...

The American journal of sports medicine, 2015

The tibial tubercle-trochlear groove (TTTG) distance is used to quantify the degree of lateraliza... more The tibial tubercle-trochlear groove (TTTG) distance is used to quantify the degree of lateralization of the patellar tendon insertion on the tibial tubercle relative to the deepest part of the trochlear groove. Disagreement exists as to whether the TTTG distance measured on computed tomography (CT) and magnetic resonance imaging (MRI) can be considered equivalent. To compare TTTG distance as measured on axial CT and MRI and to investigate the potential effect of patient positioning between modalities. Cohort study (diagnosis); Level of evidence, 3. Patients who received both CT and MRI of the same knee for any indication from August 2010 to April 2014 were included in this study. The TTTG distances were measured twice by 2 raters in a randomized order, with at least 30 days between ratings to minimize recall bias. Inter- and intrarater reliability of CT and MRI measurements and intermethod reliability were assessed with intraclass correlation coefficients (ICCs). Bland-Altman plots...

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014

The purpose of this study was to determine the accuracy of 3-Tesla magnetic resonance imaging (MR... more The purpose of this study was to determine the accuracy of 3-Tesla magnetic resonance imaging (MRI) in detecting ligamentum teres (LT) lesions in patients before they undergo hip arthroscopy for the treatment of femoroacetabular impingement. From 2010 to 2011, data were prospectively collected on all patients presenting for treatment of hip pain. All patients underwent MRI followed by arthroscopic surgery. A radiologist prospectively documented MRI findings, and the surgeon recorded the findings at arthroscopy. Radiologic and surgical data included classification of the LT as not torn, hypertrophic, partially torn, or completely torn. All MR images were read by a single radiologist, and all surgery was performed by a single surgeon. Arthroscopy was considered the diagnostic gold standard. One hundred forty-two patients with a mean patient age of 35 years (range, 19 to 73 years) met the inclusion criteria. Only one complete LT tear was found in the study. The accuracy of MRI for the ...

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 14, 2015

Scapular incongruity has been described as a contributing factor to the development of snapping s... more Scapular incongruity has been described as a contributing factor to the development of snapping scapula syndrome (SSS). The purpose of this retrospective case-control study was to determine the association between scapula bony morphology on magnetic resonance imaging (MRI) and the diagnosis of SSS. Bony morphologies of the scapula were evaluated on MRI scans of 26 patients with SSS and 19 patients with non-SSS pathologies. The medial scapula corpus angle (MSCA) was measured on axial MRI sequences. Scapulae were categorized as straight, S shaped, or concave. Two independent observers performed the measurements. Interobserver and intraobserver agreements of MSCA measurements were determined with intraclass correlation coefficients. Axial scapula bony morphology identified 28 scapulae of the straight type, 14 S-shaped scapulae, and 5 concave scapulae. All 5 concave scapulae had confirmed SSS. Measurement of the MSCA showed excellent interobserver agreement of 0.80 (95% confidence inter...

Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014

The purpose of this study was to determine whether outcomes after hip arthroscopy were different ... more The purpose of this study was to determine whether outcomes after hip arthroscopy were different based on femoral version. The inclusion criteria were diagnosis of femoroacetabular impingement (FAI) based on clinical examination and/or imaging findings and preoperative measurement of femoral version by magnetic resonance imaging. For this study, the definition of FAI was a positive impingement sign, a positive flexion-abduction-external rotation examination finding, or radiographic signs of impingement. A query of a prospective data registry identified 180 patients who matched the inclusion and exclusion criteria. Group 1 had version of less than 5° (n = 48), group 2 had version of 5° to 15° (n = 84), and group 3 had version greater than 15° (n = 48). The mean age of the patients was 35 years (range, 18 to 61 years). On radiographic examination, the mean alpha angle for all patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; injured hips was 63° (range, 42° to 88°). The mean center-edge angle was 30° (range, 20° to 43°), and mean femoral version was 9.9° (range, -16° to 29°). There was no significant difference in age, alpha angle, or center-edge angle among the 3 version groups. A significant difference in psoas release procedures (psoas impingement) was seen with increasing femoral version. The mean follow-up period was 30 months (range, 18 to 47 months). Patient-reported functional outcomes were not statistically different among the groups. Patient-reported functional outcomes after hip arthroscopy for labral tears and FAI were not different based on femoral version in this population. Although some differences were observed regarding intraoperative findings, these also did not result in differences in patient outcomes reported at a mean follow-up of 2 years. Level IV, therapeutic case series.

Foot & ankle international, Jan 24, 2014

Talar chondral defects can be a source of persistent ankle pain and disability. If untreated, the... more Talar chondral defects can be a source of persistent ankle pain and disability. If untreated, there is an increased risk of osteoarthritis. The purpose of our study was to determine diagnostic accuracy of 3T MRI in detecting Outerbridge grades 3 and 4 articular cartilage lesions of the talus in a clinical setting, utilizing a standardized clinical MRI protocol. Patients who had a 3T ankle MRI and subsequent ankle surgery, by a single surgeon, were included in this study. MRI exams were performed 180 days or less before surgery. Seventy-nine ankles in 78 patients (mean age of 42.3 years) were included in this study. Mean body mass index was 26.3. A standard clinical MRI exam was performed on a 3T MRI scanner. Mean days from MRI to surgery was 39 days. All MRI exams were read and findings recorded by a musculoskeletal radiologist. Arthroscopic examination was performed by a single orthopaedic surgeon. Detailed arthroscopic findings and demographic data were collected prospectively and...

Veterinary Radiology & Ultrasound, 2009

Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. ... more Seventy-two horses with recent onset of navicular syndrome and normal radiographs were assessed. Horses underwent magnetic resonance (MR) imaging of both front feet. All abnormalities were characterized and the most severe abnormality identified, if possible. Abnormal signal intensity in the navicular bone was the most severe abnormality in 24 (33%) horses. Pathologic change in the deep digital flexor tendon was the most severe abnormality in 13 (18%) horses. Pathologic change in the collateral sesamoidean ligament was the most severe abnormality in 11 (15%) horses. Pathologic change in the distal sesamoidean impar ligament was the most severe abnormality in seven (10%) horses. Multiple abnormalities were observed in 13 (18%) horses in which an abnormality that was more severe than the others could not be determined. Abnormalities were not observed in the navicular bone or its supporting soft tissues in four (5%) horses. Fifty-six horses had abnormalities that were most severe in one limb; in 52 (93%) horses, the most severe abnormalities were in the foot of the most lame limb. In 7% (4/56) of horses, the most severe findings were in the opposite limb, and in 16 horses, the findings on both limbs were similar. MR imaging is a useful technique for evaluating horses with navicular syndrome and can differentiate between multiple abnormalities. This provides a more specific diagnosis which affects further treatment of the horse. Pathologic changes in different locations in the foot can cause similar clinical signs that, before MR imaging, were categorized as one syndrome.

Veterinary Radiology & Ultrasound, 2007

Injury to the oblique and straight distal sesamoidean ligaments is becoming recognized as a more ... more Injury to the oblique and straight distal sesamoidean ligaments is becoming recognized as a more common cause of lameness in horses than was previously thought. The purpose of this study was to review the magnetic resonance (MR) imaging findings of 27 horses affected with desmitis of the oblique and/or straight distal sesamoidean ligament and determine long-term prognosis for horses with this diagnosis. Imaging was performed with horses in right lateral recumbency in a high-field 1 T magnet. All horses had lameness localized to the digit or metacarpophalangeal/metatarsophalangeal joint region with diagnostic local anesthetic blocks. Ten horses had forelimb lameness and 17 horses had hind limb lameness. MR imaging revealed abnormalities in the oblique distal sesamoidean ligaments in 18 horses, in the straight distal sesamoidean ligament in three horses, and in both the oblique and straight distal sesamoidean ligament in six horses. Treatment consisted of a 6-month rest and rehabilitation program in all horses. The digital flexor tendon sheath was injected with methylprednisolone acetate and hyaluronic acid in 22 horses to decrease inflammation in the injured ligaments before starting the rest and rehabilitation program. Two horses had ligament splitting performed, one in the oblique distal sesamoidean ligament and one in the straight distal sesamoidean ligament. MR imaging is an effective method for diagnosing injury to the oblique and straight distal sesamoidean ligaments in horses. Treatment, primarily a 6-month rest and rehabilitation program, allowed 76% of the horses to successfully resume performance.

Veterinary Radiology & Ultrasound, 2007

Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal m... more Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal metacarpal or metatarsal region have not been described. To accomplish that, the medical records of 45 horses evaluated with MR imaging that had lameness localized to either the proximal metacarpal or metatarsal region were reviewed. Abnormalities observed in the proximal suspensory ligament or the accessory ligament of the deep digital flexor tendon included abnormal high signal, enlargement, or alteration in shape. Twenty-three horses had proximal suspensory ligament desmitis (13 hindlimb, 10 forelimb). Sixteen horses had desmitis of the accessory ligament of the deep digital flexor tendon. One horse had desmitis of the proximal suspensory ligament and the accessory ligament of the deep digital flexor tendon on the same limb and one horse had desmitis of the proximal suspensory ligament on one forelimb and desmitis of the accessory ligament of the deep digital flexor tendon on the other forelimb. Four horses did not have abnormalities in the proximal suspensory ligament or accessory ligament of the deep digital flexor tendon. Eighty percent of horses with forelimb proximal suspensory ligament desmitis and 69% of horses with hindlimb proximal suspensory ligament desmitis returned to their intended use. Sixty-three percent of horses with desmitis of the accessory ligament of the deep digital flexor tendon were able to return to their intended use. MR imaging is a valuable diagnostic modality that allows diagnosis of injury in horses with lameness localized to the proximal metacarpal and metatarsal regions. The ability to accurately diagnose the source of lameness is important in selecting treatment that will maximize the chance to return to performance.

Sports Health: A Multidisciplinary Approach, 2013

This report presents 2 cases of subtle injuries to the subtalar joint, specifically, osteochondra... more This report presents 2 cases of subtle injuries to the subtalar joint, specifically, osteochondral defects of the middle facet of the talus and concomitant involvement of the middle talocalcaneal articulation sustained while snowboarding. The 3T magnetic resonance image revealed fracture of the lateral talar process with osteochondral lesions of the middle talocalcaneal articulation. This injury can lead to severe and chronic disability if undetected and could ultimately end athletic participation prematurely.

The American Journal of Sports Medicine, 2006

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, Jan 29, 2015

The purpose of this study was to determine whether there is an association between the critical s... more The purpose of this study was to determine whether there is an association between the critical shoulder angle (CSA) and rotator cuff tears (RCT) as well as osteoarthritis (OA), and to compare the reproducibility and accuracy of CSA values as measured with radiograph and MRI. Based on a pre hoc power analysis, three independent reviewers measured CSAs for three groups of 10 age-matched patients each (RCT group, OA group, and non-RCT/non-OA group) using radiographs and MRIs. Inter- and intra-observer agreements of CSAs were determined with intraclass correlation coefficients. ANOVA analysis was performed. Interobserver and intra-observer agreements on radiographs were 0.87 (95 % CI 0.78-0.93) and 0.91 (95 % CI 0.82-0.96), respectively. Significant differences in mean CSAs by radiographs were found between the groups (RCT 37.3° ± 2.6°; OA 28.7° ± 2.2°; non-RCT/non-OA 32.7° ± 2.5°; p < 0.001). CSAs obtained from MRI scans had interobserver agreement of 0.62 (95 % CI 0.43-0.78) and i...