Service de Radiologie Osteoarticulaire

Paris, France

Service de Radiologie Osteoarticulaire

Paris, France

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Choufani C.,Service de chirurgie orthopedique et traumatologique | Rousseau R.,Service de chirurgie orthopedique et traumatologique | Massein A.,Service de radiologie osteoarticulaire | Pascal-Moussellard H.,Service de chirurgie orthopedique et traumatologique | Khiami F.,Service de chirurgie orthopedique et traumatologique
Orthopaedics and Traumatology: Surgery and Research | Year: 2017

Background: Fibular tendon dislocation is a rare and usually sports-related injury. We report the functional and ultrasonographic outcomes of a simple technique for re-tensioning the superior fibular retinaculum. Hypothesis: Our retinaculum re-tensioning technique is not followed by recurrent fibular tendon dislocation, as demonstrated by ultrasonography. Material and method: This single-centre single-surgeon retrospective study included 17 patients who underwent surgery to treat fibular tendon dislocation between January 2008 and December 2013. The functional outcome at last follow-up was assessed based on the AOFAS score. Subjective patient satisfaction and return to sports were recorded. Dynamic comparative ultrasonography was performed at last follow-up and the results used to separate the patients into four categories: normal, recurrent dislocation, subluxation, and residual tendinopathy. Results: The 17 patients had a mean age of 32.6. ±. 9.7 years (range, 18-52 years) and a mean pre-operative AOFAS score of 59.9. ±. 11.3 (range, 34-71). Mean follow-up was 36.9. ±. 16.9 months (range, 12-60 months). The mean AOFAS score at last follow-up was 89. ±. 9.0 (range, 68-100). Of the 17 patients, 7 (41%) returned to the same level of sports. The remaining 10 patients returned to a lower level or did not return to sports, usually (70%) for personal or work-related reasons. Follow-up ultrasonography was normal in 12 (71%) patients. Of the remaining 5 patients, 2 had clinically silent recurrent dislocation and 3 had residual tendinopathy, including 1 who was only moderately satisfied due to persistent pain. Of the 4 patients who reported pain due to the knots in the non-absorbable sutures used to tighten the retinaculum, 1 required removal of the sutures. No other complications were recorded. Finally, 16 (94%) patients were satisfied or very satisfied. Discussion: Retinaculum re-tensioning is effective in stabilising the fibular tendons, with no true recurrences. Ultrasonography can detect clinically silent subluxation. This simple and reproducible technique is associated with a very low complication rate and with excellent functional and anatomical outcomes. Level of evidence: Retrospective, level IV. © 2017 Elsevier Masson SAS.


Museyko O.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bousson V.,Service de Radiologie OsteoArticulaire | Adams J.,Royal Infirmary | Laredo J.-D.,Service de Radiologie OsteoArticulaire | Engelke K.,Friedrich - Alexander - University, Erlangen - Nuremberg
Osteoporosis International | Year: 2016

Summary: For quantitative computed tomography (QCT), most relevant variables to discriminate hip fractures were determined. A multivariate analysis showed that trabecular bone mineral density (BMD) of the trochanter with “cortical” thickness of the neck provided better fracture discrimination than total hip integral BMD. A slice-by-slice analysis of the neck or the inclusion of strength-based parameters did not improve fracture discrimination. Introduction: For QCT of the proximal femur, a large variety of analysis parameters describing bone mineral density, geometry, or strength has been considered. However, in each given study, generally just a small subset was used. The aim of this study was to start with a comprehensive set and then select a best subset of QCT parameters for discrimination of subjects with and without acute osteoporotic hip fractures. Methods: The analysis was performed using the population of the European Femur Fracture (EFFECT) study (Bousson et al. J Bone Min Res: Off J Am Soc Bone Min Res 26:881-893, 2011). Fifty-six female control subjects (age 73.2 ± 9.3 years) were compared with 46 female patients (age 80.9 ± 11.1 years) with acute hip fractures. The QCT analysis software MIAF-Femur was used to virtually dissect the proximal femur and analyze more than 1000 parameters, predominantly in the femoral neck. A multivariate best-subset analysis was used to extract the parameters best discriminating hip fractures. All results were adjusted for age, height, and weight differences between the two groups. Results: For the discrimination of all proximal hip fractures as well as for cervical fractures alone, the measurement of neck parameters suffices (area under the curve (AUC) = 0.84). Parameters characterizing bone strength are discriminators of hip fractures; however, in multivariate models, only “cortical” cross-sectional area in the neck center remained as a significant contributor. The combination of one BMD parameter, trabecular BMD of the trochanter, and one geometry parameter, “cortical” thickness of the neck discriminated hip fracture with an AUC value of 0.83 which was significantly better than 0.77 for total femur BMD alone. A comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination. Conclusions: If QCT of the hip is performed, the analysis should include neck and trochanter. In particular, for fractures of any type, a comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination nor did the inclusion of strength-related parameters other than “cortical” area or thickness. One BMD and one geometry parameter, in this study, the combination of trabecular BMD of the trochanter and of “cortical” thickness of the neck resulted in significant hip fracture discrimination. © 2015, International Osteoporosis Foundation and National Osteoporosis Foundation.


Zerfass P.,Friedrich - Alexander - University, Erlangen - Nuremberg | Lowitz T.,Friedrich - Alexander - University, Erlangen - Nuremberg | Museyko O.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bousson V.,Service de Radiologie OsteoArticulaire | And 7 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2012

We have developed a new integrated approach for quantitative computed tomography of the knee in order to quantify bone mineral density (BMD) and subchondral bone structure. The present framework consists of image acquisition and reconstruction, 3-D segmentation, determination of anatomic coordinate systems, and reproducible positioning of analysis volumes of interest (VOI). Novel segmentation algorithms were developed to identify growth plates of the tibia and femur and the joint space with high reproducibility. Five different VOIs with varying distance to the articular surface are defined in the epiphysis. Each VOI is further subdivided into a medial and a lateral part. In each VOI, BMD is determined. In addition, a texture analysis is performed on a high-resolution computed tomography (CT) reconstruction of the same CT scan in order to quantify subchondral bone structure. Local and global homogeneity, as well as local and global anisotropy were measured in all VOIs. Overall short-term precision of the technique was evaluated using double measurements of 20 osteoarthritic cadaveric human knees. Precision errors for volume were about 2-3% in the femur and 3-5% in the tibia. Precision errors for BMD were about 1-2% lower. Homogeneity parameters showed precision errors up to about 2 and anisotropy parameters up to about 4%. © 2012 IEEE.


Degardin A.,Lille University Hospital Center | Morillon D.,Service de Radiologie Osteoarticulaire | Lacour A.,Lille University Hospital Center | Cotten A.,Service de Radiologie Osteoarticulaire | And 2 more authors.
Skeletal Radiology | Year: 2010

Objective: To determine if magnetic resonance imaging (MR imaging) is useful in the diagnostic workup of muscular dystrophies and idiopathic inflammatory myopathies for describing the topography of muscle involvement. Materials and methods: MR imaging was performed in 31 patients: 8 with dystrophic myotony types 1 (n∈=∈4) or 2 (n∈=∈4); 11 with limb-girdle muscular dystrophy, including dysferlinopathy, calpainopathy, sarcoglycanopathy, and dystrophy associated with fukutin-related protein mutation; 3 with Becker muscular dystrophy; and 9 with idiopathic inflammatory myopathies, including polymyositis, dermatomyositis, and sporadic inclusion body myositis. Results: Analysis of T1 images enabled us to describe the most affected muscles and the muscles usually spared for each muscular disease. In particular, examination of pelvis, thigh, and leg muscles demonstrated significant differences between the muscular diseases. On STIR images, hyperintensities were present in 62% of our patients with muscular dystrophies. Conclusion: A specific pattern of muscular involvement was established for each muscular disease. Hyperintensities observed on STIR images precede fatty degeneration and are not specific for inflammatory myopathies. © 2010 ISS.


Cattelan M.,Service de Chirurgie Orthopedique et de Traumatologie | Bonnomet F.,Service de Chirurgie Orthopedique et de Traumatologie | Bierry G.,Service de Radiologie Osteoarticulaire | Di Marco A.,Service de Chirurgie Orthopedique et de Traumatologie | And 3 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2016

Introduction: Villonodular synovitis (VNS) is a rare disease with an incidence of 1.8 per 1,000,000 inhabitants. VNS of the ankle has seldom been described and evaluated given its extreme rarity (2.5% of VNS cases). It presents an 11% recurrence rate. We report a continuous retrospective series with the main objective of clinically and radiologically evaluating these ankles searching for any risk factors of recurrence. At revision the study's main endpoint was the existence of local recurrence (radiological and clinical) and the secondary endpoint was the existence of tibiotalar osteoarthritis. The working hypothesis was that recurrence could be subclinical, warranting systematic imaging studies during follow-up. Material and methods: The study was retrospective, conducted on seven patients (six males) whose mean age was 42 years treated over a period of 9 years (two diffuse forms and five localized forms). The initial treatment consisted in synovectomy via the conventional approach. Four patients also received adjuvant isotopic synoviorthesis treatment. The revision was clinical (MMTS, AOFAS, and OMAS scores) and radiological (standard and MRI) to evaluate the joint after-effects and search for recurrence. Results: Six patients were seen at a mean 6.5 years of follow-up. One case of early recurrence (4 years) was noted, with a major clinical manifestation because it was associated with joint destruction requiring arthrodesis, and one case of late asymptomatic recurrence (9 years), diagnosed radiologically on the follow-up MRI. The functional results remained good at follow-up (MMTS 77%, AOFAS 71, OMAS 71). Five of the six patients returned to their daily activities. At revision, no sign of osteoarthritis was observed. No risk factor for recurrence was demonstrated. Discussion/conclusion: The hypothesis was confirmed with the existence of asymptomatic recurrence at revision, underscoring the value of systematic MRI at follow-up. Other than major joint destruction, the prognosis remains good even in case of recurrence. The literature emphasizes the existence of an initial diffuse form and partial surgical resection as risk factors of recurrence. None of the reports in the literature has proven that adjuvant treatment, whose modalities do not meet with consensus, reduces this risk. Level of evidence: Retrospective series, level IV. © 2016 Elsevier Masson SAS.


Salmon J.-H.,Reims University Hospital Center | Perotin J.-M.,Reims University Hospital Center | Direz G.,Reims University Hospital Center | Brochot P.,Reims University Hospital Center | And 2 more authors.
Revue de Medecine Interne | Year: 2013

Introduction: The prevalence of vertebral sarcoidosis is highly variable (1 to 36% of reported case series). Because of limited clinical expression, its frequency is probably underestimated. Its proper management is not clearly defined. Case report: A 42-year-old woman who had a past medical history of cutaneous and pulmonary sarcoidosis presented with low back pain that was refractory to usual medical treatment. A diagnosis of vertebral localisation of sarcoidosis was considered on the history of proven sarcoidosis, radiological features, and the absence of evidence of an alternative diagnosis. In the absence of other clinical or biological evidence of active sarcoidosis, a simple follow-up was planned. MRI control at 1 year showed the resolution of vertebral sarcoidosis lesions. Conclusion: Spontaneous regression is a possible outcome of vertebral sarcoidosis. Initiation of a specific treatment should be discussed in the absence of other visceral involvement. © 2012 Société nationale française de médecine interne (SNFMI).


Lowitz T.,Friedrich - Alexander - University, Erlangen - Nuremberg | Museyko O.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bousson V.,Service de Radiologie OsteoArticulaire | Bousson V.,University Paris Diderot | And 6 more authors.
Osteoarthritis and Cartilage | Year: 2013

Objective: Bone marrow lesions (BMLs) in the knee are associated with pain and compartment-specific joint space narrowing. However, the correlation of BMLs with bone mineral density (BMD) has rarely been investigated. The aim of the present study was to examine whether BMD in BMLs is altered compared to the surrounding bone. Design: Thirty-four BMLs detected in osteoarthritis (OA) knees (KL grade 2 and 3) of 26 patients were investigated. A 3D-segmentation was used to determine BML volumes of interest (VOI) and their surrounding bone in MR images. These VOIs were registered to corresponding single-energy QCT images and a BMD analysis was performed. The same VOIs were transferred to control datasets (19 OA patients without BMLs) by an elastic registration, where the BMD analysis was repeated. To account for the dependence of bone marrow composition on BMD measures derived using single-energy QCT, simulations were performed to evaluate how changing fat-water compositions likely occurring with BML development may influence BMD measures and observed BMD differences between patients with and without BMLs. The association between loading in the knee and the occurrence of BMLs was investigated by medial to lateral (M:L) BMD ratios. Results: BMD was significantly increased at BML locations, even with a fat-to-water conversion rate of 39%. The M:L BMD ratio was significantly increased in bones with medial BMLs. Conclusions: BMD was examined exactly at BML locations and surrounding bone using highly accurate segmentation and registration methods. BMD was significantly increased at BML locations (P<0.05). © 2013 Osteoarthritis Research Society International.


Bousson V.D.,Service de Radiologie OsteoArticulaire | Bousson V.D.,University Paris Diderot | Adams J.,Royal Infirmary | Engelke K.,Friedrich - Alexander - University, Erlangen - Nuremberg | And 10 more authors.
Journal of Bone and Mineral Research | Year: 2011

In assessing osteoporotic fractures of the proximal femur, the main objective of this in vivo case-control study was to evaluate the performance of quantitative computed tomography (QCT) and a dedicated 3D image analysis tool [Medical Image Analysis Framework-Femur option (MIAF-Femur)] in differentiating hip fracture and non-hip fracture subjects. One-hundred and seven women were recruited in the study, 47 women (mean age 81.6 years) with low-energy hip fractures and 60 female non-hip fracture control subjects (mean age 73.4 years). Bone mineral density (BMD) and geometric variables of cortical and trabecular bone in the femoral head and neck, trochanteric, and intertrochanteric regions and proximal shaft were assessed using QCT and MIAF-Femur. Areal BMD (aBMD) was assessed using dual-energy X-ray absorptiometry (DXA) in 96 (37 hip fracture and 59 non-hip fracture subjects) of the 107 patients. Logistic regressions were computed to extract the best discriminates of hip fracture, and area under the receiver characteristic operating curve (AUC) was calculated. Three logistic models that discriminated the occurrence of hip fracture with QCT variables were obtained (AUC=0.84). All three models combined one densitometric variable-a trabecular BMD (measured in the femoral head or in the trochanteric region)-and one geometric variable-a cortical thickness value (measured in the femoral neck or proximal shaft). The best discriminant using DXA variables was obtained with total femur aBMD (AUC=0.80, p=.003). Results highlight a synergistic contribution of trabecular and cortical components in hip fracture risk and the utility of assessing QCT BMD of the femoral head for improved understanding and possible insights into prevention of hip fractures. Copyright © 2011 American Society for Bone and Mineral Research.


PubMed | Service de radiologie osteoarticulaire and Service de chirurgie orthopedique et traumatologique
Type: | Journal: Orthopaedics & traumatology, surgery & research : OTSR | Year: 2016

Fibular tendon dislocation is a rare and usually sports-related injury. We report the functional and ultrasonographic outcomes of a simple technique for re-tensioning the superior fibular retinaculum.Our retinaculum re-tensioning technique is not followed by recurrent fibular tendon dislocation, as demonstrated by ultrasonography.This single-centre single-surgeon retrospective study included 17 patients who underwent surgery to treat fibular tendon dislocation between January 2008 and December 2013. The functional outcome at last follow-up was assessed based on the AOFAS score. Subjective patient satisfaction and return to sports were recorded. Dynamic comparative ultrasonography was performed at last follow-up and the results used to separate the patients into four categories: normal, recurrent dislocation, subluxation, and residual tendinopathy.The 17 patients had a mean age of 32.69.7 years (range, 18-52 years) and a mean pre-operative AOFAS score of 59.911.3 (range, 34-71). Mean follow-up was 36.916.9 months (range, 12-60 months). The mean AOFAS score at last follow-up was 899.0 (range, 68-100). Of the 17 patients, 7 (41%) returned to the same level of sports. The remaining 10 patients returned to a lower level or did not return to sports, usually (70%) for personal or work-related reasons. Follow-up ultrasonography was normal in 12 (71%) patients. Of the remaining 5 patients, 2 had clinically silent recurrent dislocation and 3 had residual tendinopathy, including 1 who was only moderately satisfied due to persistent pain. Of the 4 patients who reported pain due to the knots in the non-absorbable sutures used to tighten the retinaculum, 1 required removal of the sutures. No other complications were recorded. Finally, 16 (94%) patients were satisfied or very satisfied.Retinaculum re-tensioning is effective in stabilising the fibular tendons, with no true recurrences. Ultrasonography can detect clinically silent subluxation. This simple and reproducible technique is associated with a very low complication rate and with excellent functional and anatomical outcomes.retrospective, level IV.


PubMed | Friedrich - Alexander - University, Erlangen - Nuremberg, Service de Radiologie OsteoArticulaire and Royal Infirmary
Type: Journal Article | Journal: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA | Year: 2016

For quantitative computed tomography (QCT), most relevant variables to discriminate hip fractures were determined. A multivariate analysis showed that trabecular bone mineral density (BMD) of the trochanter with cortical thickness of the neck provided better fracture discrimination than total hip integral BMD. A slice-by-slice analysis of the neck or the inclusion of strength-based parameters did not improve fracture discrimination.For QCT of the proximal femur, a large variety of analysis parameters describing bone mineral density, geometry, or strength has been considered. However, in each given study, generally just a small subset was used. The aim of this study was to start with a comprehensive set and then select a best subset of QCT parameters for discrimination of subjects with and without acute osteoporotic hip fractures.The analysis was performed using the population of the European Femur Fracture (EFFECT) study (Bousson et al. J Bone Min Res: Off J Am Soc Bone Min Res 26:881-893, 2011). Fifty-six female control subjects (age 73.29.3 years) were compared with 46 female patients (age 80.911.1 years) with acute hip fractures. The QCT analysis software MIAF-Femur was used to virtually dissect the proximal femur and analyze more than 1000 parameters, predominantly in the femoral neck. A multivariate best-subset analysis was used to extract the parameters best discriminating hip fractures. All results were adjusted for age, height, and weight differences between the two groups.For the discrimination of all proximal hip fractures as well as for cervical fractures alone, the measurement of neck parameters suffices (area under the curve (AUC)=0.84). Parameters characterizing bone strength are discriminators of hip fractures; however, in multivariate models, only cortical cross-sectional area in the neck center remained as a significant contributor. The combination of one BMD parameter, trabecular BMD of the trochanter, and one geometry parameter, cortical thickness of the neck discriminated hip fracture with an AUC value of 0.83 which was significantly better than 0.77 for total femur BMD alone. A comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination.If QCT of the hip is performed, the analysis should include neck and trochanter. In particular, for fractures of any type, a comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination nor did the inclusion of strength-related parameters other than cortical area or thickness. One BMD and one geometry parameter, in this study, the combination of trabecular BMD of the trochanter and of cortical thickness of the neck resulted in significant hip fracture discrimination.

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