James Linklater

Objective: The aims of this study were to (1) examine the relationship between magnetic resonance imaging (MRI)-confirmed hamstring strain grade and time to return to play; (2) examine this relationship specifically in pace bowlers; and (3) describe the incidence, prevalence, and grade of MRI-confirmed hamstring strains in elite Australian cricket players. Design: This is a retrospective cohort study. Setting: Elite Australian cricket teams over 13.5 seasons were analyzed. Participants: Four hundred seventy-eight male and 365 female contracted Australian cricketers participated in this study. Independent variable: British Athletics Muscle Injury Classification system grading of hamstring strains, which had received MRI scan, was the independent variable. Main outcome measure: The main outcome was time to return to play (days). Results: One hundred forty-one hamstring strain injuries with available MRI imaging scans were recorded during the study period (average 3.2 per 100 players per season: male 4.5, female 1.2). The most commonly injured muscle was biceps femoris (63%, 95% confidence interval: 56%-71%) and the most frequent category of injury was grade 2C (27%, 20%-35%). Across all injury grades, players were unavailable for full participation for a median of 22 (interquartile range: 15-38) days and missed 3 (1-6) matches. The number of days unavailable were higher for injuries that were graded 2 or 3, compared with grade 1 injuries ( P = 0.004 and P = 0.007, respectively), and injuries that included the tendon compared with those which did not ( P = 0.002). Pace bowlers has a higher number of days unavailable compared with players with other dominant skills for grade B and C injuries combined ( P = 0.046). Conclusions: This study provides evidence that higher grade injuries and those involving the intramuscular tendon are associated with a more prolonged return to play. This finding should be viewed in context of the study limitation that MRI findings may have informed management.

Background: Joint line obliquity (JLO) often increases after medial opening wedge high tibial osteotomy (MOWHTO), and excessive JLO may adversely affect the lateral compartment. However, its effects on cartilage tissue and postoperative outcomes remain unclear. This study investigated whether increased postoperative JLO is associated with early cartilage changes on quantitative MRI T 2 mapping and differences in clinical outcomes. Methods: A total of 33 knees undergoing MOWHTO were retrospectively reviewed. Radiographic parameters—hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and JLO—were assessed preoperatively and at 6 months. Based on postoperative radiographic measurements, patients were classified as increased JLO/MPTA (Group I: JLO > 5° and/or MPTA > 94°) or acceptable range JLO/MPTA (Group A: JLO < 5° and MPTA < 94°). Quantitative MRI T 2 mapping was performed preoperatively and at 12 months to measure T 2 relaxation times ( T 2 values) and Δ T 2 values (postoperative–preoperative) in the patella, trochlea, lateral femoral condyle (LFC), and lateral tibial plateau (LTP), analyzing superficial, deep, and total cartilage layers. Knee Injury and Osteoarthritis Outcome Score (KOOS) was assessed at both time points. Results: Group I included 13 patients and group A included 20 patients. Postoperative HKA was similar between groups ( p = 0.326). No significant intergroup differences were observed in preoperative or postoperative T 2 values in the patellofemoral or lateral compartments. However, Δ T 2 values in the LTP were significantly higher in group I than in group A in the superficial (3.3 ± 6.5 versus −1.7 ± 5.9 ms, p = 0.022) and total (4.5 ± 5.7 versus − 0.6 ± 5.0 ms, p = 0.012) layers. Group I also had worse KOOS–Symptoms ( p = 0.016), QOL ( p = 0.022), and Sport/Rec ( p = 0.040). Conclusions: Even with similar postoperative limb alignment, increased JLO/MPTA was associated with early degenerative changes in lateral tibial cartilage and worse clinical outcomes. Maintaining postoperative JLO within the acceptable range during MOWHTO may help maintain lateral compartment cartilage health and optimize clinical outcomes. Level of Evidence : Level IV.

Objective: i) determine whether the grade of hamstring strain confirmed by magnetic resonance imaging (MRI) is related to time to return to play, and ii) describe the incidence, prevalence and grade of hamstring strains confirmed by MRI in elite Australian cricket players. Design: Retrospective case series. Methods: Hamstring strains from professional domestic and international cricket teams over 13.5 seasons which had received MRI scans were graded using British Athletics Muscle Injury Classification (BAMIC) system. The main outcome measure was time to return to play. Results: 141 hamstring strain injuries with available MRI imaging scans were recorded during the study period (average 3.2 per 100 players per season: male 4.5, female 1.2). The most commonly injured muscle was biceps femoris (64%, 95% CI 56-71%) and the most frequent category of injury was grade 2C (27%, 20-35%). Across all injury grades, players were unavailable for full participation for a median of 23 (IQR 15-38) days and missed 3 (1-6) matches. The number of days unavailable were higher for injuries which were graded 2 or 3, compared to grade 1 (p=0.018, p=0.002 respectively), and injuries which included the tendon compared to those which did not (p=0.002). Conclusions: This study provides evidence that higher grade injuries and those involving the intramuscular tendon are associated with a more prolonged return to play. This finding should be viewed in context of the study limitation that clinicians treating players were not blinded to the MRI findings.

Capsuloligamentous injury of the first metatarsophalangeal (MTP) joint (eponymously called “turf toe”) mostly occurs in athletes and involves acute trauma, whereas tears of the lesser MTP joint plantar plate typically are an attritional-degenerative condition. This article reviews the anatomy, pathophysiology, mechanism and patterns of injury, grading and classification of injury, imaging appearances (pre- and postoperative), and management of first MTP joint capsuloligamentous injuries and lesser MTP joint plantar plate tears. These two distinct pathologies are discussed in separate sections. Article published online: 15 February 2023 © 2023. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Thumb-base osteoarthritis (OA) is a common cause of pain and disability This study aimed to investigate the associations of musculoskeletal ultrasound OA pathologies with the extent of pain, function, radiographic scores, and muscle strength in symptomatic thumb-base osteoarthritis. This is a cross-sectional study of an ongoing clinical trial with eligibility criteria including thumb-base pain on Visual Analogue Scale (VAS) ≥40 (0 to 100 mm), Functional Index for Hand OA (FIHOA) ≥ 6 (0 to 30) and Kellgren Lawrence (KL) grade ≥ 2. The most symptomatic side was scanned to measure synovitis and osteophyte severity using a 0–3 semi-quantitative score, power Doppler and erosion in binary score. A linear regression model was used for associations of ultrasound findings with VAS pain, FIHOA and hand grip and pinch strength tests after adjusting for age, gender, body mass index, disease duration and KL grade as appropriate. For correlation of ultrasound features with KL grade, OARSI ((Osteoarthritis Research Society International) osteophyte and JSN scores, Eaton grades, Spearman coefficients were calculated, and a significant test defined as a p-value less than 0.05. The study included 93 participants (mean age of 67.04 years, 78.5% females). Presence of power Doppler has a significant association with VAS pain [adjusted β coefficient = 11.29, P = 0.02] while other ultrasound pathologies revealed no significant associations with all clinical outcomes. In comparison to radiograph, ultrasonographic osteophyte score was significantly associated with KL grade [rs = 0.44 (P < 0.001)], OARSI osteophyte grade [rs = 0.35 (P = 0.001)], OARSI JSN grade [rs = 0.43 (P < 0.001)] and Eaton grade [rs = 0.30 (P < 0.01)]. Ultrasonographic erosion was significantly related with radiographic erosion [rs = − 0.49 (P = 0.001)]. From a clinical perspective the significant relationship of power Doppler with pain severity in thumb base OA suggests this might be a useful tool in understanding pain aetiology. It is important to recognise that power Doppler activity was only detected in 14% of the study so this might be an important subgroup of persons to monitor more closely. Registered at Australian New Zealand Clinical Trials Registry (ANZCTR), http://www.anzctr.org.au/ , ACTRN12616000353493.