André Fukunishi Yamada

Objective: To determine the prevalence of MRI findings of pubic apophysitis in asymptomatic elite youth soccer players compared with non-athletes and to evaluate other pelvic and hip abnormalities in both groups. Materials and methods: This cross-sectional observational study included asymptomatic elite male youth soccer players and male non-athletes matched by age and body mass index. Forty-seven soccer players who underwent pelvic MRI for complaints unrelated to the pelvis and had no current groin pain were recruited. A control group of 114 non-athletes was retrospectively identified from the PACS database. These individuals had undergone pelvic MRI primarily for low back pain or other indications and were asymptomatic for hip and groin pain at the time of imaging. MRI examinations were independently reviewed by two musculoskeletal radiologists blinded to clinical data and group allocation. Interobserver agreement was assessed for all variables. Between-group comparisons were performed using regression models adjusted for age and body mass index. Results: After application of the eligibility criteria, 40 athletes and 32 controls were included. Compared with controls, athletes showed a higher prevalence of MRI findings related to pubic apophysitis, including subapophyseal bone marrow edema (77.5% vs 18.8%; p < 0.01), bilateral widening between the apophyses and the subapophyseal bone (15.0%–40.0% vs 0%–6.2%; p < 0.05), cortical irregularity of the subapophyseal bone (82.5% vs 25.0%; p < 0.01), and pubic osteophytes (40.0% vs 3.1%; p = 0.01). Other findings more frequently observed in athletes included adductor longus tendinosis, adductor longus peritendinitis, trochanteric bursitis, and iliotibial band syndrome. Interobserver agreement ranged from moderate to almost perfect for most variables. Conclusion: Asymptomatic elite youth soccer players demonstrate a high prevalence of MRI findings related to pubic apophysitis compared with non-athletes.

INTRODUCTION: Managing partial Achilles’ tendon tears in elite soccer players during a competitive season requires a balance between structural healing and performance maintenance. Transcranial direct current stimulation (tDCS) has emerged as a potential neuromodulatory adjunct to manage pain and optimize motor efficiency through top-down regulation. OBJECTIVES: This case report evaluates the effects of a 17-session dual-site tDCS protocol on pain modulation, competitive performance, and structural tendon repair in a professional top-level soccer player. MATERIALS AND METHODS: The intervention consisted of 17 tDCS sessions (2mA) using a dual-target montage: anodal stimulation over the left primary motor cortex (M1) and left dorsolateral prefrontal cortex (DLPFC), with cathodal electrodes over the supraorbital and contralateral frontal midline areas. Assessments included the Visual Analog Scale (VAS) for pain and the Rating of Perceived Exertion (RPE) for recovery training and competitive matches. Structural evolution was monitored via serial ultrasonography (US) and confirmed by multi-sequence magnetic resonance imaging (MRI). RESULTS: The athlete exhibited a positive pain-exertion dissociation: a consistent progressive reduction in VAS pain scores occurred simultaneously with an increasing trend in match-play RPE, indicating a higher capacity for physical exertion despite the injury. Training RPE remained stable and low (1–3), reflecting controlled recovery workloads. Serial axial US initially identified a partial tear in the lateral and deep fibers with laminar fluid. A 30-day follow-up US and MRI (T1, T2-weighted with fat saturation) confirmed successful tissue repair, with intermediate-signal intensity tissue filling the defect, indicating organized scar formation without transfixing lesions. Serial axial ultrasonography initially identified a partial tear within the lateral and deep fibers of the tendon midbody, accompanied by localized laminar fluid. A 30-day follow-up, utilizing US and multi-sequence MRI (T1; T2-weighted with fat saturation), confirmed structural restoration. The previous defect was replaced by tissue of intermediate-signal intensity, consistent with organized fibroblastic repair and scar formation, in the absence of residual transfixing lesions. CONCLUSION: The dual-site tDCS intervention was associated with significant pain modulation and improved motor efficiency, allowing the athlete to increase competitive output during the structural healing phase. The correlation between reduced pain (VAS), increased match effort (RPE), and confirmed biological repair suggests that tDCS facilitated an optimal environment for recovery. This suggests that tDCS is a promising adjunct for maintaining elite performance during injury rehabilitation, though further controlled research is needed to elucidate the specific mechanisms of tDCS-mediated tissue repair.

Over the past decades, the growing pursuit of the “ideal body” has increased the demand for aesthetic procedures. There are four main types of procedures: autologous fat grafting, gluteal implants, dermal fillers, and local flaps. Fat grafting is the most commonly performed with the lowest complication rates, while implants are associated with higher risks. The use of dermal flaps is generally restricted to patients with massive weight loss, as in bariatric surgeries. Dermal fillers are not recommended by the Food and Drug Administration (FDA) for use on the buttocks; however, they have been increasingly used, especially by unqualified professionals. Complications include infections, seromas, hematomas, and suture dehiscence; however, the most feared complication is pulmonary embolism, more related to fat grafting and filling substances. Given the rising number of postoperative magnetic resonance imaging (MRI) exams, more and more radiologists have come across aesthetic gluteoplasty exams in daily practice and must understand the anatomy and the main anatomical variations of the gluteal region. Besides, it is important to have knowledge of the surgical techniques employed and actively look for potential postoperative complications related to each type of procedure. This article reviews surgical techniques, anatomical considerations, expected MRI findings, and common complications after gluteoplasty.

Purpose: To map the scientific literature on the use of dynamic ultrasound in the assessment of medial knee instability. Methods: Primary (clinical or experimental) and secondary studies that used dynamic ultrasound to assess medial knee opening were included. There were no restrictions on language or date. Sources of information: The searches were conducted in the PubMed/MEDLINE, Scopus, Web of Science, Embase and CINAHL databases. Data selection and extraction: The process of data selection and extraction was conducted by two independent reviewers. The information was organised into thematic tables and a conceptual matrix was developed based on the components of population, concept, and context. Results: Ten studies were included: two biomechanical, six clinical, and two reviews. Ultrasound demonstrated good reliability in measuring medial opening and distinguishing between injured and normal knees. Heterogeneity was observed in the stress protocols, evaluation angles, units of measurement, and anatomical points. Conclusions: Dynamic ultrasound presents consolidated clinical potential in the assessment of medial knee instability. Standardisation of methods and additional clinical validation are necessary. Level of Evidence: Not applicable.

Groin pain is a common issue in athletes, and an accurate diagnosis is crucial for effective management. The complexity of the groin's anatomy, including the pubic symphysis and adductor muscles, makes diagnosing injuries in this area challenging. Additionally, the maturation of the pubic apophysis, particularly in adolescent athletes, can lead to conditions like apophysitis that are often misdiagnosed as other groin injuries. A major challenge is the inconsistent terminology, with terms like “athletic pubalgia” and “sports hernia” used interchangeably, causing confusion. The 2015 Doha Agreement helped standardize the classification of groin pain into adductor-, iliopsoas-, inguinal-, and pubic-related types. This review highlights common mistakes in imaging interpretation, particularly in diagnosing adductor- and pubic-related groin pain. Magnetic resonance imaging is a key tool, offering superior soft tissue detail that is crucial for accurate diagnosis, but misinterpretation remains common. This review will help clinicians and radiologists improve diagnostic accuracy and thus ultimately enhance patient outcomes.

Atypical proximal tibial fractures in adolescents are rare, particularly when linked to hormonal therapy for short stature. This case series reports the clinical and imaging features of atypical proximal tibial and distal femoral physeal fractures in male adolescents undergoing combined growth hormone (GH) and aromatase inhibitor (AI) therapy for idiopathic short stature. We report three cases of skeletally immature male adolescents (ages 12–16) treated with GH and anastrozole who presented with acute leg pain following low-energy trauma during soccer. Computed tomography (CT) imaging identified fractures through the physis and metaphysis with characteristic anterior displacement—resembling an “opened-bottle” configuration. Fractures occurred during periods of rapid growth with delayed physeal closure and reduced bone mineral density. Two cases were managed surgically, and one conservatively. Salter-Harris and Ogden classification systems were used. These cases highlight the potential impact of growth-modulating therapies on bone integrity, particularly their influence on the growth plate and overall bone strength, which may increase fracture risk. Imaging and clinical findings emphasize the role of hormone-related delayed physeal closure and altered biomechanics in fracture development. This report aims to raise awareness of this complication and explores possible mechanisms connecting therapy to these atypical injuries.

Sickle cell disease (SCD) is a spectrum of inherited blood disorders, leading to propensity to sickling disruption of red blood cells. Musculoskeletal complications are a common cause of acute and chronic morbidities, related to the main pathophysiological processes: (i) hemolysis and anemia, resulting in marrow hyperplasia and extramedullary hematopoiesis; and (ii) vaso-occlusion, leading to osteonecrosis/bone infarction, myonecrosis, and infection (osteomyelitis and septic arthritis). Knowing the pathophysiology and clinical manifestations is essential for imaging interpretation, but differentiation between acute osteomyelitis and bone infarction remains a clinical and imaging challenge, therefore requiring a multidisciplinary approach. Large subperiosteal fluid collections (≥ 4 mm in depth), in conjunction with elevated inflammatory markers and white blood counts, are more suggestive of osteomyelitis rather than isolated bone infarction. The unenhanced T1-weighted fat-suppressed sequence on MR images was also proposed to aid in this differentiation, but so far with controversial results. Future perspectives of MR imaging include the DIXON technique, which has shown promising results as a biomarker of morbidity of SCD, through evaluation of fat fraction (FF) of bone marrow in a single acquisition and noninvasive way.

Soccer is the most popular sport worldwide, and it is associated with high injury rates, with most of these injuries occurring in the lower extremities. Particularly, in youth soccer players with immature skeleton, the physeal plate is two to five times weaker than the surrounding fibrous structures, and therefore more vulnerable to injury. The physeal plate consists of epiphyses and apophyses, with the former serving as tendon attachment sites and being subject to traction forces. There are two types of apophyseal injury: (i) apophyseal avulsion, which consists of an acute separation across the physeal plate; and (ii) apophysitis, an injury caused by chronic and repetitive contraction of musculotendon unit, leading to inflammation of the growth plate cartilage. Apophyses of the hip and pelvis are the most commonly injured in youth soccer players, due to vigorous contractions during sports activities and the fact that they tend to fuse later compared to other epiphyseal centers, making them more susceptible to injury. In this review, we will discuss the anatomy of lower limb apophyses and clinical and imaging findings of apophyseal injuries in youth soccer players, as well as briefly review treatment options and complications.

Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.