Christopher John Burke

Purpose: To determine the association between labral width as measured on preoperative magnetic resonance imaging (MRI) and patient‐reported outcomes, achievement of clinically significant thresholds, and reoperation rates in hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at minimum 10‐year follow‐up. Methods: A retrospective review of a prospectively gathered database of hip arthroscopy patients from August 2012 to June 2014 was conducted. Inclusion criteria were patients ≥18 years with clinically and radiographically confirmed FAIS and labral tearing who underwent primary hip arthroscopy with labral repair or debridement and had ≥10 years of follow‐up. MRI labral width measurements were performed by 2 blinded musculoskeletal radiologists at standardized clockface locations using a validated technique. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Non‐Arthritic Hip Score (NAHS). Patients were classified as hypoplastic if they had a labral width below the mean on 2 or more views. Outcomes and reoperation rates were compared between groups using independent samples t‐tests for continuous variables and chi‐square tests for categorical variables. Results: A total of 83 patients (83 hips; 65.9% follow‐up) with a mean age of 42.93 ± 13.74 years and body mass index of 25.22 ± 4.51 kg/m ² were included, with a mean follow‐up of 11.30 ± 0.47 years. Patients were categorized into hypoplastic (n = 42) and nonhypoplastic (n = 41) groups. There was no significant difference between hypoplastic and nonhypoplastic groups with respect to age, sex, smoking status, or intraoperative procedures. Additionally, there were no significant intergroup differences in mHHS or NAHS improvement at 5 or 10 years postoperatively. Both groups showed high achievement of the mHHS minimal clinically important difference threshold at 10‐year follow‐up with no significant difference (nonhypoplastic: 90.3% vs hypoplastic: 85.2%, P = .549). There was also no difference achievement of the patient acceptable symptom state (nonhypoplastic: 64.5% vs. hypoplastic: 70.4%, P = .636). However, the hypoplastic group had a significantly higher rate of revision arthroscopy (28.6% vs 9.8%, P = .030) and conversion to total hip arthroplasty (21.4% vs 4.9%, P = .026) when compared with the nonhypoplastic group. Conclusions: Hypoplastic labral width on preoperative MRI was associated with an increased risk of revision hip arthroscopy and conversion to total hip arthroplasty at 10 year follow‐up in patients with FAIS. Level of Evidence: Level III, retrospective comparative case series.

Aim: To evaluate the therapeutic efficacy of ultrasound-guided injection of the transposed ulnar nerve at the elbow. Methods: Fifteen patients who underwent injection of a transposed ulnar nerve between 2014–2024 were identified. Sonographic appearances of the injected segment were scored using a Likert grading system for abnormality, and the cross-sectional area (mm2) was measured. Follow-up with respect to clinical response, need for subsequent therapeutic injection or decompressive surgery was recorded. Results: The grade of abnormality was mild (n = 4), moderate (n = 5), and severe (n = 3), with the remainder morphologically normal (n = 3). Inter-rater agreement was 0.91 (95% CI 0.80–1.00) with p 0.05), nor differences in deformity or cross-sectional area between those who underwent subsequent injection (p >0.05) or surgery (p >0.05). Conclusion: Ultrasound-guided injection is a viable option for refractory neuropathic symptoms, although relief was often temporary, and 20% eventually required revision surgery.

Objectives: To evaluate whether ultrasound‐guided preoperative localization of soft tissue masses in the musculoskeletal system using a wireless radar reflector reduces operative times and reoperation rates compared to a control group referred by the same oncology team. Methods: Retrospective review of SAVI SCOUT radar localizations performed preoperatively for soft tissue masses between 2021 and 2025. All imaging, clinical details, and operative times were evaluated. Comparison was made between the localized group and a control group matched for demographics (age and sex), comorbidities (American Society of Anesthesiologists score), location (trunk versus appendicular; subcutaneous versus deep/subfascial), histopathology (benign versus malignant), and case complexity (primary closure versus flap reconstruction). Cases were performed by the same oncological surgical team referred directly or via the multidisciplinary tumor board during the same time course. Results: Twenty‐four radar localized cases were compared with 24 control cases. Median case time in the SAVI SCOUT group was 52.0 minutes (interquartile range 38.0) and there was no significant difference in case times between the localized and control groups ( p > .05). There were no reoperations in the localized group whereas 5 patients in the non‐localized control group underwent reoperation for positive margins, though this difference fell short of statistical significance ( p = .056). The most common lesions in the localized group were metastatic melanoma (12.5%) and intramuscular myxoma (8.3%), liposarcoma (8.3%), and metastatic leiomyosarcoma (8.3%). Conclusions: Preoperative localization demonstrated no substantial improvement in operative time compared to the non‐localized group. However, re‐resection rates were higher in the non‐localized group.

Purpose The aim of this study is to evaluate the treatment response of patients with osteoid osteoma (OO) following radiofrequency ablation (RFA) and identify factors influencing the time to complete pain relief post-treatment. Materials and methods This is a retrospective cohort study of patients who underwent RFA for OO between 2010 and 2023. Demographic, clinical data, and time between symptoms onset to diagnosis and RFA were recorded. CTs were reviewed for OO location (upper extremity, lower extremity, spine/pelvis), intra-articular versus extra-articular lesions, nidus size, degree of peripheral bone formation, and presence of vessel sign. Procedural related information included needle approach, RFA active tip length, and number of RFA cycles. Statistical analysis was made on factors and their correlation to complete pain relief. Results Out of 63 patients included in our study (mean age 19.3 ± 10.6), OO were located in the upper extremity (n = 7, 11%), lower extremity (n = 48, 76%), and pelvis/spine (n = 8, 13%). OO in the pelvis/spine achieved the quickest complete pain relief (14 days) compared to those in lower (25 days, 11 days longer) and upper extremity (54 days, 40 days longer) respectively (p = 0.04). Vessel sign had significant association with shorter time to complete pain relief (p = 0.03). Longer duration of symptoms until diagnosis or RFA, larger nidus, more bone formation, and extra-articular OO responded slower to RFA, though statistical significance was not reached. Conclusions Anatomical location and certain imaging characteristics of OO may have association with time to complete pain relief following RFA. The findings can potentially help optimizing patient counseling with more realistic expectations and symptom management strategies prior to and following RFA.

Background: Rapid real-time magnetic resonance (MR) sequences enable dynamic articular kinematic assessment. The abduction-external rotation (ABER) position has long been used to characterize glenohumeral pathology. Purpose: To evaluate a dynamic gradient recall echo (GRE) sequence for ABER-positioned glenohumeral joint kinematic assessment correlating with subjective instability and clinical apprehension testing. Material and Methods: Symptomatic patients were scanned using a routine MR arthrogram protocol supplemented by an additional “dynamic ABER” GRE technique acquired with the arm abducted and then internally-externally rotated in real time. Dynamic motion of the humeral head between the extremes of motion in the abducted and externally rotated positions was evaluated. The cohort was followed for 3 years. Results: A total of 15 dynamic ABER studies in 15 different patients were evaluated by three readers (right: n=9; left: n=6), with a mean age of 30 years (range=19–45 years). Good accuracy of the humeral head excursion between the abducted and externally-internally rotated positions (AUC=0.88) was observed as a test for positively detecting instability. An association was detected between clinical instability and mean humeral head excursion as measured by all three readers ( P = 0.026), although no association between positive apprehension testing and mean humeral head excursion was detected. There was a trend towards surgery-naïve patients with higher mean humeral head excursion subsequently undergoing surgical management ( P =0.088), although this did not reach statistical significance. Conclusion: Correlation between subjective instability and humeral head translation demonstrated on a dynamic ABER sequence added to MR shoulder arthrograms was observed but without association with clinical apprehension testing.

Ultrasound (US) is a valuable tool in the evaluation of arthritis both for diagnosis and treatment response. Pertinent findings such as joint effusions, synovitis, bursitis, bone erosions, tenosynovitis, and enthesitis can all be readily evaluated sonographically. In this article, we describe specific considerations in the US evaluation of rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, crystalline arthritis (gout, calcium pyrophosphate deposition disease, and hydroxyapatite deposition disease), septic arthritis, and osteoarthritis with attention to certain differentiating features. The potential role of US in the diagnosis of specific arthritides is discussed, together with an overview of newer technologies and future directions.