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Ashley S. Long and James R. Scifers

Edited by Patrick McKeon

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Thilo Hotfiel, Marion Kellermann, Bernd Swoboda, Dane Wildner, Tobias Golditz, Casper Grim, Martin Raithel, Michael Uder and Rafael Heiss

both in professional and recreational athletes. 6 – 8 Imaging of muscle tissue is essential to provide a correct assessment of the injury’s severity. 9 , 10 In diagnostic imaging, conventional ultrasound has been utilized for approximately 3 decades and has been widely described in literature. 10

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Vincenzo Ricci and Levent Özçakar

Muscle injuries are commonplace in sports medicine, and the more frequently involved muscle groups are the hamstrings, adductors, rectus femoris, and the medial head of the gastrocnemius. 1 The diagnosis is usually clinical, but diagnostic imaging modalities are often utilized to correctly

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Emily E. Kruithof, Spencer A. Thomas and Patricia Tripp

’s orthopedic surgeon for assessment and diagnostic imaging. Magnetic resonance imaging revealed: (a) grade III and IV full thickness medial femoral condyle OCD, (b) loose bodies in the intercondylar notch, and (c) grade I medial collateral ligament injury. Intervention The patient and surgeon discussed

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Leslie W. Oglesby and Andrew R. Gallucci

An 18-year-old male collegiate American football player with no previous medical history of knee injury suffered an acute left patellofemoral dislocation during preseason practice. Diagnostic imaging and exploratory surgery revealed multiple avulsions of the medial patellofemoral ligament as well as significant lateral patellar tilt and chondromalacia of the left patella. A surgical repair of the ligament was performed as well as a lateral release and debridement of multiple structures. With no rehabilitative protocols available for multiple avulsion repair, a protocol for a single avulsion repair of the medial patellofemoral ligament was used with some exceptions. The patient returned to full-contact American football activities at 5 months postoperation with no reported complications. These findings indicate that a rehabilitation protocol for single avulsion repair may be appropriate for multiple avulsions as well.

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Robson Dias Scoz, Cesar F. Amorim, Bruno O.A. Mazziotti, Rubens A. Da Silva, Edgar R. Vieira, Alexandre D. Lopes and Ronaldo E.C.D. Gabriel

Objective: To assess the diagnostic validity of an isokinetic testing to detect partial injuries on the anterior cruciate ligament (ACL). Design: Prospective diagnostic study. Settings: Orthopedic clinic, physiotherapy clinic, orthopedic hospital, and diagnostic/image clinic. Participants: Consecutive patients (n = 29) with unilateral knee complaint submitted to physical examination, magnetic resonance images (MRIs), and isokinetic testing prior to surgery of ACL reconstruction. Interventions: Not applicable. Main Outcome Measures: The isokinetic torque curves data from extensor and flexor muscles were converted to frequency domain by fast Fourier transformation and compared with healthy contralateral limb. Differences were categorized as unstable knees and these conclusions were compared with patient’s physical examinations (doctor’s conclusion on ACL integrity) and MRIs (as the radiologist conclusions on ACL integrity). After surgery, all intraoperatively confirmed partial injured patient’s data were collected. The diagnostic accuracy measures to compare the conclusions of all 3 professionals included sensitivity, specificity, positive predictive value, negative predictive value, disease prevalence, positive likelihood ratio, and accuracy—all using a confidence interval of 95%. Results: Compared with MRI, the sensitivity of isokinetic test for an ACL partial injury was 90.00%, specificity 83.33%, positive predictive value 52.94%, negative predictive value 97.56%, and accuracy 84.48%. Compared with physical examination, the sensitivity of isokinetic test for an ACL partial injury was 85.71%, specificity 78.43%, positive predictive value 35.29%, negative predictive value 97.56%, and accuracy 79.31%. Conclusions: This method of isokinetic data analysis through fast Fourier transformation can be used to improve diagnostic accuracy of a difficult detection injury. Even present, a partial ACL injury can produce a stable knee during isokinetic testing and could be used to detect candidates for conservative treatment based on strengthening exercises, reducing surgery risks, and financial and social impact on patient’s life.

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Robert Vallandingham, Zachary Winkelmann, Lindsey Eberman and Kenneth Games

, selective tissue tests Diagnostic imaging Clinical diagnosis Grade of injury (I, II, III) Section 3: Management Methods Therapeutic modalities Therapeutic rehabilitation Functional assessment tools Section 4: Outcome Measurement Tools PROMs CROMs Functional performance testing Section 5: Return

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Marion Kellermann, Christoph Lutter and Thilo Hotfiel

, Swoboda B , Engelhardt M , Heinrich M , Strobel D , Wildner D . Contrast-enhanced ultrasound in diagnostic imaging of muscle injuries: perfusion imaging in the Early Arterial Phase . Sportverletz Sportschaden . 2016 ; 30 ( 1 ): 54 – 57 . P doi:10.1055/s-0041-106954 26556787 23. Lewis PB

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James Geiselman, Rachel Gillespie and Andrew Miller

imaging. 7 , 8 Based on the clinical presentation and assessment, imaging was not ordered, however, had the patient not responded to the prescribed treatments, diagnostic imaging would have been warranted. The combination of nonoperative, conservative treatments consisting of chiropractic care, soft

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Michelle A. Sandrey

history, observation, palpation, ROM, and look for any co-morbidities (i.e., sacroiliac joint) from sites proximal and distal to the chief complaint. Ultimately, if instability is suspected, no diagnosis is complete without the information gained from diagnostic imaging. Once the evaluation is concluded