Magnetic Resonance Imaging Findings in Simple Elbow Dislocations: A Systematic Review and Meta-Analysis.

MRI-Based Retrospective Analysis of Knee Joint Injuries: Patterns and Prevalence

MRI provides a detailed evaluation of knee injuries, aiding diagnosis and management, and MRI detection of associated abnormalities helps guide treatment and improve patient outcomes.

Magnetic Resonance Imaging Evaluation of Meniscal Ramp Lesions and their Association with Anterior Cruciate Ligament Injury Severity: A Retrospective Observational Study.

The strong association with ACL injury and having a potentially important role in knee stabilisation, their injuries need to be given due importance by radiologists and should not be underreported.

Associations between MRI Findings of the Anterolateral Ligament in Knee Injuries and Clinical Variables in Candidates for Anterior Cruciate Ligament Reconstruction

Objectives: To evaluate the associations between magnetic resonance imaging (MRI) findings of the anterolateral ligament (ALL) and clinical variables in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods: This retrospective multicenter study included patients with clinically confirmed ACL tears scheduled for reconstruction between January and August 2024 at three orthopedic centers in Mashhad. MRI examinations were performed using a 1.5-T scanner and interpreted by two to three experienced radiologists. Associations between MRI-detected ALL injuries and clinical variables were analyzed statistically. Results: Eighty-three patients (mean age, 29 years; 90.6% male) were included. MRI identified ALL injuries in 34 patients (41.0%), while 45 patients (54.2%) had no detectable ALL injury; four cases were unclassified. Concomitant ACL and ALL injuries were present in 41.7% of patients. A high-grade pivot shift test was positive in 54.2% of cases. Medial and lateral meniscal injuries were observed in 53.0% and 13.3% of patients, respectively, and joint effusion was present in 60.2%. Significant associations were found between ALL injury and MRI-detected effusion (P = 0.035) as well as a positive pivot shift test (P < 0.001). No significant relationships were observed between ALL injury and age, sex, or anterior drawer test findings. Conclusion: ALL injuries were significantly associated with joint effusion and positive pivot shift test results in patients undergoing ACL reconstruction. Although a possible association with posterior cruciate ligament buckling was observed, larger studies are needed to confirm this finding.

Management of anterior shoulder instability in patients aged 40 and older: a systematic review

The incidence and epidemiology of patellar fractures following medial patellofemoral ligament reconstruction: a systematic review and meta-analysis

Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Medial patellofemoral ligament reconstruction (MPFLR) is commonly performed to treat patellar instability. The aim of this systematic review was to determine the incidence of and risk factors for patellar fractures after MPFLR. The protocol for this review was registered on PROSPERO with registration number CRD420251066107. The PRISMA 2020 checklist was followed. Electronic databases and conference proceedings were searched to the 15th of May 2025. Studies were eligible if they reported incidence of patellar fractures after MPFLR. A random-effects meta-analysis was performed. Included studies were appraised using tools respective of study design. A total of 4,972 records were screened in the initial search. A total of 110 studies satisfied the inclusion criteria, evaluating 115,496 patients. The evidence was moderate to low in quality. The incidence of patellar fracture ranged from 0 to 9.50%, with a pooled incidence of 1.17% (95% confidence interval [CI] 0.76- 1.68%). There was no difference in incidence of patellar fractures between patients who did and did not undergo bone tunnel fixation (0.94%, 95% CI 0.69–1.24 vs. 1.00%, 95% CI 0.15–2.44%, respectively). There was no difference in fracture incidence between patients who underwent concomitant procedures (1.26%, 95% CI 0.51–2.32) and those who underwent MPFLR alone (0.53%, 95% CI 0.13–1.16%). Patellar fractures are a known complication of MPFLR, with a higher incidence observed in patients undergoing this procedure compared to the baseline population risk. Current evidence suggests its incidence is not affected by tunnel location or the performance of concomitant procedures, though further prospective studies are required to corroborate this. Appropriate post-operative follow-up is required to monitor the occurrence of patellar fractures during the post-operative period.

The New Munich Elbow Soft Tissue (MEST) classification is a reliable MRI-based injury severity grading system for acute simple elbow dislocations.

PURPOSE Simple elbow dislocation (SED) is characterized by injuries to soft tissue structures. The aim of the novel Munich Elbow Soft Tissue (MEST) classification is to provide a systematic approach to grade the severity of musculoligamentous lesions after acute SED. The purpose of this study is to determine the reliability of the classification. METHODS All elbow dislocations between 1 January 2012 and 31 December 2024 that presented to a high-frequency, multilevel trauma centre were screened retrospectively for inclusion criteria. Patients with a history of elbow fractures, chronic instability, previous surgery, previous musculoligamentous injuries, time from injury to magnetic resonance imaging (MRI) > 30 days and a lack of or low-quality MRI imaging were excluded. In 30 randomly selected patients, injuries were classified according to the MEST system into Grade 1 (ligamentous) and Grade 2 (musculoligamentous), with an extended subclassification comprising eight subtypes based on detailed structure-specific MRI assessment. Inter- and intrarater reliability were evaluated using Fleiss' and Cohen's Kappa (κ). RESULTS Of the randomly selected 30 patients (age 38.1 ± 13.4 years, male 46.7%), the mean time from injury to MRI was 4.2 ± 3.9 days. Interrater reliability across all raters demonstrated substantial agreement for the MEST grade (Fleiss' κ 0.690) and for the MEST subclassification (Fleiss' κ 0.639). Exact agreement was found in 70.0% for the MEST grade and in 43.3% for the MEST subclassification. Agreement between radiologists yielded higher agreement for the MEST subclassification than between the orthopaedics, and vice versa for the MEST grade. The less experienced raters showed higher agreement than the experienced raters. The classification also showed substantial to excellent intrarater reliability, with mean κ values of 0.900 for the MEST grade and 0.800 for the MEST subclassification. CONCLUSION The MEST classification represents a comprehensive and reliable classification for injury patterns after acute SED, offering additional guidance in clinical decision-making. LEVEL OF EVIDENCE Level IV.