Focal fibrocartilaginous dysplasia ("fibrous periosteal inclusion"): an additional series of eleven cases and literature review

Focal fibrocartilaginous dysplasia (FFCD) is a benign condition first described in 1985 as a cause of tibia vara. We are reporting on 11 cases. The lesions involved proximal tibia (9 cases), distal femur (1 case), and distal ulna (1 case). We believe that this entity represents a bony anchor preventing natural sliding of the periosteum during growth (an "epiphysiodesis-like" effect). For the tibia, we believe this is the pes anserinus. We are suggesting that this entity be called a "fibrous periostal inclusion." Treatment indications result from this concept: (1) for tibial lesions with a metaphyseal-diaphyseal angle less than 20 degrees observation for 6 to 12 months; (2) if the deformity improves, the tether likely broke spontaneously, and no treatment is required; and (3) curettage early if the deformity worsens. This will be followed by rapid correction into physiological valgus (tibia) and prevent the need for osteotomy. Early curettage for other less common locations is recommended.

Comparison of Dynamic Expiratory CT With Bronchoscopy for Diagnosing Airway Malacia: A Pilot Evaluation

OBJECTIVE

To assess the accuracy of dynamic expiratory CT for detecting airway malacia using bronchoscopy as the diagnostic "gold standard."

MATERIALS AND METHODS

A computerized hospital information system was used to retrospectively identify all patients with bronchoscopically proven airway malacia referred for CT airway imaging at our institution during a 19-month period. CT was performed within 1 week of bronchoscopy. All patients were scanned with a standard protocol, including end-inspiratory and dynamic expiratory volumetric imaging, using an eight-detector multislice helical CT scanner. For both CT and bronchoscopy, malacia was defined as >/= 50% expiratory reduction of the airway lumen. CT and bronchoscopic findings were subsequently jointly reviewed by the radiologist and bronchoscopist for concordance.

RESULTS

Twenty-nine patients (12 men and 17 women; mean age, 60 years; range, 36 to 79 years) comprised the study cohort. CT correctly diagnosed malacia in 28 of 29 patients (97%). The most common presenting symptoms were dyspnea in 20 patients (69%), severe or persistent cough in 16 patients (55%), and recurrent infection in 7 patients (24%). The estimated radiation dose (expressed as dose-length product) for the dual-phase study is 508 mGy-cm, which is comparable to a routine chest CT.

CONCLUSION

Dynamic expiratory CT is a highly sensitive method for detecting airway malacia and has the potential to serve as an effective, noninvasive test for diagnosing this condition.

Patellar cartilage lesions: comparison of magnetic resonance imaging and T2 relaxation-time mapping

PURPOSE

To evaluate the detection and the size of focal patellar cartilage lesions in T2 mapping as compared to standard clinical magnetic resonance imaging (MRI) at 1.5T.

MATERIAL AND METHODS

Fifty-five consecutive clinical patients referred to knee MRI were imaged both with a standard knee MRI protocol (proton-density-weighted sagittal and axial series, T2-weighted sagittal and coronal series, and T1-weighted coronal series) and with an axial multislice multi-echo spin-echo measurement to determine the T2 relaxation time of the patellar cartilage. MR images and T2 maps of patellar cartilage were evaluated for focal lesions. The lesions were evaluated for lesion width (mm), lesion depth (1/3, 2/3, or 3/3 of cartilage thickness), and T2 value (20-40 ms, 40-60 ms, or 60-80 ms) based on visual evaluation.

RESULTS

Altogether, 36 focal patellar cartilage lesions were detected from 20 human subjects (11 male, nine female, mean age 40+/-15 years). Twenty-eight lesions were detected both on MRI and T2 maps, while eight lesions were only visible on T2 maps. Cartilage lesions were significantly wider (P = 0.001) and thicker (P<0.001) on T2 maps as compared to standard knee MRI. Most lesions 27 had moderately (T2 40-60 ms) increased T2 values, while two lesions had slightly (T2 20-40 ms) and seven lesions remarkably (T2 60-80 ms) increased T2 relaxation times.

CONCLUSION

T2 mapping of articular cartilage is feasible in the clinical setting and may reveal early cartilage lesions not visible with standard clinical MRI.

The evaluation of articular cartilage lesions of the knee with a 3-Tesla magnet

PURPOSE

This prospective study was performed to investigate whether 3-Tesla magnetic resonance imaging (MRI) provides an accurate assessment of the articular cartilage in clinical practice.

METHODS

Forty patients with persistent knee pain and suspected cartilage lesions underwent 3-T MRI shortly before arthroscopy with the following sequences: axial/coronal/sagittal proton density-weighted turbo spin echo with spectral fat suppression, axial/sagittal 3-dimensional T1-weighted gradient echo with selective water excitation, and axial T2-weighted gradient echo (Intera 3.0T; Philips Medical Systems, Best, The Netherlands). Knee cartilage surfaces were divided into 6 regions; lesions detected on MRI were classified into stages I to IV and compared with the arthroscopic grading.

RESULTS

For the 240 cartilage surfaces evaluated, the sensitivities, specificities, positive predictive values, and negative predictive values of 3-T MRI were 74%, 95%, 74%, and 95%, respectively, for the detection of grade IV lesions; 63%, 90%, 60%, and 91%, respectively, for grade III lesions; 62%, 90%, 57%, and 92%, respectively, for grade II lesions; and 29%, 95%, 39%, and 92%, respectively, for grade I lesions.

CONCLUSIONS

In these preliminary clinical studies 3-T MRI provided convincing visualization of the hyaline cartilage with comparatively good diagnostic values. Nonetheless, it must be pointed out that the positive predictive values were low for all grades of lesions. Thus, when 3-T MRI suggests a cartilage defect, the probability that the arthroscopic finding corresponds exactly to the MRI result is between 39% and 74%. Therefore, the value of arthroscopy for a detailed assessment and grading of a cartilage disorder with regard to definitive planning of a therapeutic procedure cannot be replaced by 3-T MRI.

LEVEL OF EVIDENCE

Level I, testing of previously developed diagnostic criteria in a series of consecutive patients with universally applied gold standard.

Tibial subchondral bone size and knee cartilage defects: relevance to knee osteoarthritis

Unlike knee plain radiography which can only detect joint space narrowing and osteophytes, magnetic resonance imaging can directly visualize and analyse the whole knee structure, including bone size, cartilage defects and loss of cartilage volume. Tibial subchondral bone area expansion may be primary and is associated with risk factors such as age, body mass index (BMI), genetics and/or limb malalignment. It can lead to the development of knee defects, which may also be caused by demographic, anthropometric and environmental factors such as age, female sex, BMI and smoking as well as structural changes such as osteophytes, bone marrow lesions, meniscal tears, meniscal extrusion and ligament abnormalities. Once knee cartilage defects develop, they have a variable natural history but are associated with subsequent cartilage loss in a dose-response manner. Both tibial subchondral bone area and knee cartilage defects are quantitatively related to the severity of knee osteoarthritis (OA), and predictive of the need for knee joint replacement in subjects with knee OA independent of radiographic change. Taken as a whole, these studies suggest that tibial subchondral bone expansion and cartilage defect development represent important targets for the prevention of cartilage loss and joint replacement.

Meniscus allograft transplantation: ten-year results of cryopreserved allografts

PURPOSE

We report the results of cryopreserved meniscus allograft transplantations with 10 or more years of follow-up.

METHODS

Fourteen medial and 8 lateral meniscus allografts were evaluated with a mean follow-up of 141 months (range, 115 to 167 months). The clinical outcome and failure rate was evaluated by use of a Lysholm score and modified pain score in 22 patients. The results of radiographic and magnetic resonance imaging (MRI) analysis were reported in 15 and 7 patients, respectively.

RESULTS

Overall, 25% of medial allografts and 50% of lateral allografts failed. The combined failure rate was 35%. There was a 90% improvement in Lysholm scores, as well as pain scores. There were no discernible Lysholm or pain score differences for both lateral and medial allografts. Furthermore, there was no discernible difference in both Lysholm and pain scores between bone plug and soft-tissue methods of graft fixation. Ten of fifteen allografts showed radiographic joint space narrowing, and twelve had progression of degenerative joint disease. On MRI, all grafts had moderate meniscus shrinkage and five had grade III signal intensities. Eighty-five percent of patients underwent subsequent procedures, 5 of whom required total allograft resection and 2 of whom required partial allograft resection. One allograft required repair.

CONCLUSIONS

Although transplantation of cryopreserved allografts improved knee pain and function, the average knee function was fair at long-term follow-up. Fifty-five percent of allografts failed when failure criteria for second-look surgery, knee improvement surveys, and MRI were added to Lysholm and pain score failures. The protective benefits of meniscus allografts remain debatable, and inferences cannot be made from this study.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

[Unexpected tracheobronchomalacia during cardiac operation in a patient with Marfan's syndrome]

A 56-year-old man with Marfan's syndrome was scheduled for a valve-sparing aortic root replacement operation because of annuloaortic ectasia and aortic regurgitation. He had severe dyspnea. When the operation started, SpO2 decreased at the time of the median sternotomy, and increased by manual inflation. After sternal closure, PIP increased from 20 cmH2O to 28 cmH2O, SpO2 decreased from 98% to 66%, and the expiratory pattern indicated airway obstruction. Because hypoxemia persisted, we reopened the sternum, resulting in increased SpO2 and decreased PIP, but hypercapnea remained. Fiberoptic bronchoscopy revealed a narrowing of the tracheal and bronchial lumen. We suspected tracheobronchomalacia, and the tracheal tube was advanced to just above the carina. We succeeded in extubating 7 days after the operation. Since he had severe persisting dyspnea, we suggested reopening the partial sternum to decompress the intrathoracic pressure, and closing the skin. The sternum was reopened, and he had no dyspnea after the second operation. The mechanism of tracheobronchomalacia is considered to be related to the connective tissue defect of Marfan's syndrome. Suddenly SpO2 is decreased and PIP and Et(CO2) are increased after closure of the sternum. Bronchoscopy was useful in making the diagnosis.

Diagnosis of articular cartilage abnormalities of the knee: prospective clinical evaluation of a 3D water-excitation true FISP sequence

PURPOSE

To prospectively evaluate the accuracy of three-dimensional (3D) water-excitation true fast imaging with steady-state precession (FISP) in the assessment of cartilage abnormalities of the knee, by using surgery as the reference standard.

MATERIALS AND METHODS

The study was approved by the hospital institutional review board. Written informed consent was obtained from all patients. Twenty-nine patients (30 knees) with a mean age of 56 years (range, 18-86 years) were prospectively evaluated with a sagittal 3D true FISP magnetic resonance (MR) sequence. The mean interval between MR imaging and surgery was 1 day (range, 0-9 days). During surgery, the articular surfaces of the knee were evaluated by using a modified Noyes score. The MR images were evaluated by two blinded readers on two separate occasions. Diagnostic performance was evaluated by setting the cutoff for abnormality between grade 1 (intact cartilage surface) and grade 2 (cartilage defects). Statistical methods used included calculation of sensitivity, specificity, and accuracy, with 95% confidence intervals (Wilson score method) and calculation of kappa values with standard errors.

RESULTS

Overall sensitivity, specificity, and accuracy for the two readers and the two evaluations ranged from 56% to 66%, 78% to 93%, and 71% to 75%, respectively. Interobserver agreement was substantial for both the first (kappa = 0.73) and the second (kappa = 0.65) evaluation. Intraobserver agreement was almost perfect (kappa = 0.84) for reader 1 and moderate (kappa = 0.60) for reader 2.

CONCLUSION

The 3D water-excitation true FISP MR sequence allows assessment of the articular cartilage of the knee with moderate-to-high specificity and low-to-moderate sensitivity.

Anterior knee pain

Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

Knee chondral lesions: incidence and correlation between arthroscopic and magnetic resonance findings

PURPOSE

To determine the incidence and morphologic characteristics of knee chondral lesions found at arthroscopy and their correlation with magnetic resonance imaging (MRI).

METHODS

This is a prospective study on 190 consecutive knee arthroscopic procedures performed between March 2003 and February 2004 by the same surgical team. The study group's age average was 34.8 years (14 to 77 years). The indication for surgery included anterior cruciate ligament tears, meniscal tears, and anterior knee pain. Patients without a preoperative MRI study were excluded. MRI reports were performed by qualified radiologists in all the cases. Chondral lesions were classified according to the International Cartilage Repair Society (ICRS) classification and were included in a database along with the MRI reports. The results were analyzed statistically with analysis of variance, Pearson, kappa, and chi-square tests.

RESULTS

One hundred fifteen chondral lesions in 82 patients were found during the arthroscopic procedure. Most of them were single lesions (72%) located on the medial femoral condyle (32.2%) or medial patellae (22.6%); 62.6% of the lesions were classified as ICRS type 2 or 3-A, with an average surface of 1.99 cm2. We found a significant direct correlation between the patient's age and the size of the lesion (P = .001). MRI sensitivity was 45% with a specificity of 100%. The sensitivity increased with deeper lesions (direct relation with the ICRS classification). Our results showed a statistical power of 100%.

CONCLUSIONS

Although unenhanced MRI using a 1.5-Tesla magnet with conventional sequences (proton density-weighted, T1-weighted, and T2-weighted) is most accurate at revealing deeper lesions and defects at the patellae, our study shows that a considerable number of lesions will remain undetected until arthroscopy, which remains the gold standard.

LEVEL OF EVIDENCE

Level III, diagnostic study of nonconsecutive patients.

Karl Fischer titration and coulometry for measurement of water content in small cartilage specimens

This study evaluated the efficiency of Karl Fischer titration and coulometry for measurement of water content in small intact and defective cartilage specimens. Cartilage from the main weight-bearing zone of the medial condyle of 38 fresh sheep knees was used. Of these, 20 condyles had an intact cartilage, while defects (14 grade I and 4 grade II) were found in the rest. The mechanical hardness was determined as Shore A. Cartilage specimens of approximately 5 mg were analyzed in special devices for moisture measurement and then continuously heated up to 105 degrees C. The actual measurement was performed in an electric cell (coulometry). An electrode was laminated with hygroscopic phosphorus pentoxide. In the electrochemical reaction, H and O are liberated from the electrode. The requirement for electric energy correlates with the amount of water in the specimen. The water content in intact cartilage was 66.9%. Grade I (72.6%) and grade II (77.8%) defects had significantly higher water content. Significantly higher and faster spontaneous evaporation was observed in cartilage defects at room temperature. The water content and spontaneous water evaporation correlated with significantly lower mechanical hardness. The experimental design (combined method of thermogravimetry, Karl Fischer titration, and coulometry) was sufficient for evaluating the water content in small cartilage specimens. It is also possible to measure the temperature-dependent water liberation from cartilage specimens.

A type II-collagen derived peptide and its nitrated form as new markers of inflammation and cartilage degradation in equine osteochondral lesions

Markers of cartilage breakdown enable studying the degradation of cartilage matrix in equine joint pathologies. This study was designed to determine the levels of Coll2-1, a peptide of the triple helix of type II collagen, and Coll2-1NO(2), its nitrated form in the plasma of healthy horses (controls; n=37) and horses suffering from osteochondrosis (n=34). Clinical and arthroscopic scores were attributed reflecting the severity of lesions and were related to the plasma levels of Coll2-1 and Coll2-1NO(2). The median of Coll2-1 was significantly higher in the control group, whereas the mean of Coll2-1NO(2) showed significant elevation in the pathological group. However, the measurement means of scoring classes did not vary significantly. The markers were able to differentiate the group of horses suffering from osteochondrosis from the group of healthy horses. The elevation of Coll2-1NO(2) in the pathological group indicates an inflammation, mediated through reactive oxygen species and/or increased myeloperoxidase activity.

[Cartilage defects of the knee joint: evaluation, classification, and natural course]

Cartilage defects of the knee joint may be either isolated or in conjunction with various disorders of the knee. There are no clinical complaints and physical findings specific for joint defects. In addition, except for some magnetic resonance imaging techniques, there are no specific imaging methods for diagnosis. Therefore, arthroscopic evaluation is the gold standard for the diagnosis. Although there are many studies on the treatment of cartilage defects, natural course of the defects has been evaluated in only a few studies. Furthermore, controversy exists as to how and in which direction different treatment methods affect the natural course of cartilage defects. This review addresses factors affecting the natural course of cartilage defects; yet, the exact indications, timing, and methods of treatment, and whether any treatment is necessary remain unclear. Prospective, randomized, and controlled studies are needed to evaluate the results of different treatment methods on the natural course of cartilage defects.

[Biochemical markers in cartilage injury and repair]

Articular cartilage is a highly specialized tissue composed of chondrocytes which regulate the metabolism of extracellular matrix molecules responsible for maintaining cartilage function. Chondrocytes and synoviocytes are metabolically highly active cells and respond to various factors such as hormones, cytokines, growth factors, and mechanical stresses. Under normal physiological conditions, degradation and synthesis of extracellular matrix molecules are maintained in a state of balance. Any disruption of this balance results in degenerative cartilage diseases such as osteoarthritis and rheumatoid arthritis. Currently, diagnoses of both diseases are based on the assessment of a combination of clinical symptoms and radiological findings. However, degenerative changes in the articular cartilage occurs long before radiological changes are observed. Therefore, new laboratory tools are required to detect cartilage degradation in the early phase of the disease, to show the progression of cartilage destruction, and to assess response to treatment. In recent years, there has been an increase in the use of some biochemical markers derived from bone and cartilage for the diagnosis and follow-up of cartilage diseases. In this paper, the utility of these markers for early diagnosis and follow-up of cartilage injury is discussed in the light of the current literature.

Subperiosteal chondromyxoid fibroma: a report of two cases

Chondromyxoid fibroma is a rare cartilage tumor that represents less than 1% of all bone tumors. When in a long bone, it is usually an intramedullary lesion that is eccentrically located in the metaphyseal region. Chondromyxoid fibroma may also have unusual presentations. These include intracortical lesions and subperiosteal lesions. There have been 14 reported cases of intracortical chondromyxoid fibroma, but there have been only four reports of subperiosteal lesions. A subperiosteal location, therefore, is extremely rare for a chondromyxoid fibroma. We present two new cases of subperiosteal chondromyxoid fibroma. Given its rarity, chondromyxoid fibroma is often not in the differential diagnosis of a painful, subperiosteal scalloped lesion in a long bone. Other entities such as periosteal chondroma, periosteal myxoma, subperiosteal ganglion cyst, or subperiosteal osteoid osteoma are more likely to be considered. Our cases illustrates that subperiosteal chondromyxoid fibroma, although rare, should be included in the differential diagnosis of a painful, radiographically inactive lytic lesion on the surface of a long bone.

[Chondropenia: early-stage degenerative disease]

Chondropenia is defined as loss of the articular cartilage volume. It is the early stage of degenerative joint disease. Risk factors include advanced age, obesity, overuse (activity-related injury), menopause, and trauma. Early detection of chondropenia is important with regard to recognition of its causes and assessment of the efficacy of treatment. Magnetic resonance imaging is the most potential tool for noninvasive assessment of articular cartilage. Arthroscopy provides information about the size, surface features, and anatomic localization of cartilage lesions, and the features of the adjacent cartilage. By arthroscopy, tissue thickness and in vivo volume of the cartilage can be measured. Studies have given weight to mechano-acoustic diagnosis and optical tools (optical coherence tomography, reflectance spectroscopy). These studies are based on the relationship between the structural and mechanical features of the cartilage. Determination of breakdown products of cartilage is another potentially important method for assessment.

[Imaging of articular cartilage]

There have been many improvements in joint cartilage imaging in recent years with the development of new imaging methods. The purpose of cartilage imaging is to assess the integrity of the cartilage surface, the thickness and volume of the cartilage matrix and its relationship with the subchondral bone. Direct radiography, the conventional imaging method for the skeletal system, is not sufficient for assessing the joint cartilage, nor are arthrography, computed tomography, and arthrography together with computed tomography. Moreover, biomechanical changes in the joint cartilage cannot be assessed with these methods. Magnetic resonance imaging (MRI), with its superior contrast resolution and multiplanar imaging capability across tissues, has become the primary diagnostic method for assessment of joint pathologies. The morphological features of the joint cartilage can be assessed adequately with the use of MRI sequences specific to the cartilage. Appropriate use of MRI sequences to determine the type of cartilage damage, the presence and degree of accompanying pathologies in the subchondral bone will help minimize diagnostic errors. This article reviews cartilage imaging in the following aspects: the technique used in MRI for cartilage imaging, findings of cartilage pathology, and anticipation of future cartilage imaging.

Analysis of cartilage matrix fixed charge density and three-dimensional morphology via contrast-enhanced microcomputed tomography

Small animal models of osteoarthritis are often used for evaluating the efficacy of pharmacologic treatments and cartilage repair strategies, but noninvasive techniques capable of monitoring matrix-level changes are limited by the joint size and the low radiopacity of soft tissues. Here we present a technique for the noninvasive imaging of cartilage at micrometer-level resolution based on detecting the equilibrium partitioning of an ionic contrast agent via microcomputed tomography. The approach exploits electrochemical interactions between the molecular charges present in the cartilage matrix and an ionic contrast agent, resulting in a nonuniform equilibrium partitioning of the ionic contrast agent reflecting the proteoglycan distribution. In an in vitro model of cartilage degeneration we observed changes in x-ray attenuation magnitude and distribution consistent with biochemical and histological analyses of sulfated glycosaminoglycans, and x-ray attenuation was found to be a strong predictor of sulfated glycosaminoglycan density. Equilibration with the contrast agent also permits direct in situ visualization and quantification of cartilage surface morphology. Equilibrium partitioning of an ionic contrast agent via microcomputed tomography thus provides a powerful approach to quantitatively assess 3D cartilage composition and morphology for studies of cartilage degradation and repair.

Cartilage imaging: motivation, techniques, current and future significance

Cartilage repair techniques and pharmacological therapies are currently areas of major clinical interest and research, in particular to prevent and treat osteoarthritis. MR imaging-based techniques to visualize cartilage are prerequisites to guide and monitor these therapies. In this review article, standard MR imaging sequences are described, including proton density-weighted fast spin echo, spoiled gradient echo and dual echo steady state sequences. In addition, new sequences that have been developed and are currently being investigated are presented, including driven equilibrium Fourier transform and steady-state free precession-based imaging. Using high-field MR imaging at 3.0-T, visualization of cartilage and the related pathology has been improved. Volumetric quantitative cartilage MR imaging was developed as a tool to monitor the progression of osteoarthritis and to evaluate new pharmacological cartilage protective therapies. The most exciting developments, however, are in the field of cartilage matrix assessment with quantitative dGEMRIC, T2 and T1rho mapping techniques. These techniques aim at detecting cartilage damage at a stage when changes are potentially still reversible, before cartilage tissue is lost. There is currently substantial interest in these techniques from rheumatologists and orthopedists; radiologists therefore need to keep up with these developments.

Clinically relevant tracheomalacia after repair of esophageal atresia: the role of minimal intra-operative dissection and timing for aortopexy

BACKGROUND

Tracheomalacia is associated with esophageal atresia (EA), but may go unnoticed from external splinting forces. Intra-operative dissection with fistula division releases external splinting, revealing tracheomalacia only post-operatively. Analysis of surgical technique may disclose an iatrogenic etiology.

METHODS

From 1995 - 2004, 44 neonates underwent surgery for EA. All patients underwent pre-, intra- and postoperative bronchoscopy. Operative and bronchoscopic notes were studied for malacia, and extensive dissection of the esophagus and fistula from the trachea.

RESULTS

Surgical mortality was 6.8 %. Pre-operative tracheomalacia was diagnosed in 3 patients, who eventually fared well. In 17 other patients, the pre-operative bronchoscopy was negative, but airway obstruction developed post-operatively. Tracheomalacia was documented at the site of the former fistula and surgical release maneuvers. Aortopexy was required in 5 instances, whereas 12 others with malacia were managed conservatively.

CONCLUSIONS

Mediastinal connective tissue and the fistula may splint open the marginally diseased airway in patients with EA, the lack of which may disclose previously unknown tracheomalacia after repair. When aggressive release maneuvers have been required, early aortopexy may be preferred to ventilator dependency.

[New developments in cartilage imaging]

Development of drugs able to modify the natural course of osteoarthritis is a major research objective. Imaging methods are needed to evaluate the effect of new medications in the experimental and clinical settings. Conventional radiographs are the gold-standard technique for routine imaging. However, magnetic resonance imaging (MRI) has transformed hyaline cartilage imaging by providing direct visualization without exposure to radiation. In addition, MRI can provide direct cartilage volumetry and tissue characterization for research purposes, using specific sequences. MRI can also give information on the content and organization of the collagen fibril network and proteoglycan chains, as well as water content. Computed tomography, arthrography and MR-arthrography require contrast medium injection into the joint space but provide high-resolution 3D images of the hyaline and fibrous cartilage.

Pericruciate intra-articular lateral meniscal cyst without meniscal tear

A case of intra-articular pericruciate type of meniscal cyst from anterior horn of lateral meniscus without associated meniscal tear is reported with review of literature. To our knowledge such association has not been reported earlier.