Calf muscle strain injuries (CMSI), also known as “tennis leg,” are frequently observed in middle-aged and physically active people, including non-professional athletes. While magnetic resonance imaging (MRI) is frequently used to assess the extent of these injuries, the relationship between MRI findings and long-term functional outcomes in non-athletic populations remains underexplored. This study aimed to investigate the correlation between MRI-detected injury severity and functional outcomes using the Achilles Tendon Rupture Score (ATRS) and the Tegner Activity Scale (TAS). A retrospective review was conducted on 78 non-athletic patients diagnosed with CMSI and were followed for an average of 25.6 ± 16.1 months. Injury severity was classified into three grades: Grade 1 (edema without architectural disruption), Grade 2 (partial muscle disruption with hematoma), and Grade 3 (complete muscle disruption or tendon detachment) based on MRI examination. The functional outcomes were assessed using the ATRS and TAS. A simple linear regression analysis was conducted to assess the impact of demographic variables and MRI findings on ATRS. The mean ATRS at the final follow-up was 92.9 ± 10.6, with 75.6% of patients achieving an excellent outcome. Despite the excellent ATRS scores, a notable reduction in TAS was evident from the pre-injury assessment (4.4 ± 1.2) to the final follow-up (3.8 ± 1.3; p < 0.001). Moreover, 44.9% of patients did not resume their pre-injury activity levels. The regression analysis demonstrated no statistically significant correlation between MRI-detected injury severity, demographic factors (age, gender, BMI), and ATRS outcomes (R² = 0.094, adjusted R² = -0.011). MRI-detected injury severity does not significantly predict long-term functional outcomes in patients with CMSI, even though most patients achieved excellent ATRS scores. However, nearly half of the patients did not return to their pre-injury activity levels. These findings suggest that additional factors might influence recovery, and further research is needed to elucidate these factors in non-athletic patients. Level IV, Retrospective case series.

Purpose: The success of medial patellofemoral ligament (MPFL) reconstruction is closely linked to the precise positioning of the femoral tunnel. Intraoperative fluoroscopy is commonly utilized to identify the MPFL footprint. This study aimed to ascertain the most accurate fluoroscopic method among the five previously described methods used to determine the MPFL femoral footprint. Materials and methods: Using 44 well-preserved dry femur bones, the MPFL femoral insertion site was demarcated using anatomical bony landmarks, namely the center of the saddle sulcus between the medial epicondyle, adductor tubercle and gastrocnemius tubercle. Fluoroscopic true lateral knee images were acquired and measurements taken, referencing established methods by Schottle et al., Redfern et al., Wijdicks et al., Barnett et al., and Kaipel et al. The distance between anatomic and fluoroscopic MPFL footprints was then measured on digital fluoroscopic images. The accuracy of the locations was compared using a margin of error of 5 and 7 mm. Results: The Schottle method consistently emerged superior, showcasing the smallest mean distance (3.2 ± 1.2 mm) between the anatomic and radiographic MPFL footprints and a high in-point detection rate of 90.9% under 5 mm criteria. While the Redfern method displayed perfect accuracy (100%) within the 7 mm criteria, the Schottle method also performed 97.7% accuracy. Conclusions: For intraoperative identification of the MPFL footprint using fluoroscopy, the Schottle method is the most consistent and accurate among the assessed methods. Thus, its accuracy in detecting the MPFL footprint makes it recommended for MPFLR to ensure optimal outcomes. Level of evidence: Level IV, cadaveric study.

The aim of this study was to define the actual rate of the traction needed and the balloon catheter or tenaculum requirement for hysterosalpingography (HSG) examinations, and to investigate the correlation between pain scores with the type of traction, operator, parity or the type of infertility. 788 patients undergoing HSG participated in the trial. The HSG examinations were completed in 58% of the patients (458) without any traction. Traction was needed in 42% of patients, those with the balloon catheter in 26.9%, and those with the tenaculum only at 15%. Patients with balloon catheter traction had similar pain scores to those using tenaculum traction. The pain scores changed according to the operator. HSG examinations should be performed step-by-step and the need for traction evaluated during the procedure.

Objectives: Hysterosalpingography (HSG) remains the first-line imaging technique for assessing fallopian tube conditions due to its accessibility, cost-effectiveness, and high diagnostic accuracy. Intravasation, the leakage of contrast media into myometrial or vascular structures during HSG, has been documented as a complication. This study aimed to determine the prevalence of intravasation, explore the relationship between intravasation and tubal occlusion, and assess the applicability of grading intravasation. Methods: A retrospective analysis of 3032 HSG examinations performed between January 2021 and May 2024 was conducted. Intravasation, tubal occlusion, and related findings were recorded using standard X-ray equipment and categorized prospectively. Statistical analysis included logistic regression to identify predictors of tubal occlusion and inter-observer agreement using Fleiss Kappa. Diagnostic metrics for intravasation as a radiological marker of tubal occlusion were calculated. Results: Intravasation was observed in 2.6% of cases. Among cases with tubal occlusion, 16.4% exhibited intravasation. The sensitivity, specificity, positive predictive value, and negative predictive value of intravasation for detecting tubal occlusion were 14.5%, 99.8%, 92.3%, and 85.6%, respectively. Adjusted odds ratios indicated that intravasation increased the likelihood of tubal occlusion approximately 55-fold. Inter-observer agreement for intravasation detection was almost perfect (Kappa = 0.97). Limitations included the absence of oil-based contrast and a pressure manometer during contrast infusion. Conclusions: Intravasation, traditionally viewed as a complication, emerges as a significant radiological indicator of tubal occlusion. Incorporating intravasation characteristics, such as initiation time, into grading systems may enhance diagnostic accuracy. Further refinement of classification systems and broader clinical validation are recommended. Advances in knowledge: About 92.3% of tubes with intravasation were occluded and the site of intravasation correlated with the occlusion site. Occlusion was 55× more likely in cases with intravasation, traditionally viewed as a complication, emerges as a significant radiological indicator of tubal occlusion.