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Imaging & Diagnosis

Foot & ankle imaging: MRI for occult fractures, WBCT for deformity assessment, and evolving roles of advanced modalities.

Overview

Musculoskeletal imaging serves as a critical decision-making tool, yet reliance on specific modalities without clinical correlation risks overtreatment or diagnostic error. Management decisions based solely on MRI findings in the pre-radiographic stage of osteonecrosis of the femoral head carry a potential for overtreatment [1], while the absence of disease on MRI should not be the sole criterion for determining repeat resection after marginal excision of unsuspected soft tissue sarcomas of the hand [3]. Conversely, MRI utilization by orthopaedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention [39], and MRI scans showing advanced osteoarthritis would expedite definitive surgery in knee surgery patients [13].

Selection of the optimal modality depends on the specific pathology and available resources. Ultrasonography is an inexpensive and easily available examination modality compared to MRI for diagnosing old quadriceps tendon ruptures [5], whereas magnetic resonance arthrography (MRA) provides the best combination of sensitivity and specificity for the evaluation of ulnar collateral ligament (UCL) injuries among currently available imaging modalities [7]. For suspected lower extremity stress fractures, conventional radiographs often result in false negatives [8], and when MRI is available, nuclear scintigraphy is not recommended due to low specificity and high radiation dosage [8]. In the assessment of adults with chondral lesions of the knee, there remains little indication to replace arthroscopic investigation with MRI, MRA, or CTA [11].

Advanced imaging techniques further refine surgical planning and post-operative evaluation. Transparent 3-dimensional CT imaging may be useful to confirm surgical techniques and improve clinical outcomes in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique [12], while both MRI and SPECT/CT have a definite role in post-operative diagnosis for patients with ACL graft insufficiency [22]. The use of magnetic resonance fluoroscopy reduces the time needed for preoperative marking of musculoskeletal tumors [24]. Finally, general musculoskeletal imaging principles for radiography, CT, and MRI emphasize radiation safety, artifact management, and specific contraindications such as metal implants and pregnancy [21].

Anatomy & Pathophysiology

Osseous and Articular Morphology

Radiography remains the first examination of choice for foot and ankle pain, while MRI provides essential diagnostic assessment by directly visualizing soft-tissue structures and bone marrow to enable accurate diagnosis and grading [15]. Weight-bearing CT scans better demonstrate the true orientation of bones and joints during loading compared to standard imaging, aiding in the diagnosis and preoperative planning of complex foot and ankle pathologies [31]. In the knee, the soft tissue slope is more horizontal in the lateral compartment compared to the medial compartment [74], and multiple articular elements are inter-related in the pathoanatomy of knee osteoarthritis [75]. Regarding hallux valgus, angles based on margo medialis pedis measurements were slightly but statistically significantly smaller than metatarsophalangeal hallux valgus angles, making them conservative estimates [69]. Furthermore, the width of the feet and the hallux valgus angle were associated with hypermobility of the first ray in both symptomatic and asymptomatic patients [72].

Kinematics and Biomechanics

Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes [49]. Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway [65]. An increase in the hallux valgus angle and the first–second intermetatarsal angle were associated with symptoms among hallux valgus patients [72]. The plantarflexion angle is an independent predictive factor of the arthroscopic reach both medially and laterally to the talus [68], and the postoperative mechanical axis correlates with limb loading [56].

Imaging Modalities and Measurement Techniques

Diagnostic Imaging: Transparent 3-dimensional CT imaging may be useful to confirm surgical techniques and improve clinical outcomes in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique [12]. Advanced high-field (7-Tesla) MRI techniques provide a feasible method of quantifying muscle morphology and composition for individual intrinsic foot muscles [60]. Ultrasound appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle cross-sectional area [20]. Plain radiographs are sufficient to define tunnel position in the surveillance of routine clinical practice for ACL reconstruction [73]. Measurement Tools: A novel method using the built-in photo-edit function of smartphones is accurate, reliable, convenient, and time-saving in measuring the angles of hallux valgus [70]. AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities [71].

Meniscal Pathology

MRI-negative bucket-handle tears of the lateral meniscus can occur in athletes, necessitating arthroscopic evaluation for patients with ongoing mechanical symptoms if clinically indicated [10].

Classification

MRI-based Osteonecrosis: Management decisions relying solely on MRI findings in the pre-radiographic stage of osteonecrosis of the femoral head have the potential for overtreatment [1].

CT-based Spinal Gas: A classification based on CT scans for gas accumulation in the spinal canal helps guide clinical treatment [2].

MRI Bone Marrow Lesions: MRI plays a major role in distinguishing between reversible and irreversible conditions of bone marrow lesions and subchondral bone pathology based on recognizable typical patterns, age, and clinical history to guide patient management [4].

Ultrasonography for Tendon Rupture: Ultrasonography is an inexpensive and easily available examination modality compared to MRI for diagnosing old quadriceps tendon ruptures [5].

Soft-Tissue Mass Evaluation: Proper management of soft-tissue masses requires a specific process for evaluation and management, including a thorough history, physical examination, and imaging studies, with biopsy performed if the diagnosis remains unclear [6].

MRA for UCL Injury: MRA provides the best combination of sensitivity and specificity for the evaluation of ulnar collateral ligament injury among currently available imaging modalities [7].

Giant Cell Tumor Imaging: Radiologists should be familiar with the imaging characteristic of giant cell tumors of the mobile spine with invasion of adjacent vertebrae [9].

MRI for Knee Osteoarthritis: MRI scans showing advanced osteoarthritis would expedite definitive surgery in knee surgery patients [13].

Post-ACL Graft Assessment: Both MRI and SPECT/CT have a definite role in post-operative diagnosis for patients with ACL graft insufficiency and have established their value in those patients [22].

HDS Shoulder Classification: A new concise MRI classification of haemodialysis-related amyloidosis of the shoulder (HDS) was proposed [33].

Rotator Cuff Repair Criteria: Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair [35].

Lesion Differentiation: Differentiation of malignant from benign lesions of the musculoskeletal system is best made by a combination of clinical and imaging parameters rather than by any single MR characteristic [46].

Elbow Osteophyte Classification: A bony landmarks classification system effectively delineated osteophyte distribution in elbow osteoarthritis patients [48].

Deep Learning Arthroplasty Models: A deep-learning system using AP plain radiographs accurately differentiated among 18 hip arthroplasty models from four industry leading manufacturers [54].

Advanced MRI and AI: Newer MRI sequences and artificial intelligence applications may more accurately identify and quantify cartilage lesions, potentially avoiding staged procedures and improving treatment decision-making [59].

Clinical Presentation

Initial evaluation of musculoskeletal complaints begins with Radiography as the first examination of choice for foot and ankle pain [15]. While conventional radiographs often yield false negatives for suspected lower extremity stress fractures [8], they remain the primary screening tool, with radiologists appearing more likely to report osteoarthritis when clinically suspected [34]. For complex or subtle talus injuries where clinical suspicion is high, CT scans are recommended over plain radiographs due to superior accuracy [40]. CT also defines the extent of lesions in unusual locations, providing critical data on septation and density to aid surgical planning [38].

MRI serves as a major modality for distinguishing reversible from irreversible bone marrow lesions and subchondral pathology based on typical patterns, age, and clinical history [4]. It accurately diagnoses ACL and medial meniscal tears in young adults, reliably completing the workup following physical examination [36]. In the foot and ankle, MRI enables accurate diagnosis and grading by directly visualizing soft-tissue structures and bone marrow [15]. However, reliance on MRI alone in the pre-radiographic stage of osteonecrosis risks overtreatment [1], and its absence should not solely dictate repeat resection for marginal excision of unsuspected soft tissue sarcomas of the hand [3]. For suspected lower extremity stress fractures, nuclear scintigraphy is not recommended when MRI is available due to low specificity and high radiation dosage [8]. Additionally, MRI may assist in diagnosing intravascular papillary endothelial hyperplasia of the digit, which is difficult to identify clinically [18].

Advanced Imaging and Specialized Modalities offer specific diagnostic advantages for complex scenarios. MRA provides the best combination of sensitivity and specificity for evaluating ulnar collateral ligament (UCL) injuries [7]. Ultrasonography serves as an inexpensive, easily available alternative to MRI for diagnosing old quadriceps tendon ruptures [5]. SPECT-CT can predict treatment response from conservative management in middle-aged patients with chronic anterior knee pain [17]. Transparent 3-dimensional CT in anatomic double-bundle anterior cruciate ligament reconstruction with the trans-tibial tunnel technique may confirm surgical techniques and improve outcomes [12]. For spinal pathology, a CT-based classification of gas accumulation in the spinal canal helps guide clinical treatment [2], and radiologists must recognize the imaging characteristics of giant cell tumors of the mobile spine with adjacent vertebrae invasion [9].

Diagnostic Decision-Making and Limitations require integrating imaging with clinical findings to avoid misdiagnosis. Any patient with ongoing mechanical symptoms should undergo arthroscopic evaluation of the knee if clinically indicated, even in cases of MRI-negative bucket-handle tears of the lateral meniscus [10]. There remains little indication to replace the 'gold-standard' arthroscopic investigation with MRI, MRA, or CTA for assessing adults with chondral lesions of the knee [11]. Proper management of soft-tissue masses necessitates a specific process including thorough history, physical examination, and imaging, with biopsy performed if the diagnosis remains unclear [6]. Timely recognition and appropriate workup are critical to avoid misdiagnosis and unnecessary intervention in cases of metatarsal coalition with pseudarthrosis mimicking a bone tumor [14].

Investigations

Plain radiography: Radiography is the first examination of choice for foot and ankle pain [15]. However, conventional radiographs often result in false negatives for suspected lower extremity stress fractures [8]. In elite ice hockey players, MRI can reveal severe bone injuries that are not visible radiographically [37].

MRI: MRI plays a major role in distinguishing between reversible and irreversible conditions of bone marrow lesions and subchondral bone pathology based on recognizable typical patterns, age, and clinical history to guide patient management [4]. It provides useful diagnostic assessment by directly visualizing soft-tissue structures and bone marrow to enable accurate diagnosis and grading of pathologies in the foot and ankle [15]. MRI is indispensable for evaluating deeper complex structures, such as the SDM and fracture lesions, in ankle injuries [42]. MRI-based examination is useful in all symptomatic elderly patients whose plain radiographic findings reveal isolated greater trochanter fractures [41]. MRI scans can expedite definitive surgery in patients with advanced osteoarthritis [13]. MRI may help in the diagnosis of intravascular papillary endothelial hyperplasia of the digit, as it is difficult to diagnose based only on clinical features [18]. However, management decisions relying solely on MRI findings in the pre-radiographic stage of osteonecrosis of the femoral head have the potential for overtreatment [1]. The absence of disease on MRI should not be used as the sole criterion for determining whether a repeat resection should be performed after marginal excision of unsuspected soft tissue sarcomas of the hand [3]. Additionally, MRI can be negative for bucket-handle tears of the lateral meniscus in athletes, meaning any patient with ongoing mechanical symptoms should have an arthroscopic evaluation if clinically indicated [10]. Negative results of MRI should not prevent a diagnostic arthroscopy for grading knee chondral defects [19].

MRA: MRA provides the best combination of sensitivity and specificity for the evaluation of ulnar collateral ligament (UCL) injuries among currently available imaging modalities [7].

Ultrasound: Ultrasonography is an inexpensive and easily available examination modality compared to MRI for old quadriceps tendon ruptures [5]. Ultrasound appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle cross-sectional area [20]. Ultrasound and MRI exhibit a complementary relationship in the evaluation of ankle injuries [42].

CT: A CT-based classification of gas accumulation in the spinal canal helps guide clinical treatment [2].

Bone scan: When MRI is available, nuclear scintigraphy is not recommended for suspected lower extremity stress fractures due to low specificity and high radiation dosage [8].

Tomosynthesis: Digital tomosynthesis offers an affordable and safe alternative to advanced imaging such as MRI and CT for suspected scaphoid fractures given its low radiation exposure and cost comparable to plain radiographs [43].

Other Considerations: There remains little indication to replace the 'gold-standard' arthroscopic investigation with MRI, MRA, or CTA for the assessment of adults with chondral lesions of the knee [11]. Radiologists should be familiar with the imaging characteristic of giant cell tumors of the mobile spine with invasion of adjacent vertebrae [9].

Treatment

Non-Operative

Conservative management serves as the primary strategy for several distinct pathologies. Non-weightbearing conservative care is the standard of care for tarsal navicular stress fractures [51], while patients with isolated subcortical trabecular fractures (bone bruise) detected on MRI recover well in the short term with restricted weightbearing and initial activity modification [50]. Central lesions of talar avascular necrosis often remain stable without progression, warranting consideration of conservative treatment [61]. Bilateral avascular necrosis of the trapezoid can improve clinically and radiographically with nonoperative treatment, potentially achieving complete pain freedom and full wrist movement at 5 years [58]. Treatment for os trigonum syndrome begins with nonsurgical measures, though symptomatic athletes may eventually require surgical excision [64]. For nonsurgical pelvic ring injuries, the need for a change in treatment plan or further imaging should be based on the patient's clinical progress with weight bearing [16]. Additionally, conservative management is appropriate for moderate nonprogressive deformity in childhood coxa vara [53].

Operative

Indications: Surgical intervention is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara [53]. Symptomatic athletes with os trigonum syndrome may require surgical excision if nonsurgical measures fail [64]. Diagnostic arthroscopy is indicated for patients with ongoing mechanical symptoms even if MRI is negative for bucket-handle tears of the lateral meniscus [10], and negative MRI results should not prevent diagnostic arthroscopy for grading knee chondral defects [19]. Surgical arthroscopy is unnecessary for isolated subcortical trabecular fractures detected on MRI [50].

Surgical Approach / Technique: In anatomic double-bundle anterior cruciate ligament reconstruction using the trans-tibial tunnel technique, tunnel location in transparent 3-dimensional CT may be useful to confirm surgical techniques and improve clinical outcomes [12]. Proper management of soft-tissue masses requires a specific process including a thorough history, physical examination, and imaging studies, with biopsy performed if the diagnosis remains unclear [6].

Implant Selection: There remains little indication to replace arthroscopic investigation with MRI, MRA, or CTA for the assessment of adults with chondral lesions of the knee [11]. MRI examination techniques recommended in the literature are not able to replace arthroscopy for the diagnosis of cartilage damages of the knee joint [47].

Adjuncts: Advanced imaging, particularly MRI, has improved the assessment of hinge abduction and femoral head vascularity in active Legg-Calvé-Perthes disease, potentially allowing for earlier prognosis and treatment [23]. Magnetic resonance imaging has created an important role for reproducible, noninvasive, and objective evaluation and monitoring of cartilage in the setting of trauma, degenerative arthritides, and surgical treatment for cartilage injury [44]. MRI shows promise in replacing other modalities for staging the primary lesion in limb-salvage surgery for primary malignant tumors of bone to allow surgeons to be more confident and conservative [55].

Other Considerations: Management decisions for osteonecrosis of the femoral head in the pre-radiographic stage should not rely solely on MRI findings to avoid potential overtreatment [1]. The absence of disease on MRI should not be used as the sole criterion for determining whether a repeat resection is necessary after marginal excision of unsuspected soft tissue sarcomas of the hand [3]. Whether earlier recognition of Legg-Calvé-Perthes disease via advanced imaging leads to better outcomes remains to be determined [23]. Orthopaedic surgeons should develop a systematic approach to interpreting the entire image and create a discrete plan with radiologists on managing incidental benign and malignant lesions found on radiographs [57].

Complications

Other Considerations: Management decisions relying solely on MRI findings in the pre-radiographic stage of osteonecrosis of the femoral head have the potential for overtreatment [1]. The absence of disease on MRI should not be used as the sole criterion in determining whether a repeat resection should be performed after marginal excision of unsuspected soft tissue sarcomas of the hand [3]. MRI plays a major role in distinguishing between reversible and irreversible conditions of bone marrow lesions and subchondral bone pathology based on recognizable typical patterns, age, and clinical history to guide patient management [4]. Radiologists should be familiar with the imaging characteristic of giant cell tumors of the mobile spine with invasion of adjacent vertebrae [9]. Timely recognition and appropriate diagnostic workup are critical to avoid misdiagnosis and unnecessary intervention in cases of metatarsal coalition with pseudarthrosis mimicking bone tumor [14]. The need for a change in treatment plan or further imaging in nonsurgical pelvic ring injuries should be based on the patient's clinical progress with weight bearing [16].

Other Considerations: Further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time after autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee [25]. The study could not conclude that allograft shrinkage was significantly associated with inferior clinical and radiologic outcomes in the long term after transplantation of fresh-frozen lateral meniscal allografts [26]. The clinical significance of bone bruises detected by magnetic resonance imaging following lateral ankle sprains in the long term remains to be determined [27]. Further investigations with higher levels of evidence and longer periods of follow-up are warranted regarding the effect of anterolateral structure augmentation on graft maturity after anterior cruciate ligament reconstruction [28]. The degree of subchondral bone marrow edema at midterm follow-up was correlated with clinical outcomes after microfracture for osteochondral lesions of the talus, whereas no significant differences were found at short-term follow-up [29]. Follow-up radiographs are not indicated for most fifth metacarpal base and neck fractures [30]. Long-term complications such as arthritis and avascular necrosis are still commonly seen after surgical management of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation [52]. The edema size observed on MRI scans is not a valuable finding in the follow-up of bone marrow edema [62]. Further high-quality studies are needed to confirm results and to analyse the long-term effects of the procedure for treatment of osteochondral defects of the talus with platelet-derived growth factor [63]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis in mid- to long-term results after bipolar radial head arthroplasty [67].

Recovery

Light activity (weeks): Clinical decisions regarding the resumption of weight-bearing and activity levels are often guided by imaging findings and patient progress rather than fixed timelines. In nonsurgical pelvic ring injuries, the need to alter treatment plans or pursue further imaging should be based on the patient's clinical progress with weight bearing [16]. For displaced extra-articular distal radial fractures, sonography serves as an accurate, radiation-free tool for monitoring closed reduction, facilitating dynamic, real-time observation during the early recovery phase [32].

Full activity (months): The timeline for returning to full functional capacity varies by pathology and requires careful interpretation of advanced imaging. In active Legg-Calvé-Perthes disease, advanced imaging, particularly MRI, has improved the assessment of hinge abduction and femoral head vascularity, potentially allowing for earlier prognosis and treatment, though whether earlier recognition leads to better outcomes remains to be determined [23]. For focal cartilage defects in the knee treated with autologous matrix-induced chondrogenesis, further studies with long-term follow-up are needed to determine if the grafted area will maintain structural and functional integrity over time [25]. Similarly, the long-term clinical significance of bone bruises detected by MRI following lateral ankle sprains remains to be determined [27].

Complete recovery / outcome plateau (months): Final outcomes and the stability of grafts or lesions often require extended observation to confirm success. The degree of subchondral bone marrow edema at midterm follow-up was correlated with clinical outcomes after microfracture for osteochondral lesions of the talus, whereas no significant differences in clinical outcomes were found at short-term follow-up regarding the degree of subchondral bone marrow edema [29]. Regarding anterior cruciate ligament reconstruction, further investigations with higher levels of evidence and longer periods of follow-up are warranted regarding the effect of anterolateral structure augmentation on graft maturity [28]. In cases of transplanted fresh-frozen lateral meniscal allografts, studies could not conclude that allograft shrinkage was significantly associated with inferior clinical and radiologic outcomes in the long term [26].

Rehabilitation protocol: Preoperative planning and intraoperative guidance can be optimized using specific imaging modalities to streamline the surgical process. The use of magnetic resonance fluoroscopy for preoperative marking of musculoskeletal tumors reduces the time needed for the intervention [24]. For soft-tissue masses, proper management requires a specific process including a thorough history, physical examination, and imaging studies, with biopsy performed if the diagnosis remains unclear [6]. In the context of unsuspected soft tissue sarcomas of the hand, the absence of disease on MRI should not be used as the sole criterion for determining whether a repeat resection should be performed after marginal excision [3].

Functional milestones: Diagnostic accuracy is critical to avoid misdiagnosis and unnecessary intervention, which directly impacts functional trajectories. Timely recognition and appropriate diagnostic workup are critical to avoid misdiagnosis and unnecessary intervention in cases of metatarsal coalition with pseudarthrosis mimicking bone tumor [14]. Management decisions for osteonecrosis of the femoral head relying solely on MRI findings in the pre-radiographic stage have the potential for overtreatment [1]. Conversely, MRI plays a major role in distinguishing between reversible and irreversible conditions of bone marrow lesions and subchondral bone pathology based on recognizable typical patterns, age, and clinical history to guide patient management [4].

Other Considerations: Specific imaging applications provide value in monitoring disease activity and structural interdependence. A variety of applications for US and MRI for patients with Dupuytren disease have been described, with the largest value lying in the measurement of disease activity and the follow-up of treatment of patients with early stage disease [76]. CT-OAM and µCT demonstrate the interdependence of compact and trabecular bone in response to long-term loading conditions in the fourth cervical vertebra [66]. A CT-based classification of gas accumulation in the spinal canal helps guide clinical treatment [2]. Finally, follow-up radiographs are not indicated for most fifth metacarpal base and neck fractures [30].

Key Evidence

  • [L3] These findings highlight the potential for overtreatment if management decisions rely solely on MRI findings. (10.1016/j.arth.2025.05.089)
  • [L4] The classification based on CT scans helps guide clinical treatment. (10.1186/s13018-025-05895-w)
  • [L3] The absence of disease on MRI should not be used as the sole criterion in determining whether a repeat resection should be performed. (10.1016/j.jhsa.2010.05.009)
  • [L4] MRI plays a major role in distinguishing between reversible and irreversible conditions of bone marrow lesions and subchondral bone pathology based on recognizable typical patterns, age, and clinical history to guide patient management. (10.1007/s00167-016-4113-2)
  • [L2] It is furthermore an inexpensive and easily available examination modality, compared to MRI. (10.1007/s00167-004-0576-7)
  • [L5] Proper management of soft-tissue masses requires a specific process for evaluation and management, including a thorough history, physical examination, and imaging studies, with biopsy performed if the diagnosis remains unclear. (10.5435/jaaos-22-11-742)
  • [L1] Of the currently available imaging modalities, MRA provides the best combination of sensitivity and specificity of the evaluation of the UCL. (10.1177/0363546520937302)
  • [L1] When MRI is available, nuclear scintigraphy is not recommended due to low specificity and high radiation dosage, while conventional radiographs often result in false negatives. (10.1177/0363546515574066)
  • [L4] Radiologists should be familiar with this imaging characteristic. (10.1186/s12891-021-04610-0)
  • [L4] It is thus important that any patient with ongoing mechanical symptoms should have an arthroscopic evaluation of their knee if clinically indicated. (10.1007/s00167-005-0011-8)
  • [L1] Due to this limitation, there remains little indication to replace the 'gold-standard' arthroscopic investigation with MRI, MRA or CTA for the assessment of adults with chondral lesions of the knee. (10.1007/s00167-012-1905-x)
  • [L4] This imaging technique may be useful to confirm surgical techniques and to improve clinical outcomes. (10.1007/s00167-009-0989-4)
  • [L2] This would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans. (10.1016/j.arthro.2008.10.020)
  • [L4] Timely recognition and appropriate diagnostic workup are critical to avoid misdiagnosis and unnecessary intervention. (10.1186/s12891-025-09279-3)
  • [L4] The need for change in treatment plan or further imaging should be based on the patient's clinical progress with weight bearing. (10.5435/jaaos-d-18-00254)
  • [L3] SPECT-CT can benefit clinicians by predicting the treatment response from conservative management. (10.1186/s12891-015-0628-9)
  • [L4] MRI may help in the diagnosis of this condition as it is difficult to diagnose based only on clinical features. (10.1177/1753193412453541)
  • [L1] The negative results of MRI should not prevent a diagnostic arthroscopy. (10.1016/j.arthro.2012.04.138)
  • [L3] US appears to be a valid and reliable alternative to MRI when measuring intrinsic foot muscle CSA. (10.1186/s12891-022-05090-6)
  • [L3] Both imaging modalities have a definite role in post-operative diagnostic and have established their value in those patients. (10.1007/s00167-017-4588-5)
  • [L5] Advanced imaging, particularly MRI, has improved the assessment of hinge abduction and femoral head vascularity, potentially allowing for earlier prognosis and treatment; however, whether earlier recognition leads to better outcomes remains to be determined. (10.5435/jaaos-d-16-00856)
  • [L2] Use of magnetic resonance fluoroscopy reduces the time needed for the intervention. (10.2106/00004623-200408000-00021)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] The study could not conclude that allograft shrinkage was significantly associated with inferior clinical and radiologic outcomes in the long term. (10.1016/j.arthro.2019.04.031)
  • [L4] Their clinical significance in the long term remains to be determined. (10.1007/s001670050036)
  • [L3] Further investigations with higher levels of evidence and longer periods of follow-up are warranted. (10.1177/03635465221092768)
  • [L3] The degree of subchondral bone marrow edema at midterm follow-up was correlated with clinical outcomes, whereas no significant differences were found at short-term follow-up. (10.1177/0363546518782701)
  • [L4] Follow-up radiographs are not indicated for most fifth metacarpal base and neck fractures. (10.1177/1558944717733278)
  • [L5] Weight-bearing CT scans better demonstrate the true orientation of bones and joints during loading compared to standard imaging, aiding in the diagnosis and preoperative planning of complex foot and ankle pathologies. (10.5435/jaaos-d-19-00700)
  • [L4] Sonography is an accurate, simple, and radiation-free tool that provides the substantial benefits of dynamic multiple-plane and real-time observation. (10.2106/00004623-200202000-00005)
  • [L3] A new concise MRI classification of HDS was proposed. (10.1007/s00167-016-4033-1)
  • [L4] If OA is clinically suspected, radiologists appear to be more likely to report its presence. (10.1186/1471-2474-8-77)
  • [L4] Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair. (10.1007/s00167-014-3486-3)
  • [L3] 1.5-Tesla MRI accurately diagnoses ACL and medial meniscal tears and can reliably complete the diagnostic workup following physical examination, particularly in young adults. (10.1186/s12891-021-04011-3)
  • [L4] MRI can show severe bone injuries that are not visible radiographically in ice hockey players. (10.1177/0363546515626181)
  • [Case_report] Computed tomography may be useful in defining the extent of lesions in unusual locations and provides information about their characteristics, such as septation and density, to aid in diagnosis and surgical planning. (10.2106/00004623-198365090-00020)
  • [L3] MRI utilization by orthopaedic surgeons results in more appropriate interventions for patients with symptoms and findings most amenable to surgical intervention. (10.2106/jbjs.n.00947)
  • [L2] CT scans are recommended when there is high clinical suspicion, as they offer greater accuracy for complex and subtle injuries. (10.1186/s12891-025-09136-3)
  • [L4] MRI-based examination is useful in all symptomatic elderly patients whose plain radiographic findings reveal isolated GT fractures. (10.1186/s12891-018-2193-5)
  • [L3] In contrast, MRI is indispensable for evaluating deeper complex structures, such as the SDM and fracture lesions, with both modalities exhibiting a complementary relationship. (10.1186/s12891-026-09662-8)
  • [L4] Given its low radiation exposure and cost comparable to plain radiographs, DTS offers an affordable and safe alternative to advanced imaging such as MRI and CT. (10.1177/17531934231215769)
  • [L5] Magnetic resonance imaging has created an undeniably important role for reproducible, noninvasive, and objective evaluation and monitoring of cartilage in the setting of trauma, degenerative arthritides, and surgical treatment for cartilage injury. (10.1177/0363546505281938)
  • [L2] Differentiation of malignant from benign lesions of musculoskeletal system is best made by a combination of clinical and imaging parameters rather than by any single MR characteristic. (10.1186/1471-2474-10-125)
  • [L2] MRI examination techniques recommended in the literature are not able to replace arthroscopy for the diagnosis of cartilage damages of the knee joint. (10.1007/s00167-003-0393-4)
  • [L3] The bony landmarks classification system effectively delineated osteophyte distribution in elbow patients. (10.1186/s13018-025-06145-9)
  • [L4] Three-dimensional kinematics under static full weightbearing were opposite between the ankle and subtalar joints on their respective axes. (10.1186/s13018-019-1443-z)
  • [L4] If detected on MRI as an isolated injury, surgical arthroscopy is unnecessary since these patients can be expected to recover well in the short term with restricted weightbearing and initial activity modification. (10.1177/03635465000280050701)
  • [L1] Non-weightbearing conservative management should be considered the standard of care for tarsal navicular stress fractures. (10.1177/0363546509355408)
  • [L4] However, long-term complications such as arthritis and AVN are still commonly seen. (10.1186/s13018-017-0610-3)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L4] A deep-learning system using AP plain radiographs accurately differentiated among 18 hip arthroplasty models from four industry leading manufacturers. (10.1016/j.arth.2020.11.015)
  • [L4] The authors believe it shows promise in replacing other modalities for staging the primary lesion to allow surgeons to be more confident and conservative with limb-salvage procedures. (10.2106/00004623-198668060-00003)
  • [L2] The postoperative mechanical axis correlates with limb loading. (10.1007/s00167-018-5056-6)
  • [L3] Orthopaedic surgeons should develop a systematic approach to interpreting the entire image and create a discrete plan with radiologists on managing incidental findings. (10.5435/jaaos-d-19-00236)
  • [L4] The patient with bilateral avascular necrosis of the trapezoid improved clinically and radiographically with nonoperative treatment, achieving complete pain freedom and full wrist movement at 5 years. (10.1016/j.jhsa.2011.07.022)
  • [L5] Newer MRI sequences and artificial intelligence applications may more accurately identify and quantify cartilage lesions, potentially avoiding staged procedures and improving treatment decision-making. (10.1016/j.arthro.2024.03.009)
  • [L5] This proof-of-concept study demonstrates a feasible method of quantifying muscle morphology and composition for individual intrinsic foot muscles using advanced high-field MRI techniques. (10.1186/s12891-020-03926-7)
  • [L3] Conservative treatment should be considered for a central lesion of the talar AVN because it tends to remain stable without progression. (10.1186/s12891-023-07136-9)
  • [L3] The edema size observed on MRI scans is not a valuable finding in the follow-up of bone marrow edema. (10.1007/s00167-009-0842-9)
  • [L4] Further high-quality studies are needed to confirm these results and to analyse the long-term effects of the procedure. (10.1007/s00167-015-3549-0)
  • [L5] Treatment begins with nonsurgical measures, but symptomatic athletes may require surgical excision of the os trigonum. (10.5435/jaaos-22-09-545)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L5] CT-OAM and µCT demonstrate the interdependence of compact and trabecular bone in response to long-term loading conditions. (10.1186/s13018-023-03760-2)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L4] The plantarflexion angle is an independent predictive factor of the arthroscopic reach both medially and laterally. (10.1177/0363546512455403)
  • [L4] Because the hallux valgus angles based on margo medialis pedis measurements were slightly but statistically significantly smaller, these measurements should be considered conservative estimates of the metatarsophalangeal angle. (10.1186/1471-2474-15-133)
  • [L4] This novel method using the built-in photo-edit function of smartphones is accurate, reliable, convenient and time-saving in measuring the angles of hallux valgus. (10.1186/s12891-021-04604-y)
  • [L4] AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities. (10.1016/j.jisako.2025.100403)
  • [L3] Width of the feet and hallux valgus angle were associated with hypermobility of the first ray while an increase in the hallux valgus angle and the first–second intermetatarsal angle were associated with symptoms among hallux valgus patients. (10.1186/s13018-025-05856-3)
  • [L4] In the surveillance of routine clinical practice, plain radiographs are sufficient to define tunnel position. (10.1007/s00167-017-4462-5)
  • [L3] The soft tissue slope is more horizontal in the lateral compartment of the knee compared to the medial compartment. (10.1007/s00167-012-1990-x)
  • [L4] Our results support an inter-relationship of multiple articular elements in the pathoanatomy of knee OA. (10.1186/1471-2474-10-133)
  • [L2] A variety of applications for US and MRI for patients with DD has been described, with the largest value lying in the measurement of disease activity and the follow-up of treatment of patients with early stage disease. (10.1186/s12891-019-2606-0)

See Also

References

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[42] Diagnostic performance of ultrasound and magnetic resonance imaging in ankle injuries: a retrospective cohort study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09662-8

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