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Medical Radiology · Diagnostic Imaging Series Editors: Hans-Ulrich Kauczor · Paul M. Parizel · Wilfred C. G. Peh Filip M. Vanhoenacker Mario Maas Jan L. M. A. Gielen   Editors Imaging of Orthopedic Sports Injuries Second Edition Medical Radiology Diagnostic Imaging Series Editors Hans-Ulrich Kauczor Paul M. Parizel Wilfred C. G. Peh The book series Medical Radiology – Diagnostic Imaging provides accurate and up-to-date overviews about the latest advances in the rapidly evolving field of diagnostic imaging and interventional radiology. Each volume is conceived as a practical and clinically useful reference book and is developed under the direction of an experienced editor, who is a world-renowned specialist in the field. Book chapters are written by expert authors in the field and are richly illustrated with high quality figures, tables and graphs. Editors and authors are committed to provide detailed and coherent information in a readily accessible and easy-to-understand format, directly applicable to daily practice. Medical Radiology – Diagnostic Imaging covers all organ systems and addresses all modern imaging techniques and image-guided treatment modalities, as well as hot topics in management, workflow, and quality and safety issues in radiology and imaging. The judicious choice of relevant topics, the careful selection of expert editors and authors, and the emphasis on providing practically useful information, contribute to the wide appeal and ongoing success of the series. The series is indexed in Scopus. For further volumes: http://www.springer.com/series/4354 Filip M. Vanhoenacker • Mario Maas Jan L. M. A. Gielen Editors Imaging of Orthopedic Sports Injuries Second Edition Editors Filip M. Vanhoenacker Jan L. M. A. Gielen Department of Radiology Department of Radiology Antwerp University Hospital Antwerp University Hospital Edegem, Belgium Edegem, Belgium Mario Maas Department of Radiology and Nuclear Medicine Amsterdam University Medical Centres Amsterdam, The Netherlands ISSN 0942-5373 ISSN 2197-4187 (electronic) Medical Radiology ISBN 978-3-030-75361-0 ISBN 978-3-030-75362-7 (eBook) https://doi.org/10.1007/978-3-030-75362-7 © Springer Nature Switzerland AG 2007, 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword to the Second Edition Soon after we assumed Editorships of the Medical Radiology Series of Springer Nature, one of the first books that was targeted for an updated edi- tion was Imaging of Orthopedic Sports Injuries, edited by Professors Filip Vanhoenacker, Mario Maas and Jan Gielen. When approached, lead editor Professor Vanhoenacker readily agreed to take on this task and after a period of planning, commenced on the project which took about 1 year to complete. This is a very efficient turnaround time by any standard, let alone for a monu- mental project such as this. Following on the outstanding success of the original book published in 2007, Professors Vanhoenacker, Maas and Gielen have once again put together this truly excellent second edition. The new book has not only expanded in terms of additional chapters but also contains much new content that reflects the continued growth and updated knowledge of imaging and imaging-guided intervention of sports injuries. The authorship list of this book can be regarded a “Who’s who” of musculoskeletal radiologists in Europe, with the exception of one chapter authored from Singapore and Australia! It gives both of us great personal pleasure to be able to congratulate Filip for successfully overseeing the second edition of this book. Wilfred has known Filip for about 20 years, having been involved together as faculty in many annual congresses in Europe and North America organised by the European Society of Skeletal Radiology (ESSR) and the International Skeletal Society (ISS). Being fellow musculoskeletal radiologists with a strong sense of academic obligation, both have also contributed substantially to congresses and teaching programmes held in Asia under the auspices of the Asian Musculoskeletal Society, an organisation in which Wilfred served as the Founding President, as well as the ISS regional outreach programmes and meetings of other regional and national radiological societies in Asia. Wilfred and Filip have, more importantly, become firm friends over these many years. Paul and Filip go back even further, having known each other since the beginning of their professional careers as radiologists in Belgium. Their pro- fessional collaboration has expanded far beyond the local and national level, onto the international and European arena. Throughout the years, both have collaborated on many projects, courses and meetings organised by the European Society of Radiology (ESR), the ESSR and the European Society of Neuroradiology (ESNR). Through serendipity, it so happened that in the year 2017, Filip was President of the ESSR while Paul was President of the v vi Foreword to the Second Edition ESR, and this happy coincidence further enhanced their collaboration on many projects. Importantly, their collaboration on scientific projects has grown into a long-lasting friendship spanning several decades and built on a foundation of respect and mutual understanding. Over the recent two decades or so, imaging has become increasingly important in the diagnosis, management, therapy guidance, and follow-up of patients with sports injuries. Healthcare professionals, and in particular orthopaedic surgeons, are increasingly reliant on imaging data to make clini- cal decisions. New developments in imaging technology have greatly advanced our insights into the pathophysiology of sports injuries. This prog- ress has created not only new opportunities for radiologists and nuclear medi- cine physicians but also new challenges. We must learn to understand and speak the language of our clinical colleagues, and we need to acquire clinical background knowledge about mechanisms of injury and repair and about their pathophysiology. Together with orthopaedic surgeons, specialists in physical medicine and rehabilitation, physical therapists and many other healthcare professionals, radiologists and nuclear medicine physicians are an essential part of the multidisciplinary team that makes evidence-based deci- sions in patients with sports injuries. This book provides a comprehensive overview of the subject and shall prove to be equally useful to both imaging professionals and referring clinicians. The second edition of Imaging of Orthopedic Sports Injuries is therefore very timely. We have no doubt that this book will be most successful and sought after as a “must-read” by everyone with an interest in and wishing to learn more about imaging of musculoskeletal sports injuries. July 2020 Wilfred C. G. Peh Department of Diagnostic Radiology Khoo Teck Puat Hospital Singapore, Singapore Yong Loo Lin School of Medicine National University of Singapore Singapore, Singapore Paul M. Parizel Royal Perth Hospital & University of Western Australia Perth, Australia Preface to the Second Edition Today more than ever, sports activities are no longer the privilege of competi- tive and professional athletes or the “select happy few”, but almost all sports disciplines are accessible to a large population in all age groups. The sporting population is vulnerable to musculoskeletal lesions due to either acute trauma or overuse. It was already underscored in the first edition of this book that imaging of these patients plays an important role in diagno- sis, grading, defining appropriate treatment regime, and follow-up. Since the first edition in 2007, imaging techniques have been further refined, indications have expanded, and new insights in pathogenesis and imaging of musculoskeletal sports trauma evolved tremendously. Therefore, we are very grateful that the series editors of Medical Radiology (Springer) professor Wilfred Peh and professor Paul Parizel entrusted us with the task to update our work. Ultrasound is generally accepted as the “working horse” for the evaluation of trauma of the ligaments, tendons and muscles, particularly for dynamic evaluation of these structures. The overall availability of MRI has increased, and the technique is now a mature and indispensable diagnostic tool for the evaluation of internal joint derangement in every sports clinic. Although CT is generally replaced by MRI, (Cone Beam) CT may be very useful for the diagnosis of occult fractures of (small) bones and is particularly important in the evaluation of maxillofacial sports trauma, where it com- pletely replaced plain radiography. Compared to the previous edition, the general structure of this book has been maintained, with a general part on basic sciences and general imaging principles, followed by an extensive topographic discussion of musculoskel- etal sports injuries and lastly some special addenda. The text of the book has been largely updated, and many new state-of-the- art images were added. We included new chapters on imaging-guided inter- vention of sports injuries and postoperative joint imaging in the sportive patient. Furthermore, we dedicated one chapter to imaging of soccer injuries, as one of the most popular sports worldwide. We are very grateful to all contributing authors, being internationally renowned experts in musculoskeletal imaging, for their willingness to deliver outstanding contributions. vii viii Preface to the Second Edition Finally—on behalf of my co-editors—I would like to express our special thanks to Springer for giving us the opportunity to edit the second edition of this book. We hope that this work will be helpful in the daily practice of general and musculoskeletal radiologists and everyone else involved in sports medicine and we hope you enjoy reading it. Antwerp, Belgium Filip M. Vanhoenacker July 2020 Introduction Endorsement on Behalf of the European Society of Musculoskeletal Radiology (ESSR) Musculoskeletal (MSK) injuries occurring from sports play today an impor- tant role in the diagnosis and treatment of MSK disorders. Recent advances in imaging have greatly aided the diagnosis and treatment decision-making in patients with sports injuries. Imaging can be used to make diagnoses, define prognoses, influence treatment plans, or to preoperatively assess the severity of known pathology, and follow-up recovery of the injury. Let us simplify: imaging of sports injuries is challenging, interesting, and evolving. The use of imaging and its various modalities depends on the clinical information and availability of those modalities. The goal of musculoskeletal imaging is to provide as much information as possible to allow timely and appropriate patient care. The musculoskeletal radiologist plays a pivotal role and has a strong tool in hands to start managing sports injuries. A strong tool primarily assumes knowledge: Knowledge about body anatomy, pathophysiology, mechanism of injury, injuries pattern, advances and limitation of different imaging modalities as well as typical injuries for any specific sport. The aim of the European Society of Musculoskeletal Radiology and its Sports Subcommittee is to encourage the advancement of knowledge. Therefore, the publication of this book, Imaging of Orthopedic Sports Injuries, is an impor- tant highlight for the radiological profession and for all those involved in sports injuries management. All parts of the book offer an invaluable wealth of fundamental insights and new achievements in sports injuries imaging. The first part of the book contains information on relevant basic science and general imaging principles in sports traumatology. The second part com- prises a topographic discussion of sports injuries and elaborates the merit of different imaging techniques and different clinical problems focused on a specific location. In the third part, monitoring and follow-up of sports injuries and their repair by imaging are discussed. The fourth part leads through imaging-guided intervention procedures and postoperative imaging of sports injuries. ix

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