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Background: Literature describing radiologic imaging of the adolescent labia is lacking and may lead to misdiagnoses and unnecessary medical care. Cases: Two adolescent patients presented with sudden‐onset unilateral labia minora enlargement and underwent multiple imaging modalities which identified a discrete mass. One patient was diagnosed with aphthous ulcers after a prolonged emergency department stay, and the other underwent an exam under anesthesia for mass removal and was found to have an elongated labia minora rolled into itself. Conclusion: Labia minora enlargement in adolescents can be significant and may be mistaken for a discrete mass on radiologic imaging given a lack of literature on expected findings. Clinical correlation and understanding of age‐appropriate etiologies of noninfectious labial swelling is crucial to avoid unnecessary medical therapies and procedures.

Background Postoperative return to recreational activity is a common concern among the increasingly active total knee arthroplasty (TKA) patient population, though there is a paucity of research characterizing sport-specific return and function. This study aimed to assess participation level, postoperative return to activity, sport function, and limitations for recreational athletes undergoing TKA. Methods A survey of recreational sports participation among primary, elective TKA patients from a single academic center between June 2011 and January 2022 was conducted. Of the 10,777 surveys administered, responses were received from 1,063 (9.9%) patients, among whom 784 indicated being active in cycling (273 [34.8%]), running (33 [4.2%]), jogging (68 [8.7%]), swimming (228 [29.1%]), tennis (63 [8.0%]), skiing (55 [7.0%]), or high-impact team sports (64 [8.2%]) between two years preoperatively and time of survey administration, and were included for analyses. Results Cycling (62.3% at two years preoperatively vs. 59.0% at latest follow-up) and swimming (62.7% at two years preoperatively vs. 63.6% at latest follow-up) demonstrated the most favorable participation rate changes, while running (84.0% at two years preoperatively vs. 48.5% at latest follow-up) and skiing (72.7% at two years preoperatively vs. 45.5% at latest follow-up) demonstrated the least favorable participation rate changes. The majority of respondents were “satisfied” or “very satisfied” with their return across all sports, though dissatisfaction was highest among runners and joggers. For cycling, running, jogging, and swimming, respondents most commonly reported no change in speed or distance capacity, though among these cyclists reported the highest rates of improved speed and distance. The majority of returning skiers reported improved balance, form, and ability to put on skis. Conclusion Return to sport is feasible following TKA with high satisfaction. Swimming and cycling represent manageable postoperative activities with high return-rates, while runners and joggers face increased difficulty returning to equal or better activity levels. Patients should receive individualized, sports-specific counseling regarding their expected postoperative course based on their goals of treatment.

Purpose The purpose of the current study is to systematically review and network meta-analyze the current evidence in the literature to ascertain if there is a superior lateral extra-articular augmentation technique in conjunction with anterior cruciate ligament (ACL) reconstruction (ACL.R) with respect to knee stability, re-rupture rates and functional outcomes. Methods The literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL.R to ACL.R + lateral extra-articular augmentation were included. Lateral extra-articular techniques included were anterolateral ligament reconstruction (ALL.R), Cocker-Arnold, Lemaire, Losee, Maraccaci, and McIntosh. Clinical outcomes were compared between ACL.R alone and the different lateral extra-articular augmentation techniques using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P -Score. Results Twenty-eight studies with a total of 2990 patients were included. ACL.R + Cocker-Arnold technique had the highest P -Score for ACL re-ruptures and residual pivot-shift. ACL.R + Cocker-Arnold, Lemaire, and ALL.R all significantly reduced the rate of ACL re-rupture, and residual pivot-shift, compared to ACL.R alone. There was no significant difference between any of the lateral extra-articular augmentation techniques and ACL.R alone. ALL.R had the highest P -Score for return to play, and return to play at pre-injury level. Conclusion This study established that ACL.R + Cocker-Arnold, Lemaire and ALL.R resulted in significantly lower ipsilateral ACL re-ruptures, as well as reduced pivot-shift, compared to ACL.R alone. Whereas, the other lateral extra-articular augmentation techniques did not reduce pivot-shift and re-rupture. Additionally, functional outcomes and return to play were comparable between those who underwent ACL.R and lateral extra-articular augmentation and ACL.R alone. Level of evidence III.

BackgroundWork-related stress and burnout were documented to be high among pediatric radiologists prior to the coronavirus disease 2019 (COVID-19) pandemic. New challenges arose from the COVID-19 pandemic, potentially introducing new stressors and anxieties.ObjectiveTo evaluate potential sources of stress and anxiety for pediatric radiology faculty during the early phase of the COVID-19 pandemic.Materials and methodsWe conducted a survey of attending physician members of the Society for Pediatric Radiology in North America from April 27, 2020, to May 22, 2020. The response rate was 21% (251/1,206). Survey questions included demographic information and questions regarding working remotely, personal protective equipment, redeployment, personal wellness, wellness resources and financial concerns. A psychometrician reviewed the questions to ensure minimal risk of misinterpretation.ResultsMedian age of respondents was 48 years (range 33–70 years) with median number of years in practice of 14 (range 1–45 years). Fifty-three percent of respondents were women and 46% were men. Because of an increase in remote work, 69% of respondents endorsed feeling more isolated from a lack of regular interaction with colleagues. Fifty-three percent of respondents indicated that it is challenging to work remotely while overseeing home schooling for children. In comparison to men, women reported overall higher work-related stress and anxiety (P=0.02), higher feelings of guilt from radiology staff (i.e. technologists and nurses) being more exposed to COVID-19 (P=0.02) and higher levels of stress providing for dependents (P=0.04). Most respondents thought that departmental leadership was effective and respondents were not concerned about meeting financial obligations or job loss.ConclusionThe early phase of the COVID-19 pandemic caused additional stress and anxiety for pediatric radiology faculty and disproportionally affected women. Given the continuously evolving state of the COVID-19 pandemic, these results could aid in planning and implementation of future strategies to combat burnout in radiology. Specific attention should be directed to different stressors experienced by female versus male radiologists, especially in regard to dependent care.

Purpose The purpose of this study was to determine and establish the MCID for the NAHS at 2 years in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods Patients that underwent primary hip arthroscopy for FAIS between 2010 and 2016 were analyzed for eligibility. Data were collected from a single surgeon’s hip arthroscopy database. MCID was calculated for the NAHS utilizing a distribution-based method. Results The study included 298 patients (184 females) with an average age of 40.4 ± 13.0 years and average body mass index (BMI) of 25.7 ± 4.2 kg/m 2 . At baseline, the cohort’s average NAHS score was 48.7 ± 13.6 and demonstrated an improvement of 36.5 ± 17.0 for NAHS at follow-up. This resulted in MCID values of + 8.5 for NAHS. Conclusion This is the first study to report the MCID (+ 8.5) for NAHS following primary hip arthroscopy, and as such, is a valuable contribution to future hip arthroscopy research. Level of evidence IV.

Purpose The purpose of this study was to identify if the location of posterolateral corner (PLC) injury was predictive of clinical common peroneal nerve (CPN) palsy. Methods A retrospective chart review was conducted of patients presenting to our institution with operative PLC injuries. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. A fellowship-trained musculoskeletal radiologist reviewed the PLC injury and categorized it into distal, middle and proximal injuries with or without a biceps femoral avulsion. The CPN was evaluated for signs of displacement or neuritis. Results Forty-seven operatively managed patients between 2014 and 2019 (mean age-at-injury 29.5 ± 10.7 years) were included in this study. Eleven (23.4%) total patients presented with a clinical CPN palsy. Distal PLC injuries were significantly associated with CPN palsy [9 (81.8%) patients, ( P  = 0.041)]. Nine of 11 (81.8%) patients with CPN palsy had biceps femoral avulsion ( P  = 0.041). Of the patients presenting with CPN palsy, only four (36.4%) patients experienced complete neurologic recovery. Three of 7 patients (43%) with an intact CPN had full resolution of their clinically complete CPN palsy at the time of follow-up (482 ± 357 days). All patients presenting with a CPN palsy also had a complete anterior cruciate ligament (ACL) rupture in addition to a PLC injury ( P  = 0.009), with or without a posterior cruciate ligament (PCL) injury. No patient presenting with an isolated pattern of PCL-PLC injury (those without ACL tears) had a clinical CPN palsy. Conclusion Distal PLC injuries have a strong association with clinical CPN palsy, with suboptimal resolution in the initial post-operative period. Specifically, the presence of a biceps femoris avulsion injury was highly associated with a clinical CPN palsy. Additionally, CPN palsy in the context of PLC injury has a strong association with concomitant ACL injury. Furthermore, the relative rates of involvement of the ACL vs. PCL suggest that specific injury mechanism may have an important role in CPN palsy. Level of evidence IV.