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Background Chronic ankle instability (CAI) arises from the two etiological factors of functional (FAI) and mechanical ankle instability (MAI). To distinguish the contributions of the two etiologies, it is necessary to quantitively assess functional and mechanical deficits. Validated and reproducible assessment of mechanical instability remains a challenge in current research and practice. Physical examination, stress sonography and a novel 3D stress MRI have been used, while stress radiography has been called into question and arthrometry is limited to research purposes. The interaction of these primarily mechanical measurements with the functional and subjective components of CAI are subject to debate. The aim of this study was the evaluation of the clinical and biomechanical preferences of the three different methods in the diagnosis of MAI. Methods In this cross-sectional diagnostic study, we compared three different diagnostic approaches to mechanical ankle instability: (1) manual stress testing (anterior drawer test [ADT] and talar tilt test [TTT]), (2) stress sonography and (3) 3D stress MRI (3SAM) The latter includes quantification of 3D cartilage contact area (CCA) in plantarflexion-supination compared to neutral-null position. We applied these measurements to a cohort of patients suffering from chronic mechanical ankle instability ( n  = 25) to a matched cohort of healthy controls ( n  = 25). Perceived instability was assessed using the Cumberland Ankle Instability Tool (CAIT) and Forgotten Joint Score (FJS). Functional deficits were measured using postural sway and the y-Balance test. Results Significant differences between the two groups (single-factor “group” ANOVA, p  < 0.05) were found in all of the mechanical assessments with strong effect sizes. Spearman’s correlations were strong for CAIT and manual stress testing (TTT rho = − 0.83, ADT rho = − 0.81), 3D stress MRI (rho = − 0.53) and stress sonography (TTT rho = − 0.48, ADT rho = − 0.44). Furthermore, the correlation between manual stress testing and CCA in the fibulotalar articulation (CCA FT ) was strong (rho = 0.54) and the correlations to stress sonography were moderate (ADT rho = 0.47 and TTT rho = 0.43). The calculation of cutoff values revealed a distance of > 5.4 mm increase in ligament length during stress sonography (sensitivity 0.92, specificity 0.6) and > 43% loss of articulating surface in the fibulotalar joint (CCA FT in supination-plantarflexion using 3SAM, sensitivity 0.71, specificity 0.8) as potential cutoff values for diagnosing MAI. Conclusions Manual stress testing showed to be a valuable method of identifying mechanical ankle instability. However, due to is subjective character it may overvalue patient-reported instability as a factor which explains the high correlation to the CAIT-score, but this may also reduce its value in diagnosing the isolated mechanical quality of the joint. Thus, there is a persisting need for objective and reproducible alternatives focusing on MAI. According to our results, 3D stress MRI and stress sonography represent valuable alternatives and may be used to quantitively assess mechanical ankle instability in research and practice. Trial registration German Registry of Clinical Trials # DRKS00016356 , registered on 05/11/2019.

IntroductionMeniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based examination of lateral ME exists. The purpose of the present study was to test the reliability and validity of lateral ME measurements using a standardized ultrasound-based examination protocol.Materials and MethodsA group consisting of 11 healthy volunteers (Group I, male and female, 18–45 years) as well as a group of 10 consecutive patients who had undergone all-inside lateral meniscal radial tear repair were included (Group II, male and female, 23–43 years). Lateral ME, the main outcome parameter, was measured by ultrasound (US; both groups) and magnetic resonance imaging (MRI; Group II only). Both knees of all subjects were examined in an unloaded state and under axial compression of the knee (50% of body weight). Repeated measurements obtained in Group I by 2 observers were used for reliability testing, and the validity of US was assessed through comparison with MRI data (Group II).ResultsA total of 66 US images of Group I, obtained by each observer, were analyzed for reliability testing. Forty US and MR images of Group II were assessed for validation. Results showed good interrater (ICC = 0.904) and excellent intrarater (ICC = 0.942) reliability of US-based measurements of lateral ME. Agreement with MRI results was poor (ICC = 0.439), with US systematically overestimating results by 1.1 mm on average.ConclusionsUltrasound is a reliable, quick and cost-effective technique for lateral ME measurement, but results are not readily comparable with MRI.Trial registrationThe study was registered in the European Union Clinical Trials Register (EudraCT-Number: 2017-005037-24).

Aim: To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non-invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion. There is an increase in systemic and myocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats per minute. 2) Decrease in systolic blood pressure SBP by >/= 10 mm Hg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non-responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non-responders. Basic demographic variables with P value