What are the findings? SARMS. No increased rate of cyclops lesions and extension deficits after We use cookies so we can provide you with the best online experience. TECHNIQUE STEPS. So I guess my question is, for those of you who have had a cyclops lesion, does this sound like one or what you went through? Schroer WC, Berend KR, Lombardi A V., et al. The pogo practice also has absolutely everything a runner could want for their rehab process. He offers. ACL Brace, This is not medical advice. Physiotherapy was organised for regaining range of movement. Both true and cyclopoid types are simply referred to as cyclops lesions, and they are usually indistinguishable by MRI. ( a) Supine leg press with elastic band is initiated utilizing elastic band for closed-chain exercises. Loss of full extension after anterior cruciate ligament (ACL) reconstruction, with development of an audible and palpable "clunk" with terminal extension was first described by Jackson and Schaefer as "cyclops syndrome." At present, increasing the accuracy of identification of knee ligament insertions is fundamental in developing accurate patient-specific three-dimensional (3D) models for preoperative planning surgeries, designing patient-specific instrumentation or implants, and conducting biomechanical analyses. Runyan, B. R., Bancroft, L. W., Peterson, J. J., Kransdorf, M. J., Berquist, T. H., & Ortiguera, C. J. A lump of scar tissue forms in the knee after ACLR surgery. He is incredibly thorough in his assessment, diagnosis and explaination of both the injury and the process of rehab. Yes. The only case reported previously was by Rubin et al following bone-patellar tendon-bone ACL reconstruction.2. between patients with and without cyclops lesion. 2010. Simpfendorfer C, Miniaci A, Subhas N, Winalski CS, Ilaslan H. Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI. The mechanisms are thought to be similar to the post-surgery presentation (7). Featuredin theTop 50 Physical Therapy Blog. 327-332, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2009. jumping back into PT immediately described two histologic subtypes.6 The true cyclops is hard and composed of fibrocartilaginous tissue with active central bone formation and no granulation tissue or inflammatory cell infiltration.6 The true cyclops lesions are more likely to be symptomatic.7 The second type, termed a cyclopoid lesion, is soft and composed largely of fibrous and granulation tissue with occasional cartilaginous islands.6,4. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2017 October ; 35(10): 22752281, Annals of Rheumatic Diseases, 1993. 25(6), 2009: 626-631, Knee Surg, Sports Traumatol, Arthroscopy, 1992. ACL Surgery: Cyclops Lesions | POGO Physio Gold Coast Movies available at http://radiographics.rsnajnls.org/cgi/content/full/e26/DC1. MRI findings of cyclops lesions of the knee - academia.edu No matter how hard you and your physio try to get the knee straight, it wont go. that surgery was so, so much easier than the first and eliminated a ton of my pain related to the scar tissue and limited mobility. Cyclops lesions are located just above the tibial tunnel and cause loss of knee range of motion with a mechanical block that restricts getting the leg completely straight following surgery. He said it sounds like either patellofemoral pain syndrome or a cyclops lesion, but sounds more like patellofemoral, so he got me back in physical therapy and said if it still persists in a few months to come back and he'll get me scheduled for an MRI to check for the cyclops lesion. Cyclops, inverted; Anterior cruciate ligament reconstruction; Complication, Annals of The Royal College of Surgeons of England, Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction, Extension loss secondary to femoral-sided inverted cyclops lesion after anterior cruciate ligament reconstruction, Arthroscopic findings associated with roof impingement of an anterior cruciate ligament graft, Progressive loss of knee extension after injury. Thanks Pogo Physio! Also noted is fibrosis within the infrapatellar fat pad (arrowheads). All patients had a history of trauma but no history of ACL reconstruction. There are several different risk factors that are thought to increase the chance of developing this condition. Methods A Biblioteca Virtual em Sade uma colecao de fontes de informacao cientfica e tcnica em sade organizada e armazenada em formato eletrnico nos pases da Regio Latino-Americana e do Caribe, acessveis de forma universal na Internet de modo compatvel com as bases internacionais. Large graft relative to intracondylar notch, slightly higher incidence with double bundle compared to single bundle for this reason. Loss of extension is one of the most common complications following ACL surgery and can be of detriment to functional ability, especially in the athletic population (6). A focus of soft tissue thickening is compatible with a small cyclops lesion anterior to the graft (arrowhead). Neil Duplantier MD. I have seen Brad twice now and he is absolutely fantastic. A cyclops lesion is described as a focal anterior arthrofibrosis, which is an excessive formation of scar tissue on the anterior cruciate ligament. It is considered a main complication of anterior cruciate ligament ACL reconstruction. Reconstruction of the anterior cruciate ligament (ACL) is a commonly performed procedure that produces reliable and reproducible outcomes [1], [2], [3].Although the post-operative complication rate is low, loss of knee extension may require revision surgery [4], [5], [6], [7].Cyclops syndrome was first described in 1990 by Jackson and Schaefer as loss of full knee extension . 2011, 22(4). You can read about ligament injuries of the knee in our related articles: PCL Tear, MCL Injury, and LCL Injury. A 28 year-old male 5 years after ACL reconstruction presents with limited mobility. What is your diagnosis? Recovering from an ACL Injury - Sano Orthopedics The .gov means its official. When cyclops lesions measured more than 10 mm . A cyclops lesion with loss of knee extension with or without an audible or palpable cluck at terminal knee extension constitutes the cyclops syndrome. . The goal of surgery is to prevent joint instability, which may further damage articular cartilage and menisci. From 2001 to 2006, the authors identified 10 patients (five women and five men, ages 27-76 years) with cyclops nodules seen at magnetic resonance (MR) imaging. I can squat and lift a lot of weight now with little pain, but my gait is a bit off. Usually the patient will also have some quadriceps dysfunction. . The reconstruction was performed using a four-strand hamstring graft and fixed on the femoral side using the TransFix technique and Bio-Interference screw (Arthrex, Naples, FL, US) fixation for the tibial side. An often overlooked code is 29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure), which may be assigned for excision of fibrosis/adhesions/scar due to previous procedures or injuries. Magnetic resonance imaging (MRI) showed a complete rupture of the ACL with bone bruising of the lateral femoral condyle. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years. Possible problems that can lead to the re-tear of the ACL include suboptimal positioning of the graft, improper tension on the graft, or failure of the fixation of the graft. (PDF) Assessment of rotatory laxity in anterior cruciate ligament Introduction. Cyclops lesions can be found in up to 25% of ACL reconstructions at 6 months after surgery. The development of patella baja is made more apparent by comparing current and prior studies by plain film or MRI (Figure 11). Orthopedics. Petsche, T. S., & Hutchinson, M. R. (n.d.). There a couple of competing theories on why the scar tissue develops. Related Articles: ISAKOS: 2023 Congress in Boston, USA : Abstract Adverse Events and Arthroscopy: The Journal of Arthroscopic & Related Surgery, 8(1), 10-18. doi:10.1016/0749-8063(92)90129-y, Minne, C., Velleman, & Sulleman, F. E. (2012). This syndrome, which is the result of a fibrous nodule (termed a cyclops nodule), has recently been described in patients who have sustained ACL injury but have not undergone reconstructive surgery. These lesions result in pain and loss of extension with impingement of the lesion. Cyclops lesion which represents arthrofibrosis in midline anterior knee. The hallmark sign of a cyclops lesion is loss of knee extension range often about 2-3 months following an ACL surgery. Its also been suggested that the cyclops lesion was caused from graft impingement when the knee was in full extension which leads to scar tissue formation (4). On the sagittal inversion recovery image (13A) an abnormal low signal focus is noted posterior to the patella (arrowhead). A cyclops lesion is a piece of scar tissue which develops on the anterior portion of an ACL. What's new. Before reconstruction of her ACL 10 weeks after injury, she had full range of movement and findings for instability included positive Lachman and anterior drawer tests (both showing 05mm of anterior displacement of the tibia) and a negative pivot shift test. No weight on it. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years . Arthroscopic Release for Symptomatic Scarring of the Anterior Interval of the Knee. Arthrofibrosis is a common complication of ACL reconstruction and total knee arthroplasty and can result in a frustrating clinical course and poor functional results. Fibrosis in the suprapatellar bursa typically limits knee flexion. 2015 Mar;73(1):61-4. The axial proton density-weighted image (13B) reveals this structure to be a band-like region of arthrofibrosis (arrowheads) passing posterior to the patella and blending with the synovium medial and lateral to the patella, likely contributing to the patients mechanical symptoms. From the moment you walk through the door, the team make you feel very welcome and comfortable. Klay Thompson's torn ACL: How rehabilitation and return - oregonlive A cyclops lesion (2.2 1.4 2.4 cm) was seen anterior to the ACL in the . The case studies are great and it just gives me that edge when treating my own clients, giving them a better treatment. 2019 Oct 16;5(4):442-445. doi: 10.1016/j.artd.2019.09.003. 2012 Mar; 94(2): e99e100. Cyclops Lesions That Occur in the Absence of Prior - RadioGraphics Accessibility Got an MRI done and the report said: Complete rupture of the reconstructed ACL with Cyclops lesion Tear of lateral meniscus Ruptured popliteal cyst Multicomponent chondromalacia Clinical evaluation is the mainstay in establishing the diagnosis of arthrofibrosis, however MRI plays an important role in establishing the extent of involvement by fibrosis and to exclude other complications that may have a similar clinical presentation. I had a cyclops lesion without loss of extension. doi: 10.1053/jars.2001.17997. All the staff, from Michael the physio, Sato the massage therapist and Matt at reception were wonderful. In standing, anchor a resistance band to something and place it around your knee. 2. what does a cyclops lesion feel like? : r/ACL MR Imaging of Complications of Anterior Cruciate Ligament Graft Reconstruction. Its an important aspect of creating a stable knee and a lack of extension puts added stress on the quadriceps muscles and patellofemoral joint (under the knee cap) (1). Results Cyclops lesions were found in 25% (28/113), 27% To compare anterior cruciate ligament (ACL) soft-tissue allograft reconstruction using suspensory versus aperture fixation. (2A) The T2-weighted sagittal image demonstrates a nodular heterogeneously low signal mass (arrow) at the anterior margin of the ACL graft. Hart et al coined the term inverted cyclops lesion for the case of a 14-year-old boy with a T-shaped intercondylar fracture at the level of the distal physis.5 He developed loss of extension secondary to a femoral-sided fibrous nodule. When it comes to ACL reconstruction surgery, there are some options. 2007; 15:144--146, Knee Surgery, Sports Traumatology, Arthroscopy. The MRI showed my meniscus repair was not holding up at all, had new plans of tears. Glossary of terms for musculoskeletal radiology. For the minority of individuals who do experience symptoms with a cyclops lesion, they will typically have: restricted knee extension, so they are unable to fully straighten their knee. . Cyclops lesion causing loss of extension after ACL surgery - Lenny Macrina . ACL Rehab Complications - CYCLOPS LESIONS - YouTube Cyclops lesions after ACL reconstruction using either bone-t - LWW Previous studies reported that after ACL reconstruction, the incidence of joint stiffness was between 4 and 38% [8]. The https:// ensures that you are connecting to the Would you like email updates of new search results? Cyclops lesions developed within the first 6 months after surgery. Journal of the American Academy of Orthopaedic Surgeon, 7(2), 119-127. Brad and the whole team make every visit there so pleasant. It is a frequent complication associated with surgery and trauma. It seems like it's been getting better because some of them have been getting easier, and before that I couldn't do a single leg squat, period (although if I go down too far, there's still pain). Gandhi R, De Beer J, Leone J, Petruccelli D, Winemaker M, Adili A. Predictive risk factors for stiff knees in total knee arthroplasty. (i.e. An increased incidence of anterior cruciate ligament (ACL) injuries in children over the last few decades has led to a corresponding increase in ACL reconstruction procedures in children. It may be an incidental finding on a follow-up scan or if the knee is scanned for another reason. KOOS was also correlated with lesion volume. Another theory states that it may be fibrocartilage as a result of drilling the tibial tunnels. Cyclops lesions are an unfortunate sequelae of anterior cruciate ligament injury, and are most commonly seen following ACL reconstructions. Never miss a podcast or blog post when you subscribe to our weekly newsletter. 3, Quarterly Journal of Experimental Physiology, 1988. tecting cyclops lesions was found to be 85%, 84.6%, and 84.8%, respectively.15 Inverted Cyclops Lesions Only very recently, a study by Rubin and colleagues de-scribed a fibrous lesion at the femoral insertion site of the bone patellar tendon bone ACL autograft.3 The investiga-tors coined the term "inverted" cyclops lesion to separate it The authors suspect that the cause of cyclops lesions that occur in the absence of ACL reconstruction is similar to that suggested in the classic postoperative patient. Diffuse arthrofibrosis surrounding the ACL graft is rare. The arthroscopic treatment of cyclops syndrome - LWW Incidentally noted is a hemarthrosis (11B) (with joint fluid appearing hyperintense to muscle) associated with an intra-articular fracture of the posterior tibia (asterisk). In cases involving an old ACL injury or loss of extension after ACL reconstruction, the footprint of the ACL should be inspected for a remnant of the ACL (Cyclops lesion). I enjoy myself every time I walk into POGO! My surgeon still thinks it's scar tissue causing my issues. If the physiotherapist pushes the patient too hard in the presence of a cyclops, it may trigger breakdown of the articular cartilage. Palmer W, Bancroft L, Bonar F, Choi JA, Cotten A, Griffith JF, Robinson P, Pfirrmann CWA. In simple terms, it is a lump of scar tissue at the front of the knee and it blocks it from completely straightening. Haklar U, Ayhan E, Ulku TK, Karaoglu S. Arthrofibrosis of the Knee. He's worked with elite level State and National rugby and football teams in Australia, the UK and France. PMC Hoser C. Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block. Cylops lesion surgery post ACL reconstruction : r/ACL - reddit Home. The cyclops lesions had a mean size of 16 12 11 mm, with 90% of them located just anterior to the distal ACL. The triggering insult stimulating the formation of a cyclops lesion is unclear with theories including an inflammatory response to drilling debris from the tibial tunnel, remnants of the native ACL, and from scar tissue and piling up of graft fibers arising from repeated graft impingement.3,1,4No clear difference in the incidence of cyclops lesions is found between bone-patellar tendon-bone and hamstring allografts.5 Muellner et al. already built in. A 35-year-old woman sustained an ACL injury to her left knee when she slipped and fell on the deck of a boat and twisted her knee 1 week prior to presentation. Sequential sagittal proton-density weighted images demonstrate loss of ligament tissue anteriorly (arrowheads) within the intercondylar notch compatible with a partial tear. Remove the effusion if present. Cortical Suspensory Button Versus Aperture Interference Screw Fixation Previous studies reported that after ACL reconstruction, the incidence of joint stiffness was between 4 and 38% [8]. Fritz J, Lurie B, Potter HG. Best answers. official website and that any information you provide is encrypted The coronal T2-weighted image demonstrates diffuse heterogenous low signal fibrosis in the medial and lateral gutters (arrows). MRI findings of cyclops lesions of the knee - SciELO How accurate and reproducible are the identification of cruciate and Clinical Outcomes After Arthroscopic Release of Patellofemoral Arthrofibrosis in Patients With Prior Anterior Cruciate Ligament Reconstruction. Sonographic and Magnetic Resonance Imaging Examination of a Cyclops Lesion After Anterior Cruciate Ligament Reconstruction: A Case Report. Different aspects of the cyclops lesion following anterior cruciate ligament reconstruction: A multifactorial etiopathogenesis. Facchetti L, Schwaiger BJ, Gersing AS, et al. Resources. doi:10.1148/rg.e26, Sonnery-Cottet, B., Lavoie, F., Ogassawara, R., Kasmaoui, H., Scussiato, R. G., Kidder, J. F., & Chambat, P. (2010). Abreu MR, Chung CB, Trudell D, Resnick D. Hoffas fat pad injuries and their relationship with anterior cruciate ligament tears: New observations based on MR imaging in patients and MR imaging and anatomic correlation in cadavers. MRI has been shown to be 84% accurate in detecting cyclops lesions (2) and surgical intervention is generally successful in restoring knee function (8). In 13 patients without cyclops lesions, the femoral tunnel entered the notch within 2 mm of the intersection of the intercondylar roof and the posterior femoral cortex. I got an MRI at 8 months. Cyclops Lesions of the Knee: A Narrative Review of the Literature One common complication of ACL reconstruction is a limited range of motion, especially obtaining a fully straight knee. Collateral ligaments, the posterior cruciate ligament and the posterolateral corner were intact. This has since been debated however the two surgeons were actually able to reduce their incidence of cyclops lesions by leaving less debris in the joint post-surgery (7). A 17 year-old male 1 year after ACL reconstruction, felt a pop while stepping into a hole with swelling and limited extension at the knee. Patrick C. McCulloch MD. This may be due to a what is termed a Cyclops Lesion. A Cyclops lesion is a complication following an ACL injury which occurs in about 5% of cases. ACL Rehab Exercises A second arthroscopy is then needed to remove the nodule of scar tissue in order to regain extension (2). Skeletal Radiol. 73: p. 305-314, Clinical Physiology. Jackson and Shaefer first defined cyclops syndrome in 1990.1 The location of this lesion is frequently anterolateral to the tibial tunnel. Read more about ACL Rehab Exercises, in our related article. Restoring Knee Hyperextension Range of Motion - Mike Reinold MR Imaging of Cyclops Lesions : American Journal of Roentgenology : Vol In any ACL surgery it is really important to work hard on regaining extension early. Our international team of qualified experts (see above) spend hours poring over scores of technical journals and medical papers that even the most interested professionals don't have time to read. MR Imaging of Complications of Anterior Cruciate - RadioGraphics Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P. Infrapatellar contracture syndrome. 35(8): 1269-1275. Thepodcast features interviews with the worlds leading physical performers,and some of the worlds leading health and fitness experts. TECHNIQUE VIDEO. Cyclops Lesion Of The ACL | Bend - Pilates Sydney CBD Risks of ACL Surgery and Ligament Reconstruction - Verywell Health Bethesda, MD 20894, Web Policies ACL Graft Tear - Radsource There are four main tissue options for surgery: kneecap tendon with bone. 11 months post-op here missing a few degrees of extension. New posts. Log in. The origin was thought to be due to residues of bone and cartilage from drilling of the tunnels. 10(5): p. 489-500, American Journal of Sports Medicine. Subjects with cyclops lesions did not have an inferior clinical outcome. Bradley DM, Bergman AG, Dillingham MF. Factors that are felt to increase the likelihood of diffuse arthrofibrosis include ACL reconstruction within 4 weeks of the ACL injury, additional ligamentous injuries, and diminished knee flexion preoperatively. I did a few visits to physical therapy and they gave me exercises to do at home including wall squats, lateral step downs, single leg squats, and a few others. And I've stopped running for now. Cyclops lesions after ACL reconstruction: something to keep an eye on The appearance and clinical history are suggestive of patellar clunk syndrome. Su EP, Su SL, Valle AG Della. A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction. Cyclops lesions develop in the anterior aspect of the intercondylar notch typically after anterior cruciate ligament (ACL) reconstruction or injury. The anterior interval of the knee is found posterior to the patellar fat pad and anterior to the anterosuperior tibial plateau.2 Scarring over the posterior aspect of the infrapatellar fat pad from the patella to the anterior surface of the tibia or the transverse meniscal ligament can bridge the interval and result in restriction of the normal biomechanics of the anterior knee with increased tension on the fat pad, diminished translation of the patellar tendon and patellar entrapment (Figure 10).15. Cyclops lesions, a form of anterior arthrofibrosis where a localized scar nodule develops, are rare but can occur after a reconstruction following ACL surgery. Press question mark to learn the rest of the keyboard shortcuts. Excessive fibrosis of the infrapatellar fat pad can result in altered biomechanics of the anterior knee. You may switch to Article in classic view. One case has been reported previously following a bone-tendon-bone reconstruction of the ACL but a similar case has not been reported. Arthroscopic treatment of patellar clunk. For 17 years, we've helped hard-working physiotherapists and sports professionals like you, overwhelmed by the vast amount of new research, bring science to their treatment. Why are total knees failing today? After surgery, working with a physical therapist will be helpful to guide you with exercises and advice to achieve this. It occurs as a result of anterior cruciate ligament ACL reconstruction. Many authors recommend arthroscopic debridement prior to manipulation under anesthesia to mitigate the risk of fracture, chondral damage, intra-articular hemorrhage, and ligament or tendon rupture. A notchplasty was performed following debridement of the lesion from the 9 oclock to the 1 oclock position. The American Journal of Sports Medicine, 29(5), 664675. I had an MRI done a few weeks ago and the results were obnoxious vague. Sagittal proton density-weighted images demonstrate the normal appearance of the infrapatellar fat pad on the left and the typical mild post-surgical scarring following ACL reconstruction (arrowheads) on the right. B. 22:10901096, Current Orthopaedic Practice. Developing collective mental resilience to manage competition demands, State of mind: understanding cognitive load in performance and injury rehabilitation. Well trained, friendly and professional. (2007). Cyclops lesions are areas of granulation tissue with neovascularization and fibrous tissue formation peripherally, most commonly at the anterolateral aspect of the tibial graft site after ACL reconstruction. Often, this occurs due to the body's natural defenses put in place, as we described in the published research article on AMI. Chris Mallac, Physiotherapist is a highly qualified Physiotherapist and Educator. This means that it should be suspected in any patient who has a loss of extension following any form of ACL injury. Read about treatments for other ligament injuries in our related articles: PCL Recovery, MCL Injury Treatment, and LCL Injury Recovery. 2007. MRI of the right knee ( Figure 3) showed a thickened patellar tendon, supra-patellar effusion, bone contusion and oedema in the anterior aspect of the tibial plateau as well as anterior and superior to the bony tract of the ACL repair. The infrapatellar fat pad is richly innervated and is an important pain generator in the knee.14 Surgical and traumatic insults to the infrapatellar fat pad can induce fibrosis and metaplasia resulting in pain (September 2008 Web Clinic Patellar Fat Pad Abnormalities).13,14. https://www.pogophysio.com.au/wp-content/uploads/pogo-physio-with-a-finish-line2x.png, https://www.pogophysio.com.au/wp-content/uploads/acl-surgery-cyclops-lesions.jpg. Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device The site is secure. This is sometimes referred to as a "Cyclops lesion" or arthrofibrosis. Complication of ACL repair. A small amount of hyperextension of the knee is important, the knee should actually go about 5-6 past completely straight. Best of luck though. Only after surgical excision is physical therapy helpful in regaining mobility and strength. "The articles are well researched, and immediately applicable the next morning in the clinic. The functionality is limited to basic scrolling. This did not resolve following intensive physiotherapy. Early return of full extension will reduce your risk of developing a cyclops lesion. My x-ray and Ortho appointment are tomorrow. Once these structures are inspected, the probe should be placed along the lateral side of the ACL, and the knee should be brought into a varus position or a figure-four . 2020 Jul;49(Suppl 1):1-33. doi: 10.1007/s00256-020-03465-1. An avulsion injury of the ACL on the tibia or femur. Please enable it to take advantage of the complete set of features! But the sharp pain still persists with some things, especially going down steps in a slow & controlled manner. Cyclops Lesions That Occur in the Absence of Prior Anterior Ligament Reconstruction1. 31(1). 5-7,9 However, a cyclops lesion can be found in asymptomatic patients . Debridement of cyclops lesions after total knee replacement (s) is a . A band of low signal extends over the posterior aspect of the infrapatellar fat pad (short arrows). He said it sounds like either patellofemoral pain syndrome or a cyclops lesion, but sounds more like patellofemoral, so he got me back in physical therapy and said if it still persists in a few months to come back and he'll get me scheduled for an MRI to check for the cyclops lesion. On MRI, cyclops lesions are adherent to the ACL graft and are hypointense or isointense to muscle on T1-weighted images and variable in signal intensity on proton density- and T2-weighted images.4 Rarely, areas of ossification within the cyclops lesion are well formed and large enough to be detected on MRI as circumscribed foci with internal signal that mirrors marrow fat signal on T1-weighted and fluid-sensitive sequences (Figure 4).
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