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Raja AE, Meyer R, Tunis BG, Moreland ML, Tunis JG. Prone Lachman with Ultrasound: A Literature Review and Description of the Technique. Curr Sports Med Rep 2022; 21:336-342. [PMID: 36083709 DOI: 10.1249/jsr.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Magnetic resonance imaging is the current gold standard imaging modality for diagnosing anterior cruciate ligament (ACL) tears. However, ultrasound has grown in popularity for detecting ACL injuries because of its low cost, portability, and dynamic assessment capabilities. Recent studies demonstrate high sensitivity and specificity for diagnosing isolated ACL tears via ultrasound, but tremendous heterogeneity remains for optimal technique including patient positioning, transducer placement, and dynamic versus static ultrasound usage. As ultrasound becomes ubiquitous in clinics, training rooms, and on the sidelines, identifying objective and sensitive measurements to appropriately screen athletes for significant knee injuries is imperative. This article aims to review the current role of diagnostic ultrasound in ACL injuries and propose a standardized version of the Prone Lachman with Ultrasound test, which is an objective, reliable, and easily reproducible technique to evaluate ACL competency. Developing a standardized protocol will expand the use of point-of-care ultrasound, which may reduce cost and improve efficiency in care.
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Affiliation(s)
- Altamash E Raja
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
| | - Ryan Meyer
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
| | - Brandon G Tunis
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
| | - Michael L Moreland
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
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Wu WT, Lee TM, Mezian K, Naňka O, Chang KV, Özçakar L. Ultrasound Imaging of the Anterior Cruciate Ligament: A Pictorial Essay and Narrative Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:377-396. [PMID: 34949491 DOI: 10.1016/j.ultrasmedbio.2021.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/12/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Ultrasound has been extensively applied to the diagnosis of and guided interventions for knee disorders. However, although it is commonly affected during sports injuries, the anterior cruciate ligament (ACL) is not usually incorporated in the majority of ultrasound scanning protocols. In the past, because of its oblique trajectory and deeper location, the ACL was considered to be a challenging structure for ultrasound imaging. Owing to advances in ultrasound technology and knowledge of knee sono-anatomy, an increasing number of studies are investigating the clinical value of ultrasound in the diagnosis and management of ACL injuries. In this regard, the present review aims to elaborate on the sono-anatomy of the ACL, to summarize the evidence for ultrasound imaging for ACL lesions and to investigate whether it is useful in the pre-operative preparation and post-operative follow-up of ACL reconstruction.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Min Lee
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan; Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Takeuchi S, Rothrauff BB, Kanto R, Onishi K, Fu FH. Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2022; 30:93-101. [PMID: 34121144 DOI: 10.1007/s00167-021-06640-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Ultrasound with superb microvascular imaging (SMI) is a novel microvascular imaging technology which may be useful to assess the vascularity of the torn anterior cruciate ligament (ACL) as a potential measure of healing potential following surgery. This study aimed to quantify the vascularity of the torn and intact ACL using ultrasound with SMI. METHODS 23 patients (mean age ± standard deviation, 27.1 ± 12.8 years), who were diagnosed with an ACL tear with an intact contralateral ACL were enrolled (ACL injury group). Ten healthy volunteers (36.1 ± 4.9 years) who had intact ACLs in both knees were also recruited (ACL healthy controls). The vascularity of the ACL was assessed using SMI within 15 mm from the tibial insertion in both knees. The amount of the vascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0-3) and a quantified ratio of vascularized area with respect to total area of the region of interest (vascularity ratio). RESULTS In the ACL injury group, a significantly higher vascularity grade and ratio were observed in the torn ACL (vascularity grade 0-3: 1, 8, 7, and 7 patients, respectively; vascularity ratio: 1.3 ± 1.4%) than the contralateral intact ACL (vascularity grade 0-3: 21, 1, 1, and 0 patients, respectively; vascularity ratio: 0.1 ± 0.5%) (P < 0.001), whereas no significant difference was observed between both ACLs in the ACL healthy control group. CONCLUSIONS SMI was useful to assess the increased vascularity in torn ACL, which may reflect the potential for, or state of, ACL maturation following reconstruction or repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Satoshi Takeuchi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryo Kanto
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Bailowitz Z, Visco CJ, Christen K, Ahmad CS. Diagnostic Musculoskeletal Ultrasound for the Acute Evaluation and Management of Soccer Players. Curr Sports Med Rep 2021; 20:525-530. [PMID: 34622817 DOI: 10.1249/jsr.0000000000000890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Musculoskeletal ultrasound (US) has many applications in the care of athletes. This article reviews the current literature and identifies research gaps regarding musculoskeletal US in the athletic training room setting to evaluate and manage soccer players. The best evidence for US in the training room setting is for diagnosis and prognosis of muscle injuries, where studies show that it is equivalent to other imaging modalities. US also has been used for injury risk prediction, although the data are mixed. Many applications of US are described in other sport settings and may have crossover applications to soccer.
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Affiliation(s)
- Zachary Bailowitz
- Department of Orthopedics, Podiatry, and Sports Medicine, Kaiser Permanente, Oakland, CA
| | - Christopher J Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY
| | | | - Christopher S Ahmad
- Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
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Breukers M, Haase D, Konijnenberg S, Klos TVS, Dinant GJ, Ottenheijm RPG. Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients. BMJ Open Sport Exerc Med 2019; 5:e000605. [PMID: 31908834 PMCID: PMC6936983 DOI: 10.1136/bmjsem-2019-000605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2019] [Indexed: 01/10/2023] Open
Abstract
Objectives Dynamic ultrasound (US) imaging shows promising possibilities for accurate imaging in diagnosing anterior cruciate ligament (ACL) tears and can be used as a point-of-care test. The aim of this study is to determine the diagnostic accuracy of dynamic US imaging for detecting partial and complete ACL tears. Methods 247 patients presenting with knee complaints, who underwent dynamic US imaging as well as arthroscopy for any intra-articular knee pathology, were retrospectively evaluated. We differentiated between partial and complete ACL tears. Results Dynamic US imaging revealed 95 of 108 arthroscopically confirmed ACL tears (sensitivity 88%, specificity 82%, positive predictive value (PPV) 79%, negative predictive value (NPV) 90%, and diagnostic OR (DOR) of 33.3). Sensitivity of US in the detection of partial ACL tears was 52%, specificity 85%, PPV 52%, NPV 84% and DOR 5.8. Complete ACL tears were depicted with a sensitivity of 79%, specificity of 89%, PPV of 63%, NPV of 95% and DOR 29.8. Multivariate regression analysis adjusting for age (dichotomised per 5 years) and previous knee surgery showed similar DOR. Conclusion The excellent NPV for complete ACL tears indicates that dynamic US imaging can be used as an initial imaging point-of-care test. However, the clinical presentation should be taken into account, especially in case of subtotal tears. Whereas it seems relatively easy to differentiate between (small) partial ACL tears, complete ACL tears and no tears, it seems to be difficult to differentiate subtotal tears from complete tears.
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Affiliation(s)
- Manon Breukers
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,ICONE Orthopedics and Sports Traumatology, Schijndel, The Netherlands
| | - Dorieke Haase
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,ICONE Orthopedics and Sports Traumatology, Schijndel, The Netherlands
| | | | | | - Geert-Jan Dinant
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Ramon P G Ottenheijm
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Efficiency of knee ultrasound for diagnosing anterior cruciate ligament and posterior cruciate ligament injuries: a systematic review and meta-analysis. Skeletal Radiol 2019; 48:1599-1610. [PMID: 31076833 DOI: 10.1007/s00256-019-03225-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of knee ultrasound for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. MATERIALS AND METHODS PubMed and EMBASE databases were searched for diagnostic accuracy studies that used ultrasound for diagnosing ACL and PCL injuries. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate diagnostic performance. Subgroup analysis was performed by assessing studies conducted using the ultrasound technique (functional ultrasound versus conventional ultrasound) for diagnosing ACL injury. We performed meta-regression analyses for a potential source of heterogeneity. RESULTS Eleven (938 ultrasound/878 patients) and six articles (281 ultrasound/237 patients) were included for ACL and PCL injuries respectively. The summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic for ACL and PCL injuries were 0.88 (95% confidence interval [CI], 0.81-0.93) and 0.99 (95% CI, 0.49-1.00), 0.96 (95% CI, 0.91-0.98) and 0.99 (95% CI, 0.73-1.00), and 0.97 (95% CI, 0.96-0.98) and 1.00 (95% CI, 0.99-1.00) respectively. In subgroup analysis, there was no significant difference between sensitivity (p = 0.63) and specificity (p = 0.72) of functional and conventional ultrasound. Among the various potential covariates, patient enrollment, patient position, and ultrasound performer were associated with heterogeneity in terms of sensitivity, and proportion of the ACL injury was associated with heterogeneity in terms of specificity. CONCLUSION Knee ultrasound demonstrates high diagnostic performance for ACL and PCL injuries, particularly when performed by experienced musculoskeletal radiologists. Future prospective studies to compare the cost- and time-effectiveness between ultrasound and magnetic resonance imaging and to determine the optimal ultrasound parameters are warranted.
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