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Castro MO, Baptista DC, Afonso PD. Demystifying the "Dark Side of the Knee": An Update on Imaging of the Posterolateral Corner. Semin Musculoskelet Radiol 2024; 28:305-317. [PMID: 38768595 DOI: 10.1055/s-0044-1781431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.
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Affiliation(s)
- Miguel Oliveira Castro
- Radiology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
- Lagoa Centro - Imagens Médicas, Lagoa, Portugal
| | - Diogo Correia Baptista
- Radiology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
- Radiology Department, Hospital Particular da Madeira, Grupo HPA, Funchal, Portugal
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2
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Müller D. [Imaging of posterolateral rotational instability of the knee joint]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:271-277. [PMID: 38289375 DOI: 10.1007/s00117-023-01258-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 03/28/2024]
Abstract
Posterolateral instability of the knee joint typically occurs with injuries to the posterolateral corner of the joint or with additional combined injuries involving the anterior and posterior cruciate ligaments. In addition to numerous, smaller anatomical structures, the most important are the lateral collateral ligament (LCL), the popliteus muscle with its tendon, and the popliteofibular ligament (PFL), which can usually be assessed using magnetic resonance imaging (MRI). On the contrary, small structures like the arcuate ligament and fabellofibular ligament cannot always be identified. However, they are also of lesser importance in the development of posterolateral rotational instability. Overlooked injuries to the posterolateral joint corner promote instability with the complication of inadequate ligament reconstruction and early onset posttraumatic osteoarthritis. Knowledge of MRI morphology of the anatomical structures involved, taking into account their biomechanical significance, is crucial to recognize and use the corresponding imaging findings.
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Affiliation(s)
- Dirk Müller
- Zentrales Röntgeninstitut, Muskuloskelettale und Traumabildgebung, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Schweiz.
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Osterholt AC, Link TW, Abrar DB, Mewes AD, Hufeland M, Schleich C, Bittersohl B. Diagnostic performance of a 3D double-echo steady-state sequence at 3 T using radial reformats for detecting and grading rotator cuff tears: a pilot diagnostic accuracy study with magnetic resonance imaging and arthroscopic correlation. Acta Radiol 2023; 64:2768-2776. [PMID: 37603569 DOI: 10.1177/02841851231190359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND In diagnosing rotator cuff tears (RCTs), magnetic resonance imaging (MRI) is the imaging modality of choice, and its accuracy is improving constantly. PURPOSE To evaluate the diagnostic performance of a high-resolution 3D double-echo steady-state (DESS) sequence with radial and paracoronal 3-T MRI regarding the grading of RCTs in correlation with conventional 2D MRI and arthroscopic findings. MATERIAL AND METHODS We retrospectively compared arthroscopic findings of RCTs with preoperative MRI, including conventional 2D sequences and radial and paracoronal DESS images in 20 patients. Two observers evaluated supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSC) tendon tears using a grading system. For statistical analysis, arthroscopy was used as the reference standard. RESULTS Inter-observer agreement for detecting and grading SSP, ISP, and SSC tendon tears on radial and paracoronal sliced 3D DESS MRI was excellent (intraclass-correlation [ICC] = 0.92-0.98; all P < 0.001). Regarding the detection of SSP lesions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 93.8%, 50%, 88.2%, and 66.7% for both radial and paracoronal DESS imaging. A sensitivity of 100%, specificity of 61.1%, PPV of 22.2%, and NPV of 100% were noted for detecting ISP tendon tears using radially reformatted DESS images. Regarding detecting SSC tendon tears using radially reformatted DESS images, sensitivity, specificity, PPV, and NPV were 100%, 81.3%, 50%, and 100%, respectively. The results with standard 2D MRI were similar. CONCLUSION The DESS technique with radially reformatted images provided excellent sensitivity and high inter-observer agreement in detecting RCTs. It showed a moderate to high correlation between MRI and arthroscopy for diagnosing SSP and SSC tendon tears.
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Affiliation(s)
- Ann-Carolin Osterholt
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Tobias W Link
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Alexander D Mewes
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Martin Hufeland
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | | | - Bernd Bittersohl
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
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MR Imaging of the Knee Posterolateral and Posteromedial Corner Injuries. Magn Reson Imaging Clin N Am 2022; 30:215-226. [DOI: 10.1016/j.mric.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sui H, Li J, Liu L, Lv Z, Zhang Y, Dai Y, Mo Z. Accelerating Knee MRI: 3D Modulated Flip-Angle Technique in Refocused Imaging with an Extended Echo Train and Compressed Sensing. J Pain Res 2022; 15:577-590. [PMID: 35241934 PMCID: PMC8887673 DOI: 10.2147/jpr.s345210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/28/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The three-dimensional (3D) sequence of magnetic resonance imaging (MRI) plays a critical role in the imaging of musculoskeletal joints; however, its long acquisition time limits its clinical application. In such conditions, compressed sensing (CS) is introduced to accelerate MRI in clinical practice. We aimed to investigate the feasibility of an isotropic 3D variable-flip-angle fast spin echo (FSE) sequence with CS technique (CS-MATRIX) compared to conventional 2D sequences in knee imaging. Methods Images from different sequences of both the accelerated CS-MATRIX and the corresponding conventional acquisitions were prospectively analyzed and compared. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the structures within the knees were measured for quantitative analysis. The subjective image quality and diagnostic agreement were compared between CS-MATRIX and conventional 2D sequences. Quantitative and subjective image quality scores were statistically analyzed with the paired t-test and Wilcoxon signed-rank test, respectively. Diagnostic agreements of knee substructure were assessed using Cohen’s weighted kappa statistic. Results For quantitative analysis, images from the CS-MATRIX sequence showed a significantly higher SNR than T2-fs 2D sequences for visualizing cartilage, menisci, and ligaments, as well as a higher SNR than proton density (pd) 2D sequences for visualizing menisci and ligaments. There was no significant difference between CS-MATRIX and 2D T2-fs sequences in subjective image quality assessment. The diagnostic agreement was rated as moderate to very good between CS-MATRIX and 2D sequences. Conclusion This study demonstrates the feasibility and clinical potential of the CS-MATRIX sequence technique for detecting knee lesions The CS-MATRIX sequence allows for faster knee imaging than conventional 2D sequences, yielding similar image quality to 2D sequences.
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Affiliation(s)
- He Sui
- China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Jin Li
- Jilin Province People’s Hospital, Changchun, People’s Republic of China
- The Department of Trauma Surgery, Shanghai Oriental Hospital, Shanghai, People's Republic of China
| | - Lin Liu
- China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Zhongwen Lv
- China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, People’s Republic of China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, 201800, People’s Republic of China
| | - Zhanhao Mo
- China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
- Correspondence: Zhanhao Mo, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Erdao District, Changchun, People’s Republic of China, Email
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Pękala PA, Mann MR, Pękala JR, Tomaszewski KA, LaPrade RF. Evidence-Based Clinical Anatomy of the Popliteofibular Ligament and Its Importance in Orthopaedic Surgery: Cadaveric Versus Magnetic Resonance Imaging Meta-analysis and Radiological Study. Am J Sports Med 2021; 49:1659-1668. [PMID: 33017542 DOI: 10.1177/0363546520950415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The popliteofibular ligament (PFL) is a static stabilizer of the posterolateral corner of the knee, preventing varus angulation, tibial rotation, and posterior translation. The PFL is anatomically variable, and there is no current review that outlines its prevalence rate and morphological variations. PURPOSE To investigate the anatomic prevalence and morphological qualities of the PFL in various global patient populations via a meta-analysis of relevant literature involving both cadaveric dissections and patient-based research using magnetic resonance imaging (MRI) scans. STUDY DESIGN Meta-analysis. METHODS We pooled literature data detailing PFL prevalence rates and performed a retrospective MRI study of 100 knees to determine the overall PFL prevalence. Data searches and analyses were performed according to Anatomical Quality Assurance and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS There were 30 cadaveric studies and 11 MRI studies (including our radiological investigation), representing a total of 1595 lower limbs. The meta-analysis of cadaveric studies showed a higher prevalence of the PFL than the meta-analysis of MRI studies, with 98.4% (95% CI, 97.5%-99.2%) and 89.0% (95% CI, 73.9%-98.6%), respectively. Our MRI investigation reported a PFL prevalence of 92.0%. CONCLUSION The PFL was found to be a constant or rarely absent anatomic structure of the human knee according to the analysis of cadaveric dissection studies, and it was identified notably less on MRI, albeit not significantly. Increasing PFL anatomic knowledge, including awareness of its prevalence and morphological diversity, will improve injury diagnoses, treatment methods, and prognoses.
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Affiliation(s)
- Przemysław A Pękala
- International Evidence-Based Anatomy Working Group, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Mitchell R Mann
- International Evidence-Based Anatomy Working Group, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
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Grassi A, Pizza N, Andrea Lucidi G, Macchiarola L, Mosca M, Zaffagnini S. Anatomy, magnetic resonance and arthroscopy of the popliteal hiatus of the knee: normal aspect and pathological conditions. EFORT Open Rev 2021; 6:61-74. [PMID: 33532087 PMCID: PMC7845568 DOI: 10.1302/2058-5241.6.200089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The popliteal hiatus is a complex region, formed by the confluence of various structures connecting the meniscus, popliteal tendon, tibia and fibula.The main structures that can be found are the three popliteomeniscal fascicles (anterior, postero-inferior and postero-superior), the lateral and posterior meniscotibial ligaments, the popliteofibular ligament and the meniscofibular fascicle.These structures can be identified in most cases using magnetic resonance imaging, and their 'static' assessment can be performed.Arthroscopic assessment is useful in identifying and testing 'dynamically' the integrity of the structures around the popliteal hiatus.Injuries or abnormalities of the popliteal hiatus and its structures could result in meniscal hypermobility and subluxation; however, these injuries are often unrecognized.Possible abnormalities in this region, apart from the well-known bucket-handle meniscal tear, are the Wrisberg Type III discoid meniscus, and meniscal fascicles tears. Cite this article: EFORT Open Rev 2021;6:61-74. DOI: 10.1302/2058-5241.6.200089.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicola Pizza
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Italy
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Concomitant Posterolateral Corner Injuries in Skeletally Immature Patients With Acute Anterior Cruciate Ligament Injuries. J Pediatr Orthop 2020; 40:271-276. [PMID: 32501906 DOI: 10.1097/bpo.0000000000001450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Missed posterolateral corner (PLC) injuries are a known cause of anterior cruciate ligament reconstruction (ACL) failure in the adult population. Failed ACL reconstruction causes significant morbidity in the skeletally immature pediatric population. There is little literature on the character and potential significance of PLC injuries in skeletally immature patients. METHODS Magnetic resonance imaging studies of the knee at a tertiary care children's hospital for patients who underwent an ACL reconstruction without PLC surgery were retrospectively reviewed. Demographic variables were obtained through chart review, and magnetic resonance imaging studies were evaluated for PLC (popliteus, fibular collateral ligament, popliteofibular ligament, and arcuate ligament) injury, and ACL, medial collateral ligament (MCL), bone bruise, fracture, and meniscal pathology by an experienced pediatric musculoskeletal radiologist. RESULTS A total of 50 patients with a mean age at 13.3 years at injury were analyzed. PLC injuries were found in 26 patients (52%), with 7 patients (14%) having a complete tear of a component of the PLC. There was no association between sex (P=0.35), Segond fracture (P=0.09), meniscus injury (P=0.92), or MCL injury (P=0.24) with the risk of PLC injury. There was an association between patient age and PLC injury (P=0.02). For each additional year of age, the odds of PLC injury increased by 1.8 times (odds ratio, 1.8; 95% confidence interval, 1.4-2.2). There was no association between PLC injury and ACL graft failure (P=0.19). CONCLUSIONS Missed PLC injuries are a significant source of morbidity and poor clinical outcomes in the management of concomitant ACL injuries in adults. This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the unique skeletally immature patient population. Incomplete PLC injuries are relatively common. Complete PLC injuries are relatively uncommon. PLC injury was more common in older patients. No other concomitant injury predicted the likelihood of PLC injury. Further research is needed regarding the risk of ACL reconstruction failure from associated PLC injury and the indications for PLC reconstruction in skeletally immature patients. LEVEL OF EVIDENCE Level IV-diagnostic study.
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An Update and Comprehensive Review of the Posterolateral Corner of the Knee. Radiol Clin North Am 2018; 56:935-951. [DOI: 10.1016/j.rcl.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Filli L, Rosskopf AB, Sutter R, Fucentese SF, Pfirrmann CW. MRI Predictors of Posterolateral Corner Instability: A Decision Tree Analysis of Patients with Acute Anterior Cruciate Ligament Tear. Radiology 2018; 289:170-180. [DOI: 10.1148/radiol.2018180194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lukas Filli
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Andrea B. Rosskopf
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Reto Sutter
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Sandro F. Fucentese
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Christian W.A. Pfirrmann
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
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Zhang J, Hao D, Duan F, Yu T, Zhang C, Che J. The rotating stretched curved planar reconstruction of 3D-FIESTA MR imaging for evaluating the anterior cruciate ligament of the knee joint. Magn Reson Imaging 2018; 55:46-51. [PMID: 30223006 DOI: 10.1016/j.mri.2018.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE To determine the feasibility of the rotating stretched curved planar reconstruction (CPR) of three-dimensional fast imaging with steady-state acquisition magnetic resonance imaging (3D-FIESTA MRI) for evaluating the anterior cruciate ligament of the knee joint. MATERIALS AND METHODS MRI of 40 knee joints in healthy volunteers was performed on a 3.0-T MR scanner and a phased-array extremity coil. The protocol consisted of oblique sagittal spin echo (SE) T1WI, coronal FS-PDWI, axial FS-FSE-T2WI, and 3D-FIESTA sequences. The rotating stretched curved planar reconstructions (CPR) of the ACL at angles of 0°, 30°, 60°, 90°, 120°, 150°, and 180° were generated from images of 3D-FIESTA sequences. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the 3D-FIESTA were compared with those of the oblique sagittal SE T1WI sequence. The presence of the tibial attachment, midportion, femoral attachment, and double bundles of the ACL on the oblique sagittal SE T1WI and CPR of 3D-FIESTA MR imaging were divided into two categories: visible and not visible. RESULTS The ACL SNR efficiency of 3D-FIESTA sequences was significantly higher than that of oblique sagittal SE T1WI sequence (P < 0.05). The 3D-FIESTA sequences produced images with a significantly higher CNR between ACL and synovial fluid than did the oblique sagittal SE T1WI sequence (P < 0.05). CPR of 3D-FIESTA MRI generated an excellent visualization of the ACL. The CPR of 3D-FIESTA MRI was rated superior to oblique sagittal SE T1WI sequence in 60% and 65% of cases with regard to the tibial attachment and midportion of ACL, respectively (P < 0.05). CPR of 3D-FIESTA MR imaging was rated superior to oblique sagittal SE T1WI sequence in 80% and 85% of cases with regard to femoral attachment and double bundles of ACL, respectively (P < 0.05). CONCLUSION The rotating stretched curved planar reconstruction of 3D-FIESTA sequences is significantly better than that of conventional 2D-MRI in evaluating the native ACL and its components, AM bundle and PL bundle, in healthy volunteers.
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Affiliation(s)
- Jun Zhang
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Dapeng Hao
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Feng Duan
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Tengbo Yu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Chuanyu Zhang
- The Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Junyi Che
- The Department of Radiology, Qingdao Municipal Hospital, Qingdao 266003, China
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Tashiro Y, Gale T, Sundaram V, Nagai K, Irrgang JJ, Anderst W, Nakashima Y, Tashman S, Fu FH. The Graft Bending Angle Can Affect Early Graft Healing After Anterior Cruciate Ligament Reconstruction: In Vivo Analysis With 2 Years' Follow-up. Am J Sports Med 2017; 45:1829-1836. [PMID: 28402758 DOI: 10.1177/0363546517698676] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A high graft bending angle (GBA) after anterior cruciate ligament (ACL) reconstruction has been suggested to cause stress on the graft. Nevertheless, evidence about its effect on graft healing in vivo is limited. HYPOTHESIS The signal intensity on magnetic resonance imaging (MRI) would be higher in the proximal region of the ACL graft, and higher signals would be correlated to a higher GBA. STUDY DESIGN Descriptive laboratory study. METHODS Anatomic single-bundle ACL reconstruction was performed on 24 patients (mean age, 20 ± 4 years) using the transportal technique. A quadriceps tendon autograft with a bone plug was harvested. To evaluate graft healing, the signal/noise quotient (SNQ) was measured in 3 regions of interest (ROIs) of the proximal, midsubstance, and distal ACL graft using high-resolution MRI (0.45 × 0.45 × 0.70 mm), with decreased signals suggesting improved healing. Dynamic knee motion was examined during treadmill walking and running to assess the in vivo GBA. The GBA was calculated from the 3-dimensional angle between the graft and femoral tunnel vectors at each motion frame, based on tibiofemoral kinematics determined from dynamic stereo X-ray analysis. Graft healing and GBAs were assessed at 6 and 24 months postoperatively. Repeated-measures analysis of variance was used to compare the SNQ in the 3 ROIs at 2 time points. Pearson correlations were used to analyze the relationship between the SNQ and mean GBA during 0% to 15% of the gait cycle. RESULTS The SNQ of the ACL graft in the proximal region was significantly higher than in the midsubstance ( P = .022) and distal regions ( P < .001) at 6 months. The SNQ in the proximal region was highly correlated with the GBA during standing ( R = 0.64, P < .001), walking ( R = 0.65, P = .002), and running ( R = 0.54, P = .015) but not in the other regions. At 24 months, signals in the proximal and midsubstance regions decreased significantly compared with 6 months ( P < .001 and P = .008, respectively), with no difference across the graft area. CONCLUSION The signal intensity was highest in the proximal region and lowest in the distal region of the reconstructed graft at 6 months postoperatively. A steep GBA was significantly correlated with high signal intensities of the proximal graft in this early period. A steep GBA may negatively affect proximal graft healing after ACL reconstruction.
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Affiliation(s)
- Yasutaka Tashiro
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Tom Gale
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vani Sundaram
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kanto Nagai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Naraghi AM, White LM. Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series. Radiology 2017; 281:23-40. [PMID: 27643766 DOI: 10.1148/radiol.2016152320] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.
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Affiliation(s)
- Ali M Naraghi
- From the Department of Medical Imaging, University of Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4
| | - Lawrence M White
- From the Department of Medical Imaging, University of Toronto, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4
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Ahn SJ, Jeong YM, Lee BG, Sim JA, Choi HY, Kim JH, Lee SW. Using three-dimensional isotropic SPACE MRI to detect posterolateral corner injury of the knee. Acta Radiol 2016; 57:1251-60. [PMID: 26823457 DOI: 10.1177/0284185115626470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/26/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Reliable magnetic resonance imaging (MRI) diagnosis is important in cases of posterolateral corner (PLC) injury due to the limitations of physical examination in patients with multi-ligament injury. PURPOSE To document the appearance of PLC of the knee on three-dimensional (3D) isotropic MR images, and to determine the significance of MRI findings in patients with confirmed posterolateral rotatory instability. MATERIAL AND METHODS Twenty-five patients that underwent surgery for posterolateral instability, and 25 individuals with normal MRI constituted the study cohort. The PLC appearances (popliteofibular, fabellofibular, arcuate ligaments, popliteomeniscal fascicle) were analyzed using 3D isotropic proton density sequence and routine two-dimensional (2D) MRI. In addition, the "fibular cap" sign was evaluated. Statistical analysis was performed using the Chi-square and McNemar's tests. RESULTS Thickening of popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle was significantly more frequent in the PLC injury group than in the control group (P < 0.05). The sensitivity and specificity of 3D MRI for popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle injury were 63/92%, 54/100%, 46/100%, and 58/92%, respectively. On comparing 3D and 2D images with respect to injury detectability (grade 3 or 4), both modalities visualized injuries, but 3D detected grade 3 or grade 1 rather than grade 4 or 0, respectively. The fibular cap sign was observed significantly more frequently in PLC group, with 58% sensitivity and 100% specificity, and was better observed by 3D than 2D (P < 0.05). CONCLUSION 3D MRI is a valid modality for detecting PLC abnormalities as it visualizes pathologies in each component and exhibits the positive fibular cap sign.
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Affiliation(s)
- Su Joa Ahn
- Department of Radiology, Gachon University, Incheon, Republic of Korea
| | - Yu Mi Jeong
- Department of Radiology, Gachon University, Incheon, Republic of Korea
| | - Beom Goo Lee
- Department of Orthopedics, Gachon University, Incheon, Republic of Korea
| | - Jae Ang Sim
- Department of Orthopedics, Gachon University, Incheon, Republic of Korea
| | - Hye-Young Choi
- Department of Radiology, Gachon University, Incheon, Republic of Korea
| | - Jeong Ho Kim
- Department of Radiology, Gachon University, Incheon, Republic of Korea
| | - Sheen-Woo Lee
- Department of Radiology, Gachon University, Incheon, Republic of Korea
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Fernandes ADRC. Are 3D FSE MRI sequences of the knee at 1.5 T effective in the detection of meniscal and ligament tears? How useful are they? Radiol Bras 2016; 49:V-VI. [PMID: 27141144 PMCID: PMC4851472 DOI: 10.1590/0100-3984.2016.49.2e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging. Skeletal Radiol 2015; 44:1413-9. [PMID: 26025122 DOI: 10.1007/s00256-015-2176-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/05/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the patterns of injury associated with injury to the popliteofibular ligament injury. MATERIALS AND METHODS A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. RESULTS The mean age was 25.7 years (range, 9-65 years) and 72.2% (n = 130) patients were male. The PFL was injured in 36 cases (20%). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25%) were associated with further injuries of posterolateral corner structures and in 27 cases (75%) the PFL was the only posterolateral corner structure torn. CONCLUSIONS PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner.
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Choi JY, Chang CB, Kim TK, Hong SH, Kang HS. Magnetic resonance imaging findings of the lateral collateral ligament and popliteus tendon in symptomatic knees without instability. Arthroscopy 2015; 31:665-72. [PMID: 25618492 DOI: 10.1016/j.arthro.2014.11.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 10/29/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe normative values of the thicknesses of the lateral collateral ligament (LCL) and popliteus tendon in patients who underwent knee surgery but had no evidence of knee instability and identify factors associated with the variations, and to estimate the prevalence and associated factors of abnormal magnetic resonance imaging (MRI) findings of the LCL and popliteus tendon. METHODS MRI scans in 120 patients without knee instability were evaluated to measure the thicknesses of the LCL and popliteus tendon and estimate the prevalence of signal alteration and abnormal thickening and thinning. We then investigated the factors associated with the thicknesses and abnormal MRI findings. RESULTS The mean thicknesses of the LCL and popliteus tendon were 5.3 ± 1.0 mm and 3.8 ± 0.6 mm, respectively. Elderly, heavier patients and patients with more varus alignment had thicker LCLs, whereas taller, heavier, and male patients had thicker popliteus tendons. Signal alterations of the LCL and popliteus tendon were found in 33% and 23%, respectively, of the knees; abnormal thickening was found in 33% and 8%, respectively. Regression analyses found the mechanical tibiofemoral angle (more varus angle) to be the only predictor for abnormal MRI findings of the LCL (odds ratio of 0.81 [95% confidence interval, 0.66 to 0.98] for signal alteration and odds ratio of 0.73 [95% confidence interval, 0.59 to 0.90] for abnormal thickening); however, no predictors were found for abnormal MRI findings of the popliteus tendon. CONCLUSIONS Even in patients without varus and posterolateral rotary instability, signal alteration and thickening of the LCL and/or popliteus tendon can be frequently found with MRI. In particular, abnormal MRI findings of the LCL were likely to be more frequent in the patients with more varus knee alignment. These findings may be considered when interpreting MRI evaluation to diagnose patients with chronic posterolateral corner injury. LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients.
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Affiliation(s)
- Ja-Young Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
| | - Tae Kyun Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Geiger D, Chang EY, Pathria MN, Chung CB. Posterolateral and Posteromedial Corner Injuries of the Knee. Magn Reson Imaging Clin N Am 2014; 22:581-99. [PMID: 25442024 DOI: 10.1016/j.mric.2014.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Daniel Geiger
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, Rome 00161, Italy
| | - Eric Y Chang
- VA Healthcare San Diego, 3350 La Jolla Village Drive, La Jolla, CA 92161, USA; Department of Radiology, University of California-San Diego, 408 Dickinson Street, San Diego, CA 92103-8226, USA
| | - Mini N Pathria
- Department of Radiology, University of California-San Diego, 408 Dickinson Street, San Diego, CA 92103-8226, USA
| | - Christine B Chung
- VA Healthcare San Diego, 3350 La Jolla Village Drive, La Jolla, CA 92161, USA; Department of Radiology, University of California-San Diego, 408 Dickinson Street, San Diego, CA 92103-8226, USA.
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Geiger D, Chang E, Pathria M, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Radiol Clin North Am 2013; 51:413-32. [PMID: 23622092 DOI: 10.1016/j.rcl.2012.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Posterolateral (PLC) and posteromedial (PMC) corners of the knee represent complex anatomic regions because of intricate soft tissue and osseous relationships in small areas. Concise knowledge of these relationships is necessary before approaching their evaluation at imaging. Magnetic resonance imaging offers an accurate imaging diagnostic tool to establish normal anatomy and diagnose and characterize soft tissue and osseous injury. It is important to carefully evaluate the PLC and PMC structures on magnetic resonance imaging before planned surgical intervention to avoid potential complications resulting from occult injury.
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Affiliation(s)
- Daniel Geiger
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome 00161, Italy
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Clinical evaluation during the acute exacerbation of knee osteoarthritis: the impact of diagnostic ultrasonography. Rheumatol Int 2012; 33:711-7. [PMID: 22562715 DOI: 10.1007/s00296-012-2441-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/15/2012] [Indexed: 10/28/2022]
Abstract
We aimed to investigate (1) the probable correlation between clinical and ultrasonographic findings in chronic painful primary knee OA patients referred with acute flare-ups and (2) the impact of diagnostic ultrasonography (US) to determine the real source of pain in these patients. We included 100 patients consecutively who were admitted to our outpatient unit with a pain complaint on a single knee with the diagnosis of primary knee OA according to the ACR criteria. The control group consisted of the patients with pain-free knees at least during the last month, who were already included in the study group. The sonographic evaluation of the knee was performed by a physician who was blinded to the clinical evaluation and/or the physical and radiological evaluations. In the present study, sonographic findings were significantly more observed on the painful knees (p < 0.001). The most commonly encountered findings on the symptomatic knees were the suprapatellar effusion (55 %), the baker cyst (25 %), and the pes anserine bursitis. The distribution of the findings on the asymptomatic knees was as follows: 22 %, the suprapatellar effusion and 5 %, the Baker cyst. Effusion was detected in 55 % of the painful knees of our patients with knee OA. This finding was statistically significant compared to the painless knees of the subjects included. The results of our study also showed that there was a significant relation between the Kellgren-Lawrence grading and the frequency of suprapatellar effusion on US examination (p = 0.026). It was concluded that in chronic, primary, painful knee osteoarthritis, US is a valuable diagnostic method in the confirmation of synovitis and/or the inflammatory episode in spite of the absence of obvious clinical parameters. In advanced osteoarthritis, when we consider that the inflammatory episodes are expected findings, the early confirmation of the inflammation on US may be particularly valuable in the clinical setting.
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Zhang Z, Meng Q, Li Z, Pan B, Regatte RR, Schweitzer ME. Simultaneous visualization of nerves and vessels of the lower extremities using magnetization-prepared susceptibility weighted magnetic resonance imaging at 3.0 T. Neurosurgery 2011; 70:1-7; discussion 7. [PMID: 21768913 DOI: 10.1227/neu.0b013e31822da57f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Identifying the extent of involvement of the vessel and nerve, particularly in regard to preoperative evaluation and precise localization of the tumor and its relation to the structures of the extremities, has important applications for advancing the treatment of lower extremity diseases. OBJECTIVE To review the technical feasibility of simultaneous visualization of nerves and vessels of the lower extremities by using magnetization-prepared susceptibility-weighted magnetic resonance (MR) imaging (MP-SWI) at 3.0T. METHODS Ten healthy volunteers and 10 patients were studied. Optimized MP-SWI, MR neurography (MRN) based on 3D diffusion-weighted steady-state free precession imaging and contrast-enhanced MR angiography (CE-MRA) sequences were performed for each subject. The means of signal-to-noise ratio (SNR)n, SNRv, SNRm, contrast-to-noise ratio (CNR)n,m and CNRv,m were calculated and the certainty of identifying nerves and vessels was determined. CNRn,m between MP-SWI and MRN, and CNRv,m between MP-SWI and CE-MRA were compared. RESULTS MP-SWI provides slightly poorer CNRv,m than CE-MRA, whereas MP-SWI provides a better CNRn,m than MRN. In thin-slice-thickness maximum-intensity projection arbitrary planes, the sciatic nerve and its branches were clearly identified (score 1 or 2 of 2) in 17 subjects (85%); the femoral artery and the main branches were identified (score 1 or 2 of 2) in all 20 subjects (100%). The nerves are isointense to slightly hypointense to muscle, and the vessels show a more obvious hyperintense signal than muscle in MP-SWI. CONCLUSION The proposed MP-SWI demonstrates the feasibility of simultaneously visualizing nerves and vessels of the lower extremities without using an exogenous contrast agent. It may enable straightforward localization of a disease process to a specific nerve and vessel.
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Affiliation(s)
- Zhongwei Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Correlation between the rotational degree of the dial test and arthroscopic and physical findings in posterolateral rotatory instability. Knee Surg Sports Traumatol Arthrosc 2010; 18:123-9. [PMID: 19565220 DOI: 10.1007/s00167-009-0850-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Abstract
Diagnosing posterolateral rotatory instability (PLRI) is difficult because it occurs rarely, takes time to manifest, and no single definitive tool exists in diagnosing posterolateral corner injuries. We sought to evaluate the correlation between rotational degrees in the dial test and physical and arthroscopic findings that surgically verified PLRI in the knee joint. Patients (n = 67) who were diagnosed as having PLRI and received posterolateral reconstruction (n = 57) and repair (n = 10) from 1998 to 2006 were recruited. Preoperative physical findings were evaluated under anesthesia, and arthroscopic findings during surgeries were analyzed. A dial test with post-anesthesia (spinal or general) was conducted. We divided patients into three subgroups (A: <15 degrees, B: 15-20 degrees, and C: >20 degrees), according to differences in rotational degrees in the dial test. All tests showed significant differences among the three groups and positive findings increased as the rotational degrees increased. No test showed a statistically significant difference in the specific group. All tests except for popliteal hiatus widening showed significant differences among the three groups and positive findings also increased as the rotational degrees increased. The total incidence and positive rate of each physical examination and the popliteal hiatus arthroscopic findings in PLRI significantly increased as the rotational degree in the dial test increased. The number of positive findings on physical examination was larger than the number of positive findings by arthroscopy in all three groups.
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Kijowski R, Davis KW, Woods MA, Lindstrom MJ, De Smet AA, Gold GE, Busse RF. Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging--diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology 2009; 252:486-95. [PMID: 19703886 DOI: 10.1148/radiol.2523090028] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine whether a three-dimensional isotropic resolution fast spin-echo sequence (FSE-Cube) has similar diagnostic performance as a routine magnetic resonance (MR) imaging protocol for evaluating the cartilage, ligaments, menisci, and osseous structures of the knee joint in symptomatic patients at 3.0 T. MATERIALS AND METHODS This prospective, HIPAA-compliant, institutional review board-approved study was performed with a waiver of informed consent. FSE-Cube was added to the routine 3.0-T MR imaging protocol performed in 100 symptomatic patients (54 male patients with a median age of 32 years and 46 female patients with a median age of 33 years) who subsequently underwent arthroscopic knee surgery. All MR imaging studies were independently reviewed twice by two musculoskeletal radiologists. During the first review, the routine MR imaging protocol was used to detect cartilage lesions, ligament tears, meniscal tears, and bone marrow edema lesions. During the second review, FSE-Cube with multiplanar reformations was used to detect these joint abnormalities. With arthroscopic results as the reference standard, the sensitivity and specificity of FSE-Cube and the routine MR imaging protocol in the detection of cartilage lesions, anterior cruciate ligament tears, and meniscal tears were calculated. Permutation tests were used to compare sensitivity and specificity values. RESULTS FSE-Cube had significantly higher sensitivity (P = .039) but significantly lower specificity (P = .003) than the routine MR imaging protocol for detecting cartilage lesions. There were no significant differences (P = .183-.999) in sensitivity and specificity between FSE-Cube and the routine MR imaging protocol in the detection of anterior cruciate ligament tears, medial meniscal tears, or lateral meniscal tears. FSE-Cube depicted 96.2% of medial collateral ligament tears, 100% of lateral collateral ligament tears, and 85.3% of bone marrow edema lesions identified on images obtained with the routine MR imaging protocol. CONCLUSION FSE-Cube has similar diagnostic performance as a routine MR imaging protocol for detecting cartilage lesions, cruciate ligament tears, collateral ligament tears, meniscal tears, and bone marrow edema lesions within the knee joint at 3.0 T.
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Affiliation(s)
- Richard Kijowski
- Department of Radiology, University of Wisconsin, Clinical Science Center-E3/311, 600 Highland Ave, Madison, WI 53792, USA.
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Boutry N, Bourges M, Dupont S, Budzik J, Demondion X, Cotten A. Apport de l’imagerie dans les lésions du point d’angle postéro-latéral du genou. ACTA ACUST UNITED AC 2009; 90:681-91. [DOI: 10.1016/s0221-0363(09)74723-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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