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Huntington L, Griffith A, Spiers L, Pile R, Batty L, Tulloch S, Tran P. Suture-tape augmentation of anterior cruciate ligament reconstruction: a prospective, randomised controlled trial (STACLR). Trials 2023; 24:224. [PMID: 36964584 PMCID: PMC10037835 DOI: 10.1186/s13063-023-07127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/30/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction aims to restore anteroposterior and rotatory stability to the knee following ACL injury. This requires the graft to withstand the forces applied during the process of ligamentisation and the rehabilitative period. We hypothesise that the use of suture tape augmentation of single bundle ACL reconstruction (ACLR) will reduce residual knee laxity and improve patient-reported outcomes at 2-year follow-up. We will conduct a 1:1 parallel arm single-centre randomised controlled trial comparing suture tape augmented ACLR to standard ACLR technique. METHODS The study design will be a parallel arm 1:1 allocation ratio randomised controlled trial. Sixty-six patients aged 18 and over waitlisted for primary ACLR will be randomised. Patients requiring osteotomy and extra-articular tenodesis and who have had previous contralateral ACL rupture or repair of meniscal or cartilage pathology that modifies the post-operative rehabilitation will be excluded. The primary outcome measure will be the side-to-side difference in anterior tibial translation (measured on the GNRB arthrometer) at 24 months post-surgery. GNRB arthrometer measures will also be taken preoperatively, at 3 months and 12 months post-surgery. Secondary outcomes will include patient-reported outcome measures (PROMs) collected online, including quality of life, activity and readiness to return to sport, complication rates (return to theatre, graft failure and rates of sterile effusion), examination findings and return to sport outcomes. Participants will be seen preoperatively, at 6 weeks, 3 months, 12 months and 24 months post-surgery. Participants and those taking arthrometer measures will be blinded to allocation. DISCUSSION This will be the first randomised trial to investigate the effect of suture-tape augmentation of ACLR on either objective or subjective outcome measures. The use of suture-tape augmentation in ACLR has been associated with promising biomechanical and animal-level studies, exhibiting equivalent complication profiles to the standard technique, with initial non-comparative clinical studies establishing possible areas of advantage for the technique. The successful completion of this trial will allow for an improved understanding of the in situ validity of tape augmentation whilst potentially providing a further platform for surgical stabilisation of the ACL graft. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12621001162808. Universal Trial Number (UTN): U1111-1268-1487. Registered prospectively on 27 August 2021.
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Affiliation(s)
- Lachlan Huntington
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia.
| | - Andrew Griffith
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Libby Spiers
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Rebecca Pile
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Lachlan Batty
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Scott Tulloch
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
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Griffith JF. How to Report: Knee MRI. Semin Musculoskelet Radiol 2021; 25:690-699. [PMID: 34861714 DOI: 10.1055/s-0041-1736585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The knee is the most commonly examined joint with magnetic resonance imaging (MRI) and, as such, it is the joint that most trainee radiologists start reporting. This article addresses the main pathologies encountered on MRI examination of the knee, outlining the key features to note and report, as well as providing examples of terminology used to describe these findings.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
This article highlights five knee injuries that, in the author's experience, are commonly overlooked by readers inexperienced in knee MRI: ramp lesions, meniscocapsular tears, meniscal root ligament tears, posterior capsular ligament tears, and partial anterior cruciate ligament tear. While these injuries are readily apparent when the images are assessed for the given abnormality, the author's belief is that these may be overlooked because either the injury is not considered, or the affected area is not closely inspected. While these injuries may not alter immediate clinical management or require surgical intervention, they may, nevertheless, result in patient symptoms and may potentially increase the risk of further knee injury. Further, these injuries are difficult to recognize clinically and arthroscopically. In this review, we present these five injuries, emphasising relevant anatomy, normal MRI appearances, common injury patterns, and tips to avoid their being overlooked. Routine review of these areas when interpreting knee MRI, with additional imaging as necessary, will allow these injuries to be recognized more regularly.
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Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability. Diagnostics (Basel) 2021; 11:diagnostics11061035. [PMID: 34199917 PMCID: PMC8226919 DOI: 10.3390/diagnostics11061035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.
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Shu HT, Wegener NR, Connors KM, Yang DS, Lockey SD, Thomas JM, Argintar EH. Accuracy of magnetic resonance imaging in predicting anterior cruciate ligament tear location and tear degree. J Orthop 2021; 25:129-133. [PMID: 34025056 DOI: 10.1016/j.jor.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/02/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this study is to evaluate the reliability of magnetic resonance imaging (MRI) in predicting the location of ACL tears in preoperative planning for anterior cruciate ligament (ACL) repair. Methods Thirty-four patients who underwent ACL repair were retrospectively analyzed to compare intraoperative arthroscopic findings with preoperative MRIs. Results For identifying type I tears, the sensitivity of MRI was 9.0% and the accuracy of MRI was 8.8%. There was moderate interrater agreement between MRI findings for tear location and tear degree. Conclusion MRI alone may not necessarily be accurate in identifying which ACL tears are amenable to repair. Study design Retrospective case series; Level of Evidence: IV.
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Affiliation(s)
- Henry T Shu
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, 20007, USA.,School of Medicine, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | - Katherine M Connors
- Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, N.Y., 11203, USA
| | - Daniel S Yang
- Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Stephen D Lockey
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Ground Floor Pasquerilla Healthcare Center, Washington, DC, 20007, USA
| | - Jennifer M Thomas
- Department of Radiology, MedStar Washington Hospital Center, Washington, D., 20007, USA
| | - Evan H Argintar
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, 20007, USA
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Zhang F, Xiong S, Liu S, Xia P. Application of Three-Dimensional Magnetic Resonance Imaging in the Diagnosis of Perianal Abscess. Health (London) 2019. [DOI: 10.4236/health.2019.115046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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The best cited articles of the European Journal of Orthopaedic Surgery and Traumatology (EJOST): a bibliometric analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:533-544. [DOI: 10.1007/s00590-018-2147-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
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Fazio CG, Muir P, Schaefer SL, Waller KR. Accuracy of 3 Tesla magnetic resonance imaging using detection of fiber loss and a visual analog scale for diagnosing partial and complete cranial cruciate ligament ruptures in dogs. Vet Radiol Ultrasound 2017; 59:64-78. [PMID: 29094513 DOI: 10.1111/vru.12567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 01/22/2023] Open
Abstract
Canine cranial cruciate ligament rupture is often bilateral and asymmetrical, ranging from partial to complete rupture. The purpose of our diagnostic accuracy study was to assess the accuracy of 3 Tesla magnetic resonance imaging (MRI) detection of fiber loss and use of a visual analog scale in the diagnosis of complete versus partial cranial cruciate ligament rupture in 28 clinical dogs with unilateral complete rupture and contralateral partial rupture. Three Tesla MRI was performed on 56 stifles using sagittal sequences (T2-weighted fast spin echo with fat saturation, proton density fast spin echo, and T2-weighted 3D fast spin echo CUBE). Two MRI observers assessed the cranial cruciate ligament for fiber loss and completed a visual analog scale. The MRI data were compared to arthroscopy and clinical status. Accuracy classifying partial or complete rupture was assessed using receiver operating characteristic analysis. Compared to arthroscopy, for complete cranial cruciate ligament rupture, sensitivity, specificity, and accuracy of MRI detection of fiber loss were 0.78, 0.50-0.60, and 0.68-0.71, respectively, and, for partial tears, specificity was 1.00. An MRI visual analog scale score ≥79 was indicative of complete cranial cruciate ligament rupture (sensitivity 0.72-0.94 and specificity 0.71-0.84). Using a visual analog scale cut-point ≥79, observers achieved good accuracy discriminating clinical status of partial or complete cranial cruciate ligament rupture (area under the curve 0.87-0.93). MRI evaluation for fiber loss and use of a visual analog scale are specific in stifles with clinically stable partial cranial cruciate ligament rupture. In stifles with clinically unstable complete cranial cruciate ligament rupture, both MRI tests are sensitive though not specific compared to arthroscopy. As a diagnostic imaging method, MRI may help guide treatment in patients with cranial cruciate ligament damage, particularly for stable partial rupture.
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Affiliation(s)
- Constance G Fazio
- Department of Surgical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, 53706
| | - Peter Muir
- Department of Surgical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, 53706
| | - Susan L Schaefer
- Department of Surgical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, 53706
| | - Kenneth R Waller
- Department of Surgical Sciences, University of Wisconsin-Madison School of Veterinary Medicine, Madison, WI, 53706
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Meng XH, Wang Z, Guo L, Liu XC, Zhang YW, Zhang ZW, Ma XL. Quantitative evaluation of knee cartilage and meniscus destruction in patients with rheumatoid arthritis using T1ρ and T2 mapping. Eur J Radiol 2017; 96:91-97. [PMID: 29103482 DOI: 10.1016/j.ejrad.2017.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/19/2017] [Accepted: 09/26/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To calculate T1ρ and T2 values of articular cartilage and menisci in knee joints of patients with RA, and compare the values between RA patients and healthy volunteers, to gain insight into the pathogenesis of cartilage and meniscus degradation in patients with RA. MATERIALS AND METHODS Nine patients with RA and knee joints symptoms were enrolled in the study, twenty healthy volunteers without knee joint diseases were included as controls. Sagittal fat-saturated T1ρ and T2 mapping images were obtained on a 3T MR scanner (GE750, GE Healthcare, Waukesha, WI), using a dedicated 8-channel knee coil. In the T1rho mapping sequence, the amplitude of the spin-lock pulse was 500Hz, spin lock durations=10/20/30/50ms. In the T2 mapping sequence,TR/TE were 1794/6.5, 13.4, 27, 40.7ms. Both sequences were performed with the following parameters: flip angle (FA)=90°, matrix: 320×256, FOV: 16×16cm2, slice thickness: 3mm, bandwidth: 62.5kHZ, and a total scan time of 5:11min. T1ρ- and T2-mapping images were used for the segmentation of the articular cartilage of the patella, femoral trochlea, medial and lateral femoral condyle, medial and lateral tibial plateau. These images were also used for the segmentation of the anterior and posterior horns of the medial and lateral menisci with livewire semi-automatic segmentation algorithm of MATLAB. A Mann-Whitney U test was performed to compare the T1ρ and T2 values of the above mentioned regions between the two groups. RESULTS T1ρ (Z=-3.913 to -2.121, P=0.000-0.034) and T2 (Z=-3.866 to -2.216, P=0.000-0.026) values of knee cartilage in patients with RA were higher than that in healthy volunteers, except the cartilage of the patella (T1ρ: Z=-1.273, P=0.203,T2: Z=-0.236, P=0.814) and lateral tibial plateau (T1ρ:Z=-1.037, P=0.317). The T1ρ (Z=-1.462 to 0.572, P=0.095-0.908) and T2 (Z=-1.461 to 0.278, P=0.153-0.764) values of medial and lateral menisci showed no difference between the two groups. CONCLUSION Patients with RA exhibit diffuse knee cartilage destruction in the medial and lateral tibiofemoral joints and in the femoral trochlea. However, we found no increase in T1ρ and T2 values in menisci, this finding warrants further investigation.
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Affiliation(s)
- Xiang Hong Meng
- Department of Radiology, Tianjin Hospital, No. 406, Jiefangnan Road, Hexi District, Tianjin, 300211, China.
| | - Zhi Wang
- Department of Radiology, Tianjin Hospital, No. 406, Jiefangnan Road, Hexi District, Tianjin, 300211, China.
| | - Li Guo
- School of Medical Imaging, Tianjin Medical University, No.1, Guangdong Road, Hexi District, Tianjin, 300203, China.
| | - Xiu Chan Liu
- Department of Rheumatology, Tianjin Hospital, No. 406, Jiefangnan Road, Hexi District, Tianjin, 300211, China.
| | - Yu Wei Zhang
- School of Medical Imaging, Tianjin Medical University, No.1, Guangdong Road, Hexi District, Tianjin, 300203, China.
| | - Ze Wei Zhang
- Department of Radiology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China.
| | - Xin Long Ma
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefangnan Road, Hexi District, Tianjin, 300211, China.
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Ducouret E, Loriaut P, Boyer P, Perozziello A, Pesquer L, Mounayer C, Dallaudiere B. Tunnel positioning assessment after anterior cruciate ligament reconstruction at 12months: Comparison between 3D CT and 3D MRI. A pilot study. Orthop Traumatol Surg Res 2017; 103:937-942. [PMID: 28655628 DOI: 10.1016/j.otsr.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/29/2017] [Accepted: 06/02/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tunnel positioning assessment is a major issue after anterior cruciate ligament (ACL) reconstruction surgery. Historically, it used plain X-ray and, more recently, CT with 3D reconstruction. MRI is a reliable method of assessing ACL graft integrity and postoperative complications. To our knowledge, there have been no studies of efficacy in tunnel positioning assessment. The aim of this study was to assess the efficacy of 3D MRI in assessing femoral and tibial tunnel positioning after ACL reconstruction. The hypothesis was that 3D MRI sequences with reconstruction are as accurate as 3D CT for tunnel positioning assessment in ACL reconstruction. METHODS Twenty-two patients who underwent an arthroscopic ACL reconstruction using hamstring graft were included in a prospective study. All patients were examined on 3D CT and 3D MRI at 12months post-surgery. Tunnel positioning was assessed on both imaging systems by a musculoskeletal radiologist and an orthopedic surgeon specialized in knee arthroscopy, both blind to all clinical data. RESULTS No statistically significant difference was found between 3D CT and 3D MRI on coronal and sagittal reconstructions. For coronal assessment of tibial tunnel orifice, sagittal assessment of tibial tunnel orifice and sagittal assessment of femoral tunnel orifice, P-values ranged from 0.37 to 0.99, 0.051 to 0.64 and 0.19 to 0.59, respectively. For tibial and femoral tunnel angulation, P-values were respectively 0.52 and 0.29. CONCLUSION 3D MRI is a reliable method to assess femoral and tibia tunnel positioning in ACL reconstruction, compared to 3D CT as gold standard. Indeed, in our opinion 3D MRI could in the future replace CT for ACL reconstruction assessment, concerning not only the meniscus and ligaments but also tunnel position. LEVEL OF EVIDENCE Level 3; comparative prospective study.
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Affiliation(s)
- E Ducouret
- Département de radiologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - P Loriaut
- Département de chirurgie orthopédique, CHU Bichat, 48, rue Henri-Huchard, 75018 Paris France
| | - P Boyer
- Département de chirurgie orthopédique, CHU Bichat, 48, rue Henri-Huchard, 75018 Paris France
| | - A Perozziello
- Laboratoire de biostatistiques, CHU Bichat, 48, rue Henri-Huchard, 75018 Paris, France
| | - L Pesquer
- Centre d'imagerie ostéoarticulaire, clinique du sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France
| | - C Mounayer
- Département de neuroradiologie interventionnelle, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - B Dallaudiere
- Centre d'imagerie ostéoarticulaire, clinique du sport, Bordeaux Mérignac, 2, rue Georges-Négrevergne, 33700 Mérignac, France; Service de radiologie, département d'imagerie musculo-squelettique, CHU Pellegrin, place Amélie-Léon-Rabat, 33000 Bordeaux, France; Centre de résonance magnétique des systèmes biologiques, UMR 5536, CNRS, université de Bordeaux, 146, rue Léo-Saignat, 33076 Bordeaux, France.
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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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Altahawi FF, Blount KJ, Morley NP, Raithel E, Omar IM. Comparing an accelerated 3D fast spin-echo sequence (CS-SPACE) for knee 3-T magnetic resonance imaging with traditional 3D fast spin-echo (SPACE) and routine 2D sequences. Skeletal Radiol 2017; 46:7-15. [PMID: 27744578 DOI: 10.1007/s00256-016-2490-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 08/19/2016] [Accepted: 09/14/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare a faster, new, high-resolution accelerated 3D-fast-spin-echo (3D-FSE) acquisition sequence (CS-SPACE) to traditional 2D and high-resolution 3D sequences for knee 3-T magnetic resonance imaging (MRI). MATERIALS AND METHODS Twenty patients received knee MRIs that included routine 2D (T1, PD ± FS, T2-FS; 0.5 × 0.5 × 3 mm3; ∼10 min), traditional 3D FSE (SPACE-PD-FS; 0.5 × 0.5 × 0.5 mm3; ∼7.5 min), and accelerated 3D-FSE prototype (CS-SPACE-PD-FS; 0.5 × 0.5 × 0.5 mm3; ∼5 min) acquisitions on a 3-T MRI system (Siemens MAGNETOM Skyra). Three musculoskeletal radiologists (MSKRs) prospectively and independently reviewed the studies with graded surveys comparing image and diagnostic quality. Tissue-specific signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were also compared. RESULTS MSKR-perceived diagnostic quality of cartilage was significantly higher for CS-SPACE than for SPACE and 2D sequences (p < 0.001). Assessment of diagnostic quality of menisci and synovial fluid was higher for CS-SPACE than for SPACE (p < 0.001). CS-SPACE was not significantly different from SPACE but had lower assessments than 2D sequences for evaluation of bones, ligaments, muscles, and fat (p ≤ 0.004). 3D sequences had higher spatial resolution, but lower overall assessed contrast (p < 0.001). Overall image quality from CS-SPACE was assessed as higher than SPACE (p = 0.007), but lower than 2D sequences (p < 0.001). Compared to SPACE, CS-SPACE had higher fluid SNR and CNR against all other tissues (all p < 0.001). CONCLUSIONS The CS-SPACE prototype allows for faster isotropic acquisitions of knee MRIs over currently used protocols. High fluid-to-cartilage CNR and higher spatial resolution over routine 2D sequences may present a valuable role for CS-SPACE in the evaluation of cartilage and menisci.
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Affiliation(s)
- Faysal F Altahawi
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St Suite 800, Chicago, IL, 60611, USA.
| | - Kevin J Blount
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St Suite 800, Chicago, IL, 60611, USA
| | | | | | - Imran M Omar
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair St Suite 800, Chicago, IL, 60611, USA
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Bao S, Tamir JI, Young JL, Tariq U, Uecker M, Lai P, Chen W, Lustig M, Vasanawala SS. Fast comprehensive single-sequence four-dimensional pediatric knee MRI with T 2 shuffling. J Magn Reson Imaging 2016; 45:1700-1711. [PMID: 27726251 DOI: 10.1002/jmri.25508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 09/19/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To develop and clinically evaluate a pediatric knee magnetic resonance imaging (MRI) technique based on volumetric fast spin-echo (3DFSE) and compare its diagnostic performance, image quality, and imaging time to that of a conventional 2D protocol. MATERIALS AND METHODS A 3DFSE sequence was modified and combined with a compressed sensing-based reconstruction resolving multiple image contrasts, a technique termed T2 Shuffling (T2 Sh). With Institutional Review Board (IRB) approval, 28 consecutive children referred for 3T knee MRI prospectively underwent a standard clinical knee protocol followed by T2 Sh. T2 Sh performance was assessed by two readers blinded to diagnostic reports. Interpretive discrepancies were resolved by medical record chart review and consensus between the readers and an orthopedic surgeon. Image quality was evaluated by rating anatomic delineation, with 95% confidence interval. A Wilcoxon rank-sum test assessed the null hypothesis that T2 Sh structure delineation compared to conventional 2D is unchanged. Intraclass correlation coefficients were calculated for interobserver agreement. Imaging time of the conventional protocol and T2 Sh was compared. RESULTS There was 81% and 87% concordance between T2 Sh reports and diagnostic reports, respectively, for each reader. Upon consensus review, T2 Sh had 93% sensitivity and 100% specificity compared to clinical reports for detection of clinically relevant findings. The 95% confidence interval of diagnostic or better rating was 95-100%, with 34-80% interobserver agreement. There was no significant difference in structure delineation between T2 Sh and 2D, except for the retinaculum (P < 0.05), where 2D was preferred. Typical imaging time for T2 Sh and the conventional exam was 7 and 13 minutes, respectively. CONCLUSION A single-sequence pediatric knee exam is feasible with T2 Sh, providing multiplanar, reformattable 4D images. LEVEL OF EVIDENCE 2 J. MAGN. RESON. IMAGING 2017;45:1700-1711.
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Affiliation(s)
- Shanshan Bao
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jonathan I Tamir
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
| | - Jeffrey L Young
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Umar Tariq
- Department of Radiology, Geisinger Health System, Danville, Pennsylvania, USA
| | - Martin Uecker
- Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany.,German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - Peng Lai
- Global Applied Science Laboratory, GE Healthcare, Menlo Park, California, USA
| | - Weitian Chen
- Global Applied Science Laboratory, GE Healthcare, Menlo Park, California, USA
| | - Michael Lustig
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
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15
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A Current Review of the Meniscus Imaging: Proposition of a Useful Tool for Its Radiologic Analysis. Radiol Res Pract 2016; 2016:8329296. [PMID: 27057352 PMCID: PMC4766355 DOI: 10.1155/2016/8329296] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/07/2023] Open
Abstract
The main objective of this review was to present a synthesis of the current literature in order to provide a useful tool to clinician in radiologic analysis of the meniscus. All anatomical descriptions were clearly illustrated by MRI, arthroscopy, and/or drawings. The value of standard radiography is extremely limited for the assessment of meniscal injuries but may be indicated to obtain a differential diagnosis such as osteoarthritis. Ultrasound is rarely used as a diagnostic tool for meniscal pathologies and its accuracy is operator-dependent. CT arthrography with multiplanar reconstructions can detect meniscus tears that are not visible on MRI. This technique is also useful in case of MRI contraindications, in postoperative assessment of meniscal sutures and the condition of cartilage covering the articular surfaces. MRI is the most accurate and less invasive method for diagnosing meniscal lesions. MRI allows confirming and characterizing the meniscal lesion, the type, the extension, its association with a cyst, the meniscal extrusion, and assessing cartilage and subchondral bone. New 3D-MRI in three dimensions with isotropic resolution allows the creation of multiplanar reformatted images to obtain from an acquisition in one sectional plane reconstructions in other spatial planes. 3D MRI should further improve the diagnosis of meniscal tears.
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16
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Adachi N, Ochi M, Takazawa K, Ishifuro M, Deie M, Nakamae A, Kamei G. Morphologic evaluation of remnant anterior cruciate ligament bundles after injury with three-dimensional computed tomography. Knee Surg Sports Traumatol Arthrosc 2016; 24:148-53. [PMID: 25283501 DOI: 10.1007/s00167-014-3354-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to investigate the morphological patterns of remnant anterior cruciate ligament bundles after injury (ACL remnant) on three-dimensional computed tomography (3DCT) and compare them with those on arthroscopy. METHODS Sixty-three patients (33 males and 30 females; mean age 25.2 ± 10.1 years) who had undergone primary ACL reconstruction between March 2011 and December 2012 were included in this study. The average durations between traumas and 3DCT and between 3DCT and surgery were 101.7 ± 87.2 and 38.2 ± 38.7 days, respectively. ACL remnants were classified into four morphological patterns on 3DCT. 3DCT findings were compared with arthroscopic findings with and without probing. RESULTS The morphological patterns of the ACL remnants on 3DCT were well matched with those on arthroscopy without probing (the concordance rate was 77.8%). However, the concordance rate was reduced to 49.2% when arthroscopic probing was used to confirm the femoral attachment of ACL remnants (p ≤ 0.05). CONCLUSIONS This study demonstrates that the morphological patterns of ACL remnants on 3DCT were well matched with those on arthroscopy without probing. Therefore, the technique can be useful for preoperative planning of the ACL reconstruction or informed consent to the patients. However, for definitive diagnosis, arthroscopic probing is required. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nobuo Adachi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kobun Takazawa
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Minoru Ishifuro
- Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Goki Kamei
- Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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17
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Racette M, Al saleh H, Waller KR, Bleedorn JA, McCabe RP, Vanderby R, Markel MD, Brounts SH, Block WF, Muir P. 3D FSE Cube and VIPR-aTR 3.0 Tesla magnetic resonance imaging predicts canine cranial cruciate ligament structural properties. Vet J 2015; 209:150-5. [PMID: 26831152 DOI: 10.1016/j.tvjl.2015.10.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 10/24/2015] [Accepted: 10/26/2015] [Indexed: 01/07/2023]
Abstract
Estimation of cranial cruciate ligament (CrCL) structural properties in client-owned dogs with incipient cruciate rupture would be advantageous. The objective of this study was to determine whether magnetic resonance imaging (MRI) measurement of normal CrCL volume in an ex-vivo canine model predicts structural properties. Stifles from eight dogs underwent 3.0 Tesla 3D MRI. CrCL volume and normalized median grayscale values were determined using 3D Fast Spin Echo (FSE) Cube and Vastly under-sampled Isotropic PRojection (VIPR)-alternative repetition time (aTR) sequences. Stifles were then mechanically tested. After joint laxity testing, CrCL structural properties were determined, including displacement at yield, yield load, load to failure, and stiffness. Yield load and load to failure (R(2)=0.56, P <0.01) were correlated with CrCL volume determined by VIPR-aTR. Yield load was also correlated with CrCL volume determined by 3D FSE Cube (R(2)=0.32, P <0.05). Structural properties were not related to median grayscale values. Joint laxity and CrCL stiffness were not related to MRI parameters, but displacement at yield load was related to CrCL volume for both sequences during testing (R(2)>0.57, P <0.005). In conclusion, 3D MRI offers a predictive method for estimating canine CrCL structural properties. 3D MRI may be useful for monitoring CrCL properties in clinical trials.
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Affiliation(s)
- Molly Racette
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Habib Al saleh
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth R Waller
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Jason A Bleedorn
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Ronald P McCabe
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ray Vanderby
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark D Markel
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Sabrina H Brounts
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Walter F Block
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Muir
- Comparative Orthopaedic Research Laboratory, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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Johnson VL, Kwoh CK, Guermazi A, Roemer F, Boudreau RM, Fujii T, Hannon MJ, Hunter DJ. Loss of anterior cruciate ligament integrity and the development of radiographic knee osteoarthritis: a sub-study of the osteoarthritis initiative. Osteoarthritis Cartilage 2015; 23:882-7. [PMID: 25732185 PMCID: PMC4444391 DOI: 10.1016/j.joca.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 01/21/2015] [Accepted: 02/01/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to determine whether loss of ACL integrity in an older cohort precedes the onset of radiographic OA (ROA). METHODS Participants in this nested case-control study were selected from the Osteoarthritis Initiative (OAI) study who had risk factors for OA development but did not have ROA (Kellgren-Lawrence grading (KLG) of 0 or 1) in both knees at baseline. The MRIs were assessed for the presence of ACL tears. Case knees were defined by the development of ROA on knee radiographs between the 12 and 48 month visits. Their radiographs were assessed at P0 (time of onset of radiographic knee OA), 1 year prior to P0 (P-1) and at baseline. Controls were selected from amongst those who did not develop incident ROA and were matched to cases. RESULTS 355 persons who developed ROA were matched to 355 controls. No relationship between loss of ACL integrity and incident ROA was found at any assessment time point. Odds ratios (OR) for baseline, 1 year prior to incident ROA (P1) and at point of occurrence of incident ROA (P0) were 2.00 (0.66-6.06), 2.5 (0.76-8.24) and 2.75 (0.85-8.88) respectively. A significant risk of incident ROA was found in participants who had a history of knee injury with an OR of 1.51 (1.05-2.16). CONCLUSION Loss of ACL integrity does not confer a significantly increased risk of incident ROA in an older adult cohort. In contrast, a history of knee injury was associated with an increased risk of incident ROA.
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Affiliation(s)
- V L Johnson
- Institute of Bone and Joint Research, University of Sydney, Australia; School of Medicine, University of Sydney, Australia
| | - C K Kwoh
- University of Pittsburgh, Pennsylvania, USA
| | - A Guermazi
- Boston University School of Medicine, Boston, MA, USA
| | - F Roemer
- Boston University School of Medicine, Boston, MA, USA; Klinikum Augsburg, Augsburg, Germany
| | | | - T Fujii
- University of Pittsburgh, Pennsylvania, USA
| | - M J Hannon
- University of Pittsburgh, Pennsylvania, USA
| | - D J Hunter
- Institute of Bone and Joint Research, University of Sydney, Australia.
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Uozumi H, Aizawa T, Sugita T, Kunii T, Abe S, Itoi E. Visualization of torn anterior cruciate ligament using 3-dimensional computed tomography. Orthop Rev (Pavia) 2013; 5:e22. [PMID: 24191182 PMCID: PMC3808797 DOI: 10.4081/or.2013.e22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 12/17/2022] Open
Abstract
Recently, a remnant-preserving anterior cruciate ligament (ACL) reconstruction technique has been developed. However, the preoperative condition of remnant ACL is occasionally difficult to evaluate by magnetic resonance imaging. The purpose of this study is to evaluate the accuracy of pre-operative visualization of remnant ACL using three-dimensional computed tomography (3D-CT). The remnant ACL in 25 patients was examined by 3DCT before ACL reconstruction surgery. Findings on 3D-CT images and arthroscopy were compared. The 3D-CT images were classified into 4 groups: Group A, remnant fibers attached to the posterior cruciate ligament (PCL); Group B, those located between the PCL and the lateral wall; Group C, those attached to the lateral wall; and Group D, no identifiable remnant fibers on the tibial side. These groups were made up of 4, 3, 9 and 9 patients, respectively. Findings on 3D-CT images were identical to those during arthroscopy in 20 of 25 cases (80%). Remnant ACL can be accurately evaluated using 3D-CT in 80% of cases of torn ACL. This novel method is a useful technique for pre-operative assessment of remnant ACL.
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Affiliation(s)
- Hiroaki Uozumi
- Department of Orthopaedic Surgery, Hiraka General Hospital ; Yokote
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