Posterolateral and Posteromedial Corner Injuries of the Knee
Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, Rome 00161, Italy.Radiologic Clinics of North America (Impact Factor: 1.98). 05/2013; 51(3):413-32. DOI: 10.1016/j.rcl.2012.10.004
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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ABSTRACT: The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers. Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 × 170; matrix, 424 × 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 × 105; matrix, 200 × 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections. Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. Sagittal MR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to volume averaging. Although the anatomy of the distal semimembranosus tendon is complex, six different semimembranosus insertions can be identified on routine proton density and FFE sequences at 3 T. Analysis of images at defined levels in the three imaging planes simplifies MR interpretation of the anatomy of the distal semimembranosus tendon.Skeletal Radiology 02/2014; 43(6). DOI:10.1007/s00256-014-1830-9 · 1.51 Impact Factor
Article: MRI of the Knee: What Do We Miss?[Show abstract] [Hide abstract]
ABSTRACT: Magnetic resonance (MR) imaging is a commonly used tool when evaluating patients with acute knee injury or chronic knee pain. Although it has shown excellent accuracy in diagnosing knee pathology, there remain many potential pitfalls and missed lesions. These can be secondary to inherent technical limitations or artifacts related to MR. Also subtle pathology can be overlooked, and anatomic structures and associated variants can be misinterpreted as tears. In this article, we will review some of the more common misses or pitfalls that occur in the setting of sport-related injuries.04/2014; 2(4). DOI:10.1007/s40134-014-0043-2
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ABSTRACT: Background The knee is the largest and one of the most complex joints of the human body. Registered Advanced Nurse Practitioners frequently encounter patients with knee injuries as part of their practice due to the knees inherent instability and vulnerability to trauma. The posterolateral corner (PLC) of the knee has a complex anatomy of osseous, myotendinous and ligamentous structures to provide stability. PLC injuries may be present in 9.1% of acute knee injuries with haemarthrosis, and 68% of patients with tibial plateau fractures. Methods The following paper is a case study based on a patient who presented to the Emergency Department (ED), focusing on initial assessment and management of a patient who presented with an injury to the posterolateral knee Results This case study increases awareness of PLC injuries, and the importance of prompt recognition and management to ensure optimal outcomes for patients. The paper raises many discussion points including the benefits of collaborative care, the role of clinical diagnostic tests, analgesia, the various imaging required to supplement musculoskeletal and neuromuscular evaluation of these injuries and appropriate disposal. Conclusion Unrecognised injuries to the PLC can result in profound symptomatic knee instability. This case study highlights the diagnostic approach and challenges to managing patients with acute knee injuries, and specifically how timely assessment, prompt recognition and appropriate management in the ED assists in achieving optimal outcomes for patients.International Emergency Nursing 08/2014; 23(2). DOI:10.1016/j.ienj.2014.07.008 · 0.72 Impact Factor
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