Major advances in MRI and arthroscopy have allowed for enhanced diagnosis and subsequent management of ligamentous and soft tissue injuries of the knee. Recognition of the appearance of acute ACL and PCL injuries on MRI can enhance arthroscopic reconstruction. PCL injuries are often more subtle and can present with indirect signs. T2-weighted MRI imaging can examine which structures have been damaged in the posterolateral corner which may manifest arthroscopically as a drive-through sign. Characterization of PLC, meniscus, MCL injuries and OCD lesions on MRI have remarkable correlation with arthroscopic findings. This article focuses on current understanding of how MRI and athroscopy can enhance treatment of ligamentous and soft tissue injuries of the knee.
[Show abstract][Hide abstract] ABSTRACT: Meniscal resection decreases the ability of the meniscus to evenly distribute forces placed on it. These forces are oriented centrifugally on the meniscus by normal weight-bearing and are distributed by circumferentially oriented fibers. This alteration may predispose the knee to radial tears after surgery.
One of three musculoskeletal radiologists prospectively interpreted 100 consecutive postoperative MRI examinations of the knee. A prospective MRI report was generated for the referring orthopedic surgeon, and prospective MRI interpretations were correlated with arthroscopic findings (n = 63). MRI examinations on those patients who underwent second-look arthroscopy were retrospectively reviewed by three musculoskeletal radiologists who reached a consensus on the prevalence of new postoperative meniscal radial tears. MRI criteria for radial tear diagnosis were used as outlined by Tuckman et al.: truncation, abnormal morphology, lack of continuity, absence of the meniscus, or any combination of those criteria on one or more MR images. An additional criterion used was abnormal increased signal in that area on T2-weighted images.
Thirty-two of the 100 patients had meniscal radial tears on prospective MRI interpretations. In 29 of these 32 patients, second-look arthroscopy confirmed meniscal radial tears in the areas described on the MRI examinations. Five additional radial tears were shown on second-look arthroscopy that were not seen on prospective MRI interpretations. Two of those additional five radial tears were seen on consensus retrospective MRI review.
In this study, a 32% prevalence of meniscal radial tears in the postoperative knee was present on prospective MRI interpretations as opposed to a reported 14% prevalence in the nonoperated knee. Meniscal resection decreases the ability of the meniscus to evenly distribute forces placed on it. This circumstance may increase the prevalence of meniscal radial tears in the postoperative knee. New meniscal radial tears are common in patients presenting with pain after knee surgery.
American Journal of Roentgenology 05/2004; 182(4):931-6. DOI:10.2214/ajr.182.4.1820931 · 2.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to identify differences in the MRI findings of septic arthritis and transient synovitis in patients with nontraumatic acute hip pain and hip effusion.
The MRI findings in nine patients with septic arthritis and 11 with transient synovitis were reviewed retrospectively. This study was approved by our institutional review board. The diagnoses were based on findings at physical examination, laboratory studies, and joint aspiration and bacteriologic study. The MRI findings were analyzed with emphasis on the grade of joint effusion, alterations in signal intensity in the soft tissues and bone marrow, and the presence of decreased perfusion at the femoral head.
Low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted coronal MRI suggesting decreased perfusion at the femoral head of the affected hip joint was seen in eight of nine patients with septic arthritis and in two of 11 patients with transient synovitis. Statistically reliable differences (p = 0.005) were found between the two groups. Alterations in signal intensity in the bone marrow were seen in three patients with septic arthritis but in none of the patients with transient synovitis. Decreased perfusion on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI was seen in the six patients with septic arthritis who did not have alterations in signal intensity involving the bone marrow.
Decreased perfusion at the femoral epiphysis on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI is useful for differentiating septic arthritis from transient synovitis.
American Journal of Roentgenology 09/2007; 189(2):437-45. DOI:10.2214/AJR.07.2080 · 2.73 Impact Factor
[Show abstract][Hide abstract] 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.
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
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.
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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