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ABSTRACT: The posterior cruciate ligament (PCL) of the knee has received little attention in the radiology literature, but its importance in knee stability has come under close scrutiny in recent years. Unrepaired injury of the PCL can lead to chronic instability and early joint degeneration. Three major mechanisms of trauma that involves the PCL are posterior displacement of the tibia in a flexed knee, hyperextension, and rotation combined with an adduction or abduction force. The spectrum of PCL injuries includes partial tear or intrasubstance injury, complete ligamentous rupture, and avulsion of the PCL insertion site on the posterior tibia. Associated injuries include injury of other ligaments, meniscal tear, bone injury, and joint effusion. PCL rupture is easily identified with magnetic resonance (MR) imaging by using simple signal intensity and structural characteristics. Because clinical and arthroscopic assessment of the PCL can be difficult, MR imaging can be valuable for evaluating the acutely injured knee when operative repair of the PCL is being considered.
Radiographics 06/1995; 15(3):551-61. · 2.85 Impact Factor
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ABSTRACT: Trauma to the extensor mechanism of the knee, a common clinical problem, can be accurately evaluated with magnetic resonance (MR) imaging. The extensor mechanism consists of the quadriceps muscle and tendon, patella, patellar tendon, and patellar retinacula. Injuries of these structures can be classified into partial and complete tears. Acute injuries are associated with edema, hemorrhage, and fluid collections; chronic injuries often demonstrate redundancy, atrophy, and retraction of the affected structures. MR imaging is useful in differentiating partial and complete tears and in evaluating tissue edema and hemorrhage. It also allows detection of unsuspected nondisplaced patellar fractures and chronic conditions due to repetitive trauma. Transient dislocation of the patella is an often clinically unsuspected entity for which MR imaging can serve an important diagnostic role. A detailed understanding of the functional and anatomic relationships of the extensor mechanism can greatly assist in interpretation of MR images of the traumatized knee.
Radiographics 04/1995; 15(2):367-82. · 2.85 Impact Factor
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ABSTRACT: To review the authors' experience with magnetic resonance (MR) imaging of patients with suspected injury of the distal biceps tendon.
Twenty-one patients with clinically suspected injury of the distal biceps tendon were evaluated with MR imaging. Surgical correlation was performed in 15 patients, and long-term clinical follow-up was performed in the remaining six cases.
Twelve complete biceps tears, four partial tears, one brachialis rupture, and one ganglion were identified. Axial MR images were more valuable than sagittal images in accurately grading distal biceps tendon injury preoperatively. There was 100% agreement between MR imaging and surgical findings. MR imaging findings led to changes in clinical treatment plans in eight patients (38%).
MR imaging is useful in the evaluation of patients with suspected distal biceps tendon injury. In particular, axial MR images of the distal biceps insertion are important for accurate grading of the injury.
Radiology 05/1994; 191(1):203-6. · 5.73 Impact Factor
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ABSTRACT: To illustrate the variety of posterior cruciate ligament (PCL) injuries and assess the type and frequency of associated knee injuries.
In a retrospective review of 1,950 magnetic resonance (MR) examinations of the knee, 47 patients with MR imaging findings of PCL injury were identified. In 24 patients, the findings on MR images were correlated with athroscopic findings (n = 14) or findings at physical examination (n = 10). Patterns of associated injuries were described and tabulated.
Twenty-one patients (45%) had complete PCL tears; 22 patients (47%), partial tears; and four patients (9%), bone avulsion. Associated injuries were seen in 34 patients (72%). Patterns of injuries differed from those seen in anterior cruciate ligament injury and correlated with the mechanism of trauma.
MR imaging proved accurate in assessment of the PCL in patients with clinical correlation and demonstrated patterns of associated injury that may affect management strategy.
Radiology 03/1994; 190(2):455-8. · 5.73 Impact Factor
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ABSTRACT: Transient lateral patellar dislocation is frequently difficult to diagnose accurately on the basis of clinical findings. Accordingly, we studied the MR findings in 26 cases to determine if MR imaging is useful in establishing the diagnosis.
A retrospective review of 1450 MR examinations of acutely injured knees was performed to determine the MR findings resulting from transient lateral patellar dislocation. A distinctive constellation of MR findings reflecting the known mechanism of injury indicative of transient lateral patellar dislocation was found in 26 patients. Patellar dislocation was not clinically suspected before imaging in 19 (73%) of these 26 patients; most patients had been referred for suspected injury of the cruciate ligaments or menisci. Axial, sagittal, and coronal MR images were obtained in all patients, and all had clinical follow-up. Correlation of MR findings with surgical findings was possible in six.
Specific components of the constellation of MR findings included disruption or sprain of the medial retinaculum in 25 (96%) of 26 patients, lateral patellar tilt or subluxation in 24 patients (92%), lateral femoral condyle contusion in 21 patients (81%), osteochondral injury in 15 patients (58%), and joint effusion in all 26 patients (100%). Concomitant injury to major ligaments or menisci was present in eight (31%).
Our findings suggest that patients with transient lateral patellar subluxation have a distinctive constellation of MR findings that can be used to distinguish this entity from other common knee injuries.
American Journal of Roentgenology 08/1993; 161(1):109-13. · 2.78 Impact Factor
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ABSTRACT: Most studies evaluating the anterior cruciate ligament have focused on sagittal MR images for the diagnosis of injury. Limitations of sagittal images have been reported, however, including nonvisualization and incomplete visualization of the ligament. This study was undertaken to assess the value of adding coronal and axial MR images to sagittal images in the evaluation of the anterior cruciate ligament.
We reviewed oblique sagittal T1-weighted, coronal T2-weighted, and axial T2-weighted images to determine the status of the anterior cruciate ligament in 325 patients. All patients had arthroscopy. Sagittal images were initially interpreted alone and then in combination with coronal and axial images.
Sagittal T1-weighted images alone had a 94% sensitivity and an 84% specificity for determining the status of the anterior cruciate ligament. A multiplanar evaluation of the anterior cruciate ligament resulted in a change in MR interpretation in 21 patients (6%), which led to an improved sensitivity of 98% and a specificity of 93%. Diagnostic confidence was improved in an additional 14 patients (4%).
Our results show that the efficacy of MR imaging for the detection of anterior cruciate ligament tears is greater when axial and coronal images are used in combination with sagittal images than when sagittal images are used alone.
American Journal of Roentgenology 07/1993; 160(6):1233-7. · 2.78 Impact Factor
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ABSTRACT: The anterior cruciate ligament (ACL) is an important stabilizer of knee motion. Injury of the ACL can lead to substantial disability; an accurate diagnosis of ACL injury is vital in both short-term and long-term patient care. Magnetic resonance (MR) imaging has emerged as the study of choice to evaluate the status of the ACL and other associated structures in the knee. Sagittal MR images have been commonly used in the evaluation of the ACL. However, the authors believe that coronal and axial imaging planes can add useful information about ACL injury and, thus, lead to improved accuracy and confidence regarding diagnosis. Multiplanar imaging can readily demonstrate meniscal, ligamentous, and bone marrow injuries that commonly occur with the most frequent mechanisms of ACL injury. These mechanisms, in order of frequency, include internal rotation and valgus stress, hyperextension, and varus stress with external rotation. An understanding of these mechanisms is helpful in the MR diagnosis of ACL injury.
Radiographics 10/1992; 12(5):901-15. · 2.85 Impact Factor
