scholarly journals MR imaging of anterio cruciate ligament injuries

Author(s):  
Nilesh H. Chaudhari ◽  
Rounak R. Bagga ◽  
Zoya M. Patni

Background: Of all the ligaments of the knee joint the Anterior cruciate ligament (ACL) is the most commonly injured. It is an important pillar of the ligament stabilization of knee joint preventing anterior translation of Tibia over Fibula. Magnetic resonance imaging (MRI) is an excellent modality providing fine-resolution and multiplanar imaging without any radiation, for detection and evaluation of ACL injury with the associated injuries to other ligaments of the knee join. The purpose of the work was to study the role of MRI in classifying the ACL injuries.Methods: MRI Knee of 162 patients with ACL injuries was studied. All the MR imaging scans were performed on 1.5-T MR system (Siemens magnetom Essenza).Results: A total of 162 patients were studied in which majority of them i.e. 43 patients had interstitial sprain, 38 patients had complete tear, 33 patients had mucoid degeneration, 27 had partial tear and 14 had high grade partial tear, however 7 patients had normal ACL. There were associated injuries to the other ligaments of the knee joint along with ACL injury, medial meniscus tear being the most common and was seen in 39.50% followed by lateral meniscus tear in 9.87%, MCL tear in 6.79%, LCL tear in 1.85% and PCL tear in 2.46 %.Conclusions: MRI is a good modality for classifying ACL injury and evaluation of injuries to the associated ligaments.

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Xinsheng Qi ◽  
Qing Jiang ◽  
Caiwei Xia

Abstract Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscectomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscectomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors. Results 592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p = 0.002), patients aged 40 years or younger (p < 0.001), increased weight (p = 0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p < 0.001), lateral meniscus (p = 0.039) and early surgery (p < 0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p = 0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p < 0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p = 0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p < 0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p = 0.008) were associated with the prevalence of meniscus repair. Conclusions Meniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior. Study design Case-control study; level of evidence, 3.


Author(s):  
Carmen E. Quatman ◽  
Ata M. Kiapour ◽  
Ali Kiapour ◽  
Jason W. Levine ◽  
Samuel C. Wordeman ◽  
...  

Over 100,000 anterior cruciate ligament (ACL) injuries occur annually in the United States [1]. Of these, 70% are classified as non-contact, many of which occur subsequent to a landing from a jump [2]. While most agree that quadriceps (Q) and hamstrings (H) have a significant contribution in knee biomechanics, the role of quadriceps and hamstrings muscle loads and their ratio (Q/H) in ACL injury remains controversial. Understanding muscle recruitment in high risk activities may improve our knowledge of ACL injury mechanisms. Such insight may improve current prevention strategies to decrease the risk of ACL injury and damage to secondary anatomical structures, all of which may in turn minimize associated posttraumatic knee osteoarthritis. As in vivo quantification of muscle loads remains challenging, especially under dynamic conditions, validated finite element (FE) models of the knee can be used to characterize the role of muscle loads in ACL injury. FE analysis has provided considerable insight into knee joint biomechanics, including ligament function, ligament reconstruction technique and implant design. This study utilized a validated FE model of the knee joint to study the effects of quadriceps to hamstrings ratio (Q/H) on ACL strain during a simulated landing from a jump. We hypothesized that both the ratio and magnitude of muscle loads are critical determinants of ACL loading. Further, a threshold may be reached as the magnitude of quadriceps load exceeds hamstrings load.


2021 ◽  
Vol 2 ◽  
pp. 34-40
Author(s):  
Prateek Gupta ◽  
Shakti Swaroop ◽  
Rakesh Arya

Objectives: Anterior cruciate ligament (ACL) injury of the knee is commonly associated with meniscal and chondral lesions. This study was performed to assess the relative risk factors as well as the extent of the meniscal and chondral pathology at the time of arthroscopic ACL reconstruction. Materials and Methods: In this prospective study, patients undergoing ACL reconstruction were enrolled. Association of meniscal and chondral lesions was analyzed with age, sex, body mass index (BMI), mechanism of injury (sports-related or not), time gap between injury and surgery (<3 month and >3 months), and instability episodes. Logistic regression and Pearson Chi-square test were applied for evaluating the association. Results: A total of 55 patients (mean age 30 years [19–50 years]; 45 male:10 female) underwent arthroscopic ACL reconstruction, out of which 20 (36.3%) had isolated lateral meniscus tear, 14 (25.4%) had isolated medial meniscus tear, and 3 (5.4%) had both lateral and medial meniscus tear. BMI (P = 0.031) and instability episodes (P = 0.033) were predictor for meniscal lesions. Male sex was associated with significantly higher medial (P = 0.049) and lateral meniscal (P = 0.008) lesions. The older age group (>30 years) was associated with medial meniscus lesions (P = 0.047), while the younger age group (<30 years) had significantly higher lateral meniscal lesions (P = 0.008). Chronic ACL injuries (>3 months) had a significantly higher risk of medial meniscus lesions (P = 0.006). Age (>30 years) (P = 0.002) and obesity (BMI >30 kg/m2) (P = 0.043) were predictors of chondral lesions. Conclusion: Significant association is observed between age (>30 years), male gender, obesity, and chronicity with medial meniscal injuries in patients with an ACL injury, while younger patients (<30 years) and patient operated within 3 months had a higher incidence of lateral meniscus lesions. Age and BMI (>30 kg/m2) were predictors of chondral lesions in ACL injury.


2020 ◽  
Vol 10 (4) ◽  
pp. 387-391
Author(s):  
Shaza Mahgoub Masaad ◽  
Mohamed Yousef ◽  
Hanady Elyas Osman ◽  
Mustafa Z. Mahmoud

Background: Magnetic resonance imaging (MRI) is currently regarded as the reference standard for the diagnosis and evaluation of internal derangements of the knee and shoulder girdle. This study aimed to evaluate traumatic injuries of the knee and shoulder joint ligaments by MRI and classify the most common ligament injuries. Methods and Results: This study included 50 patients, who were presented in the Radiology Department of Modern Medical Center in Khartoum, in the period from October 2019 to January 2020. The sample was divided into two groups: shoulder joint group (Group 1, n=30) with an age range between 16 and 74 years and knee joint group (Group 2, n=20) with an age range between 16 and 77 years. The age group most affected with shoulder (46.7%) and knee joint (25%) injuries was 46-65 years. The injuries of the shoulder (40%) and knee joints (55%) were common in patients with body weight ranging from 71-80kg and >81kg, respectively. Different grades of partial meniscus tear of both shoulder and knee joints were noted as Grades 1 and 2 in 8.7% of cases, Grade 2 - 13%, Grades 2 and 3 - 34.8%, and Grade 3 - 30.4%. There were incidences of 27.3%, 0%, 54.5%, 15.20, 0%, and 3% for anterior cruciate ligament, posterior cruciate ligament, medial meniscus C-shape (M Me C), lateral meniscus C-shape (L Me C), MCL, and LCL tears in the knee joints of the affected patients. Conclusion: MRI revealed that injuries to the shoulder and knee joints were common in patients with body weight ranging from 71-80kg and >81kg, respectively. Different grades of partial meniscus tear of the shoulder and knee joints were noted though Grades 2 and 3 partial tears were the most common finding. Finally, it was noted that in the knee joints of the affected patients, the M Me C shaped tear was the major type of tear.


2018 ◽  
Vol 32 (11) ◽  
pp. 1128-1132
Author(s):  
Kun-Hui Chen ◽  
En-Rung Chiang ◽  
Hsin-Yi Wang ◽  
Hsiao-Li Ma

AbstractThe incidence of meniscal tear was reported to increase with the delay of anterior cruciate ligament reconstruction (ACLR). The tear may occur concurrently with the ACL injury or after the ACL injury. Few studies had focused on the patients whose meniscus is intact during ACL injury. We determined the correlation between timing of surgery and incidence of meniscal tears in ACL-deficient knees with initially intact meniscus. We retrospectively reviewed 387 patients who had undergone primary ACLR. Time of initial ACL injury, magnetic resonance imaging (MRI) examination, and surgery was recorded. The MRI was reviewed by experienced radiologic and orthopaedic doctors. Intraoperative arthroscopic images were also obtained and reviewed. The type of tear noted during surgery was classified according to the modification of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification of meniscal tears. Patients were divided into early (surgery within 12 months from injury) and late surgery group (surgery at more than 12 months from injury). There were 216 patients with intact medial meniscus and 257 patients with intact lateral meniscus on the postinjury MRI study. The incidence of medial meniscus tear (MMT) was significantly higher than lateral meniscus tear (LMT) during the ACLR (33.8 vs. 19.8%, p < 0.001). The incidence of MMT is higher in late group than in early group (53.7 vs. 29.1%, p = 0.004, odds ratio= 2.815). The incidence of LMT is mildly higher in late group but without statistics significance (23.8 vs. 18.6%, p = 0.364). In both MMT and LMT, the most common injury pattern observed was a longitudinal tear. The incidence of each type is not different between early and late group. For patients without concurrent meniscal injuries with the ACL tear, the incidence of MMT significantly increased if ACLR was performed more than 12 months after injury. The medial meniscus was more prone to injury than the lateral meniscus in chronic ACL-deficient knee. ACLR should be performed earlier to reduce the risk of meniscal tears for patients without initially concurrent meniscal tear.


2020 ◽  
Author(s):  
Xiaoxiao Song ◽  
Dongyang Chen ◽  
Xinsheng Qi ◽  
Qing Jiang ◽  
Caiwei Xia

Abstract PurposeTo investigate the potential factors associated with the prevalence of meniscal repairMethodsPatients who received partial menisectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscetomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscetomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors.Results592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p=0.002), patients aged 40 years or younger (p<0.001), increased weight (p=0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p<0.001), lateral meniscus (p=0.039)and early surgery (p<0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p=0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p<0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p=0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p<0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p=0.008) were associated with the prevalence of meniscus repair. ConclusionsMeniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior.Study DesignCase-control study; level of evidence, 3.


Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1035
Author(s):  
Eva-Maria Winkelmeyer ◽  
Justus Schock ◽  
Lena Marie Wollschläger ◽  
Philipp Schad ◽  
Marc Sebastian Huppertz ◽  
...  

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.


2014 ◽  
Vol 26 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Birgitta Nordahl ◽  
Rita Sjöström ◽  
Maria Westin ◽  
Suzanne Werner ◽  
Marie Alricsson

Abstract Aim: To explore the experiences of alpine skiing at the elite level after anterior cruciate ligament (ACL) injury and reconstruction. Design: A qualitative approach where semi-structured interviews were conducted, and an analysis of the manifest content was performed. Participants: Five ski high school students, two male and three female skiers, who had suffered ACL injuries and undergone ACL reconstructions. Results: Seven categories were identified. The participants described their perceived opportunities with regard to returning to alpine skiing after ACL injury and reconstruction as something positive to do with self-belief, being mentally and physically prepared, regaining confidence in their own ability, being given time and using active strategies. In contrast, perceived barriers to a return to elite alpine skiing gave rise to negative feelings, for example, fear, disheartenment, a total lack of or ambivalent confidence in their own ability and the use of passive strategies. Conclusion: The two male skiers returned to alpine skiing. They reported confidence in their own ability, active strategies and support on all levels, as well as enhanced physical ability. The female skiers did not return to their pre-injury level of competitive alpine skiing. They stated a lack of support on all levels, deterioration in their physical ability and two out of three reported passive strategies and no or ambivalent confidence in their own ability. The most important factors were family support, support on all levels, access to a physiotherapist and time given.


2018 ◽  
Vol 47 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Einar Andreas Sivertsen ◽  
Kari Bente Foss Haug ◽  
Eirik Klami Kristianslund ◽  
Anne-Marie Siebke Trøseid ◽  
Jari Parkkari ◽  
...  

Background: Several single-nucleotide variants (SNVs) in collagen genes have been reported as predisposing factors for anterior cruciate ligament (ACL) tears. However, the evidence is conflicting and does not support a clear association between genetic variants and risk of ACL ruptures. Purpose: To assess the association of previously identified candidate SNVs in genes encoding for collagen and the risk of ACL injury in a population of elite female athletes from high-risk team sports. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 851 female Norwegian and Finnish elite athletes from team sports were included from 2007 to 2011. ACL injuries acquired before inclusion in the cohort were registered by interview. The participants were followed prospectively through 2015 to record new complete ACL injuries. Six selected SNVs were genotyped ( COL1A1: rs1800012, rs1107946; COL3A1: rs1800255; COL5A1: rs12722, rs13946; COL12A1: rs970547). Results: No associations were found between ACL rupture and the SNVs tested. Conclusion: The study does not support a role of the 6 selected SNVs in genes encoding for collagen proteins as risk factors for ACL injury. Clinical Relevance: Genetic profiling to identify athletes at high risk for ACL rupture is not yet feasible.


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