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Assessment of the Usefulness of Image Reconstruction in the Oblique and Double-oblique Sagittal Planes for Magnetic Resonance Imaging of the Canine Cranial Cruciate Ligament. J Vet Res 2021; 65:209-216. [PMID: 34250306 PMCID: PMC8256465 DOI: 10.2478/jvetres-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of the study was to determine the quality and significance of the magnetic resonance image of the canine knee after reconstruction in the oblique and double-oblique sagittal plane. This reconstruction and 3D images are rarely used in common protocols due to the longer study time they require. The study aimed to demonstrate significance for such diagnostic images in specific sequences in order to stimulate consideration of their more frequent use in diagnosis of diseases of the cruciate ligament in dogs. Material and Methods All tests were carried out using an open magnetic resonance tomography scanner with magnetic field induction. The images obtained from the 30 canine patients examined were reconstructed and evaluated by independent appraisers. Statistical analysis was performed. Results The study showed that MRI of the stifle joint using 3D sequences provides higher quality images of the cranial cruciate ligament in dogs. The results of the statistical analysis showed that multi-faceted reconstruction allows the secondary determination of the oblique imaging planes and obtains images of adequate quality. Conclusion It can be concluded that multi-faceted reconstruction facilitates the secondary determination of oblique imaging planes. This reconstruction additionally makes images available of better quality compared to the 2D sequence.
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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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van der List JP, DiFelice GS. Preoperative magnetic resonance imaging predicts eligibility for arthroscopic primary anterior cruciate ligament repair. Knee Surg Sports Traumatol Arthrosc 2018; 26:660-671. [PMID: 28707115 DOI: 10.1007/s00167-017-4646-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the role of preoperative magnetic resonance imaging (MRI) on the eligibility for arthroscopic primary anterior cruciate ligament (ACL) repair. METHODS All patients undergoing ACL surgery between 2008 and 2017 were included. Patients underwent arthroscopic primary repair if sufficient tissue length and quality were present, or they underwent single-bundle ACL reconstruction. Preoperative MRI tear locations were graded with the modified Sherman classification: type I (>90% distal remnant length), type II (75-90%), or type III (25-75%). MRI tissue quality was graded as good, fair, or poor. Arthroscopy videos were reviewed for tissue length and quality, and final treatment. RESULTS Sixty-three repair patients and 67 reconstruction patients were included. Repair patients had more often type I tears (41 vs. 4%, p < 0.001) and good tissue quality (89 vs. 12%, p < 0.001). Preoperative MRI tear location and tissue quality predicted eligibility for primary repair: 90% of all type I tears and 88% of type II tears with good tissue quality were repaired, while only 23% of type II tears with fair tissue quality, 0% of type II tears with poor tissue quality, and 14% of all type III tears could be repaired. CONCLUSIONS This study showed that tear location and tissue quality on preoperative MRI can predict eligibility for arthroscopic primary ACL repair. These findings may guide the orthopaedic surgeon on the preoperative assessment for arthroscopic primary repair of proximal ACL tears. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jelle P van der List
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA.
| | - Gregory S DiFelice
- Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY, 10021, USA
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Park HJ, Lee SY, Chung EC, Rho MH, Ahn JH, Kim MS, Park JY, Lee EJ. The usefulness of the oblique coronal plane in knee MRI on the evaluation of the posterior cruciate ligament. Acta Radiol 2014; 55:961-8. [PMID: 24136985 DOI: 10.1177/0284185113508180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Imaging findings of posterior cruciate ligament (PCL) injury may be equivocal, particularly when the patient has suffered a partial ligament tear. Some PCLs are positioned more horizontally, making it difficult to diagnose injury based on routine imaging planes alone due to partial volume artifact. PURPOSE To evaluate the diagnostic accuracy of combining oblique coronal imaging (PCL view) with traditional orthogonal views for PCL evaluation. MATERIAL AND METHODS This retrospective study included 20 patients with PCL injury and 43 patients with intact PCL who underwent PCL view imaging. Anatomic identification of PCL pathology on the orthogonal magnetic resonance imaging (MRI) sequences and PCL views was evaluated. Subjective scoring of the PCL was performed by two radiologists who assessed the possibility of a PCL tear based on an entire length view, an entire width view, and margin sharpness according to a 4-point scale. Diagnostic accuracy using these two views was evaluated by calculating the sensitivity, specificity, and accuracy. Arthroscopic and clinical findings were used as the reference standard. RESULTS Total scores for the PCL view were higher than those of orthogonal views (P < 0.001). Both readers found that anatomic identification using the full width view and sharp margin to be superior using the PCL view compared with the orthogonal views (P < 0.001). The specificities and accuracies were higher in cases where an additional PCL view was provided, but did not show statistical significance. CONCLUSION PCL view provides better anatomic evaluation of the PCL and mild improvement in the specificity and accuracy.
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Affiliation(s)
- Hee-Jin Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Eun-Chul Chung
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Myung-Ho Rho
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Mi-Sung Kim
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Ji-Yeon Park
- Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Eun-Ja Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Seoul, Republic of Korea
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Poureisa M, Daghighi MH, Navali AM, Shafaeian M. “Floating Meniscus” a Specific Indicator of Anterior Cruciate Ligament Rupture. JOURNAL OF MEDICAL SCIENCES 2013. [DOI: 10.3923/jms.2014.36.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Han Y, Kurzencwyg D, Hart A, Powell T, Martineau PA. Measuring the anterior cruciate ligament's footprints by three-dimensional magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2012; 20:986-95. [PMID: 21987362 DOI: 10.1007/s00167-011-1690-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 09/20/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to compare 3D MR imaging and open cadaveric measurements of the ACL's footprints to see whether 3D MR imaging measurements are accurate enough to be used for preoperative templating in anatomic ACL reconstruction. METHODS Eight formalin-injected cadaveric knees were scanned by rapid acquisition isotropic 3D MR imaging. The femoral and tibial footprints were measured on MR imaging and compared with cadaveric dissection. Bland-Altman plots were used to assess the level of agreement. RESULTS The AM and PL bundles were clearly appreciated in each specimen by 3D MR imaging and cadaveric dissection. The average paired difference in the femoral and tibial footprint measurements was 2, 1, 2, and 2 mm for the femoral footprint length, femoral footprint width, tibial footprint length, and tibial footprint width, respectively. The individual paired measurements were all within the mean difference ± two standard deviations of the difference in the Bland-Altman plot showing strong agreement. CONCLUSION Measuring the ACL's footprint by 3D MR imaging or open cadaveric dissection has strong agreement and can be used interchangeably. 3D MR imaging has the potential to allow surgeons to: (1) tailor ACL reconstruction technique or graft choice based on ACL footprint size, (2) plan for selective bundle ACL reconstruction for partial tears, and (3) preoperatively template tunnel position according to the patient's individual anatomy.
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Affiliation(s)
- Yung Han
- Department of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
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Guenoun D, Le Corroller T, Amous Z, Pauly V, Sbihi A, Champsaur P. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Diagn Interv Imaging 2012; 93:331-41. [PMID: 22542209 DOI: 10.1016/j.diii.2012.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
When faced with a clinical suspicion of knee ligament injury, MRI nowadays has a central role in the diagnostic strategy. In particular, it is essential for assessing the cruciate ligaments and any associated meniscal tears. The objective of this review is to present the various direct and indirect MRI signs of tearing of the anterior cruciate ligament (ACL) and then describe the lesions associated with it. The anatomical and clinical aspects are also discussed so that the contribution of MRI to the diagnosis and therapeutic management of an ACL tear can be better understood.
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Affiliation(s)
- D Guenoun
- Departement of Radiology, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
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Stanford FC, Kendoff D, Warren RF, Pearle AD. Native anterior cruciate ligament obliquity versus anterior cruciate ligament graft obliquity: an observational study using navigated measurements. Am J Sports Med 2009; 37:114-9. [PMID: 18815237 DOI: 10.1177/0363546508323257] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The goal of anterior cruciate ligament reconstruction is to attain a graft that closely resembles the native anterior cruciate ligament anatomy. By reconstructing the original anatomy, one hopes to eliminate issues related to graft elongation, impingement, and excessive tension while achieving ideal knee kinematics. HYPOTHESIS Clinical grafts placed using the transtibial technique will differ in the sagittal and coronal planes when compared with obliquity of the anatomic anterior cruciate ligament. STUDY DESIGN Controlled laboratory study/case series; Level of evidence, 4. METHODS With the assistance of computer navigation, our study compared the anterior cruciate ligament orientation of 5 cadaver knees with 12 clinical anterior cruciate ligament-reconstructed knees using the transtibial technique. RESULTS Clinical graft obliquity differed from the anatomic anterior cruciate ligament in all flexion angles: 0 degrees, 30 degrees, 60 degrees, and 90 degrees. In the sagittal plane, the clinical graft obliquity differed from the anatomic anterior cruciate ligament by 13.6 degrees, 12.7 degrees, 16.7 degrees, and 17 degrees, respectively. In the coronal plane, the clinical graft obliquity differed from the anatomic anterior cruciate ligament by 4.9 degrees, 7.6 degrees, 8.9 degrees, and 12.7 degrees, respectively. Paired t tests demonstrated that the difference between the clinical and anatomic anterior cruciate ligament was significant (P <.05), except in the coronal plane at 0 degrees of flexion. In spite of this, all patients demonstrated a negative pivot shift and Lachman at the conclusion of their reconstructions and at 6-month follow-up. CONCLUSION The sagittal and coronal plane obliquity of well-functioning grafts placed using the transtibial technique were more vertical than anatomic fibers. CLINICAL RELEVANCE Graft obliquity, in both the coronal and sagittal plane, may be an important means to target appropriate anterior cruciate ligament graft position and can be monitored using surgical navigation systems.
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Affiliation(s)
- Fatima C Stanford
- Shoulder and Sports Medicine Service, Hospital for Special Surgery, New York, New York, USA.
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Kwon JW, Yoon YC, Kim YN, Ahn JH, Choe BK. Which oblique plane is more helpful in diagnosing an anterior cruciate ligament tear? Clin Radiol 2008; 64:291-7. [PMID: 19185659 DOI: 10.1016/j.crad.2008.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 10/03/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the diagnostic role of additional oblique coronal and oblique sagittal magnetic resonance imaging (MRI) for an anterior cruciate ligament (ACL) tear. MATERIALS AND METHODS A total of 101 patients who had undergone preoperative knee MRI examinations with orthogonal and two sets of oblique images were enrolled in the study. Two radiologists evaluated the MRI images by the use of four methods: orthogonal images only (method A); orthogonal and additional oblique coronal images (method B); orthogonal and oblique sagittal images (method C); and orthogonal images with oblique coronal and sagittal images (method D). The status of the ACL (normal or tear) was determined by consensus. The sensitivity, specificity, and accuracy for an ACL tear with the use of each method were calculated in comparison with arthroscopy as the reference standard, and values were statistically analysed using the McNemar test. The diagnostic accuracies were compared using receiver operating characteristic (ROC) analysis. RESULTS Arthroscopy identified 10 partial ACL tears and 30 complete ACL tears. The specificities and accuracies for methods B, C, and D were significantly higher than the specificities and accuracies for method A (p<0.05). There was no significant difference in the sensitivity, specificity, and accuracy for methods B, C, and D. Diagnostic ability was not significantly different for each method, as determined by ROC analysis (p>0.05). CONCLUSIONS Additional oblique imaging for an ACL tear improved the specificity. Either of the oblique imaging methods is sufficient, and no further improvement in the diagnostic efficacy was achieved by simultaneous use.
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Affiliation(s)
- J W Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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Roberts CC, Towers JD, Spangehl MJ, Carrino JA, Morrison WB. Advanced MR imaging of the cruciate ligaments. Radiol Clin North Am 2008; 45:1003-16, vi-vii. [PMID: 17981180 DOI: 10.1016/j.rcl.2007.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The anterior and posterior cruciate ligaments are crucial stabilizers of the knee. These ligaments are named by the location of their tibial attachments. Each ligament is composed of separate functional bundles that differ in size but are equally important in function. MR imaging is accurate and sensitive, making it the imaging technique of choice for evaluating these ligaments. Acute and chronic injuries involving the cruciate ligaments have typical appearances and associated findings. MR imaging interpretation must take into account atypical injuries and imaging pitfalls. Knowledge of normal ligament reconstruction techniques allows differentiation of the normal postoperative appearance from reconstruction failure and complications. Ligament reconstruction techniques, complications, and appearances are reviewed in this article.
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Affiliation(s)
- Catherine C Roberts
- Department of Radiology, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
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Steckel H, Vadala G, Davis D, Musahl V, Fu FH. 3-T MR imaging of partial ACL tears: a cadaver study. Knee Surg Sports Traumatol Arthrosc 2007; 15:1066-71. [PMID: 17497130 DOI: 10.1007/s00167-007-0337-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
Magnetic resonance imaging (MRI) is the most commonly used diagnostic imaging procedure for suspected injuries to the anterior cruciate ligament (ACL). However, MRI has less utility for the evaluation of partial ACL tears. The goal of this study was to evaluate the possibility of distinguishing partial ACL tears applying the double bundle concept by dividing the ACL anatomy in the anteromedial (AM) and posterolateral bundle (PL). Six human cadaver knees were used in this laboratory study. The protocol consisted of sagittal, oblique coronal, and oblique sagittal proton-density-weighted fast spin echo sequences. After MRI the AM and the PL bundle were severed to mimic different partial ACL rupture patterns. MRI scanning of each knee was repeated, to record the quantitative parameters tilt and ACL angles and discontinuity as a nonquantitative parameter. Three orthopaedic surgeons and two radiologists were enlisted as blinded observers to evaluate the images. The transection patterns could be differentiated by evaluating discontinuity both in the paracoronal and in the sagittal plane. Evaluating the transection patterns, the AM bundle reached a better result in both planes compared to the PL bundle and the paracoronal plane had a better result in assessing the transection patterns compared to the sagittal plane for the PL bundle. Partial ACL transections could predictably be recognized on oblique sagittal and oblique coronal planes utilizing 3-T MRI technology. This concept allows a more precise description of ACL rupture patterns and might lead to a more distinctive approach for reconstructive surgery. The presurgical planning could be improved by applying a treatment algorithm based on a description of each bundle as intact or ruptured, leading to a reconstruction of the torn and a preservation of the intact bundle.
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Affiliation(s)
- Hanno Steckel
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213, USA.
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Roberts CC, Towers JD, Spangehl MJ, Carrino JA, Morrison WB. Advanced MR Imaging of the Cruciate Ligaments. Magn Reson Imaging Clin N Am 2007; 15:73-86. [PMID: 17499182 DOI: 10.1016/j.mric.2007.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The anterior and posterior cruciate ligaments are crucial stabilizers of the knee. These ligaments are named by the location of their tibial attachments. Each ligament is composed of separate functional bundles that differ in size but are equally important in function. MR imaging is accurate and sensitive, making it the imaging technique of choice for evaluating these ligaments. Acute and chronic injuries involving the cruciate ligaments have typical appearances and associated findings. MR imaging interpretation must take into account atypical injuries and imaging pitfalls. Knowledge of normal ligament reconstruction techniques allows differentiation of the normal postoperative appearance from reconstruction failure and complications. Ligament reconstruction techniques, complications, and appearances are reviewed in this article.
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Affiliation(s)
- Catherine C Roberts
- Department of Radiology, Mayo Clinic College of Medicine, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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Breitenseher MJ, Mayerhoefer ME. Oblique MR imaging of the anterior cruciate ligament based on three-dimensional orientation. J Magn Reson Imaging 2007; 26:794-8. [PMID: 17729337 DOI: 10.1002/jmri.20922] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the three-dimensional (3D) course of the anterior cruciate ligament (ACL) and determine the optimum planes for oblique full-length MRI of the ligament. MATERIALS AND METHODS Twenty-five healthy volunteers were examined. Axial proton density-weighted (PDw) images of the knees of 20 volunteers were obtained. 3D paths along the course of the ACL and corresponding tangents were constructed. Angles between these tangents and reference lines RFL-1 (the line connecting the posterior edges of the femoral condyles), RFL-2 (the line through the intercondylar joint space), and RFL-3 (the line connecting the anterior and posterior edge of the medial tibial condyle) were measured. These angles were used for oblique T2-weighted (T2w) MRI of the knees of the remaining five volunteers, and the number of slices that depicted the entire ACL was calculated. RESULTS The mean angles to the ACL were 74.0 degrees for RFL-1, 79.9 degrees for RFL-2, and 70.4 degrees for RFL-3. Full-length visualization of the ACL was demonstrated by 1.4 slices using the sagittal oblique plane prescribed for RFL-1, 2.4 slices using the sagittal oblique plane prescribed for RFL-2, and 1.4 slices using the coronal oblique plane prescribed for RFL-3. CONCLUSION The ACL is best depicted using a sagittal oblique imaging plane angled at 80 degrees from a line through the intercondylar joint space.
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Steckel H, Starman JS, Baums MH, Klinger HM, Schultz W, Fu FH. The double-bundle technique for anterior cruciate ligament reconstruction: a systematic overview. Scand J Med Sci Sports 2006; 17:99-108. [PMID: 17076829 DOI: 10.1111/j.1600-0838.2006.00600.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In traditional anterior cruciate ligament reconstruction, there is a subset of patients complaining of knee instability, especially rotational instability, and athletes not able to return to their preinjury level of sports activity. Currently, controversy exists over the usefulness of the double bundle technique (DBT) in addressing these problems. In order to evaluate the DBT, we completed a literature review from 1969 to February 2006 focusing on anatomy, magnetic resonance imaging, graft incorporation, biomechanics, kinematics, surgical techniques, complications and outcome. The DBT is not a standardized technique, which makes it difficult to compare results. Cadaver studies have proven biomechanical advantages with respect to ap-stability, but assessing the rotational stability remains difficult. There is a lack of available outcome studies with sufficient follow-up to demonstrate the potential advantages of DBT. The theoretical advantages of DBT require careful evaluation with outcome, biomechanical and kinematic studies. In addition, studies are needed to address issues such as graft incorporation and complications. An advantage offered by DBT is the possibility to identify rupture patterns that can lead to surgical preservation of an intact and augmentation of an injured bundle. The approach of augmentating a single bundle technique reconstruction with adequate anterior-posterior but poor rotational stability is promising.
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Affiliation(s)
- H Steckel
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Steckel H, Vadala G, Davis D, Fu FH. 2D and 3D 3-tesla magnetic resonance imaging of the double bundle structure in anterior cruciate ligament anatomy. Knee Surg Sports Traumatol Arthrosc 2006; 14:1151-8. [PMID: 16937152 DOI: 10.1007/s00167-006-0185-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
For anterior cruciate ligament (ACL) surgery using the anatomic approach of the double bundle concept it is helpful to describe the anteromedial (AM) and posterolateral (PL) bundle using Magnetic Resonance Imaging (MRI), since this is the most important preoperative parameter next to the physical examination. The aim of this study was to distinguish both bundles in MRI. In a prospective study we evaluated the double bundle structure in ACL anatomy with a 3-T ultra-high-field strength MR imaging of cadaver knees, which allows faster imaging times, increased resolution and increased signal-to-noise ratio. Using oblique sagittal and oblique coronal planes, we were able to distinguish the double bundle structure in each knee. The following arthroscopic evaluation of the knees confirmed our MRI findings. Our study demonstrates the possibility of distinguishing the two bundles in the native ACL with 3T MRI. Following examinations must study the value for clinical application by describing different rupture patterns of the bundles and correlating this to arthroscopy. It would be advantageous to know the rupture pattern in advance. Presurgical planning could be improved by reconstructing only the torn and preserving the intact bundle.
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Affiliation(s)
- Hanno Steckel
- Department of Orthopaedic Surgery, University of Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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Duc SR, Zanetti M, Kramer J, Käch KP, Zollikofer CL, Wentz KU. Magnetic resonance imaging of anterior cruciate ligament tears: evaluation of standard orthogonal and tailored paracoronal images. Acta Radiol 2005; 46:729-33. [PMID: 16372693 DOI: 10.1080/02841850500215907] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the three standard orthogonal imaging planes and a paracoronal imaging plane for anterior cruciate ligament (ACL) tears. MATERIAL AND METHODS Ninety patients (91 knees; 29 F and 61 M) aged between 15 and 84 years (mean 36.9 +/- 16.4 years) underwent magnetic resonance imaging (MRI) of the knee prior to arthroscopy. At surgery, 32 knees had an intact ACL, 4 a partial tear, and 55 a complete ACL tear. In all patients, axial, sagittal, coronal, and paracoronal T2-weighted turbo-SE images were acquired. The ACL was classified as intact, partially, or completely torn. Partial and complete tears were combined for statistical evaluation. RESULTS Partial ACL tears (four cases) were not correctly diagnosed at MRI except in one knee by one observer on coronal images. Sensitivity in detecting ACL tears was 95%/63% (reader1/reader2) in the axial, 93%/95% in the sagittal, 93%/86% in the coronal, and 100%/93% in the paracoronal plane. Specificity was 75%/81% in the axial, 72%/81% in the sagittal, 78%/94% in the coronal, and 78%/88% in the paracoronal plane. CONCLUSION ACL tears can be diagnosed accurately with each of the standard orthogonal planes. Based on reader confidence and interobserver agreement paracoronal images may be useful in equivocal cases.
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Affiliation(s)
- S R Duc
- MR Research Group, Institute of Radiology, Cantonal Hospital, Winterthur, Switzerland.
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Mellado JM, Calmet J, Olona M, Giné J, Saurí A. Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle. Knee Surg Sports Traumatol Arthrosc 2004; 12:217-24. [PMID: 14530852 DOI: 10.1007/s00167-003-0431-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2003] [Accepted: 06/23/2003] [Indexed: 10/26/2022]
Abstract
We evaluated the diagnostic utility of magnetic resonance imaging (MRI) for predicting anterior cruciate ligament (ACL) tears using both quantitative parameters and nonquantitative imaging findings. MRI examinations were retrospectively evaluated in a group of patients with arthroscopically confirmed complete ACL tear and in a control group with arthroscopically confirmed intact ACL. We evaluated multiple MRI features to compare their sensitivity and specificity for detecting ACL tears. Particular emphasis is put on the evaluation of three different quantitative parameters, including a simplified method for measuring the ACL angle. With a threshold value of 45 degrees the ACL angle reached a sensitivity and specificity of 100% for detecting ACL tears. With a threshold value of 0 degrees the Blumensaat angle had a sensitivity of 90% and a specificity of 98%. Finally, a threshold value of 115 degrees gave the posterior cruciate ligament angle a sensitivity of 70% and a specificity of 82%. Discontinuity was found to be the most useful of the ACL abnormalities. Of the secondary findings anterior tibial displacement was the best predictor of ligamentous injury. However, ACL abnormalities and secondary findings, alone or combined, failed to surpass the diagnostic value of the ACL angle for predicting ACL tears. Quantitative parameters are thus good predictors of ACL tears and may increase the overall sensitivity and specificity of MRI. The ACL angle may be confidently measured in a single MRI section and can be considered to be the most reliable quantitative parameter for detecting ACL tears.
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Affiliation(s)
- J M Mellado
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Tarragona Joan XXIII, Carrer Doctor Mallafrè Guasch 4, 43007 Tarragona, Spain.
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