Magnetic Resonance Imaging of Asymptomatic Knees in Collegiate Basketball Players: The Effect of One Season of Play

Advanced MRI Approaches for Evaluating Common Lower Extremity Injuries in Basketball Players: Current and Emerging Techniques

Magnetic resonance imaging (MRI) can provide accurate and non-invasive diagnoses of lower extremity injuries in athletes. Sport-related injuries commonly occur in and around the knee and can affect the articular cartilage, patellar tendon, hamstring muscles, and bone. Sports medicine physicians utilize MRI to evaluate and diagnose injury, track recovery, estimate return to sport timelines, and assess the risk of recurrent injury. This article reviews the current literature and describes novel developments of quantitative MRI tools that can further advance our understanding of sports injury diagnosis, prevention, and treatment while minimizing injury risk and rehabilitation time. Innovative approaches for enhancing the early diagnosis and treatment of musculoskeletal injuries in basketball players span a spectrum of techniques. These encompass the utilization of T2, T1ρ, and T2* quantitative MRI, along with dGEMRIC and Na-MRI to assess articular cartilage injuries, 3D-Ultrashort echo time MRI for patellar tendon injuries, diffusion tensor imaging for acute myotendinous injuries, and sagittal short tau inversion recovery and axial long-axis T1-weighted, and 3D Cube sequences for bone stress imaging. Future studies should further refine and validate these MR-based quantitative techniques while exploring the lifelong cumulative impact of basketball on players' knees. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason

Background

Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements.

Purpose

To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs.

Results

There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA.

Conclusion

Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.

Multiparametric MRI of Knees in Collegiate Basketball Players: Associations With Morphological Abnormalities and Functional Deficits

Background

Rates of cartilage degeneration in asymptomatic elite basketball players are significantly higher compared with the general population due to excessive loads on the knee. Compositional quantitative magnetic resonance imaging (qMRI) techniques can identify local biochemical changes of macromolecules observed in cartilage degeneration.

Purpose/Hypothesis

The purpose of this study was to utilize multiparametric qMRI to (1) quantify how T1ρ and T2 relaxation times differ based on the presence of anatomic abnormalities and (2) correlate T1ρ and T2 with self-reported functional deficits. It was hypothesized that prolonged relaxation times will be associated with knees with MRI-graded abnormalities and knees belonging to basketball players with greater self-reported functional deficits.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

A total of 75 knees from National Collegiate Athletic Association Division I basketball players (40 female, 35 male) were included in this multicenter study. All players completed the Knee injury and Osteoarthritis Outcome Score (KOOS) and had bilateral knee MRI scans taken. T1ρ and T2 were calculated on a voxel-by-voxel basis. The cartilage surfaces were segmented into 6 compartments: lateral femoral condyle, lateral tibia, medial femoral condyle, medial tibia (MT), patella (PAT), and trochlea (TRO). Lesions from the MRI scans were graded for imaging abnormalities, and statistical parametric mapping was performed to study cross-sectional differences based on MRI scan grading of anatomic knee abnormalities. Pearson partial correlations between relaxation times and KOOS subscore values were computed, obtaining r value statistical parametric mappings and P value clusters.

Results

Knees without patellar tendinosis displayed significantly higher T1ρ in the PAT compared with those with patellar tendinosis (average percentage difference, 10.4%; P = .02). Significant prolongation of T1ρ was observed in the MT, TRO, and PAT of knees without compared with those with quadriceps tendinosis (average percentage difference, 12.7%, 13.3%, and 13.4%, respectively; P ≤ .05). A weak correlation was found between the KOOS-Symptoms subscale values and T1ρ/T2.

Conclusion

Certain tissues that bear the brunt of impact developed tendinosis but spared cartilage degeneration. Whereas participants reported minimal functional deficits, their high-impact activities resulted in structural damage that may lead to osteoarthritis after their collegiate careers.

The influence of different sports on cartilage adaptations: A systematic review

Molecular composition and structural adaptation are changes in the cartilage tissue after different stimuli. Sports activities with different loads at different angles, speeds, and intensities can modify the molecular composition of the articular cartilage, hence it is crucial to understand the molecular adaptations and structural modifications generated by sports practice and this review aims to synthesize the current evidence on this topic. A systematic search until July 2022 was performed on the database Medline, Pubmed, Scopus, and Web of Science with a collection of 62,198. After the screening process, the included articles were analyzed narratively. Thirty-one studies have been included in the analysis. From the results emerged that running, swimming, ballet and handball were not correlated with detrimental structural or molecular cartilage adaptation; instead, soccer, volleyball, basketball, weightlifting, climbing, and rowing showed signs of cartilage alteration and molecular adaptation that could be early predictive degeneration's signs. From the included studies it came to light that the regions more interested in morphological cartilage changes were the knee in athletes from different disciplines. In conclusion, different sports induce different cartilage modifications both at a molecular and structural level and it is important to know the risks correlated to sports to implement preventive strategies.

Short term clinical outcomes of a Prochondrix® thin laser-etched osteochondral allograft for the treatment of articular cartilage defects in the knee

Objective: The purpose of this study is to evaluate the short-term clinical outcomes of Prochondrix® novel thin, laser-etched osteochondral allograft on isolated articular cartilage defects. Methods: Eighteen patients with isolated, symptomatic, full-thickness articular cartilage lesions were treated with marrow stimulation followed by placement of a T-LE allograft. Demographic and intra-operative data was recorded as well as pre- and post-operative International Knee Documentation Committee (IKDC), Short Form-36 (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), Visual Analogue Scale (VAS) and Tegner scores. Pre- and post-operative data was compared at 6, 12, 24 and 36 months post operatively. Failures requiring reoperation were also recorded. Results: At a mean follow-up of 2.5 years (6-43 months), VAS decreased from 6.55 to 2.55 (p = .02) and subjective IKDC scores increased from 37.61 to 59.65 (p = .02). Statistically significant increases were also seen in KOOS Function-Sports and Recreational Activities (+26.04, p = .04) and KOOS QOL (+18.76, p = .007) as well as in SF-36 Physical Functioning (+25.20, p = .04), Energy/Fatigue (+16.50, p = .02), Social Functioning (+11.79, p = .04), and Bodily Pain (+25.18, p = .04). There were two failures requiring reoperation: one conversion to a patellofemoral arthroplasty (PFA), and one graft dislodgement which required removal. Conclusion: Treatment of articular cartilage lesions of the knee with ProChondrix® has demonstrated sustained positive results out to a mean follow-up of two and a half years in this prospective case series with a low failure rate that required reoperation (2 patients) in this series. These results are comparable to the short-term results of other cartilage restoration procedures currently in use today. A meta-analysis of osteochondral allografting demonstrated a mean 86.7% survival rate at 5 years with significant improvements in clinical outcome scores reaching MCID values.

Analysis of surgery rates among 25 national collegiate athletic association sports

OBJECTIVES

While injuries among collegiate athletes are common and well-studied, there have been no studies comparing which sports and injury types have the highest operation rates. This information would be valuable for athlete governing bodies and providers to improve player safety. Our hypothesis was the surgery incidence rates vary substantially between sports and injury types, with football and knee injuries representing the sport and injury type with the highest respective surgery rates.

METHODS

This was a descriptive epidemiology study of all injuries requiring surgery as recorded in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) for academic years 2004-2005 to 2013-2014. Surgery incidence rates (and 95% confidence intervals, CI) were calculated for each sport (per 10,000 athletic exposures [AE]) and for the most common injury types, by academic year. In addition, absolute numbers of performed surgeries were calculated as well as rates of return to sport.

RESULTS

Sports with the highest surgery incidence rate (per 10,000 AEs) were women's gymnastics (8.9; 95% CI 7.2-10.9), men's football (6.1; 95% CI 5.8-6.4), and men's wrestling (5.3; 95% CI 4.5-6.3). Absolute numbers of injury-related surgeries performed were greatest for men's football (n = 31,043), women's basketball (6,625), and men's basketball (5,717). Anterior cruciate ligament tears had the greatest surgery incidence rate per 100,000 AEs for all sports combined (7.95; 95% CI = 7.5 to 8.5), and also represented the injuries with the lowest rate of return to sport.

CONCLUSION

Women's gymnastics, men's football, and men's and women's basketball are NCAA sports with an elevated risk of injury requiring of surgery. The results from this study can guide the NCAA and providers regarding which sports should be the focus of future research, new injury prevention strategies, and healthcare personnel allocation during events.

Clinical relevance of MRI knee abnormalities in Australian rules football players: a longitudinal study

Background/Aim

The clinical relevance of MRI knee abnormalities in athletes is unclear. This study aimed to determine the prevalence of MRI knee abnormalities in Australian Rules Football (ARF) players and describe their associations with pain, function, past and incident injury and surgery history.

Methods

75 male players (mean age 21, range 16–30) from the Tasmanian State Football League were examined early in the playing season (baseline). History of knee injury/surgery and knee pain and function were assessed. Players underwent MRI scans of both knees at baseline. Clinical measurements and MRI scans were repeated at the end of the season, and incident knee injuries during the season were recorded.

Results

MRI knee abnormalities were common at baseline (67% bone marrow lesions, 16% meniscal tear/extrusion, 43% cartilage defects, 67% effusion synovitis). Meniscal tears/extrusion and synovial fluid volume were positively associated with knee symptoms, but these associations were small in magnitude and did not persist after further accounting for injury history. Players with a history of injury were at a greater risk of having meniscal tears/extrusion, effusion synovitis and greater synovial fluid volume. In contrast, players with a history of surgery were at a greater risk of having cartilage defects and meniscal tears/extrusion. Incident injuries were significantly associated with worsening symptoms, BML development and incident meniscal damage.

Conclusions

MRI abnormalities are common in ARF players, are linked to a previous knee injury and surgery history, as well as incident injury but do not dictate clinical symptomatology.

Multiparametric MRI characterization of knee articular cartilage and subchondral bone shape in collegiate basketball players

Magnetic resonance imaging (MRI) is commonly used to evaluate the morphology of the knee in athletes with high-knee impact; however, complex repeated loading of the joint can lead to biochemical and structural degeneration that occurs before visible morphological changes. In this study, we utilized multiparametric quantitative MRI to compare morphology and composition of articular cartilage and subchondral bone shape between young athletes with high-knee impact (basketball players; n = 40) and non-knee impact (swimmers; n = 25). We implemented voxel-based relaxometry to register all cases to a single reference space and performed a localized compositional analysis of T 1ρ - and T 2 -relaxation times on a voxel-by-voxel basis. Additionally, statistical shape modeling was employed to extract differences in subchondral bone shape between the two groups. Evaluation of cartilage composition demonstrated a significant prolongation of relaxation times in the medial femoral and tibial compartments and in the posterolateral femur of basketball players in comparison to relaxation times in the same cartilage compartments of swimmers. The compositional analysis also showed depth-dependent differences with prolongation of the superficial layer in basketball players. For subchondral bone shape, three total modes were found to be significantly different between groups and related to the relative sizes of the tibial plateaus, intercondylar eminences, and the curvature and concavity of the patellar lateral facet. In summary, this study identified several characteristics associated with a high-knee impact which may expand our understanding of local degenerative patterns in this population.

The role of viscosupplementation in patellar chondropathy

Patellar chondropathy has a high incidence in the general population, being more common in patients younger than 50 years, female and recreational athletes, and overweight and obese patients. The most common complaints are pain, limited mobility, crepitus, difficulty climbing and descending stairs, and joint instability, usually showing unsatisfactory results with anti-inflammatory, physiotherapy, rehabilitation, and many other conservative treatment methods. The presumed hyaluronic acid (HA) disease-modifying activity may include effects on cartilage degradation, endogenous HA synthesis, synoviocyte and chondrocyte function, and other cellular inflammatory processes. Currently, HA is widely used as a safe and effective conservative treatment for osteoarthritis in the knee and other joints. HA improves the physiological environment in an osteoarthritic joint and the shock absorption and lubrication properties of the osteoarthritic synovial fluid, thus restoring the protective viscoelasticity of the synovial HA, reducing the pain, and improving the mobility. The complete mechanism of HA in the joint is not fully understood, but a wide range of actions in the joint is recognized. Its anti-inflammatory, analgesic, and chondroprotective action is related to the modulation of the intra- and extracellular inflammation cascade. HA has been shown to be safe and effective in the treatment of pain related to patellar chondropathy.

Physical Activity and Investigation With Magnetic Resonance Imaging Partly Explain Variability in the Prevalence of Patellar Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals

OBJECTIVE

To estimate the pooled prevalence of, and factors associated with, the presence of patellar tendon abnormalities observed on imaging in people without symptoms.

DESIGN

Systematic review with stratified meta-analysis and meta-regression.

LITERATURE SEARCH

We searched Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science from 1980 to August 2020.

STUDY SELECTION CRITERIA

We included studies that reported the prevalence of asymptomatic patellar tendon abnormalities on imaging. We excluded studies of participants with current tendon pain, a history of tendon pain, or other systemic conditions.

DATA SYNTHESIS

Stratification and meta-regression of studies based on study-level descriptive statistics (mean age, body mass index, proportion of female participants, physical activity participation, imaging modality) were performed using a random-effects model to account for between-study heterogeneity. Risk of bias was assessed using the modified Newcastle-Ottawa scale.

RESULTS

Meta-analysis of 64 studies (7125 limbs from 4616 participants) found significant between-study heterogeneity (I²≥90%, P<.01), which precluded a summary prevalence estimate. Heterogeneity was partially explained by studies that included participants who were physically active and studies that assessed tendon abnormalities using magnetic resonance imaging compared to ultrasound (P<.05). Mean age, body mass index, proportion of female participants, and sample size did not explain the remaining heterogeneity.

CONCLUSION

There was substantial variability in the reported prevalence of asymptomatic patellar tendon abnormalities. A clear and valid method is needed to assess and report the presence of patellar tendon abnormalities to increase research capacity and establish the clinical value of imaging the patellar tendon. J Orthop Sports Phys Ther 2021;51(5):216-231. Epub 28 Mar 2021. doi:10.2519/jospt.2021.10054.

Effects of the Competitive Season and Off-Season on Knee Articular Cartilage in Collegiate Basketball Players Using Quantitative MRI: A Multicenter Study

BACKGROUND

Injuries to the articular cartilage in the knee are common in jumping athletes, particularly high-level basketball players. Unfortunately, these are often diagnosed at a late stage of the disease process, after tissue loss has already occurred.

PURPOSE/HYPOTHESIS

To evaluate longitudinal changes in knee articular cartilage and knee function in National Collegiate Athletic Association (NCAA) basketball players and their evolution over the competitive season and off-season.

STUDY TYPE

Longitudinal, multisite cohort study.

POPULATION

Thirty-two NCAA Division 1 athletes: 22 basketball players and 10 swimmers.

FIELD STRENGTH/SEQUENCE

Bilateral magnetic resonance imaging (MRI) using a combined T_1ρ and T₂ magnetization-prepared angle-modulated portioned k-space spoiled gradient-echo snapshots (MAPSS) sequence at 3T.

ASSESSMENT

We calculated T₂ and T_1ρ relaxation times to compare compositional cartilage changes between three timepoints: preseason 1, postseason 1, and preseason 2. Knee Osteoarthritis Outcome Scores (KOOS) were used to assess knee health.

STATISTICAL TESTS

One-way variance model hypothesis test, general linear model, and chi-squared test.

RESULTS

In the femoral articular cartilage of all athletes, we saw a global decrease in T₂ and T_1ρ relaxation times during the competitive season (all P < 0.05) and an increase in T₂ and T_1ρ relaxation times during the off-season (all P < 0.05). In the basketball players' femoral cartilage, the anterior and central compartments respectively had the highest T₂ and T_1ρ relaxation times following the competitive season and off-season. The basketball players had significantly lower KOOS measures in every domain compared with the swimmers: Pain (P < 0.05), Symptoms (P < 0.05), Function in Daily Living (P < 0.05), Function in Sport/Recreation (P < 0.05), and Quality of Life (P < 0.05).

CONCLUSION

Our results indicate that T₂ and T_1ρ MRI can detect significant seasonal changes in the articular cartilage of basketball players and that there are regional differences in the articular cartilage that are indicative of basketball-specific stress on the femoral cartilage. This study demonstrates the potential of quantitative MRI to monitor global and regional cartilage health in athletes at risk of developing cartilage problems.

LEVEL OF EVIDENCE

2 Technical Efficacy Stage: 2.

Remarkably high prevalence of overuse-related knee complaints and MRI abnormalities in youth competitive alpine skiers: a descriptive investigation in 108 athletes aged 13-15 years

Background/aim

Competitive alpine skiing is known to be associated with a high risk of traumatic knee injuries. However, little is known about the exact prevalence of knee overuse injuries and their associations with structural changes, particularly in youth skiers. Accordingly, the aim of the present study was to describe the overuse-related knee complaints and MRI abnormalities in a cohort of youth skiers around the growth spurt.

Methods

108 youth competitive alpine skiers aged 13–15 years were examined using an MRI of both knees, an interview on existing knee complaints and a physical examination. As a common baseline for these assessments, skiers were prospectively monitored by the use of the Oslo Sports Trauma Research Centre questionnaire on health problems over a period of 12 months preceding the major investigations.

Results

88.0% of the youth skiers showed at least one MRI abnormality in the knees. The most frequent findings were distal femoral cortical irregularities (63%), focal periphyseal oedema (FOPE) zones (25.0%) and cartilage lesions (18.5%). 47.2% of all skiers suffered from at least one overuse-related knee complaint during the 12 months preceding the MRI examination, mostly at the distal and proximal patellar tendon. However, despite a certain association with corresponding MRI abnormalities, the sensitivity of an MRI-based detection of such complaints was strongly limited.

Conclusion

Youth competitive alpine skiers suffer from a remarkably large number of knee overuse injuries. Accordingly, an effective prevention strategy should include a systematic screening of clinical complaints, ideally already starting around the growth spurt.

The Effect of Training Experience and Leg Dominance on the Prevalence of Asymptomatic Intraarticular Changes of the Knee Joints in Adult Professional Male Soccer Players

Background

Currently, no data is available regarding the association between professional experience or limb dominance and the prevalence of asymptomatic knee joint lesions in adult professional male soccer players.

Hypothesis

The prevalence of the accumulated changes increases with training experience. This is especially true for the dominant leg, which is involved in a large proportion of the athletes’ movements.

Study Design

Level 2 cross-sectional cohort study

Methods

MRI was used to assess the condition of 94 knee joints in 47 adult professional male soccer players (mean age 25.7 ± 4.6 years, BMI 22.8 ± 1.4). Previous surgery on joints was an exclusion criterion. No football player had knee injuries (including fresh bruises) for at least 3 months before the examination. All the scans were performed using a 1.5T MRI scanner and a slice thickness of 3 mm. The images were blindly analyzed by two experienced radiologists. We analyzed all the three compartments of the knee joint. We consider a chondral lesion already from grade I in modified Noyes and Stabler classification system. To assess the influence of soccer training experience, all players were divided into two groups: group 1 formed from players with less than 20 years of experience and group 2 with more than 20 years of experience.

Results

One hundred percent of the soccer players had at least one chondral and meniscal lesion.

In both legs, the posterior horn of the medial meniscus (95.6%) was the most frequent site of injury. Most of the injuries were classified as grade II injuries (73.3% for the dominant and 75.6% for the non-dominant leg).

Experience and age of the athletes significantly increased the probability of subcortical bone lesions. They were significantly positively correlated with the grades of patellar lesions and lesions of the patellar surface of the femur and significantly negatively correlated with the grades of lesions of posterior horn of lateral meniscus and anterior horn of medial meniscus.

No statistically significant differences in the prevalence and grades of cartilage and meniscal lesions in the dominant and non-dominant limb were observed.

Conclusion

Soccer practice is associated with the increased prevalence of asymptomatic chondral and meniscal lesions.

The probability of subcortical bone lesions significantly increases with training experience and age. These factors are also positively correlated with the grades of patellar lesions and lesions of the patellar surface of the femur.

The prevalence and grade of asymptomatic chondral and meniscal lesions is independent of leg dominance.

Bone Marrow Oedema in the Knees of Asymptomatic High-Level Athletes: Prevalence and Associated Factors

BACKGROUND

Bone marrow oedema (BMO), seen on magnetic resonance imaging, can be associated with various injuries to the knee but may also occur in asymptomatic athletes. The prevalence and causal factors for these observations are not well understood. The aim of this study was to determine the prevalence of BMO in asymptomatic knees of athletes, competing at a high level, and to investigate the associated factors.

MATERIALS AND METHODS

Twenty-five asymptomatic university athletes, competing at regional to international level, were recruited. Bilateral knee magnetic resonance imaging was performed in each athlete (total 50 knee scans) at the end of their competitive season. Imaging studies were reported independently by two experienced consultant musculoskeletal radiologists.

RESULTS

There was almost perfect agreement between reporters for diagnosis of BMO (κ = 0.896). Seven participants (28%) were found to have BMO (six in one knee and one bilaterally). The amount of time spent training, during the season, was significantly associated with the appearance of BMO (p < 0.05).

CONCLUSION

The occurrence of BMO in asymptomatic knees of athletes is common (occurring in over one-quarter of knees) and may be associated with training intensity. This should be considered when treating athletes and deciding upon appropriate treatment plans.

Evaluation of the Knees of Asymptomatic Kangoo Jumpers with MR Imaging

Purpose:

The aim of this study is to determine the prevalence of pathologic findings in asymptomatic knees of Kangoo Jumpers by using a 3T MRI and to compare them with age and sex-matched controls who do not regularly participate in any impact sports.

Methods:

Both knees of 18 Kangoo Jumpers were examined by 3T MRIs in a total of 36 MRI scans. The control group was comprised of 20 volunteers from the same age group and with similar weights who did not participate in any competitive sports, in a total of 40 MRI scans. Two orthopedists and one radiologist independently assessed all images for the presence or absence of any abnormalities.

Results:

In 32 (88.9%) of the 36 Kangoo Jumpers’ knees, one or more abnormalities were observed. The most prevalent abnormality was bone marrow edema, which was detected in 32 knees (88.9%). The other significant findings were quadriceps tendinopathy (80.6%), patellar tendinopathy (63.9%), gastrocnemius tendinopathy (63.9%), infrapatellar fat pad edema (75%), suprapatellar fat pad edema (63.9%), meniscal signal change (72.2%) and cartilage damage in the patellofemoral joint (72.2%). There were no statistically significant differences in terms of joint effusion (8.3%), ganglion cysts (8.3%) or tibiofemoral joint cartilage injury (0%).

Conclusion:

This study reveals many types of knee MRI findings of asymptomatic Kangoo Jumpers compared to the control group. These MRI findings may be associated with acute knee injuries or chronic joint problems such as osteoarthritis, which may develop in long-term follow-up studies.

Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI

OBJECTIVE

To identify abnormalities in asymptomatic sedentary individuals using 3.0 Tesla high-resolution MRI.

MATERIALS AND METHODS

The cohort comprised of 230 knees of 115 uninjured sedentary adults (51 males, 64 females; median age: 44 years). All participants had bilateral knee 3.0 T MRIs. Two senior musculoskeletal radiologists graded all intraarticular knee structures using validated scoring systems. Participants completed Knee Injury and Osteoarthritis Outcome Score questionnaires at the time of the MRI scan.

RESULTS

MRI showed abnormalities in the majority (97%) of knees. Thirty percent knees had meniscal tears: horizontal (23%), complex (3%), vertical (2%), radial (2%) and bucket handle (1%). Cartilage and bone marrow abnormalities were prevalent at the patellofemoral joint (57% knees and 48% knees, respectively). Moderate and severe cartilage lesions were common, in 19% and 31% knees, respectively, while moderate and severe bone marrow oedema in 19% and 31% knees, respectively. Moderate-intensity lesion in tendons was found in 21% knees and high-grade tendonitis in 6% knees-the patellar (11% and 2%, respectively) and quadriceps (7% and 2%, respectively) tendons being most affected. Three percent partial ligamentous ruptures were found, especially of the anterior cruciate ligament (2%).

CONCLUSION

Nearly all knees of asymptomatic adults showed abnormalities in at least one knee structure on MRI. Meniscal tears, cartilage and bone marrow lesions of the patellofemoral joint were the most common pathological findings. Bucket handle and complex meniscal tears were reported for the first time in asymptomatic knees.

Prevalence of Asymptomatic Intra-articular Changes of the Knee in Adult Professional Soccer Players

Background:

Currently, there are few data on the association between participation in soccer and the condition of the knee joints in adult professional players.

Hypothesis:

A high percentage of professional soccer players will have asymptomatic intra-articular changes of the knee.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The condition of the intra-articular structures (osteophytes, cartilage, and menisci) in 94 knee joints of 47 adult professional soccer players (mean ± SD age, 25.7 ± 4.6 years; body mass index, 22.8 ± 1.4 kg/m²) was analyzed. A 1.5-T magnetic resonance imaging scanner was used to perform the imaging, and the anonymized data were analyzed by 2 experienced radiologists.

Results:

Cartilage of both knee joints was affected in 97.9% of soccer players. Meniscal lesions were detected in 97.8% of joints, affecting both joints in 93.6% of athletes. Grade 2 cartilage lesions were the most prevalent (36%-60% depending on the lesion site), and grade 4 lesions were detected in 12.7% of joints. The medial femoral condyle and medial tibial plateau were most frequently affected by cartilage lesions (85.1%). Among meniscal lesions, grade 2 lesions were the most prevalent, being detected in 71% of the cases. Grade 3 lesions were detected in 13.8% of the joints. The posterior horn of the lateral meniscus was the most common site of meniscal lesions (affected in 95.7% of the joints). Osteophytes were detected in 4.2% of joints.

Conclusion:

The prevalence of asymptomatic cartilage and meniscal lesions in the knees of adult professional soccer players is extremely high and is not associated with the reduction of sports involvement. This research should promote the correct interpretation of magnetic resonance imaging data obtained from soccer players with acute trauma and the reduction of the number of unwarranted surgical procedures.

Increased signal in the proximal patellar tendon: normal or pathologic?

OBJECTIVE

To determine the clinical significance of T2 signal hyperintensity in the proximal patellar tendon seen on MRI of the knee.

MATERIALS AND METHODS

MRIs of 100 patients who underwent MRI of the knee between 1 May 2018 and 15 July 2018 were retrospectively evaluated. All examinations were performed on 3-Tesla MRI scanners with a dedicated knee coil and in accordance with our institution's standard knee MRI protocol. The presence of increased T2 signal was assessed on both sagittal and axial T2-weighted fat-saturated images. The amount of increased signal in the proximal patellar tendon on T2-weighted images was characterized as: none, mild, moderate, or severe. A corresponding chart review of the referring physicians' notes was performed to determine the presence of clinical symptoms of patellar tendinopathy. Patellar tendinopathy was considered present if the clinical notes described tenderness on palpation of the inferior patellar pole, infrapatellar tenderness, or patellar tendinosis/tendinitis.

RESULTS

The majority (66%) of knee MRIs demonstrated the presence of increased T2 signal in the proximal patellar tendon. Only 4.5% of these patients had associated clinical findings of patellar tendinopathy.

CONCLUSION

Although increased T2 signal in the proximal patellar tendon is a common finding, only in rare cases are there associated clinical symptoms. Thus, increased T2 signal in the proximal patellar tendon may not be a pathological finding in the absence of clinical findings of patellar tendinopathy.

Prevalence of MRI Shoulder Abnormalities in Asymptomatic Professional and Collegiate Ice Hockey Athletes

Background

The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes.

Purpose/Hypothesis

The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI.

Study Design

Cross-sectional study; Level of evidence, 4.

Methods

A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance.

Results

Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient -0.731; P = .021).

Conclusion

Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

Surgical modalities for the management of bone marrow edema of the knee joint

Background

Bone marrow edema (BME) is a radiological term which can be found in many conditions with varied pathogenesis and histopathological images. It usually presents with pain in the affected joint and is diagnosed with MRI. Subchondroplasty (SCP) and core decompression (CD) are the surgical methods that are available to achieve pain relief and functional improvement. Both surgical methods have their own indications and are used depending on the patient's history. The aim of this literature review article is to discuss the surgical modalities for the management of bone marrow edema focusing on the knee joint. Such topic which analyzes both surgical methods for treatment of bone marrow edema of the knee joint has never been described in a review article before.

Materials and methods

For the purpose of our manuscript we thoroughly searched electronic databases such as Pubmed and Medline to acquire the appropriate material for our review paper. Only English articles were used in this review. In our study we included every article that had described the surgical management of BME of the knee by CD and SCP. In the discussion we included 18 studies (9 CD and 9 SCP) with a total number of patients equal to 397, while 206/397 had undergone surgical intervention (169 underwent SCP and 37 CD).

Results

Follow-up of 180 patients out of 206 were available for our review. A total number of 166 patients (92.2%) were successfully treated. Specifically, 29 (100%) patients were treated by CD and 137 (90.7%) by SCP. In a study, 10 patients who underwent SCP for BME secondary to advanced osteoarthritis (OA) yielded poor results. In other studies, pain persistency was observed in 2 patients, 1 patient had postoperative infection and another patient eventually underwent total knee arthroplasty (TKA). 70% prevention of TKA was achieved by SCP in a study of 66 patients with BME secondary to advanced OA. Thus, a total number of 166 patients were considered as clinical success and 14 patients as clinical failure.

Conclusions

The included studies that have been published referred to the surgical methods of CD or SCP for the management of BME of the knee but none of that summarizes all current studies on both methods. Those studies seem that CD is a surgical technique that is proposed to perform in patients without findings of OA that usually fail to respond to conservative treatment. On the other hand, the option of SCP technique is carried out in patients with varied stage of OA associated with subchondral BME. Both methods aim to reduce the pain and to improve function in the setting of subchondral BME. Nevertheless it is not clear in literature which method is the best according to the criteria of the use. This literature review shows a lack of standardized guidelines with respect to diagnosis and surgical treatment.

Outcomes Associated with Return to Sports Following Osteochondral Allograft Transplant in the Knee: a Scoping Review

PURPOSE OF REVIEW

The purposes of this review were to report the currently validated outcomes for OCA transplant patients, discuss the benefits and challenges associated with "return to sports" as an outcome measure, and summarize the currently available data on patients' ability to return to sports after OCA transplant.

RECENT FINDINGS

College athletes may take less time than professionals to return to basketball, but there are many factors that can influence this timeframe. Player productivity is decreased ~ 40% and future career length is only 1 to 2 years following return to play. When evaluating all OCA transplant patients, 75-88% of patients return to sport and 38-80% return to their previous level of play at approximately 8-10 months following surgery. Overall graft failure rates are low (0-9.4%) but are based on limited short- to medium-term data. Data on the return to professional and college sports after OCA transplant is limited. Surgeons should consider collecting patient outcomes across multiple domains and contributing data to aggregate databases to allow for better quality outcome data to be reported.

Neuromuscular activity during stair descent in ACL reconstructed patients: A pilot study

BACKGROUND

The anterior cruciate ligament (ACL) rupture is a severe knee injury. Altered kinematics and kinetics in ACL reconstructed (ACL-R) patients compared to healthy participants (ACL-I) are known and attributed to an altered sensorimotor control. However, studies on neuromuscular control often lack homogeneous patient cohorts. The objective was to examine neuromuscular activity during stair descent in patients one year after ACL reconstruction.

METHOD

Neuromuscular activity of vastus medialis (VM) and lateralis (VL), biceps femoris (BF) and semitendinosus (ST) was recorded by electromyography in 10 ACL-R (age: 26  ±  10   years; height: 175  ±  6  cm; mass: 75  ±  14   kg) and 10 healthy matched controls (age: 31  ±  7  years; height: 175  ±  7  cm; mass: 68  ±  10  kg). A 10-minute walking treadmill warm-up was used for submaximal normalization. Afterwards participants descended 10 times a six-step stairway at a self-selected speed. The movement was separated into pre-activation (PRE), weight acceptance (WA) and push-off phase (PO). Normalized root mean squares for each muscle, limb and movement phase were calculated. Kruskal-Wallis ANOVA compared ACL-R injured and contralateral leg and the ACL-I leg (α  =  0.05).

RESULTS

Significant increased normalised activity in ST during WA in ACL-R injured leg compared to ACL-I and during PO in VL in the ACL-R contralateral leg compared to ACL-I. Decreased activity was shown in VM in ACL-R injured compared to contralateral leg (p < 0.05).

CONCLUSION

Altered neuromuscular activations are present one year after ACL reconstruction compared to the contralateral and healthy matched control limb. Current standard rehabilitation programs may not be able to fully restore sensorimotor control and demand further investigations.

Quadriceps tendinopathy: a review-part 1: epidemiology and diagnosis

Overuse injuries of the extensor mechanism of the knee are common in both athletes and non-athletes and usually occur during activities associated with repetitive loading, stress, and knee extension. Historically, they have been labeled as Jumper's knee due to the high prevalence seen in the athletic community. In many published reports, the name "patellar tendinopathy" is used to describe this disorder of the quadriceps tendon at the patellar insertion, and the names are often used interchangeably. Numerous reports have been published describing extensor mechanism injuries in athletes, but there is a paucity of studies that focus on quadriceps tendinopathy. In addition, there is no universally accepted classification system for tendon pathology. Therefore, we performed a comprehensive literature review of these studies. This review consists of 2 parts. In the first part we review: (I) epidemiology and (II) diagnosis of quadriceps tendinopathy in the athlete as well as the general population. In the second part we discuss: (I) classification; (II) prognosis; and (III) treatment results.

Return to Play Among Elite Basketball Players After Osteochondral Allograft Transplantation of Full-Thickness Cartilage Lesions

Background:

Osteochondral allograft transplantation (OCA) is a recognized option for full-thickness articular cartilage defects of the knee, especially in the setting of large lesions or those involving the subchondral bone. Previous heterogenous studies of athletes have shown a 75% to 79% rate of return to play after the procedure.

Purpose:

To define return-to-play rates in a cohort of elite collegiate and professional basketball players following osteochondral allograft of the knee.

Study Design:

Case series; Level of evidence, 4.

Methods:

Prospectively collected data from an institutional cartilage repair registry were retrospectively reviewed. Patients were eligible for inclusion if they were collegiate or professional basketball players at the time of surgery. Patient demographics, lesion size and location, and surgical details were collected. Postoperative magnetic resonance imaging scans were scored with the OCAMRISS system. Time to return to play and pre- versus postoperative player performance were determined with publicly available internet resources.

Results:

Eleven athletes (4 professional, 7 collegiate) with a total of 14 treated lesions (1 to the medial femoral condyle, 6 to the lateral femoral condyle, 5 to the trochlea, and 2 to the patella) were eligible for study inclusion. Mean lesion size was 509 mm². All patients underwent OCA through an arthrotomy, with fresh grafts. The overall rate of return to play at the same level of competition was 80%. Median time to return to play was 14 months (range, 6-26 months). Among players with available statistics, there was no significant reduction in any performance category.

Conclusion:

OCA in elite basketball players results in an 80% return to previous level of competition, which is consistent with previous reports of athletes playing other sports. Osteochondral allografting is a reasonable option to consider for full-thickness cartilage lesions of the knee, even for elite jumping athletes.

Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis

Background

Knee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees.

Methods

We searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs ≥40 years). Meta-regression explored heterogeneity.

Results

We included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect <40 years 11% (6%to 17%) and ≥40 years 43% (29% to 57%); meniscal tear <40 years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias.

Conclusions

Summary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%–14% in adults aged <40 years to 19%–43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.