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Fritz B. [Imaging of the anterior cruciate ligament and anterolateral rotational instability of the knee joint]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:261-270. [PMID: 38441595 DOI: 10.1007/s00117-024-01278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
The anterior cruciate ligament (ACL) is essential for the stability of the knee joint and ACL tears are one of the most common sports injuries with a high incidence, especially in sports that require rotational movements and abrupt changes in direction. Injuries of the ACL are rarely isolated and are often accompanied by meniscal and other internal knee injuries, which increase the risk of osteoarthritis. The spectrum of ACL injuries includes strains, partial tears and complete tears. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnostics as it can accurately depict not only the ACL but also accompanying injuries. Proton density and T2-weighted sequences are particularly suitable for evaluating the ACL, which is usually well visible and assessable in all planes. In addition to depicting fiber disruption as a direct sign and central diagnostic indicator of an ACL tear, there are numerous other direct and indirect signs of an ACL injury in MRI. These include abnormal fiber orientations, signal increases and an anterior subluxation of the tibia relative to the femur. The bone marrow edema patterns often associated with ACL tears are indicative of the underlying injury mechanism. The treatment of ACL tears can be conservative or surgical depending on various factors, such as the patient's activity level and the presence of accompanying injuries. The precise and comprehensive description of ACL injuries by radiology is crucial for optimal treatment planning. Anterolateral rotational instability (ALRI) of the knee joint characterizes a condition of excessive lateral and rotational mobility of the tibia in relation to the femur in the anterolateral knee region. This instability is primarily caused by a rupture of the ACL, with the anterolateral ligament (ALL) that was rediscovered about 10 years ago, also being attributed a role in stabilizing the knee. Although ALRI is primarily diagnosed through clinical examinations, MRI is indispensable for detecting injuries to the ACL, ALL, and other internal knee structures, which is essential for developing an optimal treatment strategy.
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Affiliation(s)
- Benjamin Fritz
- Abteilung für Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
- Medizinische Fakultät, Universität Zürich, Zürich, Schweiz.
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Gong H, Wang H, Zhang X, Fu L, Chen L. Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case-control study. Arch Orthop Trauma Surg 2023; 143:927-934. [PMID: 35230503 DOI: 10.1007/s00402-022-04366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries. MATERIALS AND METHODS A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored. RESULTS The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035). CONCLUSION The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.
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Affiliation(s)
- Heng Gong
- School of Clinical Medicine, Tsinghua University, Beijing, China.,Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Haijun Wang
- Peking University Third Hospital, Beijing, China
| | - Xiaofei Zhang
- Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Ligong Fu
- Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China
| | - Lianxu Chen
- School of Clinical Medicine, Tsinghua University, Beijing, China. .,Beijing Tsinghua Changgung Hospital Affiliated To Tsinghua University, Beijing, China.
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Kim DH, Chai JW, Kang JH, Lee JH, Kim HJ, Seo J, Choi JW. Ensemble deep learning model for predicting anterior cruciate ligament tear from lateral knee radiograph. Skeletal Radiol 2022; 51:2269-2279. [PMID: 35792956 DOI: 10.1007/s00256-022-04081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop an ensemble deep learning model (DLM) predicting anterior cruciate ligament (ACL) tears from lateral knee radiographs and to evaluate its diagnostic performance. MATERIALS AND METHODS In this study, 1433 lateral knee radiographs (661 with ACL tear confirmed on MRI, 772 normal) from two medical centers were split into training (n = 1146) and test sets (n = 287). Three single DLMs respectively classifying radiographs with ACL tears, abnormal lateral femoral notches, and joint effusion were developed. An ensemble DLM predicting ACL tears was developed by combining the three DLMs via stacking method. The sensitivities, specificities, and area under the receiver operating characteristic curves (AUCs) of the DLMs and three radiologists were compared using McNemar test and Delong test. Subgroup analysis was performed to identify the radiologic features associated with the sensitivity. RESULTS The sensitivity, specificity, and AUC of the ensemble DLM were 86.8% (95% confidence interval [CI], 79.9-92.0%), 89.4% (95% CI, 83.4-93.8%), and 0.927 (95% CI, 0.891-0.954), achieving diagnostic performance comparable with that of a musculoskeletal radiologist (P = 0.193, McNemar test; P = 0.131, Delong test). The AUC of the ensemble DLM was significantly higher than those of non-musculoskeletal radiologists (P = 0.043, P < 0.001). The sensitivity of the DLM was higher than that of the radiologists in the absence of an abnormal lateral femoral notch or joint effusion. CONCLUSION The diagnostic performance of the ensemble DLM in predicting lateral knee radiographs with ACL tears was comparable to that of a musculoskeletal radiologist.
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Affiliation(s)
- Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hee Kang
- Department of Radiology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
| | - Ji Hyun Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Choi
- Armed Forces Yangju Hospital, Yangju, Republic of Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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The coronal lateral collateral ligament sign in the anterior cruciate ligament-injured knees was observed regardless of the knee laxity based on the quantitative measurements. Knee Surg Sports Traumatol Arthrosc 2022; 30:3508-3514. [PMID: 35412065 DOI: 10.1007/s00167-022-06970-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The coronal lateral collateral ligament (LCL) sign has been reported to be associated with deviated position of the tibia on MRI due to anterior cruciate ligament (ACL) injuries. However, the relationships between LCL sign and clinical knee laxity evaluations are still unclear. The purpose of the study was to investigate the relationship between the coronal LCL sign and knee laxity measurements. METHODS A retrospective review of unilateral ACL injured patients who underwent ACL reconstruction was performed. The coronal LCL sign was determined using magnetic resonance imaging (MRI). Clinical grading of the pivot-shift test, KT-1000 measurements, and quantitative measurements of the Lachman test and the pivot-shift test using an electromagnetic system, were compared between patients with positive and negative coronal LCL sign. A subgroup analysis of different age groups was then performed, dividing patients to adolescent (age ≤ 18 years) and adult (age > 18 years) groups. RESULTS A total of 85 patients were enrolled, of which 45 patients had coronal LCL signs. The coronal LCL sign was not associated with the pivot-shift test clinical grading (n.s), KT-1000 measurement (n.s), the tibial translation during the Lachman test (n.s), or with tibia acceleration (n.s) and translation (n.s) during the pivot-shift test. The subgroup analysis also showed that the aforementioned parameters were not associated with the coronal LCL sign in either adolescent or adult subgroups. CONCLUSION The occurrence of coronal LCL sign in MRI did not imply greater clinical knee laxity evaluations in patients with ACL tears. The knee laxity should routinely be evaluated regardless the coronal LCL sign. LEVEL OF EVIDENCE Level III.
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Lateral Femoral Condyle CRATER sign of BRIK an Ancillary Sign of Lateral Patellar Dislocation. Indian J Radiol Imaging 2022; 32:505-509. [PMID: 36451938 PMCID: PMC9705146 DOI: 10.1055/s-0042-1755253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction
Acute lateral patellar dislocation is a common knee injury pattern. However, coincidental osseous defect may be present in normal knees.
Purpose
Evaluate the characteristics of osseous bone defect and describe a new ancillary sign associated with lateral patellar dislocation.
Materials and Methods
Magnetic resonance imaging (MRI) of 50 consecutive patients referred following a traumatic lateral patellar dislocation of the knee joint and 50 patients with knee pain without MR features of patellar dislocation were obtained for evaluation over a 7-year period. They were analyzed for location of bony defects in the periarticular region.
Results
Of the 50 patients who underwent MRI following a reduced traumatic lateral patellar dislocation, 3 patients had an osseous “crater” of more than 2 mm in depth on the non-articular surface of the lateral femoral condyle. None of control group of patients had an osseous defect measuring more than 2 mm in depth.
Conclusion
This associated finding of an osseous “crater” of more than 2 mm on the non-articular surface of the lateral femoral condyle following traumatic lateral patellar dislocation is a rare occurrence. We highlight this as an ancillary sign of lateral patellar dislocation necessitating careful evaluation (Crater sign of Bhamidipaty Rajesh Iyengar Kartik [BRIK]). The presence of lateral femoral condyle “CRATER” sign of BRIK on MRI undertaken for other reasons in the knee, in the absence of osseous edema may suggest a past episode of severe, reduced patellar dislocation.
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Kong AP, Robbins RM, Stensby JD, Wissman RD. The Lateral Knee Radiograph: A Detailed Review. J Knee Surg 2022; 35:482-490. [PMID: 35062040 DOI: 10.1055/s-0041-1741391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Initial imaging evaluation for a variety of knee pathologies often begins with a radiographic series. Depending on the specific indication, this will include at least two different projections of the knee. In most cases, these are the anteroposterior and lateral radiographs of the affected knee, and sometimes with the contralateral knee for comparison. Typically, knee pathologies visible on lateral view can also be appreciated on the anteroposterior view. However, several pathologic processes occur in anatomic locations typically obscured on other projections because of superimposed osseous structures. Examples of these pathologies include injuries involving the quadriceps or patellar tendons, avulsion fractures involving anterior or posterior structures, and many soft-tissue injuries. Knowledge of the relevant anatomy and typical pathologies typically visualized on the lateral radiograph of the knee is imperative to avoid overlooking these disease processes.
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Affiliation(s)
- Andrew P Kong
- Department of Radiology, University of Missouri System, 1 Hospital Dr., Columbia, Missouri
| | - Robert M Robbins
- Department of Radiology, University of Missouri System, 1 Hospital Dr., Columbia, Missouri
| | - James D Stensby
- Musculoskeletal Imaging Division, Department of Radiology, Faculty of Clinical Radiology, University of Missouri System, Columbia, Missouri
| | - Robert D Wissman
- Musculoskeletal Imaging Division, Department of Radiology, Faculty of Clinical Radiology, University of Missouri System, Columbia, Missouri
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Hong CK, Lin YJ, Cheng TA, Chang CH, Hsu KL, Kuan FC, Su WR. Adult patients with ACL tears have greater tibial internal rotation in MRI compared to adolescent patients. J Orthop Surg Res 2022; 17:17. [PMID: 35016704 PMCID: PMC8753912 DOI: 10.1186/s13018-022-02912-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose To compare the anterior translation and internal rotation of tibia on magnetic resonance imaging (MRI) between adult and adolescent patients with anterior cruciate ligament (ACL) tears.
Methods Patients who underwent isolated ACL reconstruction from January 2013 to May 2021 were retrospectively reviewed. The exclusion criteria included incomplete data, poor image quality, a prior ACL surgery, and concomitant fractures or other ligament injuries. The enrolled patients were divided into two groups based on their ages: an adult group (age > 19 years) and an adolescent group (15 to 19 years of age). Anterior tibial translation and femorotibial rotation were measured on MRI. A Student’s t-test was used for the statistical analysis comparing the adult and adolescent groups. Results A total of 365 patients (279 adults and 86 adolescents) were enrolled in the present study. The anterior tibial translation in the adult group (4.8 ± 4.4 mm) and the adolescent group (5.0 ± 4.2 mm) was not significantly different (p = 0.740). On the other hand, the tibial internal rotation in the adult group (5.6 ± 5.0 degree) was significantly greater compared to the adolescent group (4.2 ± 5.6 degree) (p = 0.030). The intraclass correlation coefficients (ICC) of the measured data from two independent observers showed excellent reliability (0.964 and 0.961 for anterior tibial translation and tibial internal rotation, respectively). Conclusion The adult patients with ACL tears exhibited significant greater tibial internal rotation compared to the adolescent patients, whereas the magnitude of the anterior tibial translation was similar in both groups. Care should be taken if clinicians plan to establish the cutoff point values for diagnosis of ACL tears using the femorotibial internal rotation angle.
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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan.,Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yu-Ju Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan
| | - Ting-An Cheng
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan
| | - Chih-Hsun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan.,Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan.,Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70428, Taiwan. .,Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan. .,Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan City, Taiwan.
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Gong H, Qiao X, Chen L. [Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1200-1204. [PMID: 34523289 DOI: 10.7507/1002-1892.202104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. Methods The relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed. Results The LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury. Conclusion The diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.
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Affiliation(s)
- Heng Gong
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
| | - Xinrong Qiao
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Radiology, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
| | - Lianxu Chen
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, P.R.China.,Department of Orthopedics, Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University, Beijing, 102218, P.R.China
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Geeslin AG, Lemos DF, Geeslin MG. Knee Ligament Imaging: Preoperative and Postoperative Evaluation. Clin Sports Med 2021; 40:657-675. [PMID: 34509204 DOI: 10.1016/j.csm.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Preoperative and postoperative imaging of knee ligament injury hinges on the appropriate use of available modalities. Knowledge of injury patterns as well as the surgical significance of certain image findings enhances injury detection and supports appropriate preoperative planning. The radiologist must be familiar with the strengths and weaknesses of each modality for evaluating specific aspects of ligamentous pathology. This article focuses on preoperative and postoperative imaging of knee ligament injury. Basic topics pertaining to preoperative image modality selection and isolated injury detection are addressed. More advanced areas including ligamentous injury patterns, surgical indications, and postoperative imaging are also discussed.
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Affiliation(s)
- Andrew G Geeslin
- Department of Orthopedic Surgery, University of Vermont Medical Center, 192 Tilley Drive, South Burlington, VT 05403, USA
| | - Diego F Lemos
- Radiology and Orthopedic Surgery, University of Vermont Medical Center, Burlington, VT, USA; Department of Radiology, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Matthew G Geeslin
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Avenue, Burlington, VT 05401, USA.
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Berthold DP, Muench LN, Herbst E, Mayr F, Chadayammuri V, Imhoff AB, Feucht MJ. High prevalence of a deep lateral femoral notch sign in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus. Knee Surg Sports Traumatol Arthrosc 2021; 29:1018-1024. [PMID: 32440714 DOI: 10.1007/s00167-020-06071-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the prevalence of a deep lateral femoral notch sign (LFNS) in magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) and concomitant posterior root tears of the lateral meniscus (PLRT). METHODS A retrospective chart review was conducted to identify all patients undergoing ACL reconstruction between 2016 and 2018. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: isolated ACL tear (ACL-Group), ACL tear with concomitant lateral meniscus tear not involving the posterolateral root (Meniscus-Group), and ACL tear with concomitant PLRT (PLRT-Group). Incidence and depth of a LFNS on preoperative MRI was compared between the three cohorts. RESULTS 115 patients (mean age: 29.5 ± 11.3 years) were included in the study, with 58 patients (50.4%) assorted to the ACL-Group, 24 patients (20.9%) to the Meniscus-Group, and 33 patients (28.7%) to the PLRT-Group. The prevalence of a LFNS was significantly higher in the PLRT-Group (39.4%), when compared to the ACL- (5.2%) or Meniscus-Groups (25.0%; p < 0.001, respectively). Additionally, logistic regression analysis demonstrated that patients with PLRT were 5.3 times more likely to have a LFNS as compared to those without a lateral root tear (p < 0.001). CONCLUSION In patients with ACL tears, the presence of a LFNS on preoperative MRI may be predictive for a PLRT. As the LFNS occurs in almost 40% of the patients with combined ACL tears and PLRT, the LFNS may be a useful secondary diagnostic finding in early MRI diagnostic. Identifying PLRT on MRI is clinically relevant, as it prevents misdiagnosis and facilitates surgical decision-making, thus avoiding subsequent delayed treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Felix Mayr
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Vivek Chadayammuri
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Duggleby LS, Smith A. An Unusual Proximal Tibia Physis Injury in an Adolescent. Cureus 2020; 12:e12052. [PMID: 33447481 PMCID: PMC7802402 DOI: 10.7759/cureus.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tibial tuberosity fractures are uncommon but are usually seen in adolescents approaching skeletal maturity. Typically this fracture results from an avulsion of the tibial tuberosity as the powerful quadriceps overcome skeletal strength in passive flexion. We present the case of a 17-year-old female who presented with severe pain in her left knee sustained after stepping off a curb. She had no significant past medical history apart from a raised body mass index (BMI) of 46. Radiographs demonstrated that she had sustained a rare type of physeal injury not previously reported in the literature. This unique fracture developed along the physeal scar but interestingly the anterior cortex remained intact. Closed reduction of this fracture was attempted and the fracture healed uneventfully leaving a slight asymptomatic positive slope on the tibia.
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12
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Waite S, Farooq Z, Grigorian A, Sistrom C, Kolla S, Mancuso A, Martinez-Conde S, Alexander RG, Kantor A, Macknik SL. A Review of Perceptual Expertise in Radiology-How it develops, How we can test it, and Why humans still matter in the era of Artificial Intelligence. Acad Radiol 2020; 27:26-38. [PMID: 31818384 DOI: 10.1016/j.acra.2019.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
As the first step in image interpretation is detection, an error in perception can prematurely end the diagnostic process leading to missed diagnoses. Because perceptual errors of this sort-"failure to detect"-are the most common interpretive error (and cause of litigation) in radiology, understanding the nature of perceptual expertise is essential in decreasing radiology's long-standing error rates. In this article, we review what constitutes a perceptual error, the existing models of radiologic image perception, the development of perceptual expertise and how it can be tested, perceptual learning methods in training radiologists, and why understanding perceptual expertise is still relevant in the era of artificial intelligence. Adding targeted interventions, such as perceptual learning, to existing teaching practices, has the potential to enhance expertise and reduce medical error.
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Jacques T, Badr S, Michelin P, Lefebvre G, Dartus J, Cotten A. Joint Effusion and Bone Outlines of the Knee: Radiographic/MR Imaging Correlation. Magn Reson Imaging Clin N Am 2019; 27:685-699. [PMID: 31575400 DOI: 10.1016/j.mric.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knee radiographs are widely used in clinical practice. Many features can be depicted when a systematic analysis of the different views is performed. This article focuses on different types of joint effusion and on the analysis of the bone outlines of the knee, particularly on the lateral view. Systematic analysis of these bone outlines and knowledge of several key points are particularly useful for the depiction of abnormal bone morphology or positioning, and of several conditions, such as trochlear dysplasia, patellar dislocation, impaction fractures, or ligament injuries and avulsion fractures.
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Affiliation(s)
- Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France; Lille University School of Medicine, Faculté de Médecine Henri Warembourg, F-59045 Lille CEDEX, France; Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), Rue du Professeur, Emile Laine, 59037 Lille CEDEX, France.
| | - Sammy Badr
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France; Lille University School of Medicine, Faculté de Médecine Henri Warembourg, F-59045 Lille CEDEX, France; Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), Rue du Professeur, Emile Laine, 59037 Lille CEDEX, France
| | - Paul Michelin
- Department of Radiology, Rouen University Hospital, 1 Rue de Germont, 76031 Rouen Cedex 1, France; Imagerie de l'Appareil Locomoteur, CHU Rouen Normandie, 1 Rue de Germont, 76031 Rouen Cedex 1, France
| | - Guillaume Lefebvre
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France; Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), Rue du Professeur, Emile Laine, 59037 Lille CEDEX, France
| | - Julien Dartus
- Lille University School of Medicine, Faculté de Médecine Henri Warembourg, F-59045 Lille CEDEX, France; Department of Orthopedic Surgery, Lille University Hospital, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France; Service d'Orthopédie D, Hopital Roger Salengro, CHRU de Lille, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, Rue du Professeur Emile Laine, 59037 Lille CEDEX, France; Lille University School of Medicine, Faculté de Médecine Henri Warembourg, F-59045 Lille CEDEX, France; Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultations et d'Imagerie de l'Appareil Locomoteur (C.C.I.A.L.), Rue du Professeur, Emile Laine, 59037 Lille CEDEX, France
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Lodewijks PCAM, Delawi D, Bollen TL, Dijkhuis GR, Wolterbeek N, Zijl JAC. The lateral femoral notch sign: a reliable diagnostic measurement in acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2019; 27:659-664. [PMID: 30317524 PMCID: PMC6394542 DOI: 10.1007/s00167-018-5214-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/09/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the validity and inter- and intra-observer reliability of the lateral femoral notch sign (LFNS) as measured on conventional radiographs for diagnosing acute anterior cruciate ligament (ACL) injury. METHODS Patients (≤ 45 years) with a traumatic knee injury who underwent knee arthroscopy and had preoperative radiographs were retrospectively screened for this case-control study. Included patients were assigned to the ACL injury group (n = 65) or the control group (n = 53) based on the arthroscopic findings. All radiographs were evaluated for the presence, depth and location of the LFNS by four physicians who were blind to the conditions. To calculate intra-observer reliability, each observer re-assessed 25% of the radiographs at a 4-week interval. RESULTS The depth of the LFNS was significantly greater in ACL-injured patients than in controls [median 0.8 mm (0-3.1 mm) versus 0.0 mm (0-1.4 mm), respectively; p = 0.008]. The inter- and intra-observer reliabilities of the LFNS depth were 0.93 and 0.96, respectively. Secondary knee pathology (i.e., lateral meniscal injury) in ACL-injured patients was correlated with a deeper LFNS [median 1.1 mm (0-2.6 mm) versus 0.6 mm (0-3.1 mm), p = 0.012]. Using a cut-off value of 1 mm for the LFNS depth, a positive predictive value of 96% was found. CONCLUSION This was the first study to investigate the inter- and intra-observer agreement of the depth and location of the LFNS. The depth of the LFNS had a very high predictive value for ACL-injured patients and could be used in the emergency department without any additional cost. A depth of > 1.0 mm was a good predictor for ACL injury. Measuring the depth of the LFNS is a simple and clinically relevant tool for diagnosing ACL injury in the acute setting and should be used by clinicians in patients with acute knee trauma. LEVEL OF EVIDENCE Diagnostic study, level II.
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Affiliation(s)
- Prabath C. A. M. Lodewijks
- 0000 0004 0622 1269grid.415960.fDepartment of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands ,0000000090126352grid.7692.aDepartment of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Diyar Delawi
- 0000 0004 0622 1269grid.415960.fDepartment of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Thomas L. Bollen
- 0000 0004 0622 1269grid.415960.fDepartment of Radiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Gawein R. Dijkhuis
- 0000 0004 0622 1269grid.415960.fDepartment of Radiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- 0000 0004 0622 1269grid.415960.fDepartment of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Jacco A. C. Zijl
- 0000 0004 0622 1269grid.415960.fDepartment of Orthopaedic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
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Liu YW, Skalski MR, Patel DB, White EA, Tomasian A, Matcuk GR. The anterior knee: normal variants, common pathologies, and diagnostic pitfalls on MRI. Skeletal Radiol 2018; 47:1069-1086. [PMID: 29574492 DOI: 10.1007/s00256-018-2928-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/20/2018] [Accepted: 03/11/2018] [Indexed: 02/02/2023]
Abstract
The anterior aspect of the knee is host to an array of normal variants and potential pathology. These normal anatomic variants are often encountered and may mimic pathologies, leading to unnecessary work-up and treatments. On the other hand, there are several subtle abnormalities that may be easily overlooked or mistaken for variants or other injuries or diseases. Recognition of these diagnostic challenges is essential for radiologists to make an accurate diagnosis. This article reviews normal anatomical variants of ligaments, tendons, bones, and other important structures of the anterior knee, focusing on magnetic resonance imaging features. Commonly encountered injuries and abnormalities of the anterior knee and their diagnostic pitfalls are also discussed, highlighting findings on magnetic resonance imaging.
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Affiliation(s)
- Yong Wei Liu
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, CA, 90509, USA
| | - Matthew R Skalski
- Department of Radiology, Palmer College of Chiropractic - West Campus, San Jose, CA, 95134, USA
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - Anderanik Tomasian
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA
| | - George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite L1600, Los Angeles, CA, 90033, USA.
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Chan CYH, Tsang HHC, Kwok SKY. X-Ray Quiz: A Young Lady with Knee Pain - Radiographic Signs that you should know. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- CYH Chan
- Queen Elizabeth Hospital, Department of Diagnostic Radiology & Imaging, 30 Gascoigne Road, Hong Kong
| | - HHC Tsang
- Queen Elizabeth Hospital, Department of Diagnostic Radiology & Imaging, 30 Gascoigne Road, Hong Kong
| | - SKY Kwok
- Queen Elizabeth Hospital, Department of Diagnostic Radiology & Imaging, 30 Gascoigne Road, Hong Kong
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The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc 2015; 23:2250-2258. [PMID: 24797811 DOI: 10.1007/s00167-014-3022-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 04/19/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to determine the incidence of the "lateral femoral notch sign" in acute anterior cruciate ligament (ACL) tears and its correlation with lateral meniscal tears. METHODS Lateral plain radiographs and sagittal magnetic resonance images (each performed within 1 month following injury) of 500 patients with acute and arthroscopically confirmed ACL tears were retrospectively evaluated for depth, length and position of the "lateral femoral notch sign". The accompanying bone bruise was measured, as well. The correlation of the lateral femoral notch sign with high-risk and low-risk pivoting activities as well as with a lateral meniscus tear was evaluated. RESULTS A total of 26.4 % of the patients had a lateral femoral notch sign deeper than 2.0 mm with a mean depth of 2.8 ± 0.8 mm SD. All lateral femoral notches were situated near or slightly posterior to Blumensaat's line. ACL injuries sustained during high-risk pivoting sports were more prone to a lateral femoral notch sign than ACL injuries in low-risk pivoting sports (r = 0.107 vs r = -0.107). Of all patients with a lateral femoral notch sign, 40.2 % also had lateral meniscus tears. The correlation between the presence of the lateral femoral notch sign and lateral meniscus tears was statistically significant (p = 0.004). CONCLUSION In more than one-quarter of patients, plain radiographs may help to establish the diagnosis of an ACL tear. Further, a lateral femoral notch sign greater than 2.0 mm also correlates with lateral meniscus tears. Hence, the lateral femoral notch sign is a useful diagnostic tool in daily clinical practice. LEVEL OF EVIDENCE IV.
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L’encoche du condyle fémoral externe, un signe indirect majeur de rupture totale du ligament croisé antérieur. ANNALES FRANCAISES DE MEDECINE D URGENCE 2013. [DOI: 10.1007/s13341-013-0312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jaremko JL, Guenther ZD, Jans LBO, Macmahon PJ. Spectrum of injuries associated with paediatric ACL tears: an MRI pictorial review. Insights Imaging 2013; 4:273-85. [PMID: 23657940 PMCID: PMC3675256 DOI: 10.1007/s13244-013-0250-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/01/2013] [Accepted: 04/16/2013] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) injury are well known, but most published reviews show obvious examples of associated injuries and give little focus to paediatric patients. Here, we demonstrate the spectrum of MRI appearances at common sites of associated injury in adolescents with ACL tears, emphasising age-specific issues. METHODS Pictorial review using images from children with surgically confirmed ACL tears after athletic injury. RESULTS ACL injury usually occurs with axial rotation in the valgus near full extension. The MRI findings can be obvious and important to management (ACL rupture), subtle but clinically important (lateral meniscus posterior attachment avulsion), obvious and unimportant to management (femoral condyle impaction injury), or subtle and possibly important (medial meniscocapsular junction tear). Paediatric-specific issues of note include tibial spine avulsion, normal difficulty visualising a thin ACL and posterolateral corner structures, and differentiation between incompletely closed physis and impaction fracture. CONCLUSION ACL tear is only the most obvious sign of a complex injury involving multiple structures. Awareness of the spectrum of secondary findings illustrated here and the features distinguishing them from normal variation can aid in accurate assessment of ACL tears and related injuries, enabling effective treatment planning and assessment of prognosis. TEACHING POINTS • The ACL in children normally appears thin or attenuated, while thickening and oedema suggest tear. • Displaced medial meniscal tears are significantly more common later post-injury than immediately. • The meniscofemoral ligaments merge with the posterior lateral meniscus, complicating tear assessment. • Tibial plateau impaction fractures can be difficult to distinguish from a partially closed physis. • Axial MR sequences are more sensitive/specific than coronal for diagnosis of medial collateral ligament (MCL) injury.
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Affiliation(s)
- Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, 2A2.42 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2B7,
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Witjes S, Pels Rijcken TH, van der Hart CP. A 30-year-old woman with acute knee injury. Br J Sports Med 2012; 48:1390, 1394-6. [PMID: 23222194 DOI: 10.1136/bjsports-2012-090952a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Suzanne Witjes
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Cor P van der Hart
- Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands
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Sharma G, Naik VA, Pankaj A. Displaced osteochondral fracture of the lateral femoral condyle associated with an acute anterior cruciate ligament avulsion fracture: a corollary of "the lateral femoral notch sign". Knee Surg Sports Traumatol Arthrosc 2012; 20:1599-602. [PMID: 22113226 DOI: 10.1007/s00167-011-1795-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/14/2011] [Indexed: 12/11/2022]
Abstract
Anterior cruciate ligament (ACL) rupture is usually accompanied by bone contusions resulting from impact of tibia on femur. The injury sometimes becomes manifest as a depression on the lateral femoral condyle giving rise to "lateral femoral notch" sign. The authors describe a rare case of impaction of the tibia and femur resulting in an osteochondral fracture rather than the usual bone contusion, which frequently occurs with ACL rupture. Open reduction and internal fixation of both the ACL avulsion fracture and the osteochondral fracture from the lateral femoral condyle were done, and the patient had a good outcome at 1-year follow-up. Level of evidence V.
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Affiliation(s)
- Gaurav Sharma
- Department of Orthopedics, University College of Medical Sciences and GTB Hospital, Delhi, 110095, India.
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Ng WHA, Griffith JF, Hung EHY, Paunipagar B, Law BKY, Yung PSH. Imaging of the anterior cruciate ligament. World J Orthop 2011; 2:75-84. [PMID: 22474639 PMCID: PMC3302044 DOI: 10.5312/wjo.v2.i8.75] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/05/2011] [Accepted: 06/12/2011] [Indexed: 02/06/2023] Open
Abstract
The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging.
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Arthroscopic treatment of a large lateral femoral notch in acute anterior cruciate ligament tear. Arch Orthop Trauma Surg 2008; 128:1313-6. [PMID: 18060552 DOI: 10.1007/s00402-007-0535-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Indexed: 10/22/2022]
Abstract
A 24-year-old professional soccer player suffered an acute anterior cruciate ligament tear associated with a radiologically evident impression fracture of the lateral femoral condyle, the so-called "lateral femoral notch sign". Following MRI validation of the injury with detection of an additional lateral meniscus tear, arthroscopy was carried out 3 days after the injury. Due to the extended impression of about 5 mm, arthroscopically assisted closed reduction of the depression fracture was performed. A 3.2 mm tunnel was drilled at the lateral femoral condyle in a supero-inferior direction using an ACL tibial guide and the depressed area could be restored using an elevator. The resulting subchondral bone defect in the femoral condyle was filled with freeze-dried human cancellous bone allograft. As a one-stage procedure ACL reconstruction was carried out using a hamstring tendon technique. At 1-year follow up the patient has returned to full sporting function, including playing soccer with a radiographically reduced lateral femoral notch sign.
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Malghem J, Maldague B, Lecouvet F, Koutaïssoff S, Vande Berg B. Relecture des radiographies standard du genou : les surfaces articulaires. ACTA ACUST UNITED AC 2008; 89:692-7; quiz708-10. [DOI: 10.1016/s0221-0363(08)71505-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sadlo PA, Nebelung W. Arthroscopically assisted reduction of a lateral femoral notch in acute tear of the anterior cruciate ligament. Arthroscopy 2006; 22:574.e1-3. [PMID: 16651178 DOI: 10.1016/j.arthro.2005.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the case of a 20-year-old soccer player who suffered a tear of the anterior cruciate ligament with a depression fracture of the lateral femoral condyle. In addition to repairing the ligament we were able to arthroscopically reduce the depression fracture using a bioabsorbable screw. We tamped the surrounding cancellous bone with dilatators and chisels to create a bearing for an interference screw. This prepared for the placing of the screw and resulted in a sufficient reshaping of the condyle. We then inserted a threaded bioabsorbable interference screw into the lateral condyle under arthroscopic guidance to reline the fracture and reduce joint incongruity. Postoperative magnetic resonance imaging showed a significant reduction of the fracture.
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Affiliation(s)
- Philip A Sadlo
- Department of Arthroscopic Surgery, Marienkrankenhaus Orthopedic Hospital, Düsseldorf, Germany
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Prince JS, Laor T, Bean JA. MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. AJR Am J Roentgenol 2005; 185:756-62. [PMID: 16120930 DOI: 10.2214/ajr.185.3.01850756] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the MRI characteristics of anterior cruciate ligament (ACL) injuries and associated findings relative to skeletal maturity. We also contrast the frequency of findings in this younger population to adult data. MATERIALS AND METHODS Eighty-two consecutive knees with an MRI report diagnosis of ACL injury (partial tear, sprain, or complete tear) or tibial spine avulsion fracture imaged over 4 years were retrospectively reviewed. Patients were grouped by degree of skeletal maturity as determined from the MR images. The examinations were reviewed for the type of ACL injury, secondary imaging findings, and associated knee injuries. Findings were correlated to skeletal maturity, and frequencies were compared with adult data. RESULTS ACL injuries were more common in boys in the skeletally immature group, but more common in girls in the skeletally mature group (p = 0.03). Tibial spine avulsion fractures were most common in skeletally immature patients (p < 0.01), whereas complete tears of the ACL were most common in skeletally mature patients. Associated injuries were less common in the skeletally immature group, but this trend did not reach statistical significance. Most secondary signs of ACL injuries occurred at similar rates in all groups with frequencies similar to those reported in adults. CONCLUSION ACL injuries in skeletally immature patients are seen more often in boys. Tibial avulsion fractures and partial tears are more common in younger, less rigid skeletons that may absorb the forces of trauma. As children mature, complete ACL tears and associated injuries occur in frequencies approaching those patterns seen in adults. Similarly, skeletally mature girls are affected more often than mature boys.
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Affiliation(s)
- Jeffrey S Prince
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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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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