Imaging evaluation of the postoperative knee ligaments (original) (raw)
MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage
Skeletal Radiology, 2005
The surgical management of knee injuries has increased in recent years. Postoperative magnetic resonance (MR) imaging of the knee following surgical intervention serves an important role in the diagnostic evaluation of patients with recurrent or residual symptoms following surgical intervention. MR imaging additionally assists in the noninvasive documentation of temporal changes at the surgical site potentially reflective of procedural success, or failure. Background understanding of the common surgical procedures performed, their normal postoperative MR imaging appearance, and imaging features of potential procedural complications are essential in the accurate evaluation of patients following prior knee surgery. The focus of the following article is to review the clinical and MR imaging features of the postoperative knee following prior surgical treatment of ligamentous, meniscal, and articular cartilage injuries of the joint.
Imaging ACL reconstructions and their complications
Diagnostic and interventional imaging, 2015
Examination of ligament reconstructions, particularly of the anterior cruciate ligament (ACL), are common situations in everyday knee imaging practice. Knowledge of normal appearances, the expected changes over time and the potential complications of these plasties are essential. MRI is the imaging method of choice. This article illustrates the main complications specific to this procedure: suboptimal positioning of the femoral or tibial tunnels, impingement between the graft and bony contours, rupture (partial or complete) of the plasty due to friction or injury, arthrofibrosis and particularly the "Cyclops" syndrome, fragmentation or migration of the fixation materials and a granulomatous reaction to biomaterials.
American Journal of Sports Medicine, 2019
Background: Combined Anterior Cruciate Ligament (ACL) and Anterolateral ligament (ALL) reconstruction is associated with improved clinical outcomes compared to isolated intraarticular reconstruction but the indications are not precisely defined. It may be the case that patients with proven anterolateral injury on pre-operative imaging are most likely to benefit but the accuracy of MRI is not known. Hypothesis/Purpose: To evaluate the correlation between MRI findings and intra-operative anterolateral compartment exploration in acute ACL injured knees. The study hypothesis was that a positive correlation would be identified between imaging and surgical findings for injuries to the ALL/capsule and the iliotibial band and that pre-operative MRI would be associated with high sensitivity, specificity and accuracy for these parameters. Study Design: Case Series Methods: Between January 2016 to May 2016 patients presenting with an acute ACL injury were considered for study eligibility. A sample size calculation determined the numbers enrolled. Included patients underwent 1.5T MRI and this was evaluated by three investigators who attributed a Ferretti grade of injury to the anterolateral structures. At the time of ACL reconstruction, a lateral exploration was undertaken and macroscopic injuries were identified, classified and repaired. An evaluation of correlation between MRI and surgical exploration findings was performed. Results: patients participated in the study. 96% had an ALL/capsule injury. The sensitivity, specificity and accuracy of MRI in the evaluation of ALL/capsule injury, when using surgical exploration as a gold standard were 88%, 100% and 88.5% respectively. For evaluation of iliotibial band injury these values were 62.5%, 40% and 50%. The percentage agreement between MRI and surgical findings for ALL/capsule injury was 88% but only 65% for the ITB. The sensitivity and specificity of MRI for complete or partial tear of ALL and capsule were 78.6 and 41.7 respectively. The k test for correlation between surgical and MRI findigs was 0.27 for ITB abnormalities, 0.47 for ALL/capsule abnormalities, 0.23 for ALL/capsule determination of partial or complete tear and 0.49 for ALL/capsule determination of anterior or posterior tear. The overall percentage agreement between MRI and the classification based on surgical findings was only 53% and the Altman classification of kappa was fair. This suggests that whilst the classification is useful for description of surgical findings the grade cannot be reliably established from MRI, at least with the parameters used in the current study Conclusion: Surgical exploration demonstrates that injuries occur to the anterolateral structures in almost all acute ACL injured knees. Pre-operative MRI is highly sensitive, specific and accurate, for detection of abnormalities of the ALL/capsule and shows a high percentage of agreement with surgical findings. In contrast MRI has low sensitivity, specificity, and accuracy for the diagnosis of ITB injury. The agreement between MRI and surgical exploration with respect to ITB abnormality and determination of whether ALL/capsular tears were partial or complete was only fair.
La radiologia medica
MRI of the knee was performed in 30 patients who had been submitted to arthroscopically-guided reconstruction of the anterior cruciate ligament from patellar tendon. The autograft structure was investigated and MR results were correlated with clinical findings. Partial/total meniscectomy had been carried out in 21/30 cases. The patients were imaged at various postoperative intervals (3-24 months) by means of an 0.5-T magnet (GE MR Max Plus) in full knee extension and internal rotation. Sagittal and axial T1-weighted images (slice thickness: 3 mm) were combined with real-time reconstruction which better demonstrated the whole graft. T2-weighted coronal images (slice thickness: 5 mm) were also acquired. In each patient the following clinical variables were considered: anterior drawer sign, Lachman test, pivot shift, degree of leg extension, and finally functional recovery. The following MR variables were then considered: structure and alignment of bone tunnels, structure and signal in...
The Egyptian Journal of Radiology and Nuclear Medicine, 2011
This study was conducted to determine the magnetic resonance imaging (MRI) findings in cases of complications following anterior cruciate ligament (ACL) reconstructive surgery, and to correlate these complications with their possible etiological factors based on clinical and radiological criteria. Methods: The study included 48 symptomatic patients (40 males and 8 females) after arthroscopic ACL reconstruction in the period between 2006 and 2008. Clinical evaluation of the patients was performed using the International Knee Documentation Committee scoring system (IKDC). MRI was performed using 1.5 T dedicated system and a standard imaging protocol. The scans were then reviewed by two senior radiologists for the assessment of integrity of the reconstructed ligament and the presence of related complications. The findings were then analyzed and correlated with the clinical evaluation.
Advances in Orthopedics
Introduction. Recently, there has been a resurgence of interest in arthroscopic primary anterior cruciate ligament (ACL) repair. To date, no studies have assessed the role of postoperative magnetic resonance imaging (MRI) on the status and maturation of the repaired ligament. The goal of this study was therefore to assess (I) the accuracy of MRI on rerupture of the repaired ligament and (II) the maturation of the repaired ACL. Methods. All postoperative MRIs of patients that underwent arthroscopic primary ACL repair were included. A musculoskeletal radiologist, blinded for MRI indication, surgery-MRI time interval, and clinical stability, retrospectively assessed the ligament continuity and graded ligament maturation as hypointense (similar to intact PCL), isointense (>50% similar to PCL), or hyperintense (<50% similar to PCL). Results. Thirty-seven MRIs were included from 36 patients. Mean age was 30 years (range: 14–57 years), and mean surgery-MRI interval was 1.5 years (ran...
Anterior cruciate ligament reconstruction: the diagnostic value of MRI
International Orthopaedics, 1998
A prospective study was carried out in order to evaluate the predictive value of MRI in the early postoperative course after cruciate ligament replacement. Twenty patients who had undergone anterior cruciate ligament reconstruction using autologous patellar tendon/bone grafts were examined clinically and with contrast enhanced MRI at 2, 12 and 24 weeks, and 1 and 2 years after operation. The clinical findings were evaluated according to the scores established by Lysholm, OAK and IKDC. The MRI scans (SP 63, 1.5 Tesla) were assessed in terms of the quality and signal intensity of the reconstructed ligaments. During the first postoperative year there was a significant increase of signal intensity and in homogeneity of the neoligament on in the MRI. Seventeen patients had an average value for signal/noise of 1.1 at two weeks after surgery, which had increased to 7.1 at 1 year. In 14 patients the reconstructed ligament could not be evaluated in MRI scans after 1 year but clinical instability was not suspected in any of these patients. Two years after operation the MRI signal intensity of the neoligament was again decreasing. & p. 1 : Résumé. Une étude prospective a été faite, afin d'estimer la valeur de pronostic de l'IRM dans la phase postopératoire précoce du remplacement des ligaments croisés. 20 patients, avec des ligaments croisés antérieurs remplacés (transplantation autologue du tendon rotulien) ont été examinés cliniquement et à l'aide d'IRM de contraste, la 2e, 12e, 24e semaine post-opératoire et, 1 et 2 ans post-opératoires. Les examens cliniques ont été évalués selon le score de Lysholm, OAK et IKDC. Les imageries IRM (SP 63, 1.5 Tesla) ont été évaluées et mettant en évidence la qualité et l'intensité du signal du ligament reconstitué. Pendant la première année post-opératoire, on a noté à l'IRM une augmentation significative de l'intensité du signal et de la non-homogénéité du nouveau ligament chez 17 patients, avec une valeur moyenne du signal/écho allant de 1.1, 2 semaines postopératoire, jusqu' à 7.1, un an post-opératoire. Chez 14 patients dans la première année postopératoire, le ligament reconstitué a pu être visualisé à l'IRM, bien qu'aucun de ces patients n'ai eu un examen clinique suspect, quand à l'instabilité. A l'IRM post-opératoire de la deuxième année, l'intenstié du signal du nouveau ligament a à nouveau diminué, selon une constatation régulière.
ACL/PCL/MCL reconstruction: University of Pittsburgh arthroscopically assisted technique
Operative Techniques in Sports Medicine, 1999
Multiligament knee injuries involving the medial complex create multiplanar knee instability. Low-grade injuries to the medial complex are treated surgically after an initial delay to allow the medial complex to heal but Grade III injuries are treated more aggressively, with acute repair/reconstruction of these structures. This article describes the surgical approach at the Urdversity of Pittsburgh in treating these complex injuries.
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction We have previously reported results after 2-5 and 5-10 years follow-up of repair of acute anterior cruciate ligament (ACL) ruptures by suturing. Reports of results after more than 10 years are rare. Materials and methods A total of 140 patients were operated on in the period 1975-1983 (age range 13-71 years, median 28 years) by the modified Palmer technique. Only 2 meniscus resections and 4 meniscectomies were performed at the primary operation; while 28 menisci were sutured. At follow-up,12 patients were dead. Eighteen patients (13%) underwent repeat operations for secondary instability. Of the remaining 110 patients, 81 appeared for follow-up. Results Only 6 secondary meniscus resections were performed, all in the group of 18 patients operated on again for instability. No secondary meniscus surgery was performed on the 81 patients who appeared for follow-up. The median Lysholm score was 88, and 58 of the 81 patients (71%) classified their total knee function as good or excellent. By KT-1000 testing, 33 (41%) patients had less than 3 mm anterior instability, 29 (36%) had 3-5 mm instability, and 17 (21%) had more than 5 mm. With 18 patients from the total of 128 living patients re-operated for instability, we estimate the rate of total failure of stability as 27%. Radiological osteoarthritis grade C was present in 8 operated and 2 control knees, while only 1 operated knee revealed osteoarthritis grade D. Thirty-four operated and 20 control knees had grade B. Osteoarthritis was correlated to more advanced age at injury, while correlation to function could not be proven. Radiographs were obtained of 61 patients at followup. Conclusions Some 50% of patients had stable or slightly unstable knees, and 40% good or excellent function according to the Lysholm score. Re-operation for instability was more frequent in younger patients, while ostearthritis was more frequent in older patients. The rate of meniscus resection or extirpation was low. Open repair by suture is no longer recommended. Further research is indicated on the possible use of refixation of the ruptured ACL by arthroscopy.
Evaluation of the Anterolateral Ligament of the Knee in Magnetic Resonance Mri: Case Series
Acta Ortopédica Brasileira
Objective: To evaluate the citation of the ligament in the magnetic resonance imaging (MRI) reports and confirm its presence and injury in the images of exams performed in the acute phase retrospectively. Methods: In total, 103 patients who underwent anterior cruciate ligament (ACL) reconstruction in 2019 were included. The images were reanalyzed by two radiologists. Results: In the first analysis, only one report mentioned the anterolateral ligament (ALL) and its injury (0.97%). On reanalysis, ALL was visualized in almost all cases (95% and 97%). An injury was found in 53 (51.5%) cases by radiologist A and in 56 (54.4%) cases by radiologist B. The injury was diagnosed by both in 39 (37.9%) cases (p < 0.0001). Radiologists disagreed regarding the injury (Kappa = 0.411). Conclusion: The reports failed to describe the ligament and diagnose a significant number of injuries. The analysis of conventional resonance images still presents divergences in the diagnosis of ALL injury associ...
Results of the surgical reconstruction of the anterior cruciate ligament
Collegium Antropologicum, 2012
Results of the surgical reconstruction of the anterior cruciate ligament (ACL), using as a graft fourfold hamstring tendons (gracilis and semitendinosus) and middle third of the patellar ligament, were compared. In all patients that were participating in this study clinical examination and magnetic resonance showed ACL rupture, and apart from the choice of the graft, surgical technique was identical. We evaluated 112 patients with implemented patellar ligament graft and fourfold hamstring tendons graft six months after the procedure. Both groups were similar according to age, sex, activity level, knee instability level and rehabilitation program. The results showed that there was no significant difference between groups regarding Lysholm Knee score, IKDC 2000 score, activity level, musculature hypotrophy, and knee joint stability 6 months after the surgery. Anterior knee pain incidence is significantly higher in the group with patellar ligament graft (44% vs. 21%). Both groups had a...
Assessment of the anterolateral ligament of the knee by 1.5 T magnetic resonance imaging
The Journal of international medical research, 2018
Objective This study was performed to evaluate the visibility of the knee's anterolateral ligament (ALL) by magnetic resonance (MR) imaging when evaluating injuries of the ALL in relation to injuries of the anterior cruciate ligament (ACL). Methods Two reviewers retrospectively analyzed MR images for the visibility and dimensions of the ALL and the relationship between ALL and ACL injuries. The intraclass correlation coefficient (ICC) and kappa analysis were used to assess interobserver reliability. The chi-square test was used to assess the relationship between ALL and ACL injuries. Results The entire ALL was viewed on 82% of all MR images. The ICC for ALL visualization ranged from moderate to perfect between the two readers. There was almost perfect agreement between the reviewers when evaluating ALL dimensions. The mean length ± standard error, median thickness, and mean width ± standard error of the ALL were 36.5 ± 0.6 mm, 2.5 mm, and 8.2 ± 0.2 mm, respectively. A statistica...
Skeletal Radiology, 2013
Objective The aim of this study was to evaluate, with contrast-enhanced-magnetic resonance imaging (MRI), the changing imaging appearance of an anterior cruciate ligament (ACL) graft during the revascularization phase by quantitatively assessing the morphological and signal intensity changes taking place at its cross-sectional surface over time. Materials and methods Fifty patients underwent contrastenhanced-MRI on the third postoperative day and at a mean of 6, 12, and 24 months time interval after surgery. Protondensity images were obtained to evaluate morphological and signal intensity characteristics. Oblique-axial T1-weighted images obtained before and after intravenous gadolinium administration were used for quantitative analysis. Enhancement index (EI: signal-to-noise quotient after gadolinium ÷signal-to-noise quotient before gadolinium ) and cross-sectional area (CSA) were calculated for two regions of interest: the transplanted graft and its surrounding hypervascular tissue, and at three distinct graft sites (intra-articular, intraosseous tibial tunnel, and intraosseous juxta screw sites). Comparisons of EI and CSA at every site and time interval were performed using analysis of variance. Results A variable MRI appearance of the graft during the different time intervals was attributed to the varying amount of the hypervascular tissue gradually surrounding the graft. Graft EI and peripheral tissue CSA progress in a parallel, time-and site-related pattern along the graft course. The initial heterogeneity with intermediate signal intensity at the intra-articular graft site reflected intense revascularization. A slower revascularization progress was noticed at the other two intraosseously enclosed sites. Conclusion During the healing process the amount of revascularization tissue influences the MR imaging characteristics of the graft according to the examined site and the time interval after surgery. By 2 years postoperatively, revascularization completion coincides with the homogeneously low signal intensity of the graft, closely resembling native ACL.