Knee Ligament Injury in Athletes. Laura W. Bancroft, M.D

Knee Ligament Injury in Athletes Laura W. Bancroft, M.D. Objectives • To review the imaging appearance of knee ligament injury in athletes: – – – – ...
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Knee Ligament Injury in Athletes Laura W. Bancroft, M.D.

Objectives • To review the imaging appearance of knee ligament injury in athletes: – – – – – –

Anterior cruciate ligament (ACL) Posterior cruciate ligament (PCL) Medial collateral ligament (MCL) Lateral collateral ligament (LCL) Patellofemoral ligament Iliotibial band

Knee Injuries FORCE Anterior Translation Posterior Translation Varus (medial to lateral) Valgus (lateral to medial) Internal Rotation (femur fixed) External Rotation (femur fixed)

RESISTANCE ACL PCL LCL MCL LCL MCL

Hyperextension

PCL

•Hayes CW, et al. Mechanism-based pattern approach to classificaiton of complex injuries of the knee depicted at MR imaging. RadioGraphics 2000; 20:S121-134.

ANTERIOR CRUCIATE LIGAMENT

posterolateral

posterolateral

Normal 2 bands – posterolateral and anteromedial

anteromedial

anteromedial

Normal 2 bands – posterolateral and anteromedial

Mucinous degeneration of ACL + ACL ganglion

Mucinous degeneration of ACL + ACL ganglion

ACL ganglion

Posterolateral bundle

Partial tear

Torn near femoral origin

Midsubstance tear

Torn near tibial attachment

Chronic ACL tear

Buckled PCL

Anterior drawer sign

*

ACL • Contusions – Posterior lateral tibial plateau • “7” sign

– Lateral femoral condyle (coup) • Deep lateral sulcus

– Medial femoral condyle (contrecoup)

ACL tear

Coup and contrecoup contusions

Coup contusions

Contrecoup contusions

ACL • Adolescents may have same contusion pattern as adults, but may preserve ACL • Increased ligamentous laxity

ACL

Tibial avulsion fracture at ACL attachment

ACL Sprain with marrow edema

O’Donoghue’s Triad

Segond fracture • Cortical avulsion of the tibia at the insertion of the middle 1/3 of the lateral capsular ligament • Internal rotation and varus stress • High association with: – ACL injuries (75-100%) – Meniscal tears (66-75%) – Posterolateral corner of knee

Segond fracture

Segond fracture + ACL tear

Knee Dislocation

Knee Dislocation

Knee Dislocation

ACL torn and fibrosed to PCL

Posterior Cruciate Ligament

PCL sprain

PCL sprain

PCL sprain

PCL partial tear

PCL sprain – high grade

PCL sprain

PCL ganglion

PCL rupture

PCL rupture

PCL rupture

Medial Collateral Ligament

MCL sprain

MCL sprain

MCL

MCL sprain

MCL partial thickness tear

MCL distal rupture

MCL high grade partial tear and femoral epicondylar spurring

MCL grade 2 sprain

MCL – avulsive marrow changes deep fiber rupture

MCL rupture deep fibers and near complete rupture of superficial fibers

•Schweitzer ME, et al. Medial collateral ligament injuries. Radiology 1995; 194:825-829.

MCL mid rupture

MCL distal rupture

Pellegrini-Stieda calcifications

Pelligrini-Stieda calcifications

uptu

MCL bursitis

Edema-like signal about the MCL: -MCL sprain -osteoarthrosis -extruded meniscus

Lateral Collateral Ligament

Fibular collateral ligament sprain

Fibular collateral ligament rupture

Patellofemoral Ligament

Patellofemoral ligament avulsion

Patellofemoral ligament avulsion

Patellofemoral ligament avulsion

Patellofemoral ligament avulsion

Patellofemoral ligament avulsion

Iliotibial Band

Iliotibial Band Friction Syndrome – Repetitive flexion and extension – Friction against lateral femoral condyle – Runners

Muhle C, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology 1999; 212:103-110. Nishimura G, et al. MR findings in iliotibial band syndrome. Skeletal Radiol 1997; 26:533-537.

Iliotibial Band Friction Syndrome – Repetitive flexion and extension – Friction against lateral femoral condyle – Runners

Muhle C, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology 1999; 212:103-110. Nishimura G, et al. MR findings in iliotibial band syndrome. Skeletal Radiol 1997; 26:533-537.

Iliotibial band friction syndrome

Iliotibial band friction syndrome

Conclusion • The integrity of the anterior cruciate ligament can be assessed by primary and multiple secondary signs, and can be associated with multiple other injuries involving the MCL, menisci and medial tibial rim

Conclusion • Posterior cruciate ligament sprains are more common than full thickness tears • Medial collateral ligament tears are associated with valgus forces and can be part of O’Donoghue’s triad

Conclusion • Lateral collateral ligaments tears are due to varus force and often involve the conjoined tendon • Patellofemoral ligament strains and tears should be sought in patients with PDRS • Iliotibial band syndrome occurs in runners, with thickening and fluid deep to the iliotibial band

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