Common mistakes and pitfalls in magnetic resonance imaging of the knee

This pictorial review presents an overview of common interpretation errors and pitfalls in magnetic resonance imaging (MRI) of the knee. Instead of being exhaustive, we will emphasize those pitfalls that are most commonly encountered by young residents or less experienced radiologists

Clinical examination, MRI and arthroscopy in meniscal and ligamentous knee Injuries – a prospective study

Data from 565 knee arthroscopies performed by two experienced knee surgeons between 2002 and 2005 for degenerative joint disorders, ligament injuries, loose body removals, lateral release of the patellar retinaculum, plica division, and adhesiolysis was prospectively collected. A subset of 109 patients from the above group who sequentially had clinical examination, MRI and arthroscopy for suspected meniscal and ligament injuries were considered for the present study and the data was reviewed. Patients with previous menisectomies, knee ligament repairs or reconstructions and knee arthroscopies were excluded from the study. Patients were categorised into three groups on objective clinical assessment: Those who were positive for either meniscal or cruciate ligament injury [group 1]; both meniscal and cruciate ligament injury [group 2] and those with highly suggestive symptoms and with negative clinical signs [group 3]. MRI was requested for confirmation of diagnosis and for additional information in all these patients. Two experienced radiologists reported MRI films. Clinical and MRI findings were compared with Arthroscopy as the gold standard. A thorough clinical examination performed by a skilled examiner more accurately correlated at Arthroscopy. MRI added no information in group 1 patients, valuable information in group 2 and was equivocal in group 3 patients. A negative MRI did not prevent an arthroscopy. In this study, specificity, positive and negative predictive values were more favourable for clinical examination though MRI was more sensitive for meniscal injuries. The use of MRI as a supplemental tool in the management of meniscal and ligament injuries should be highly individualised by an experienced surgeon

Spinal involvement in mucopolysaccharidosis IVA (Morquio-Brailsford or Morquio A syndrome): presentation, diagnosis and management.

Mucopolysaccharidosis IVA (MPS IVA), also known as Morquio-Brailsford or Morquio A syndrome, is a lysosomal storage disorder caused by a deficiency of the enzyme N-acetyl-galactosamine-6-sulphate sulphatase (GALNS). MPS IVA is multisystemic but manifests primarily as a progressive skeletal dysplasia. Spinal involvement is a major cause of morbidity and mortality in MPS IVA. Early diagnosis and timely treatment of problems involving the spine are critical in preventing or arresting neurological deterioration and loss of function. This review details the spinal manifestations of MPS IVA and describes the tools used to diagnose and monitor spinal involvement. The relative utility of radiography, computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of cervical spine instability, stenosis, and cord compression is discussed. Surgical interventions, anaesthetic considerations, and the use of neurophysiological monitoring during procedures performed under general anaesthesia are reviewed. Recommendations for regular radiological imaging and neurologic assessments are presented, and the need for a more standardized approach for evaluating and managing spinal involvement in MPS IVA is addressed

Anterior Cruciate Ligament injury, Patient Variables, Outcomes and Knee Osteoarthritis

The ruptured anterior cruciate ligament (ACL) leads to immediate symptoms that severely affect the individual and receives great attention among the scientific community, yet there is still no consensus on the optional form of treatment. An ACL injury is also a well known high risk factor for the development of knee osteoarthritis (OA) some decades later. Knee OA development after an ACL injury is multi-factorial. All patient variables must be further explored before better guidelines on ACL injury treatment can be issued. I studied 100 patients with an acute complete ACL tear over 15 years and evaluated the outcome after a primary non-surgical treatment algorithm based on early neuromuscular knee rehabilitation by a physical therapist and initial activity restrictions. Patients had less radiographic knee OA than in historical retrospective studies, and still had very small subjective symptoms. When OA was present, a concomitant meniscal injury treated by means of partial meniscectomy was the most important risk factor. Another cohort of 29 ACL-injured patients were examined with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to estimate cartilage GAG content, as a proxy for cartilage integrity. Results indicated knee cartilage GAG changes 2 years after an ACL injury. Patients who had sustained a meniscectomy, or had a BMI > 25 kg/m2, had the most impaired cartilage quality, which supports the contention that this method can detect a cartilage matrix change that may be indicative of increased risk of OA. The data presented can help medical staff in decision-making when treating the ACL-injured patient

Outcome of Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament

Mucoid degeneration of the anterior cruciate ligament is a rare pathological entity. Several authors have identified this condition, described their experiences, and suggested their own guidelines for management. The aim of this study was to detail the clinical, radiological, arthroscopic, and pathological findings of mucoid degeneration of the anterior cruciate ligament and report the clinical outcomes following arthroscopic treatment. A historical cohort of patients who underwent arthroscopic total or partial excision of the anterior cruciate ligament due to mucoid degeneration between 2011 and 2014 were reviewed. The minimum follow-up was 3 years. Demographic, radiological, and histological findings, type of surgery, and clinical pre- and postoperative data were analyzed. The visual analogue scale score, the International Knee Documentation Committee score, and the Tegner Lysholm Knee Score were collected preoperatively, postoperatively, and during the follow-up period. Seventeen females (67%) and eight males (33%) were included in the final analysis. The mean age at the time of surgery was 57 years (range, 31 to 78 years). Partial resection of the anterior cruciate ligament was done in seven cases and a complete resection in 18 cases. No reconstruction was performed at the same time. A positive Lachman test and a negative pivot shift were noted after surgery in all cases. Anterior cruciate ligament reconstruction was required in only one young patient due to disabling instability. At last follow-up, the mean visual analogue scale score, International Knee Documentation Committee score, and Tegner Lysholm Knee score improved (p < 0.01). Our study provides further evidence that arthroscopic total or partial excision of anterior cruciate ligament is a safe and effective treatment for mucoid degeneration of the anterior cruciate ligament, improving patient satisfaction and function without causing clinical instability in daily activities. However, young patients should be forewarned about the risk of instability, and an anterior cruciate ligament reconstruction could be necessary

Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years

ObjectivesTo assess the impact of cyclops lesions with MRI in patients treated for anterior cruciate ligament (ACL) tears on clinical outcome.MethodsIn 113 patients (age 29.8 ± 10.5y; 55 females; BMI 24.8 ± 3.7&nbsp;kg/m2) with complete ACL tear, 3&nbsp;T-MRI scans were obtained before, 6-months, 1-year (n = 75) and 2-years (n = 33) after ACL reconstruction. Presence and volume of cyclops lesions were assessed. Clinical outcomes were measured using the Knee injury and Osteoarthritis Outcome Score (KOOS) and differences between time points (∆KOOS) were calculated. Changes of KOOS subscales were compared between patients with and without cyclops lesion. KOOS was also correlated with lesion volume.ResultsCyclops lesions were found in 25% (28/113), 27% (20/75) and 33% (11/33) of patients after 6-months, 1- and 2-years, respectively. The lesion volume did not change significantly (P &gt; 0.05) between time points, measuring 0.65 ± 0.59, 0.81 ± 0.70 and 0.72.9 ± 0.96&nbsp;cm3, respectively. Clinical outcomes based on KOOS subscales were not significantly different in patients with cyclops lesions compared to those without cyclops lesions (each comparison P &gt; 0.05), and no significant associations of clinical outcomes with lesion volume were found (P &gt; 0.05).ConclusionsNeither presence nor size of cyclops lesions within the first 2-years after ACL surgery were associated with inferior clinical outcome.Key points• Cyclops lesions had a prevalence of 25% in patients after ACL reconstruction. • Subjects with cyclops lesions did not have an inferior clinical outcome. • Cyclops lesions developed within the first 6&nbsp;months after surgery. • The size of cyclops lesions did not significantly change over a period of 2&nbsp;years

The loss of anterior cruciate ligament integrity and the development of radiographic knee osteoarthritis

The knee is one of the most commonly injured joints with injury to the anterior cruciate ligament (ACL) being strongly associated with an increased risk of knee osteoarthritis (OA). As the risk of ACL injury is highest amongst adolescents who participate in sports the majority of the literature has focused on knee injury amongst this cohort. It is not currently understood whether a similar relationship exists in an elderly population. This thesis utilised participants from two different cohorts, the first being the Osteoarthritis Initiative (OAI), which is an ongoing 10-year, multi-centered, prospective observational study designed to identify risk factors for the development and progression of knee OA. This cohort was utilized in chapters 3, 5, 6 and 7 to investigate whether elderly individuals with an ACL tear were at an increased risk of radiographic knee OA and to further examine the relationship between the severity of radiographic disease and the extent of injury to the ACL and the surrounding tissues as well as for the presence of knee symptoms. The second cohort was a 15-year prospective, longitudinal, single center study that contained participants who underwent primary reconstruction following ACL rupture. This cohort was utilized in chapter 4 to assess whether an age-related dose-response relationship existed for incident radiographic knee OA following ACL injury. Overall, knees that had a loss of ACL integrity secondary to age-related degeneration did not have an increased risk of incident radiographic knee OA. However, an ACL injury sustained in an aged knee was associated with an increased risk of radiographic OA development within the first 5 to 10 years of the initial injury and an increased risk of region specific disease progression secondary to meniscal and subchondral bone pathology. Overall joint damage patterns were similar amongst individuals with either a partial or complete ACL rupture suggesting that joint health carries a similar prognosis regardless of the extent of ACL fiber disruption. Finally, a loss of ACL integrity and radiographic OA severity was also associated with knee disability. Whilst injuries amongst the younger, active population have been the focus of study for the association of injuries and OA, injury amongst older adults demands significant attention

Chondral Injury Associated With ACL Injury: Assessing Progressive Chondral Degeneration With Morphologic and Quantitative MRI Techniques.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are associated with a risk of post-traumatic osteoarthritis due to chondral damage. Magnetic resonance imaging (MRI) techniques provide excellent visualization and assessment of cartilage and can detect subtle and early chondral damage. This is often preceding clinical and radiographic post-traumatic osteoarthritis. HYPOTHESIS: Morphologic and quantitative MRI techniques can assess early and progressive degenerative chondral changes after acute ACL injury. STUDY DESIGN: Prospective longitudinal cohort. LEVEL OF EVIDENCE: Level 3. METHODS: Sixty-five participants with acute unilateral ACL injuries underwent bilateral knee MRI scans within 1 month of injury. Fifty-seven participants presented at 6 months, while 54 were evaluated at 12 months. MRI morphologic evaluation using a modified Noyes score assessed cartilage signal alteration, chondral damage, and subchondral bone status. Quantitative T1ρ and T2 mapping at standardized anatomic locations in both knees was assessed. Participant-reported outcomes at follow-up time points were recorded. RESULTS: Baseline Noyes scores of MRI detectable cartilage damage were highest in the injured knee lateral tibial plateau (mean 2.5, standard error (SE) 0.20, P &lt; 0.01), followed by lateral femoral condyle (mean 2.1, SE 0.18, P &lt; 0.01), which progressed after 1 year. Longitudinal prolongation at 12 months in the injured knees was significant for T1ρ affecting the medial and lateral femoral condyles (P &lt; 0.01) and trochlea (P &lt; 0.01), whereas T2 values were prolonged for medial and lateral femoral condyles (P &lt; 0.01) and trochlea (P &lt; 0.01). The contralateral noninjured knees also demonstrated T1ρ and T2 prolongation in the medial and lateral compartment chondral subdivisions. Progressive chondral damage occurred despite improved patient-reported outcomes. CONCLUSION: After ACL injury, initial and sustained chondral damage predominantly affects the lateral tibiofemoral compartment, but longitudinal chondral degeneration also occurred in other compartments of the injured and contralateral knee. CLINICAL RELEVANCE: Early identification of chondral degeneration post-ACL injury using morphological and quantitative MRI techniques could enable interventions to be implemented early to prevent or delay PTOA

Prevalence of radiographic and symptomatic knee OA 10 years after ACL injury: Between patients treated surgical or non-surgical

Masteroppgave - Norges idrettshøgskole, 2021Background: Following an Anterior Cruciate Ligament (ACL) injury, there is an 3-4 times increased chance of developing post-traumatic osteoarthritis (PTOA). After an ACL injury, the treatment options are typically an ACL Reconstruction (ACLR) with rehabilitation or rehabilitation-alone. Earlier studies have shown no difference between these two groups regarding pain, symptoms, or radiographic Osteoarthritis (OA). But more high-quality research surrounding the prevalence of symptomatic and radiographic OA is warranted. Objective: Investigate the differences in prevalence of symptomatic and radiographic knee OA in those treated with ACLR and those treated with rehabilitation alone, 10 years after an ACL injury. Material and Methods: The data used is derived from the Norwegian part of the Delaware-Oslo ACL Cohort study. Of the 123 eligible for the 10-year follow up, 84.5% (n=104) agreed to participate. The primary outcome measures were x-rays of the knee diagnosing tibial-femoral joint (TFJ) and patella-femoral joint (PFJ) OA using the Kellgren & Lawrence grading. The prevalence of symptomatic OA was decided by applying three different models based on a combination of knee pain, Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire subscale scores, and radiographic OA. Results: There was no significant difference between the two groups of ACLR and rehabilitation-alone regarding the prevalence of radiographic OA and symptomatic OA. A low prevalence of radiographic OA was observed in both groups. The prevalence in the ACLR group was 11.9% TFJ OA and 10.2% PFJ OA in the injured knee. The prevalence in the rehab-alone group was 0% TFJ OA and 4.3% PFJ OA in the injured knee. The highest prevalence of symptomatic OA was observed when applying the third model, where there was a prevalence of 13.2% symptomatic TFJ OA and 14.7% PFJ symptomatic OA in the ACLR group, and a prevalence of 26% symptomatic TFJ OA and 17.4% PFJ symptomatic OA in the rehabilitation alone group. Conclusion: Following 10 years post ACL injury, there were no significant differences between the ACLR group and rehabilitation alone group regarding the prevalence of radiographic and symptomatic OA.Institutt for idrettsmedisinske fag / Department of Sports Medicin