Orienting the imaging planes according to the calculated angular deviation allows the full-length visualization of the ligaments and is the basis for optimal imaging of the lateral ankle ligaments. The MR examinations included routine sequences and oblique coronal T2-weighted images, which oriented in parallel to the course of the femoral intercondylar roof. anatomical dimensions, but it remains unknown whether side-to-side differences preclude using the contralateral as a valid surrogate for the ruptured ACL. Observed changes in ACL cross‐sectional area‐to‐length ratio indicate that age‐ and sex‐dependent changes in ACL size are not homogenous. A controlled, prospective study of 30 patients with suspected acute internal derangement of the knee was undertaken to evaluate the sensitivity, specificity, predictive value, and accuracy of nonorthogonal (oblique) sagittal magnetic resonance imaging (MRI) in the assessment of anterior cruciate ligament (ACL) injuries. Magnetic resonance imaging is the most sensitive, specific, and accurate noninvasive method for diagnosing internal derangement of the knee. 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. The trends seen in normalized ACL size measurements suggest that unlike ACL cross‐sectional area, ACL length is primarily controlled by body size. L'amélioration de la qualité des images IRM (1,5 et 3 Tesla, antenne genou ... excellent MR imaging of the entire length of the anterior cruciate ligament in its oblique sagittal plane. This article is protected by copyright. 3D paths along the course of the ACL and corresponding tangents were constructed. Axial proton density-weighted (PDw) images of the knees of 20 volunteers were obtained. Magnetic resonance images of 269 unique knees (3‐18 years old; 51% female) were used to measure ACL length, cross‐sectional area, length‐to‐cross‐sectional area ratio, and elevation angles. The imaging diagnosis should be based on primary signs, although the secondary signs are sometimes useful, particularly in chronic cases. Most importantly, stiffness and muscular strength increase stress on the anterior cruciate ligament in female athletes. The study data support our hypothesis that sex differences in anterior cruciate ligament tear rates are caused primarily by several interrelated intrinsic factors. This pictorial essay reviews the MRI appearance of normal and injured cruciate ligaments. A focus is put on distinct diseases including intra-articular and intraosseous ganglion cysts, iliotibial band friction syndrome, transient osteoporosis, osteonecrosis, osteochondritis dissecans, and imaging of the articular cartilage. Thirty patients with acute hemarthroses underwent MRI within 12 days of injury, followed by arthroscopy within 24 h of the MRI. We believe that we have demonstrated the superiority of T2-weighted nonorthogonal sagittal over conventional orthogonal sagittal ACL MRI in the evaluation of ACL injury. L’objectif de cette mise au point est de présenter les différents signes IRM directs et indirects de rupture du ligament croisé antérieur (LCA), puis de définir les lésions associées. It is important to establish the distinction between a partial and total tear since it modifies the therapeutic management: a partial tear can heal with functional treatment, which is not the case for complete tears [1,41]. To investigate the three-dimensional (3D) course of the anterior cruciate ligament (ACL) and determine the optimum planes for oblique full-length MRI of the ligament. In both males and females, ACLs became longer, thicker, and more vertical in sagittal and coronal planes by increasing age (R² > 0.2, P < 0.001 for all associations). To read the full-text of this research, you can request a copy directly from the authors. The detection of associated injuries of other structures of the knee, including menisci, collateral ligaments, cartilage, and bone, are also important. The severity of the ACL injury was graded using a 4-point system from MR images, namely, intact, low-grade partial tear, high-grade partial tear, and complete tear, and results were compared with arthroscopic findings. The radiographers did perform additional ACL sequences in 63 patients (27%). We describe a simple technique that consistently produces excellent MR imaging of the entire length of the anterior cruciate ligament in its oblique sagittal plane. We evaluated multiple MRI features to compare their sensitivity and specificity for detecting ACL tears. To determine the three-dimensional orientation of the lateral ankle ligaments with MRI. Between 10 degrees and 20 degrees of external rotation of the knee is considered ideal. Mechanisms of injury, primary and secondary MRI signs, and associated abnormalities are discussed. Only two patients (0.9%) were recalled for additional sequences by the radiologist, and one ACL was normal and one had a full thickness tear at arthroscopy. The entire ACL and the meniscus were imaged by oblique sagittal and midsagittal PD-FS, respectively, with the following parameters: TR/TE = 3000/33 ms, field of view (FOV) = 150 × 150 mm, slice thickness = 4 mm, matrix = 320 × 240, pixel size = 0.6 × 0.5 × 4.0 mm, number of excitations = 1, flip angle = 150 degrees, bandwidth = 240 Hz/pixel, and scan time = 2:32 min, ... MRI has a high diagnostic performance for complete ACL ruptures 4 . Of the secondary findings anterior tibial displacement was the best predictor of ligamentous injury. Sa conformation anatomique lui offre une capacité de ciatrisation en cas de lésion. Particular emphasis is put on the evaluation of three different quantitative parameters, including a simplified method for measuring the ACL angle. The MRI sequences were evaluated in a blinded fashion by three radiologists, and compared to the knee arthroscopy findings, with the normal ACL acting as internal controls. Oblique sagittal images prescribed off a coronal localizer are both subjectively and objectively more effective than axially prescribed sagittal obliques in evaluating the ACL. In the evaluation of partial ACL injury, four partial tears were correctly diagnosed on nonorthogonal MRI, with one false-positive diagnosis. Results showed significantly higher anterior cruciate ligament injury rates in both female sports compared with the male sports. Le LIGAMENT CROISE POSTERIEUR (LCP) est un des ligaments croisés du genou. Il chemine vers le haut, l'avant et le côté pour s'insérer dans la partie antérieure latérale du condyle médial du fémur. After routine orthogonal sequences, if general MRI radiographers, with over four years experience, were not able to identify the presence of the ACL, then two 3D volume sequences and 2D limited sagittal oblique T1 sequences were performed. Patients requiring extra sequences, missed by the radiographers, were recalled. Apport de l’IRM dans le diagnostic des ruptures traumatiques du ligament croisé antérieur, The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament, Quantitative T2-Mapping and T2 ⁎ -Mapping Evaluation of Changes in Cartilage Matrix after Acute Anterior Cruciate Ligament Rupture and the Correlation between the Results of Both Methods, Diagnostic performance of volume and limited oblique MRI of the anterior cruciate ligament compared to knee arthroscopy, Age‐Related Changes in ACL Morphology During Skeletal Growth and Maturation Are Different Between Females and Males, Radiographer led supplementary anterior cruciate ligament MRI sequences: Technical report, Magnetic Resonance Imaging of Cruciate Ligament Injuries of the Knee, MRI of the lateral ankle ligaments: Value of three-dimensional orientation, Anterior cruciate ligament: Oblique sagittal MR imaging, Accuracy of nonorthogonal magnetic resonance imaging in acute disruption of the anterior cruciate ligament, Oblique Sagittal MRI of Anterior Cruciate Ligament, Knee Injury Patterns Among Men and Women in Collegiate Basketball and Soccer: NCAA Data and Review of Literature, MRI of normal anterior cruciate ligament (ACL) and reconstructed ACL: Comparison of when the knee is extended with when the knee is flexed, Correlation of Anthropometric Measurements, Strength, Anterior Cruciate Ligament Size, and Intercondylar Notch Characteristics to Sex Differences in Anterior Cruciate Ligament Tear Rates, Oblique sagittal view of the anterior cruciate ligament: Comparison of coronal vs. axial planes as localizing sequences, Grading of anterior cruciate ligament injury. The coronally prescribed sagittal oblique was subjectively preferred in 18 patients, the axially prescribed oblique was preferred in one patient, and both sequences were felt to be equivalent in 12 patients. The anterior cruciate ligament, when adjustments have been made for body weight, is smaller in female athletes, and therefore, probably does not compensate for the lack of stiffness and strength. We performed a prospective study based on the hypothesis that physiologic differences exist between men and women in strength after adjustments for body weight; that the size of the anterior cruciate ligament is proportionate to the strength of its antagonists, the quadriceps muscles; and that women have a relatively small anterior cruciate ligament, thus predisposing them to a disproportionate number of anterior cruciate ligament injuries. With a threshold value of 45 degrees the ACL angle reached a sensitivity and specificity of 100% for detecting ACL tears. To ascertain whether radiographers could identify patients requiring supplementary MRI sequences of anterior cruciate ligament (ACL) tears, without a supervising radiologist.Methods Oblique sagittal images parallel to the ACL were obtained at various flexed angles of the knee joint. The MRI sequences were independently evaluated in a blinded fashion by two consultant radiologists and a specialist radiology registrar and compared to the subsequent knee arthroscopy, as the gold standard, to determine the diagnostic performance statistics.ResultsThe cohort was on the knee arthroscopy weighting list and comprised 205 patients with chronic, 20 acute and 6 acute on chronic mechanical knee symptoms. A control population of 30 chondromalacia patients underwent similar evaluation. The usual MRI sequences for the knee are sagittal T1 , and proton density-weighting with fat saturation (PD fat-sat) in the three axial, coronal and sagittal planes. Conclusion You can request the full-text of this article directly from the authors on ResearchGate. The early degeneration could occur in various knee cartilage compartments after acute ACL rupture, especially in the superficial layer of LT. T2⁎-mapping might be more sensitive in detecting deep layer of cartilage than T2-mapping. Full-length visualization of the ACL was demonstrated by 1.4 slices using the sagittal oblique plane prescribed for RFL-1, 2.4 slices using the sagittal oblique plane prescribed for RFL-2, and 1.4 slices using the coronal oblique plane prescribed for RFL-3. With adjustments for body weight, the size of the anterior cruciate ligament in girls was found to be statistically smaller than in boys. Magnetic resonance imaging (MRI) can diagnose cruciate ligament injuries with high accuracy. The ACL is best depicted using a sagittal oblique imaging plane angled at 80 degrees from a line through the intercondylar joint space. Finally, a threshold value of 115 degrees gave the posterior cruciate ligament angle a sensitivity of 70% and a specificity of 82%. Auteur : Docteur Philippe LORIAUT - Chirurgien Orthopédiste Paris Lilas Greater participation has increased awareness of health and medical issues specific to the female athlete. The limited oblique T1 sequence had sensitivities and negative predictive value of over 90%, but low specificity and positive predictive values and slight interobserver reliability (Kappa 0.42, 95% CI 0.2–0.6).Conclusions Male players had statistically greater quadriceps and hamstring muscle strength than female players, even when adjustments were made for body weight. This study was undertaken to evaluate the diagnostic efficacy of additional oblique coronal magnetic resonance (MR) imaging of the knee for the grading of anterior cruciate ligament (ACL) injury. Nevertheless, the ACL may not always be visualised. An additional volume sequence was beneficial when filmed. Two patients in the control population demonstrated evidence of chronic ACL tears. In the acute hemarthrosis patient population, the incidence at arthroscopy of acute complete ACL tears was 60% (18/30); of partial ACL tears, 13.3% (4/30); and of chronic tears, 10% (3/30). The male players were taller and heavier than their female counterparts, although they had 11% less body fat. There were no posterior cruciate, medial, or lateral collateral ligament tears at arthroscopy, used as the gold standard. Beyond the basic principles of imaging knee injuries great impact was made on the understanding of indirect or collateral findings, even in rare diseases. In this article the spectrum of disorders of the knee are reviewed and an overview of the current literature is given. II-Biomécanique du compartiment interne On distingue, sur la face interne du genou, un plan superficiel, le ligament collatéral médial proprement dit, et un plan profond capsulaire avec trois chefs : § Le chef moyen : renforcement profond du ligament collatéral médial § Le chef postérieur : le ligament postérieur oblique du Hughston. Dans cette vidéo, nous abordons le test de Muller, également appelé "Quadriceps active test", dans le cadre des atteintes du ligament croisé postérieur. All rights reserved. Use of the monitor can offer some benefits. The knee cartilage was segmented into six compartments, including lateral femur (LF), lateral tibia (LT), medial femur (MF), medial tibia (MT), trochlea (Tr), and patella (Pa). tl'e athlete: clinical and magnetic resonance irnaging features. This was a pragmatic study to see if the six general MRI radiographers, each with over four years experience, could evaluate the ACL on routine orthogonal sequences (sagittal T1, Gradient Echo T2, Coronal STIR and axial fat suppressed dual echo). We hypothesized that ACL size and orientation will change by age during skeletal growth and maturation with different trends in males versus females. This non-invasive, in vivo technique for measuring ACL volume may prove useful in future large-scale comprehensive studies of potential risk factors for ACL rupture, in quantifying potential loading effects on ACL size as a prophylactic measure against ACL rupture, and in the use of ACL volume as a screening tool for assessing risk of injury. If they identified no ACL, then two 3D volume sequences (Dual Echo Steady State and Fast Low Angle Shot) and 2D limited sagittal oblique T1 sequences were also performed. Twenty-five healthy volunteers were examined. Eighteen normal controls and 22 ACL graft patients were studied. The reciprocal of T2⁎ value was correlated with that of T2 value (r = 0.886, P < 0.001). All rights reserved. This includes considerations about how to achieve a high-standard MR imaging study of the knee, and principles of imaging anterior cruciate ligament and meniscal tears. They then had a knee arthroscopy within seven days of the MRI. Objective (average number of images to demonstrate ACL) and subjective (radiologist's confidence level) evaluations of both sequences were performed independently of the other and then comparatively by two radiologists. Radiol 2OOO; Cmciate and posterolateral corner injuries ln tl'e athlete: clinical and magnetic resonance irnaging features. The weighted kappa scores (kappaws) were 0.752 (reader 1) and 0.784 (reader 2) by routine knee MR imaging only; with additional oblique coronal imaging, the kappaws increased to 0.809 (reader 1) and 0.843 (reader 2). Many imagers can perform oblique sagittal imaging, but the operator must set the proper degree of obliquity for the examination. MRI enables the exact determination of the three-dimensional orientation of the lateral ankle ligaments. There was no statistically significant difference in the notch width index between the sexes. Ce ligament agit essentiellement entre 70 et 90° de flexion du genou. Possible causative factors for this increase in anterior cruciate ligament injuries among women may be extrinsic (body movement, muscular strength, shoe-surface interface, and skill level) or intrinsic (joint laxity, limb alignment, notch dimensions, and ligament size). Despite a well‐established role of ACL anatomy on its biomechanics, little is known on how ACL anatomy develops and changes during skeletal growth. With a threshold value of 0 degrees the Blumensaat angle had a sensitivity of 90% and a specificity of 98%. Discontinuity was found to be the most useful of the ACL abnormalities. These ligaments are commonly injured in sports and motor vehicle accidents. Secondly, either volume sequence (DESS or FLASH) could be used as the supplementary sequence, to evaluate the ACL, but a limited oblique T1 sequence of the intercondylar notch cannot be recommended. A normal ACL was found in 16.6% (5/30) of patients. Eur The anatomical and clinical aspects are also discussed so that the contribution of MRI to the diagnosis and therapeutic management of an ACL tear can be better understood. The contralateral ACL may be an appropriate surrogate for measuring, Access scientific knowledge from anywhere. The filmed ACL evaluation for complete tears and a normal ACL had a sensitivity of 100%, specificity of 97.1% and accuracy of 97.3%, slightly higher than evaluating on the monitor. The radiography technicians performed additional ACL sequences in 63 patients (27%); of these, 10 patients had a partial and 12 patients had a complete ACL tear. A simple template was devised to facilitate this process, resulting in more consistently oriented imaging planes. T2 and T2⁎ values were measured in full-thickness as well as superficial and deep layers of each cartilage compartment. To quantitatively assess changes in cartilage matrix after acute anterior cruciate ligament (ACL) rupture using T2- and T2⁎-mapping and analyze the correlation between the results of both methods. Spin-echo (SE) T1-weighted images (TR 330 ms/TE 15 ms, NEX 1) were obtained with a slice thickness of 3 mm. Many strategies have been used to improve the visualisation of the ACL including sagittal, coronal oblique sequences, and 3D volume imaging. The angles deviating from the axial imaging plane were 18.0 degrees for the anterior talofibular ligament, 52.3 degrees for the calcaneofibular ligament and 28.2 degrees for the posterior talofibular ligament. When faced with a clinical suspicion of knee ligament injury, MRI nowadays has a central role in the diagnostic strategy. With an increasing number of people participating in recreational and competitive sporting activities, sports-related injuries of the knee and knee ligaments have increased in incidence. Les aspects anatomiques et cliniques sont également exposés afin de mieux comprendre l’apport de l’IRM dans la conduite diagnostique et dans la prise en charge thérapeutique de la rupture du LCA. L’imagerie par résonance magnétique (IRM) du genou occupe aujourd’hui une place centrale dans la stratégie diagnostique devant une suspicion clinique de lésion ligamentaire du genou. Noncontact mechanisms were the primary cause of anterior cruciate ligament injury in both female sports. With the right ankle in the normal anatomic position stabilized in a splint, coronal T2-weighted spin-echo sequences (TSE) were obtained. 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. Semin Musculoskel Radiol 2OO4;8: I I l-131. It is concluded that the morphological changes seen on MR images of ACL grafts from when the knee is extended to when the knee is flexed are different from those in the normal ACL. The results of this study show that the volume of the contralateral ACL is a valid surrogate measure for a missing ACL on the injured side. Accurate interpretation of the MRI examination requires a meticulous MRI technique, knowledge of the imaging anatomy, and understanding of the lesion appearance. Two independent readers evaluated the status of the ACL by routine knee MR imaging and then by additional oblique coronal imaging. Angles between these tangents and reference lines RFL-1 (the line connecting the posterior edges of the femoral condyles), RFL-2 (the line through the intercondylar joint space), and RFL-3 (the line connecting the anterior and posterior edge of the medial tibial condyle) were measured. Optimal visualization of the anterior cruciate ligament with magnetic resonance imaging requires oblique sagittal imaging planes. Volume sequences including partial tears, had specificities and accuracies over 94%, with substantial interobserver agreement (Kappa 0.86, 95% CI 0.71–1.0). Many strategies have been used to improve the visualisation of the ACL including sagittal, coronal oblique sequences, and 3D volume imaging. Twenty-three patients and 23 healthy controls were enrolled and underwent quantitative MRI examination. ... Les séquences habituelles pour les IRM de genou sont : le T1 sagittal , la densité protonique avec saturation de la graisse (DP FS) dans les trois plans axial, coronal et sagittal . Magnetic resonance imaging (MRI) has proven to be an excellent tool in the evaluation of meniscal tears and associated pathology. Les entorses du Ligament Croisé Postérieur. However, ACL abnormalities and secondary findings, alone or combined, failed to surpass the diagnostic value of the ACL angle for predicting ACL tears. Se connecter avec Facebook Ligament croisé postérieur - Ligamentum cruciatum posterius Structures anatomiques Quantitative parameters are thus good predictors of ACL tears and may increase the overall sensitivity and specificity of MRI. Differences of T2 and T2⁎ values between patients and controls were compared using unpaired Student's t-test, and the correlation between their reciprocals was analyzed using Pearson's correlation coefficient. Despite similar ACL size between males and females at early ages, adolescent males had significantly longer and thicker ACLs compared to the age‐matched females (P<0.05). Orthogonal imaging failed to correctly identify any of the partial ACL injuries. Results Experienced radiographers identified most cases requiring supplementary MRI ACL sequences. In 15 of the 22 ACL graft patients the grafts appeared straight when the knee was extended and became convex toward the anterior side when the knee was flexed. An accurate diagnosis of cruciate ligament injuries is vital in patient care. Objectives Twenty healthy volunteers without previous injury to the ankle were included in the study. The template can be reproduced by photocopying the diagram provided onto a transparency. In particular, it is essential for assessing the cruciate ligaments and any associated meniscal tears. In 12 of the 18 normal controls the ACL appeared convex toward the posterior side when the knee was extended and gradually became straight when the knee was flexed. In the MRI evaluation of patients with suspected ACL injury the following results were obtained for both acute and chronic complete disruption on orthogonal (sagittal) and nonorthogonal (oblique sagittal) imaging, respectively: sensitivity, 61 (16/26) versus 100%; specificity, 70 (21/34) versus 100%; positive predictive value, 61 (16/26) versus 100%; negative predictive value 70 (24/34) versus 100%; and accuracy, 66 (40/60) versus 100%. The C-shaped fibrocartilaginous menisci aid in joint stabilization and load transmission. Results: The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are important stabilizers of the knee. Meanwhile, patients exhibited higher T2⁎ values in deep layers of lateral tibiofemoral joint. The mean ACL volume was not significantly different (p=0.2331) between the two sides in this population. l. Stabler A, Glaser C, Reiser M. Musculoskeletal MR: lmee. MR imaging has the potential to accurately identify these ligamentous injuries, as well as other potential associated combined injuries of the knee, with information from MR imaging examination assisting in decision-making and planning with regard to potential clinical and/or surgical patient management. The purpose of this study was to determine whether oblique sagittal T2-weighted images of the anterior cruciate ligament (ACL) are better prescribed off axial or coronal localizing images.
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