Knee Ligament Injury in Athletes. Laura W. Bancroft, M.D.
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1 Knee Ligament Injury in Athletes Laura W. Bancroft, M.D.
2 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
3 Knee Injuries FORCE Anterior Translation Posterior Translation Varus (medial to lateral) Valgus (lateral to medial) Internal Rotation (femur fixed) External Rotation (femur fixed) Hyperextension RESISTANCE ACL PCL LCL MCL LCL MCL PCL Hayes CW, et al. Mechanism-based pattern approach to classificaiton of complex injuries of the knee depicted at MR imaging. RadioGraphics 2000; 20:S
4 ANTERIOR CRUCIATE LIGAMENT
5 posterolateral posterolateral Normal 2 bands posterolateral and anteromedial
6 anteromedial anteromedial Normal 2 bands posterolateral and anteromedial
7 Mucinous degeneration of ACL + ACL ganglion
8 Mucinous degeneration of ACL + ACL ganglion
9 ACL ganglion
10 Partial tear Posterolateral bundle
11 Torn near femoral origin
12 Midsubstance tear
13 Torn near tibial attachment
14 Chronic ACL tear
15 Buckled PCL
16 Anterior drawer sign
17 *
18 ACL Contusions Posterior lateral tibial plateau 7 sign Lateral femoral condyle (coup) Deep lateral sulcus Medial femoral condyle (contrecoup)
19 ACL tear Coup and contrecoup contusions
20 Coup contusions
21 Contrecoup contusions
22 ACL Adolescents may have same contusion pattern as adults, but may preserve ACL Increased ligamentous laxity
23
24 ACL
25 Tibial avulsion fracture at ACL attachment
26
27
28 ACL Sprain with marrow edema
29 O Donoghue s Triad
30 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
31
32 Segond fracture
33 Segond fracture + ACL tear
34 Knee Dislocation
35 Knee Dislocation
36 Knee Dislocation
37 ACL torn and fibrosed to PCL
38 Posterior Cruciate Ligament
39 PCL sprain
40 PCL sprain
41 PCL sprain
42 PCL partial tear
43 PCL sprain high grade
44 PCL sprain
45 PCL ganglion
46 PCL rupture
47 PCL rupture
48 PCL rupture
49 Medial Collateral Ligament
50 MCL sprain
51 MCL sprain
52 MCL
53 MCL sprain
54 MCL partial thickness tear
55 MCL distal rupture
56 MCL high grade partial tear and femoral epicondylar spurring
57 MCL grade 2 sprain
58 MCL avulsive marrow changes deep fiber rupture
59 MCL rupture deep fibers and near complete rupture of superficial fibers
60 Schweitzer ME, et al. Medial collateral ligament injuries. Radiology 1995; 194: MCL mid rupture
61 MCL distal rupture
62 Pellegrini-Stieda calcifications
63 Pelligrini-Stieda calcifications
64 uptu MCL bursitis
65 Edema-like signal about the MCL: -MCL sprain -osteoarthrosis -extruded meniscus
66 Lateral Collateral Ligament
67 Fibular collateral ligament sprain
68 Fibular collateral ligament rupture
69 Patellofemoral Ligament
70 Patellofemoral ligament avulsion
71 Patellofemoral ligament avulsion
72 Patellofemoral ligament avulsion
73 Patellofemoral ligament avulsion
74 Patellofemoral ligament avulsion
75 Iliotibial Band
76 Repetitive flexion and extension Friction against lateral femoral condyle Runners Iliotibial Band Friction Syndrome 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: Nishimura G, et al. MR findings in iliotibial band syndrome. Skeletal Radiol 1997; 26:
77 Repetitive flexion and extension Friction against lateral femoral condyle Runners Iliotibial Band Friction Syndrome 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: Nishimura G, et al. MR findings in iliotibial band syndrome. Skeletal Radiol 1997; 26:
78 Iliotibial band friction syndrome
79 Iliotibial band friction syndrome
80 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
81 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
82 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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