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Abstract

Background

Reliable magnetic resonance imaging (MRI) diagnosis is important in cases of posterolateral corner (PLC) injury due to the limitations of physical examination in patients with multi-ligament injury.

Purpose

To document the appearance of PLC of the knee on three-dimensional (3D) isotropic MR images, and to determine the significance of MRI findings in patients with confirmed posterolateral rotatory instability.

Material and Methods

Twenty-five patients that underwent surgery for posterolateral instability, and 25 individuals with normal MRI constituted the study cohort. The PLC appearances (popliteofibular, fabellofibular, arcuate ligaments, popliteomeniscal fascicle) were analyzed using 3D isotropic proton density sequence and routine two-dimensional (2D) MRI. In addition, the “fibular cap” sign was evaluated. Statistical analysis was performed using the Chi-square and McNemar’s tests.

Results

Thickening of popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle was significantly more frequent in the PLC injury group than in the control group (P < 0.05). The sensitivity and specificity of 3D MRI for popliteofibular, fabellofibular, arcuate ligaments, and popliteomeniscal fascicle injury were 63/92%, 54/100%, 46/100%, and 58/92%, respectively. On comparing 3D and 2D images with respect to injury detectability (grade 3 or 4), both modalities visualized injuries, but 3D detected grade 3 or grade 1 rather than grade 4 or 0, respectively. The fibular cap sign was observed significantly more frequently in PLC group, with 58% sensitivity and 100% specificity, and was better observed by 3D than 2D (P < 0.05).

Conclusion

3D MRI is a valid modality for detecting PLC abnormalities as it visualizes pathologies in each component and exhibits the positive fibular cap sign.

Keywords

Posterolateral corner knee three-dimensional isotropic imaging magnetic resonance imaging (MRI)

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References

Larsen

Toth

. Examination of posterolateral corner injuries. J Knee Surg 2005; 18: 146–150.

Vinson

Helms

. Imaging for evaluation of posterolateral corner injury. J Knee Surg 2005; 18: 151–156.

Fanelli

. Surgical reconstruction for acute posterolateral injury of the knee. J Knee Surg 2005; 18: 157–162.

Ross

DeConciliis

Choi

. Evaluation and treatment of acute posterolateral corner/anterior cruciate ligament injuries of the knee. J Bone Joint Surg Am 2004; 86-A(Suppl. 2): 2–7.

Covey

. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 2001; 83-A: 106–118.

Ferrari

Coumas

. Posterolateral instability of the knee. J Bone Joint Surg Br 1994; 76: 187–192.

Recondo

Salvador

Villanua

. Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging. Radiographics 2000; 20: S91–S102.

Hughston

Andrews

Cross

. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 1976; 58: 173–179.

Fleming

Jr. Blatz

McCarroll

. Posterior problems in the knee. Posterior cruciate insufficiency and posterolateral rotatory insufficiency. Am J Sports Med 1981; 9: 107–113.

10.

O’Brien

Warren

Pavlov

. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg Am 1991; 73: 278–286.

11.

Pacheco

Ayre

Bollen

. Posterolateral corner injuries of the knee: a serious injury commonly missed. J Bone Joint Surg Br 2011; 93: 194–197.

12.

Salonen

Hodler

. Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. Radiology 1996; 198: 199–204.

13.

LaPrade

Gilbert

Bollom

. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 2000; 28: 191–199.

14.

Rajeswaran

Lee

Healy

. MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI. Skeletal Radiol 2007; 36: 1141–1146.

15.

Bonadio

Helito

Gury

. Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee. Acta Ortop Bras 2014; 22: 124–126.

16.

Tagliafico

Succio

Neumaier

. Brachial plexus assessment with three-dimensional isotropic resolution fast spin echo MRI: comparison with conventional MRI at 3.0 T. Br J Radiol 2012; 85: e110–116.

17.

Jung

Jee

Park

. Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences. Skeletal Radiol 2012; 41: 1401–1410.

18.

Lee

Jee

Jung

. MRI of the lumbar spine: comparison of 3D isotropic turbo spin-echo SPACE sequence versus conventional 2D sequences at 3.0 T. Acta Radiol 2015; 56: 174–181.

19.

Geiger

Chang

Pathria

. Posterolateral and posteromedial corner injuries of the knee. Radiol Clin North Am 2013; 51: 413–432.

20.

Berruto

Gala

Usellini

. Congenital absence of the cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1622–1625.

21.

Bennett

George

El-Khoury

. Anterior rim tibial plateau fractures and posterolateral corner knee injury. Emerg Radiol 2003; 10: 76–83.

22.

Van Seymortier

Ryckaert

Verdonk

. Traumatic proximal tibiofibular dislocation. Am J Sports Med 2008; 36: 793–798.

23.

Voglino

Denton

. Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography. Orthopedics 1999; 22: 255–258.

24.

Harish

O’Donnell

Connell

. Imaging of the posterolateral corner of the knee. Clin Radiol 2006; 61: 457–466.

25.

Yoon

Bae

. Anatomic reconstructive surgery for posterolateral instability of the knee. Arthroscopy 2006; 22: 159–165.

26.

Arciero

. Anatomic posterolateral corner knee reconstruction. Arthroscopy 2005; 21: 1147–1147.

27.

Davies

Unwin

Aichroth

. The posterolateral corner of the knee. Anatomy, biomechanics and management of injuries. Injury 2004; 35: 68–75.

28.

Lee

Papakonstantinou

Brookenthal

. Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skeletal Radiol 2003; 32: 619–627.

29.

Cooper

McAndrews

LaPrade

. Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment. Sports Med Arthrosc 2006; 14: 213–220.

30.

Malone

Koulouris

. MRI of the posterolateral corner of the knee: normal appearance and patterns of injury. Semin Musculoskelet Radiol 2006; 10: 220–228.

31.

Bolog

Hodler

. MR imaging of the posterolateral corner of the knee. Skeletal Radiol 2007; 36: 715–728.

32.

LaPrade

Resig

Wentorf

. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 1999; 27: 469–475.

33.

Munshi

Pretterklieber

Kwak

. MR imaging, MR arthrography, and specimen correlation of the posterolateral corner of the knee: an anatomic study. Am J Roentgenol 2003; 180: 1095–1101.

34.

Geeslin

Moulton

LaPrade

. A systematic review of the outcomes of posterolateral corner knee injuries, Part 1: surgical treatment of acute injuries. Am J Sports Med. Epub ahead of print 10 August 2015.

35.

Bonanzinga

Zaffagnini

Grassi

. Management of combined anterior cruciate ligament-posterolateral corner tears: a systematic review. Am J Sports Med 2014; 42: 1496–1503.

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Using three-dimensional isotropic SPACE MRI to detect posterolateral corner injury of the knee

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material