Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series.

Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management. These will be discussed in reference to meniscal tears and injuries of the cruciate ligaments as well as injuries of the posterolateral and posteromedial corners of the knee. (©) RSNA, 2016.

[1]  R. Warren,et al.  The microvasculature of the meniscus and its response to injury , 1983, The American journal of sports medicine.

[2]  G. Barrett,et al.  Acute anteromedial rotatory instability. Long-term results of surgical repair. , 1983, The Journal of bone and joint surgery. American volume.

[3]  F. Noyes,et al.  Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. , 1989, The Journal of bone and joint surgery. British volume.

[4]  K. Dehaven.  Decision-making factors in the treatment of meniscus lesions. , 1990, Clinical orthopaedics and related research.

[5]  M L Hull,et al.  Strain in the anteromedial bundle of the anterior cruciate ligament under combination loading , 1992, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[6]  B. Graf,et al.  Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. , 1994, AJR. American journal of roentgenology.

[7]  K. Shelbourne,et al.  Anterior Cruciate Ligament Injury , 1994 .

[8]  H. Umans,et al.  Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. , 1995, AJR. American journal of roentgenology.

[9]  J. Moseley,et al.  Partial Tears of the Anterior Cruciate Ligament , 1995, The American journal of sports medicine.

[10]  K. Markolf,et al.  Combined knee loading states that generate high anterior cruciate ligament forces , 1995, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[11]  K. Murray,et al.  Comparison of Bone Contusion Seen by MRI in Partial and Complete Tears of the Anterior Cruciate Ligament , 1995, Journal of computer assisted tomography.

[12]  S. Ostlere,et al.  MRI diagnosis of partial tears of the anterior cruciate ligament. , 1996, Injury.

[13]  Joseph S. Yu,et al.  Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. , 1996, Radiology.

[14]  J. Tehranzadeh,et al.  Accuracy of MRI patterns in evaluating anterior cruciate ligament tears , 1996, Skeletal Radiology.

[15]  D. Buss,et al.  Chronically Injured Posterior Cruciate Ligament Magnetic Resonance Imaging , 1997, Clinical orthopaedics and related research.

[16]  M. Hochman,et al.  Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus , 1997, Skeletal Radiology.

[17]  D. Resnick,et al.  Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging. , 1999, Radiology.

[18]  K. Shelbourne,et al.  The Natural History of Acute, Isolated, Nonoperatively Treated Posterior Cruciate Ligament Injuries , 1999, The American journal of sports medicine.

[19]  W. Totty,et al.  Magnetic Resonance Imaging as a Tool to Predict Meniscal Reparability , 1999, The American journal of sports medicine.

[20]  K. Shelbourne,et al.  Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing. , 1999, The American journal of knee surgery.

[21]  T. Hewett,et al.  Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. , 2000, The Journal of the American Academy of Orthopaedic Surgeons.

[22]  R. LaPrade,et al.  The Magnetic Resonance Imaging Appearance of Individual Structures of the Posterolateral Knee , 2000, The American journal of sports medicine.

[23]  K. Shino,et al.  Chondral injury associated with acute isolated posterior cruciate ligament injury. , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[24]  T. Sanders,et al.  Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[25]  S. Bollen.  Epidemiology of knee injuries: diagnosis and triage , 2000, British journal of sports medicine.

[26]  B. Boden,et al.  Mechanisms of anterior cruciate ligament injury. , 2000, Orthopedics.

[27]  B. Maldague,et al.  Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. , 2001, AJR. American journal of roentgenology.

[28]  Joseph S. Yu,et al.  Avulsion fracture of the head of the fibula (the "arcuate" sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. , 2003, AJR. American journal of roentgenology.

[29]  James R. Robinson,et al.  Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments , 2003, Knee Surgery, Sports Traumatology, Arthroscopy.

[30]  A. Weiler,et al.  Arthroscopic evaluation of articular cartilage lesions in posterior-cruciate-ligament-deficient knees. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[31]  P. Mariani,et al.  Stress radiography for quantifying posterior cruciate ligament deficiency. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[32]  L. Engebretsen,et al.  The Posterolateral Attachments of the Knee , 2003, The American journal of sports medicine.

[33]  A. Weiler,et al.  Epidemiology of posterior cruciate ligament injuries , 2003, Archives of Orthopaedic and Trauma Surgery.

[34]  M G Myriam Hunink,et al.  MR imaging of the menisci and cruciate ligaments: a systematic review. , 2003, Radiology.

[35]  M. Olona,et al.  Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle , 2004, Knee Surgery, Sports Traumatology, Arthroscopy.

[36]  C. Pfirrmann,et al.  Patients with suspected meniscal tears: prevalence of abnormalities seen on MRI of 100 symptomatic and 100 contralateral asymptomatic knees. , 2003, AJR. American journal of roentgenology.

[37]  H. Kang,et al.  Grading of Anterior Cruciate Ligament Injury: Diagnostic Efficacy of Oblique Coronal Magnetic Resonance Imaging of the Knee , 2003, Journal of computer assisted tomography.

[38]  J. Carrino,et al.  Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. , 2004, AJR. American journal of roentgenology.

[39]  A A Amis,et al.  The Posteromedial Corner Revisited an Anatomical Description of the Passive Restraining Structures of the Medial Aspect of the Human Knee Literature Review , 2022 .

[40]  Russell F Warren,et al.  Revision Anterior Cruciate Ligament Reconstruction – Etiology of Failures and Clinical Results , 2010, The journal of knee surgery.

[41]  W. F. Sims,et al.  The Posteromedial Corner of the Knee , 2004, The American journal of sports medicine.

[42]  G. Barrett,et al.  Prospective Evaluation of 1485 Meniscal Tear Patterns in Patients with Stable Knees , 2004, The American journal of sports medicine.

[43]  W. M. Wind,et al.  Evaluation and Treatment of Posterior Cruciate Ligament Injuries , 2004, The American journal of sports medicine.

[44]  A. V. van Vugt,et al.  Acute knee trauma: value of a short dedicated extremity MR imaging examination for prediction of subsequent treatment. , 2005, Radiology.

[45]  J. Hodler,et al.  MR imaging of the posterolateral corner of the knee , 2007, Skeletal Radiology.

[46]  R. LaPrade,et al.  Posterolateral Corner Injuries of the Knee: Anatomy, Diagnosis, and Treatment , 2006, Sports medicine and arthroscopy review.

[47]  Anne Benjaminse,et al.  Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. , 2006, The Journal of orthopaedic and sports physical therapy.

[48]  Adam Goode,et al.  Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. , 2007, The Journal of orthopaedic and sports physical therapy.

[49]  Lars Engebretsen,et al.  The anatomy of the medial part of the knee. , 2007, The Journal of bone and joint surgery. American volume.

[50]  J. Healy,et al.  MRI of the popliteofibular ligament: isotropic 3D WE-DESS versus coronal oblique fat-suppressed T2W MRI , 2007, Skeletal Radiology.

[51]  H. Fritts,et al.  A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[52]  A. Saifuddin,et al.  Posteromedial corner injuries of the knee. , 2007, Clinical radiology.

[53]  C. Prodromos,et al.  A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[54]  D. Resnick,et al.  Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers. , 2008, AJR. American journal of roentgenology.

[55]  Jason P Fine,et al.  Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. , 2008, AJR. American journal of roentgenology.

[56]  C. Helms,et al.  MRI appearance of posterior cruciate ligament tears. , 2008, AJR. American journal of roentgenology.

[57]  G. Krestin,et al.  Costs and effectiveness of a brief MRI examination of patients with acute knee injury , 2008, European Radiology.

[58]  I. Song,et al.  Characterization of spontaneous healing of chronic posterior cruciate ligament injury: Analysis of instability and magnetic resonance imaging , 2008, Journal of magnetic resonance imaging : JMRI.

[59]  T. Zantop,et al.  The Role of the Posterior Oblique Ligament in Controlling Posterior Tibial Translation in the Posterior Cruciate Ligament-Deficient Knee , 2008, The American journal of sports medicine.

[60]  Richard Kijowski,et al.  Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging--diagnostic performance compared with that of conventional MR imaging at 3.0 T. , 2009, Radiology.

[61]  D. Dahm,et al.  MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. , 2009, AJR. American journal of roentgenology.

[62]  D. Whelan,et al.  Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[63]  J. Kwon,et al.  Which oblique plane is more helpful in diagnosing an anterior cruciate ligament tear? , 2009, Clinical radiology.

[64]  A. Ranawat,et al.  Meniscal root tears: diagnosis and treatment. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[65]  M. Defranco,et al.  A comprehensive review of partial anterior cruciate ligament tears. , 2009, The Journal of bone and joint surgery. American volume.

[66]  T. Link,et al.  Title Isotropic 3 D fast spin-echo imaging versus standard 2 D imaging at 3 . 0 T of the knee — image quality and diagnostic performance , 2009 .

[67]  K. Shinki,et al.  MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. , 2009, AJR. American journal of roentgenology.

[68]  V. Denaro,et al.  The kneeling view: evaluation of the forces involved and side-to-side difference. , 2009, The Knee.

[69]  S. Ostlere,et al.  Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging , 2010, Skeletal Radiology.

[70]  R. LaPrade,et al.  Location of Bone Bruises and Other Osseous Injuries Associated with Acute Grade III Isolated and Combined Posterolateral Knee Injuries , 2010, The American journal of sports medicine.

[71]  P. Parizel,et al.  Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears? , 2011, Skeletal Radiology.

[72]  Elmar Kotter,et al.  Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions--feasibility study. , 2010, Radiology.

[73]  P. Parizel,et al.  Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis? , 2012, Skeletal Radiology.

[74]  W. Garrett,et al.  Management of Medial-Sided Knee Injuries, Part 1 , 2011, The American journal of sports medicine.

[75]  W. Dunn,et al.  Interobserver Reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification of Meniscal Tears , 2011, The American journal of sports medicine.

[76]  Derek J Donegan,et al.  Partial tears of the anterior cruciate ligament: diagnosis and treatment. , 2011, American journal of orthopedics.

[77]  Paul M. Parizel,et al.  Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging , 2012, Knee Surgery, Sports Traumatology, Arthroscopy.

[78]  W. Palmer,et al.  A biomechanical approach to MRI of acute knee injuries. , 2011, AJR. American journal of roentgenology.

[79]  B. Morrey.  Can the Reparability of Meniscal Tears Be Predicted With Magnetic Resonance Imaging , 2011 .

[80]  J. Griffith,et al.  MRI diagnosis of ACL bundle tears: value of oblique axial imaging , 2013, Skeletal Radiology.

[81]  O. F. Nas,et al.  Contribution of thin slice (1 mm) oblique coronal proton density-weighted MR images for assessment of anteromedial and posterolateral bundle damage in anterior cruciate ligament injuries. , 2012, European journal of radiology.

[82]  MRI appearance of the distal insertion of the anterior cruciate ligament of the knee: an additional criterion for ligament ruptures. , 2012, Skeletal radiology.

[83]  Sarah K Fields,et al.  Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. , 2012, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[84]  R. Rossi,et al.  Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. , 2012, The Iowa orthopaedic journal.

[85]  P. Munk,et al.  Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. , 2012, AJR. American journal of roentgenology.

[86]  V. Denaro,et al.  Meniscal root tears: from basic science to ultimate surgery. , 2013, British medical bulletin.

[87]  S. Klouche,et al.  Sensitivity and specificity of bell-hammer tear as an indirect sign of partial anterior cruciate ligament rupture on magnetic resonance imaging , 2014, Knee Surgery, Sports Traumatology, Arthroscopy.

[88]  D. Dahm,et al.  Case–control study to estimate the performance of dual-energy computed tomography for anterior cruciate ligament tears in patients with history of knee trauma , 2014, Skeletal Radiology.

[89]  Johan Bellemans,et al.  Anatomy of the anterolateral ligament of the knee , 2013, Journal of anatomy.

[90]  A. Seidler,et al.  Physical examination tests for the diagnosis of posterior cruciate ligament rupture: a systematic review. , 2013, The Journal of orthopaedic and sports physical therapy.

[91]  C. Servant,et al.  Diagnostic accuracy of ACL tears according to tear morphology. , 2013, Acta orthopaedica Belgica.

[92]  W. Garrett,et al.  Tram-track appearance of the posterior cruciate ligament (PCL): correlations with mucoid degeneration, ligamentous stability, and differentiation from PCL tears. , 2013, AJR. American journal of roentgenology.

[93]  L. Engebretsen,et al.  A Classification System Based on Tear Morphology , 2014 .

[94]  Kenneth S. Lee,et al.  MRI characteristics of healed and unhealed peripheral vertical meniscal tears. , 2014, AJR. American journal of roentgenology.

[95]  L. Lenchik,et al.  Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma , 2015, Skeletal Radiology.

[96]  Michael R. Aro,et al.  Fat-suppression techniques for 3-T MR imaging of the musculoskeletal system. , 2014, Radiographics : a review publication of the Radiological Society of North America, Inc.

[97]  E. Chang,et al.  Posterior medial meniscus root ligament lesions: MRI classification and associated findings. , 2014, AJR. American journal of roentgenology.

[98]  T. Link,et al.  MR imaging characteristics and clinical symptoms related to displaced meniscal flap tears , 2015, Skeletal Radiology.

[99]  P. Kurzweil,et al.  Physical Examination and Imaging of Medial Collateral Ligament and Posteromedial Corner of the Knee , 2015, Sports medicine and arthroscopy review.

[100]  Jack Porrino,et al.  The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. , 2015, AJR. American journal of roentgenology.

[101]  J. Teh,et al.  The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging , 2015, Skeletal Radiology.

[102]  M. Stuart,et al.  MRI injury patterns in surgically confirmed and reconstructed posterolateral corner knee injuries , 2015, Knee Surgery, Sports Traumatology, Arthroscopy.

[103]  H. Haro,et al.  Meniscal tears associated with anterior cruciate ligament injury , 2015, Archives of Orthopaedic and Trauma Surgery.

[104]  J. Norrie,et al.  Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley's, McMurray's and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis. , 2015, Health technology assessment.

[105]  R. LaPrade,et al.  Anatomy and Biomechanics of the Lateral Side of the Knee and Surgical Implications , 2015, Sports medicine and arthroscopy review.

[106]  B. Sonnery-Cottet,et al.  Outcome of a Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Technique With a Minimum 2-Year Follow-up , 2015, The American journal of sports medicine.

[107]  R. LaPrade,et al.  A Systematic Review of the Outcomes of Posterolateral Corner Knee Injuries, Part 1 , 2016, The American journal of sports medicine.