高频超声在膝关节侧副韧带损伤诊断中的应用

１９９６年至１９９７年应用高频超声对２０例膝关节侧副韧带损伤的患者进行了超声诊断。现报告如下。１资料与方法２０例中男性１４例、女性６例；年龄１７－６０岁；病程２—３０天；膝部扭伤２例，车祸撞击伤１８例，其中局部骨折３例（胫骨平台骨折２例、腓骨骨折１例）；右膝４例，左膝１６例；内侧副韧带损伤１４例，外侧副韧带损伤５例，内外侧副韧带同时损伤１例。临床表现：膝关节局部肿痛、活动受限以及局部压痛。所有病例均在超声诊断后手术。使用美国ＡＴＬＨＤＬ３００）全数字电脑声像仪、Ｌ５－１０ＭＨｚ超宽频高频线阵探头…     

高频超声在膝关节侧副韧带损伤中的应用

1996年至1997年应用高频超声对20例膝关节侧副韧带损伤的患者进行超声诊断。现报告如下。 1 资料与方法 20例中男性14例、女性6例。年龄17—60岁，病程2—30天。膝部扭伤2例、车祸撞击伤18例；其中局部骨折3例(胫骨平台骨折2例、腓骨骨折1例)。右膝4例、左膝16例。内侧副韧带损伤14例、外侧副韧带损伤5例、内外侧副韧带同时损伤1例。临床表现为：膝关节局部肿痛、活动受限以及局部压痛。所有病例均在超声诊断后手术。     

膝关节内侧副韧带薄层断面与MRI解剖及其诊断价值

目的研究膝关节内侧副韧带薄层断面表现及其正常和损伤的MRI表现。方法分析内侧副韧带薄层断面标本解剖特点,对120例正常膝关节内侧副韧带及25例损伤病例MRI表现进行回顾性分析。结果薄层断面清晰显示膝关节内侧副韧带解剖特点,MRI与薄层断面具有很好对应性。MRI能够对内侧副韧带损伤进行准确分级。结论薄层断面与MRI能够清晰显示内侧副韧带的解剖学特点。横轴位MRI分级评价对内侧副韧带损伤的诊断和治疗具有重要价值。     

高频彩超在腱鞘囊肿诊断中的应用

目的：探讨高频彩色多普勒超声对腱鞘囊肿的诊断价值。方法：回顾性分析56例经手术证实的腱鞘囊肿的高频超声检查情况，分析其二维超声声像图及彩色多普勒特征。结果：超声诊断腱鞘囊肿56例共60个囊肿，其中手腕部30例，踝关节周围16例，手指关节5例，足底2例，膝关节2例，大腿根部1例。结论：高频彩色多普勒超声可以清晰显示囊肿大小、形态、深度及与周围组织的关系，高频彩超检查在腱鞘囊肿诊断中具有重要作用。     

高频超声对膝关节半月板急慢性损伤的诊断价值分析

目的分析探讨高频超声对膝关节半月板急慢性损伤的诊断价值。方法选取2017年1月至2018年2月牡丹江医学院第二附属医院收治的50例膝关节半月板急慢性损伤患者(设为研究组)及50例健康体检者(设为对照组)作为研究对象,应用高频超声检测其膝关节滑膜厚度、髌上囊积液深度及滑膜血流状况,并予以对比。结果研究组患者膝关节半月板在基线外侧较为突出且可见点状或条状强回声区,内侧副韧带变形,部分患者伴有不同程度的水肿,滑膜厚度为(6.25±2.20) mm,髌上囊积液深度为(7.35±1.45) mm,滑膜血流为0级者23例、Ⅰ级者12例、Ⅱ级者12例、Ⅲ级者3例;对照组研究对象膝关节半月板回声强度中等且均匀,边缘清晰,滑膜厚度为(1. 10±0.46) mm,髌上囊积液深度为(2. 12±0.43) mm,滑膜血流为0级者38例、Ⅰ级者12例。两组研究对象膝关节滑膜厚度、髌上囊积液深度及滑膜血流状况对比,P均0.01,差异具有统计学意义。结论高频超声对膝关节滑膜厚度、髌上囊积液及滑膜血流均较敏感,在膝关节半月板急慢性损伤的诊断中特异性较高,且操作简便,可作为膝关节半月板急慢性损伤的首选诊断方法予以推广、普及。     

膝关节损伤的MRI诊断价值

目的:分析膝关节急性损伤后的MRI表现,评价膝关节损伤后MRI的诊断价值.方法:回顾性分析80例膝关节急性损伤(3月内)MRI表现.结果:在80例急性膝关节外伤患者中,同时发生半月板撕裂、韧带损伤和骨损伤三类复合性损伤者42例(52.5%),同时发生上述三类损伤中两者的共18例(22.5%),仅发生三类之一的20例(25.O%).结论:膝关节损伤常为复合性损伤,而MKI可清晰显示膝关节半月板、韧带及/或骨等多种损伤,是膝关节损伤后可信赖的非创伤性检查方法.     

3D FIESTA在膝关节MRI检查中的应用

膝关节MR I检查由于对软组织具有高分辨率、多平面成像,能清晰显示半月板、交叉韧带、关节软骨、滑膜、关节囊腔及副韧带等解剖结构,为临床提供丰富的诊断信息及无创性而被临床广泛的应用。由于膝关节交叉韧带的解剖结构及走行特点,在常规检查中有时显示不清,笔者试用3D FIESTA序列来探讨交叉韧带的显示情况。1材料与方法1.1病例资料21例患者,男14例,女7例,均有不同程度的膝关节疼痛、功能受限等临床症状。外伤引起者16例,老年性骨关节病者4例,其它原因引起者1例。1.2扫描方法对21例患者进行常规检查及3D FIESTA序列扫描。序列为矢状…     

正常成人肘部高频超声断层解剖观察

目的:探讨高频超声应用于肘部软组织的检查方法和声像图特征。方法:应用高频超声宽景成像技术观察18例正常成人的36个肘部的断层解剖,以血管、骨骼作为解剖标志,分5个切面,分别显示肘部肌肉、肌腱、神经及韧带。结果:本方法可详细描述肘部各切面肌肉、神经、血管、韧带的彼此空间解剖学关系,解决了传统超声检查肘部时视野窄小的问题,并标注了肘部各断层切面的具体超声解剖结构。以血管为标志,超声图像清楚显示了肘部尺神经声像伴行尺侧上副动脉和桡神经伴行的桡侧返动脉。结论:高频超声可作为显示肘部软组织及其毗邻的首选无创性检查方法,值得推广。     

膝关节弯曲位3T 磁共振成像的临床分析

目的：探讨3 TMR膝关节弯曲位成像的优越性。方法58例临床怀疑膝关节损伤的患者行3 TMRI检查,58例患者同时行常规成像和弯曲位成像。采用双盲法对2种方法得出的常规图像和弯曲位图像按照韧带显示程度和对病变的显示能力进行评价。结果58例膝关节常规成像中,前后交叉韧带同时完整显示19例,显示韧带损伤25例（前交叉韧带损伤9例,后交叉韧带损伤16例）。58例膝关节弯曲位成像中,前后交叉韧带同时完整显示45例,Wrisberg韧带完整显示7例,显示韧带损伤28例（前交叉韧带损伤11例,后交叉韧带损伤16例,Wrisberg 韧带损伤1例）。结论膝关节弯曲位成像的交叉韧带、Wrisberg韧带和病变显示程度明显优于常规方法。     

高频超声膝关节前交叉韧带损伤分级诊断与关节镜对比研究

目的:探讨高频超声对膝关节前交叉韧带(ACL)损伤分级诊断的临床价值。方法:对85例临床拟诊为ACL损伤的患者行高频超声与关节镜检查,将2种检查结果进行对比,并对ACL损伤进行分级。结果:根据ACL损伤的程度及表现,将其分为3级,高频超声诊断符合率91.76%(78/85),假阴性率4.71%(4/85),假阳性率3.53%(3/85)。结论:高频超声分级诊断ACL损伤具有较高的准确性,可作为膝关节ACL损伤的常规检查方法。     

Ultrasound of the knee with emphasis on the detailed anatomy of anterior,medial, and lateral structures

Objective

To describe the detailed ultrasound anatomy of the anterior, medial, and lateral aspects of the knee and present the ultrasound examination technique used.

Materials and Methods

We present ultrasound using images of patients, volunteer subjects, and cadaveric specimens. We correlate ultrasound images with images of anatomical sections and dissections.

Results

The distal quadriceps tendon is made up of different laminas that can be seen with ultrasound. One to five laminas may be observed. The medial retinaculum is made up of three anatomical layers: the fascia, an intermediate layer, and the capsular layer. At the level of the medial patellofemoral ligament (MPFL) one to three layers may be observed with ultrasound. The medial supporting structures are made up of the medial collateral ligament and posterior oblique ligament. At the level of the medial collateral ligament (MCL), the superficial band, as well as the deeper meniscofemoral and meniscotibial bands can be discerned with ultrasound. The posterior part, corresponding to the posterior oblique ligament (POL), also can be visualized. Along the posteromedial aspect of the knee the semimembranosus tendon has several insertions including an anterior arm, direct arm, and oblique popliteal arm. These arms can be differentiated with ultrasound. Along the lateral aspect of the knee the iliotibial band and adjacent joint recesses can be assessed. The fibular collateral ligament is encircled by the anterior arms of the distal biceps tendon. Along the posterolateral corner, the fabellofibular, popliteofibular, and arcuate ligaments can be visualized.

Conclusion

The anatomy of the anterior, medial, and lateral supporting structures of the knee is more complex than is usually thought. Ultrasound, with its exquisite resolution, allows an accurate assessment of anatomical detail. Knowledge of detailed anatomy and a systematic technique are prerequisites for a successful ultrasound examination of the knee.     

Evaluation of the quadriceps tendon, patellar tendon, and collateral ligaments after total knee arthroplasty: appearances in the early postoperative period.

OBJECTIVE: To evaluate and compare the normal appearance on ultrasound and magnetic resonance imaging (MRI) of the quadriceps tendon, patellar tendon, and collateral ligaments in the early postoperative period following total knee arthroplasty. METHODS: Within a 6-month period, 10 patients with a total knee arthroplasty were referred for imaging. All patients had surgery within 12 weeks, and both MRI and ultrasound were performed on the same day. Two experienced musculoskeletal radiologists, blind to the results of the opposing modality, assessed the integrity of the quadriceps tendon, patellar tendon, and collateral ligaments. RESULTS: Using ultrasound, we identified a focal defect within the medial aspect of the quadriceps tendon in 8 (80%) patients; a similar defect was detected in 5 (50%) patients on MRI. The patellar tendon was thickened in 10 (100%) patients in both modalities. The medial collateral ligament was visualized in 10 (100%) patients with ultrasound and was demonstrated in only 2 (20%) patients with MRI. The lateral collateral ligament was visualized in 7 (70%) and 4 (40%) patients with ultrasound and MRI, respectively. One moderately sized superficial hematoma was demonstrated on ultrasound but was missed on MRI. All abnormalities identified on MRI were also seen with ultrasound. CONCLUSION: A medial defect in the quadriceps tendon and thickened patellar tendon and medial collateral ligament can be considered normal findings. Knowledge of these findings will assist in preventing incorrect diagnosis of a tear. In our cases, ultrasound detected more findings than did MRI.     

The efficacy of a prophylactic knee brace to reduce knee injuries in football. A prospective, randomized study at West Point

The purpose of this prospective, randomized study was to determine the efficacy of a prophylactic knee brace to reduce the frequency and severity of acute knee injuries in football in an athletic environment in which the athletic shoe, playing surface, athlete-exposure, knee injury history, and brace assignment were either statistically or experimentally controlled. The participants in the study were 1396 cadets at the United States Military Academy, West Point, New York, who experienced a total of 21,570 athlete-exposures in the 1986 and 1987 fall intramural tackle football seasons. The use of prophylactic knee braces significantly reduced the frequency of knee injuries, both in the total number of subjects injured and in the total number of medial collateral ligament injuries incurred. However, the reduction in the frequency of knee injuries (total and medial collateral ligament) was dependent on player position. Defensive players who wore prophylactic knee braces had statistically fewer knee injuries than players who served as controls. This was not true of offensive players who served as controls; they had statistically no difference in the number of knee injuries from players who wore prophylactic knee braces. The severity of medical collateral ligament and anterior cruciate ligament knee injuries was not significantly reduced with the use of prophylactic knee braces.     

Low-intensity pulsed ultrasound accelerates and a nonsteroidal anti-inflammatory drug delays knee ligament healing

BACKGROUND: Low-intensity pulsed ultrasound and nonsteroidal anti-inflammatory drugs are used to treat ligament injuries; however, their individual and combined effects are not established. HYPOTHESES: Low-intensity pulsed ultrasound accelerates ligament healing, a nonsteroidal anti-inflammatory drug delays healing, and the nonsteroidal anti-inflammatory drug inhibits the beneficial effect of low-intensity pulsed ultrasound. STUDY DESIGN: Controlled laboratory study. METHODS: Sixty adult rats underwent bilateral transection of their knee medial collateral ligaments. Animals were divided into 2 drug groups and treated 5 d/wk with celecoxib (5 mg/kg) mixed in a vehicle solution (NSAID group) or vehicle alone (VEH group). One to 3 hours after drug administration, all animals were treated with unilateral active low-intensity pulsed ultrasound and contralateral inactive low-intensity pulsed ultrasound. Equal numbers of animals from each drug group were mechanically tested at 2 weeks (n = 14/group), 4 weeks (n = 8/group), and 12 weeks (n = 8/group) after injury. RESULTS: Ultrasound and drug intervention did not interact to influence ligament mechanical properties at any time point. After 2 weeks of intervention, ligaments treated with active low-intensity pulsed ultrasound were 34.2% stronger, 27.0% stiffer, and could absorb 54.4% more energy before failure than could ligaments treated with inactive low-intensity pulsed ultrasound, whereas ligaments from the NSAID group could absorb 33.3% less energy than could ligaments from the VEH group. There were no ultrasound or drug effects after 4 and 12 weeks of intervention. CONCLUSIONS: Low-intensity pulsed ultrasound accelerated but did not improve ligament healing, whereas the nonsteroidal anti-inflammatory drug delayed but did not impair healing. When used in combination, the beneficial low-intensity pulsed ultrasound effect was cancelled by the detrimental nonsteroidal anti-inflammatory drug effect. CLINICAL RELEVANCE: Low-intensity pulsed ultrasound after ligament injury may facilitate earlier return to activity, whereas non-steroidal anti-inflammatory drugs may elevate early reinjury risk.     

Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study

BACKGROUND: The risk of tear of the intact anterior cruciate ligament in the contralateral knee after anterior cruciate ligament reconstruction of the opposite knee and the incidence of rupturing the anterior cruciate ligament graft during the first 2 years after surgery have not been extensively studied in a prospective manner. Clinicians have hypothesized that the opposite normal knee is at equal or increased risk compared with the risk of anterior cruciate ligament graft rupture in the operated knee. HYPOTHESIS: The risk of anterior cruciate ligament graft rupture and contralateral normal knee anterior cruciate ligament rupture at 2-year follow-up is equal. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The Multicenter Orthopaedic Outcome Network (MOON) database of a prospective longitudinal cohort of anterior cruciate ligament reconstructions was used to determine the number of anterior cruciate ligament graft ruptures and tears of the intact anterior cruciate ligament in the contralateral knee at 2-year follow-up. Two-year follow-up consisted of a phone interview and review of operative reports. RESULTS: Two-year data were obtained for 235 of 273 patients (86%). There were 14 ligament disruptions. Of these, 7 were tears of the intact anterior cruciate ligament in the contralateral knee (3.0%) and 7 were anterior cruciate ligament graft failures (3.0%). CONCLUSION: The contralateral normal knee anterior cruciate ligament is at a similar risk of anterior cruciate ligament tear (3.0%) as the anterior cruciate ligament graft after primary anterior cruciate ligament reconstruction (3.0%).     

Kinematics and laxity of the knee joint after anterior cruciate ligament reconstruction: pre- and postoperative radiostereometric studies

BACKGROUND: Injury of the anterior cruciate ligament changes the kinematics of the knee joint. In studies of cadaveric knees, investigators have examined the effect of anterior cruciate ligament reconstruction on knee kinematics, but the effect on dynamic knee motion is not known. HYPOTHESIS: Reconstruction of the anterior cruciate ligament restores knee kinematics to normal. STUDY DESIGN: Prospective cohort study. METHODS: Nine patients were examined preoperatively and 1 year after reconstruction. Continuous radiostereometric exposures were performed at a speed of two to four exposures per second while the patients ascended an 8-cm high platform. Tibial rotation and tibial and femoral translation were measured with radiostereometric analysis. RESULTS: Tibial rotation and tibial and femoral translation were not significantly different after anterior cruciate ligament reconstruction compared with preoperative measurements. A radiostereometric evaluation of anterior knee laxity revealed restoration to within 1 mm of that on the uninjured side. Further evaluation of knee function using the Lysholm score, the Tegner activity level score, the International Knee Documentation Committee evaluation system score, and measurements of laxity using the KT-1000 arthrometer revealed significant improvements after reconstruction. CONCLUSION: Kinematics of the anterior cruciate ligament injured knee did not change significantly after ligament reconstruction, but the functional results were satisfactory and knee laxity was diminished.     

Ultrasound of the knee

Ultrasound is emerging as a viable imaging modality in the diagnosis and assessment of the musculoskeletal system. Advantages of ultrasound include its easy availability and multiplanar capability, as well as economic advantages. Unlike magnetic resonance imaging, ultrasound demonstrates the fibrillar microanatomy of tendons, ligaments and muscles, enhancing its diagnostic capability. The ability to compress, dynamically assess structures and compare easily with the contralateral side is advantageous. The patient’s exact point of clinical tenderness can be correlated with underlying anatomical structures and associated pathology. The main strength of knee ultrasound is the assessment of para-articular disease. The specific structures best suited for ultrasound assessment include tendons, muscles and ligaments, as well as periarticular soft tissue masses. Joint effusions, synovial thickening, bursal fluid collections, intra-articular loose bodies, ganglion cysts, ligament and tendons tears, tendonitis and occult fractures can be diagnosed. With experience, ultrasound is a time-efficient, economical imaging tool for assessment of the knee. Received: 28 November 2000 Revision requested: 26 January 2001 Revision received: 10 April 2001 Accepted: 10 April 2001     

膝关节交叉韧带损伤的MRI诊断

目的 :探讨MRI对膝关节交叉韧带损伤的诊断价值。方法 :回顾性分析 2 5例经手术或关节镜证实的前、后交叉韧带损伤患者 ,MR检查采用SE、TSE矢状位、冠状位及横断位T1WI、T2 WI及STIR。结果 :2 5例交叉韧带损伤中 ,部分性撕裂 16例 ,完全性撕裂 9例。MRI诊断交叉韧带部分性撕裂和完全性撕裂的符合率分别为 87.5 %和 88.9%。结论 :MR能较准确地诊断膝关节交叉韧带损伤及其并发症 ,为临床制订治疗方案提供可靠依据。     

The effect of anterior cruciate ligament reconstruction on knee joint kinematics under simulated muscle loads

BACKGROUND: Numerous studies have investigated anterior stability of the knee during the anterior drawer test after anterior cruciate ligament reconstruction. Few studies have evaluated anterior cruciate ligament reconstruction under physiological loads. PURPOSE: To determine whether anterior cruciate ligament reconstruction reproduced knee motion under simulated muscle loads. STUDY DESIGN: Controlled laboratory study. METHODS: Eight human cadaveric knees were tested with the anterior cruciate ligament intact, transected, and reconstructed (using a bone-patellar tendon-bone graft) on a robotic testing system. Tibial translation and rotation were measured at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion under anterior drawer loading (130 N), quadriceps muscle loading (400 N), and combined quadriceps and hamstring muscle loading (400 N and 200 N, respectively). Repeated-measures analysis of variance and the Student-Newman-Keuls test were used to detect statistically significant differences between knee states. RESULTS: Anterior cruciate ligament reconstruction resulted in a clinically satisfactory anterior tibial translation. The anterior tibial translation of the reconstructed knee was 1.93 mm larger than the intact knee at 30 degrees of flexion under anterior load. Anterior cruciate ligament reconstruction overconstrained tibial rotation, causing significantly less internal tibial rotation in the reconstructed knee at low flexion angles (0 degrees-30 degrees) under muscle loads (P < .05). At 30 degrees of flexion, under muscle loads, the tibia of the reconstructed knee was 1.9 degrees externally rotated compared to the intact knee. CONCLUSIONS: Anterior cruciate ligament reconstruction may not restore the rotational kinematics of the intact knee under muscle loads, even though anterior tibial translation was restored to a clinically satisfactory level under anterior drawer loads. These data suggest that reproducing anterior stability under anterior tibial loads may not ensure that knee joint kinematics is restored under physiological loading conditions. CLINICAL RELEVANCE: Decreased internal rotation of the knee after anterior cruciate ligament reconstruction may lead to increased patellofemoral joint contact pressures. Future anterior cruciate ligament reconstruction techniques should aim at restoring 3-dimensional knee kinematics under physiological loads.     

Anatomical reconstruction of knee posterolateral complex with the tendon of the long head of biceps femoris

BACKGROUND: There is no consensus about the best way to reconstruct the knee posterolateral complex. HYPOTHESIS: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris can restore knee posterolateral stability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Anatomical reconstruction of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon was performed consecutively in 28 patients with chronic posterolateral knee injuries. Two distally pedicled tendon slips more than 16 cm long were created from the tendon of the long head of the biceps femoris. The posterior tendon slip was used to reconstruct the popliteofibular ligament and popliteus tendon, and the anterior slip were doubled to reconstruct the lateral collateral ligament. The patients were followed up for 2 to 4 years. RESULTS: At the latest follow-up, examinations showed that 96.4% (27/28) of the patients had a normal or nearly normal reconstructed fibular collateral ligament as judged by manual examination. All patients had a normal or nearly normal reconstructed popliteofibular ligament and popliteus tendon as judged by manual examination. CONCLUSION: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris is effective in restoring knee posterolateral stability.