Current concepts in MRI of rectus femoris musculotendinous (myotendinous) and myofascial injuries in elite athletes

Rectus femoris injuries are extremely common in athletes, particularly in soccer players, rugby player, and sprinters. Magnetic resonance imaging (MRI) plays a key role in diagnosis, prognosis, and rehabilitation of these injuries. The current article discusses current concepts in the diagnosis and treatment of rectus femoris injuries in elite athletes, including a discussion of the less well known myofascial injuries and key prognostic factors as seen at MR imaging.     

Prolonged running increases knee moments in sidestepping and cutting manoeuvres in sport

Objectives

To investigate how knee kinematics, kinetics and loading changes during sidestepping tasks following a prolonged running protocol performed in a laboratory setting.

Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study

ObjectivesThe novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training.DesignBlock-randomized 2 × 2 cross-over trial.MethodsThirty athletes (18?31 years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality.ResultsPACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles ?0.3;2), training duration (mean 5.34, 95% CI: ?0.17; ?0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training.ConclusionsResults suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.     

MR imaging evaluation of knee collateral ligaments and related injuries: Comparison of T1-weighted,T2-weighted,and fat-saturated T2-weighted sequences—correlation with clinical findings

The objectives of this study were to compare the ability of T1-weighted (T1W), proton density/T2-weighted (PD/T2W), and fat saturation (FS) PD/T2W magnetic resonance (MR) sequences for depiction of the knee collateral ligaments and related injuries, and to compare MR findings with clinical findings. Ten subjects with normal knee ligaments and 64 patients with suspected collateral ligament injuries underwent coronal T1W, PD/T2W, and FS PD/T2W imaging. Abnormalities ranged from edema surrounding the collateral ligaments (grade I) to complete disruption of ligamentous fibers (grade III). FS PD/T2W images improved definition of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) compared with other sequences in 78% and 81% of patients, respectively. While the apparent grade of collateral ligament injury was similar with all pulse sequences in most patients, depiction of such injury was usually most conspicuous on FS PD/T2W images (MCL, 92% of patients; LCL, 38% of patients). In no patients were clinically diagnosed collateral ligament injuries undetected or understaged with MR imaging. MR findings indicated higher-grade MCL and LCL injuries than did clinical examination in 24 and 15 patients, respectively.     

Combination of cold and compression after knee surgery

The objective of this study was to investigate the effect of continuous long-term application of a combined cooling and compression system (Cryo/Cuff, Aircast Inc., Summit. New Jersey, USA) on postoperative swelling, range of motion (ROM), pain, consumption of analgesics, and return of function after anterior cruciated ligament (ACL) reconstruction. We compared the cold-compression system with traditional ice therapy. There were 44 patients in the series (aged 15–40 year_ who were randomly assigned to a control group (ICE) or a study group (CC). The ICE group consisted of 23 patients (aged 24.2±4.5 years); the CC group consisted of 21 patients (aged 24.8±5.6 years). The ICE group received ice bags postoperatively; the CC group was provided with the Cryo/Cuff during the 14-day hospital stay. Girth, ROM, pain score (visual analog scale), and consumption of analgesics were determined on postoperative days 1, 2, 3, 6, 14, and 28. Twelve weeks after surgery, isokinetic testing was performed, and the functional knee score was determined. In the CC group, significantly less swelling was observed (P<0.035). These patients also reported less pain and had a significantly reduced consumption of analgesics (P<0.04). On all examination days, ROM in the CC group was up to 17° greater than in the ICE group (P<0.02). The functional knee score was singificantly increased in the CC group (P=0.025). The results from our study document the advantages of conitnous cold-compression therapy over cold alone following ACL reconstructionThe study was conducted at the Kreiskrankenhaus Bopfingen, Germany     

Objective parameters to measure (in)stability of the knee joint during gait: A review of literature

BackgroundInstability of the knee joint during gait is frequently reported by patients with knee osteoarthritis or an anterior cruciate ligament rupture. The assessment of instability in clinical practice and clinical research studies mainly relies on self-reporting. Alternatively, parameters measured with gait analysis have been explored as suitable objective indicators of dynamic knee (in)stability.Research questionThis literature review aimed to establish an inventory of objective parameters of knee stability during gait.MethodsFive electronic databases (Pubmed, Embase, Cochrane, Cinahl and SPORTDiscuss) were systematically searched, with keywords concerning knee, stability and gait. Eligible studies used an objective parameter(s) to assess knee (in)stability during gait, being stated in the introduction or methods section. Out of 10717 studies, 89 studies were considered eligible.ResultsFourteen different patient populations were investigated with kinematic, kinetic and/or electromyography measurements during (challenged) gait. Thirty-three possible objective parameters were identified for knee stability, of which the majority was based on kinematic (14 parameters) or electromyography (12 parameters) measurements. Thirty-nine studies used challenged gait (i.e. external perturbations, downhill walking) to provoke knee joint instability. Limited or conflicting results were reported on the validity of the 33 parameters.SignificanceIn conclusion, a large number of different candidates for an objective knee stability gait parameter were found in literature, all without compelling evidence. A clear conceptual definition for dynamic knee joint stability is lacking, for which we suggest : “The capacity to respond to a challenge during gait within the natural boundaries of the knee”. Furthermore biomechanical gait laboratory protocols should be harmonized, to enable future developments on clinically relevant measure(s) of knee stability during gait.     

The relationship between muscle capacity utilization during gait and pain in people with symptomatic knee osteoarthritis

BackgroundMuscle capacity utilization reflects the percentage of maximal knee extensor strength required to complete physical activities.Research questionIs pain associated with muscle capacity utilization during walking in older adults with knee osteoarthritis? Secondarily, is muscle capacity utilization in older adults with knee osteoarthritis sex-specific?MethodsTwenty-three participants (15 females) with symptomatic knee OA completed this study [age 67 ( ± 8) years, body mass index 29.7 ( ± 3.9) kg/m², gait speed during the Six Minute Walk test 1.25 ( ± 0.25) m/s]. Pain was measured using the Knee injury and Osteoarthritis Outcome Score. Muscle capacity utilization was quantified as the peak external knee flexor moment during level walking normalized to knee extensor maximum voluntary isometric contraction. The knee flexor moment was calculated from kinematic and kinetic data during barefoot level walking at a self-selected speed and at 1.1 m/s. Knee extensor maximum voluntary isometric contraction was measured on a dynamometer. Multiple linear regressions were used to determine the relationship between pain and muscle capacity utilization after adjusting for age, sex, body mass index, and gait speed. Independent sample t-tests examined sex differences.ResultsPain was not associated with muscle capacity utilization during self-selected and standardized walking speeds (p = 0.38 and p = 0.36, respectively). Females did not require a greater muscle capacity utilization than males to complete gait at self-selected and standardized speeds (p = 0.28, and p = 0.40, respectively).SignificanceMuscle capacity utilization was not associated with pain during walking in people with knee osteoarthritis. Future work should explore more challenging activities of daily living in knee OA.     

武警某部统训试点新兵军事训练伤调查与防治

 

目的 调查统训试点新兵训练伤发生情况,为训练伤防治提供指导。方法 选取2017年度1420名新兵作为研究对象,查阅门诊登记日志收集数据,训练伤诊断分类参照《中国人民解放军军事训练伤诊断分类标准》,并进行数据统计分析。结果 训练伤发病率为20.14%。急性损伤占23.78%,其中关节扭伤和软组织挫裂伤分别占急性损伤44.12%和13.24%。过劳性损伤占76.22%,其中疲劳性骨折所占28.67%,其次是创伤性关节炎、腱炎及腱鞘炎。在训练第6~10周发生训练伤较多,占全部损伤51.74%。城市来源的新兵训练伤发生率(13.57%),低于农村来源新兵(21.75%),差异有统计学意义(P<0.05)。结论 训练第6~10周训练伤发生较多,其中过劳性损伤多于急性损伤,应重视农村来源新兵训练伤的防护;因人施训,有针对性预防能降低训练伤发生率。

     

Type of measurement used influences central and peripheral contributions to quadriceps weakness after anterior cruciate ligament (ACL) reconstruction

ObjectiveThe relative contribution of muscle size and voluntary activation (VA) on quadriceps strength after anterior cruciate ligament (ACL) reconstruction remains inconclusive. Here, we aimed to determine the contributions of muscle size and VA on quadriceps strength in ACL-reconstructed patients and determine if contributions were similar if unilateral outcomes (i.e. ACL-reconstructed limb) or the LSI was used. Design: A cross-sectional study.SettingA university research laboratory.ParticipantsSixteen individuals 6–12 months after ACL reconstruction (Age: 22.3 ± 6.0yr, Height: 1.7 ± 0.1 m, Mass: 68.7 ± 11.5 kg) were recruited.Main outcome measuresQuadriceps isometric strength and VA, via the interpolated triplet technique, were assessed bilaterally. Ultrasound images were acquired of the vastus lateralis to calculate cross-sectional area (CSA) in both legs. LSI’s were computed for all variables by expressing values of the reconstructed leg as a percent of the non-reconstructed leg. Separate stepwise linear regressions were performed to examine the contribution of VA and CSA on quadriceps strength. Model 1 used LSI for all outcomes and model 2 used outcomes from the reconstructed leg.ResultsWe observed between limb deficits of 27.78% in quadriceps strength, 13.61% in vastus lateralis CSA, and 13.18% in VA (P < 0.05). Strength LSI was significantly predicted by VA LSI (R² = 0.45, P < 0.01), but not by CSA LSI (R² = 0.01, P =0.87). Reconstructed leg strength was significantly predicted by VL CSA (R² = 0.50, P < 0.01) but not quadriceps VA (R² = 0.08, P =0.11).ConclusionsThe contributions of VA and CSA on quadriceps PT differed greatly if LSI or reconstructed leg outcomes were used. Evaluation of VA and CSA in unison may be provide a more holistic understanding of the sources of muscle weakness after ACL reconstruction.     

Synovial reaction and concentrations of proteoglycan fragments in joint fluid after intraarticular knee injuries

In patients with pathology to cruciate ligaments, menisci and cartilage and in some patients with symptomatic knees without gross intraarticular changes, proteoglycan fragment concentrations in joint fluid and inflammatory reaction of the synovium were related to the cartilage condition. There was a weak positive correlation between increased concentrations of proteoglycan fragments in joint fluid and the degree of cartilage degeneration, indicating higher concentrations in knees with more advanced cartilage destruction, but there was no correlation to the synovial reaction at histological inspection. However, in most knees the synovial tissue was infiltrated by inflammatory cells. Symptomatic knees free from gross intraarticular pathology showed similar synovial changes and concentrations of proteoglycan fragments in joint fluid as knees with intraarticular pathology and obvious cartilage degeneration. The complex process of proteoglycan synthesis, release, degradation, and clearance from joint fluid apparently caused the weak or absent correlations between this marker protein and the degree of synovitis and arthrosis stage.     

Clinical and functional results after the rehabilitation period in minimally-invasive unicondylar knee arthroplasty patients

The objective of the present study was to analyze the clinical and functional outcome after minimally-invasive implantation of a Repicci-type unicompartmental sledge prosthesis . In 29 patients with primary unicompartmental knee osteoarthritis, 29 replacements of the medial compartment and four of the lateral compartment were performed using the minimally-invasive technique with the metal-backed and the all-polyethylene versions of the Repicci sledge prosthesis. Electromyography (EMG) of standardized locations was measured with the MyoSystem 2000 and analyzed with Myoresearch software. Gait analysis was performed with a six-camera motion analysis system and force platforms. Established clinical and quality of life (SF-36) scores were used to compare patients with 11 healthy age-matched individuals. The Repicci sledge prosthesis led postoperatively to functional results that were in the range of healthy joints, and superior to sledge prostheses of a different design. Gait and balance parameters were comparable to the control group, whilst electromyographically lower amplitudes were found in the patients than the controls and in the operated legs as compared to the non-operated legs. Many parameters of quality of life and activity were comparable to age-matched healthy individuals, and quality of life was superior to total knee replacement. When implanted using a minimally-invasive technique and with suitable patient selection, the Repicci sledge led to functional results comparable to those of healthy joints and gait parameters comparable to those of healthy individuals. The level of evidence is Level III, retrospective cohort study.     

伞降着陆环境下踝关节外侧副韧带及关节囊损伤的生物力学研究

目的 模拟空降兵着陆瞬间踝关节由跖屈位到内翻位的变化,测定外侧副韧带及关节囊等软组织损伤时的负荷,并分析其在受力过程中所表现的特性,为研制新式伞兵护踝及伞靴提供理论依据. 方法 采用人体踝关节标本6具,通过自制夹具固定在MTS-858生物材料试验机上,施加轴向力,轴向压缩范围10 cm,当负荷曲线出现峰值时停止.记录负荷峰值及达到峰值的时间,绘制负荷-时间曲线. 结果 模拟空降兵着陆瞬间踝关节由跖屈位到内翻位试验中,标本踝关节负荷在达到峰值前随时间逐渐增加,达到峰值后迅速下降.负荷峰值约2207.18 N,达到峰值时间约9.76s.当负荷达到峰值时,踝关节外侧副韧带及关节囊主要呈现钝性断裂损伤,断端极不整齐.全部标本经C型臂摄X线片,均无骨性损伤. 结论 模拟空降兵跳伞着陆瞬间踝关节由跖屈状态到内翻状态下,外侧副韧带及关节囊纤维组织在负荷-时间曲线中表现出“等长收缩”及“等张收缩”特性.本试验为改进护踝或伞靴设计,以更好地防止外侧副韧带及相关软组织损伤提供了一定的理论依据.     

Ultrasound-detected connective tissue involvement in acute muscle injuries in elite athletes and return to play: The French National Institute of Sports (INSEP) study

ObjectivesPrevious MRI studies showed that involvement of connective tissue in muscle injuries may prolong recovery times. The relevance of ultrasound assessment of connective tissue involvement as a prognostic factor is unknown. The aim was to test the hypothesis that ultrasound-detected connective tissue involvement in acute muscle injuries are related to longer recovery times.DesignCohort study.MethodsSeventy consecutive elite athletes from the French National Institute of Sports (INSEP) sustaining an acute muscle injury showing positive findings on ultrasound at baseline were included. Ultrasound was systematically performed within 7 days after the injury for the assessment of severity (grades 1–4) and type of injury in regard to the absence (M injuries) or presence (C injuries) of connective tissue involvement. The differences in the mean time needed to return to play (RTP) between the different grades and types of injury were assessed using multiple non-parametric tests.ResultsWhen considering the overall grades independently of the type of injury (M or C), an increase in the mean time needed to RTP was observed with the increase of grades (p < 0.0001). The same relationship was found when considering grades from M and C injuries separately, with higher grades of injuries exhibiting longer times needed to RTP (p < 0.0001). Longer times needed to RTP were observed in athletes demonstrating C injuries in comparison to the ones exhibiting M injuries overall (p = 0.002).ConclusionsUltrasound-detected connective tissue involvement in acute muscle injuries are related to longer times needed to RTP, especially when disruption is detected.     

Drill design using the ’control-chaos continuum’: Blending science and art during return to sport following knee injury in elite football

Establishing the level of risk, planning and adapting the return to sport (RTS) process following a complex knee injury involves drawing on a combination of relevant high-quality evidence and practitioner experience. On-pitch rehabilitation is a critical element of this process, providing an effective transition from rehabilitation to team training. The ‘control-chaos continuum’ (CCC) is an adaptable framework for on-pitch rehabilitation moving from high control to high chaos, progressively increasing running load demands and incorporating greater perceptual and neurocognitive challenges within sport-specific drills. Drills are a key element of the CCC, and are designed to ensure specificity, ecological validity and maintaining player interest. We showcase drill progression through the phases of the CCC, highlighting the use of constraints to create drills that incorporate the physical, technical, tactical and injury-specific needs of the player. We also provide recommendations to help practitioners create training session content using the CCC to help replicate the demands of team training within their own environment.     

Musculoskeletal and head injuries in the Ultimate Fighting Championship (UFC)

Objectives: Mixed martial arts (MMA) has witnessed a surge in popularity worldwide. This study explores the musculoskeletal and head injuries sustained in the professional fights of the Ultimate Fighting Championship (UFC), and establishes associations between injury profiles and impactful contributory factors.

Methods: The Nevada State Athletic Commission database was screened for ringside physician reports of UFC fights between January 2016 and July 2018. Information on the fighter’s gender, weight, injury, way of finish, and match result were collected. Injury rates were calculated and statistical analyses were conducted to determine significant associations among variables. P-values <0.05 were considered significant (95% CI).

Results: A total of 291 injuries were recorded in 285 fights from nine weight divisions. The overall injury rate was 51 per 100 athletic exposures (AE). Males predominantly partook in 249 matches (87%) and had higher injury rates (54 injuries per 100 AE) than females (30 injuries per 100 AE). Decision was the most common way a match ended. Knockouts (KOs) were significantly higher in males (36%) than in females (14%, P = 0.0007). Submissions were significantly higher in females (36%) than in males (16%, P = 0.001). Head injuries (67%) were the most common injuries reported with a rate of 34 per 100 AE. Upper limb injuries were significantly higher in females (40%) than in males (14%, P = 0.0003). Lower limb injuries were significantly higher in males (19%) than in females (5%, P = 0.01). Head injuries were significantly associated with KOs (P < 0.0001). Upper limb injuries (P = 0.032) and lower limb injuries (P = 0.034) were significantly associated with matches that ended with Decision. Trend-line analyses showed that as weight division increases, overall injury rates, head injuries, lower limb injuries, and KOs’ frequency increase, whereas upper limb injuries, Submission frequency, and Decision frequency decrease.

Conclusion: MMA has a high injury rate. Gender, way of finish, and weight play an important role in predicting fight outcomes and injury profiles. Injury prevention policies must be entertained to limit injury risk in MMA.     

Current trends in repair and rehabilitation of complete (acute) anterior cruciate ligament injuries. Analysis of 1984 questionnaire completed by ACL Study Group

Results of a 21 question survey, taken at the ACL Study Group meeting in 1984, present a composite picture of current practices in ACL reconstruction and rehabilitation. Forty-four of the 50 questionnaires were returned. Responses represented views from knee surgeons in the United States, Canada, Australia, Sweden, and Switzerland. These results were compared with a report of a 1980 international survey in which views of 40 knee experts from the United States, Canada, England, France, and Sweden were summarized. Questions on the two surveys were similar, particularly about rehabilitation. Although the time span between the two surveys was only 4 years, we can see both consistencies and changes. Responses about length of time between ACL repair and full range of motion (by 6 months) were essentially the same (88% in 1980, and 86.4% in 1984). However, changes were evident in length of immobilization (longer in 1980) and prescribing isometric contractions of quadriceps 1st week postoperatively (more frequently in 1980). Surgeons allowed patients to return to full activity sooner in 1980 than in 1984. Electrical stimulation was being used more frequently in 1984, and apparently the practice of simultaneous hamstring and quadriceps contraction has come into prominence since 1980 as it was not mentioned in the first survey. In 1984, 50% of the respondents indicated they prescribed it. Since standardized reporting systems are not established, we cannot do reliable statistical analyses on large samples. At the present time, making surveys with responses from similar groups every few years is the best available way to capture trends in treatment of ACL injuries.     

The effect of proprioceptive knee bracing on knee stability during three different sport related movement tasks in healthy subjects and the implications to the management of Anterior Cruciate Ligament (ACL) injuries

IntroductionProprioceptive knee braces have been shown to improve knee mechanics, however much of the work to date has focused on tasks such as slow step down tasks rather than more dynamic sporting tasks.ObjectiveThis study aimed to explore if such improvements in stability may be seen during faster sports specific tasks as well as slower tasks.MethodTwelve subjects performed a slow step down, single leg drop jump and pivot turn jump with and without a silicone web brace. 3D kinematics of the knee were collected using a ten camera Qualisys motion analysis system. Reflective markers were placed on the foot, shank, thigh and pelvis using the Calibrated Anatomical Systems Technique. A two way ANOVA with repeated measures was performed with post-hoc pairwise comparison to explore the differences between the two conditions and three tasks.ResultsSignificant differences were seen in the knee joint angles and angular velocities in the sagittal, coronal and transverse planes between the tasks. The brace showed a reduction in knee valgum and internal rotation across all tasks, with the most notable effect during the single leg drop jump and pivot turn jump. The transverse plane also showed a significant reduction in the external rotation knee angular velocity when wearing the brace.DiscussionThe brace influenced the knee joint kinematics in coronal and transverse planes which confirms that such braces can have a significant effect on knee control during dynamic tasks. Further studies are required exploring the efficacy of proprioceptive braces in athletic patient cohort.     

MDCT angiography before and after thoracic endovascular aortic repair (TEVAR) in patients with thoracic traumatic aortic injuries

Objective

The objective of this study was to outline the role of multidetector computed tomography angiography (MDCTA) in the evaluation of patients with thoracic traumatic aortic injuries (TTAIs) pre- and post-thoracic endovascular aortic repair (TEVAR)

Hepatopulmonary Syndrome Induced by Common Bile Duct Ligation in a Rabbit Model: Correlation between Pulmonary Vascular Dilatation on Thin-Section CT and Angiography and Serum Nitrite Concentration or Endothelial Nitric Oxide Synthase (eNOS)1 Expression

Objective

To investigate the correlation between radiologic vascular dilatation and serum nitrite concentration and eNOS expression in the endothelial cell and pneumocyte in a rabbit model of hepatopulmonary syndrome induced by common bile duct ligation (CBDL).

Materials and Methods

Thin-section CT scans of the lung and pulmonary angiography were obtained 3 weeks after CBDL (n=6), or a sham operation (n=4), and intrapulmonary vasodilatation was assessed. The diameter and tortuosity of peripheral vessels in the right lower lobe by thin-section CT and angiography at the same level of the right lower lobe in all subjects were correlated to serum nitrite concentration and eNOS (endothelial nitric oxide synthase) expression as determined by immunostaining.

Results

The diameters of pulmonary vessels on thin-section CT were well correlated with nitrite concentrations in serum (r = 0.92, p < 0.001). Dilated pulmonary vessels were significantly correlated with an increased eNOS expression (r = 0.94, p < 0.0001), and the severity of pulmonary vessel tortuosity was found to be well correlated with serum nitrite concentration (r = 0.90, p < 0.001).

Conclusion

The peripheral pulmonary vasculature in hepatopulmonary syndrome induced by CBLD was dilated on thin-section CT and on angiographs. Our findings suggest that peripheral pulmonary vascular dilatations are correlated with serum nitrite concentrations and pulmonary eNOS expression.     

MR imaging of the knee: Improvement of signal and contrast efficiency of T1-weighted turbo spin echo sequences by applying a driven equilibrium (DRIVE) pulse

The purpose of this study was to assess the effect of a driven equilibrium (DRIVE) pulse incorporated in a standard T1-weighted turbo spin echo (TSE) sequence as used in our routine MRI protocol for examination of pathologies of the knee.Sixteen consecutive patients with knee disorders were examined using the routine MRI protocol, including T1-weighted TSE-sequences with and without a DRIVE pulse. Signal-to-noise ratios (SNRs) and contrast-to-noise ratio (CNR) of anatomical structures and pathologies were calculated and compared for both sequences. The differences in diagnostic value of the T1-weighted images with and without DRIVE pulse were assessed.SNR was significantly higher on images acquired with DRIVE pulse for fluid, effusion, cartilage and bone. Differences in the SNR of meniscus and muscle between the two sequences were not statistically significant. CNR was significantly increased between muscle and effusion, fluid and cartilage, fluid and meniscus, cartilage and meniscus, bone and cartilage on images acquired using the DRIVE pulse. Diagnostic value of the T1-weighted images was found to be improved for delineation of anatomic structures and for diagnosing a variety of pathologies when a DRIVE pulse is incorporated in the sequence.Incorporation of a DRIVE pulse into a standard T1-weighted TSE-sequence leads to significant increase of SNR and CNR of both, anatomical structures and pathologies, and consequently to an increase in diagnostic value within the same acquisition time.