Patterns of meniscal injury with acute anterior cruciate ligament tears

One hundred two patients underwent an arthrotomy for the primary repair of an acute ACL tear with or without an associated collateral ligament injury. The mean age was 23 years. Forty-seven patients (46%) had meniscal injuries. Meniscal injuries were found in 41% of Group I patients (isolated ACL injuries) and in 54% of Group II patients (injured ACL/collateral ligaments). Twenty-eight medial and 22 lateral meniscal tears were noted. Twenty-six of the 50 meniscal tears (52%) were sutured in an attempt to repair the menisci. Of these, 20 of the medial (71%), and 6 of the lateral (27%) meniscal injuries were sutured. No patients in this series required a total meniscectomy. A thorough evaluation of the menisci is mandatory in knees with an acutely injured ACL.     

Association of peripheral vertical meniscal tears with anterior cruciate ligament tears

OBJECTIVE: The purpose of this article is to describe a type of meniscal tear seen on magnetic resonance (MR) imaging, the peripheral vertical tear, and to determine the prevalence of anterior cruciate ligament (ACL) tears in knees with this type of meniscal tear compared to knees with other types of meniscal tears. MATERIALS AND METHODS: Following Institutional Review Board approval, a retrospective review of 200 knee MR examinations with imaging diagnoses of 'meniscal tear' was performed to assess the location and morphology of the meniscal tear, and to assess the status of the ACL. RESULTS: Nineteen peripheral vertical meniscal tears were identified in 17 patients, 14 of whom had acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. Three peripheral vertical tears were seen in the setting of a normal ACL. Of the 183 examinations with other types of meniscal tears, there were 17 cases with acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. The difference in the prevalence of ACL tear, reconstruction, or deficiency in knees with meniscal tears of the peripheral vertical type (82.4%) compared with the prevalence of ACL tear, reconstruction, or deficiency in knees with other types of meniscal tears (9.3%) was statistically significant (P < 0.001). The calculated specificity of the presence of peripheral vertical tear morphology in detecting an ACL injury in patients with meniscal tears was 98.2%. CONCLUSIONS: Peripheral vertical meniscal tears, particularly when involving the posterior horn, are highly associated with ACL tear, deficiency, or reconstruction. The finding of this type of tear on knee MR imaging should prompt close inspection of the ACL for evidence of acute or chronic injury, and its presence may help make the diagnosis of ACL tear in equivocal cases.     

Trends in the surgical treatment of meniscal tears in patients with and without concurrent anterior cruciate ligament tears

ABSTRACT

Objectives

Meniscal and anterior cruciate ligament (ACL) tears are common injuries. The purpose of this study was to determine trends in meniscal repair and meniscectomy both in the presence and absence of ACL reconstruction (ACLR).     

前交叉韧带撕裂的MRI诊断

目的:研究膝关节前交叉韧带撕裂的MRI表现。方法:回顾分析30例经关节镜证实的前交叉韧带撕裂MR图像及40例完好的ACL,分析其直接及间接征象的特征。结果:在评价的直接征象中,ACL不连续和ACL走行异常均具有相对高的诊断敏感性、特异性;在评价的间接征象中,后交叉韧带角、Blumensaat角、后交叉韧带指数、半月板后移征、“对吻性”骨挫伤、胫骨前移位等6个征象具有相对高的特异性,后交叉韧带角、Blumensaat角具有较高的敏感性。结论:ACL损伤的直接征象为诊断主要依据,ACL损伤的间接征象具有辅助诊断意义。     

Healing potential of meniscal tears without repair in knees with anterior cruciate ligament reconstruction

BACKGROUND: Few previous studies have documented the healing potential of meniscal tears that are left to heal without repair. PURPOSE: To determine the healing rates of meniscal tears left without repair in knees with anterior cruciate ligament reconstruction. STUDY DESIGN: Prospective cohort study. METHODS: One hundred and ninety-two knees were evaluated at the time of anterior cruciate ligament reconstruction and repeat arthroscopy. The healing rates of 41 medial and 42 lateral torn menisci without repair were evaluated by the same 2 surgeons in an identical fashion. RESULTS: Of 41 medial torn menisci left without repair, 22 (56%) were considered completely healed, 3 (7%) were incompletely healed, 11 (24%) were unhealed, and 5 (10%) had expanded unhealed lesions. Of 42 lateral torn menisci, 31 (74%) were considered completely healed, 2 (5%) were incompletely healed, 6 (14%) were unhealed, and 3 (7%) had expanded unhealed lesions. The healing rate of a medial meniscal tear was length dependent and not related to reconstructed ligament stability. CONCLUSIONS: Stable meniscal tears at the time of anterior cruciate ligament reconstruction possibly could be left in situ. However, longer medial meniscal tears are thought to require additional stabilizing procedures.     

Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency

BACKGROUND: Large bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency have been considered avascular and, thus, irreparable. HYPOTHESIS: The rate of meniscal healing is higher than previously reported. STUDY DESIGN: Prospective cohort study. METHODS: Fifty-nine patients underwent staged surgical procedures of meniscal repair followed at an average of 77 +/- 58 days by ligament reconstruction once full range of motion was obtained. RESULTS: Fifty-two patients with 55 meniscal repairs were available for follow-up. At reconstruction, 30 menisci (55%) appeared healed; 19 (34%), partially healed; and 6 (11%) showed no healing (only 4 were removed). Of 43 tears in the white-on-white zone, 21 appeared healed; 17, partially healed; and 5 showed no healing. Of 11 in the red-on-white zone, 8 appeared healed; 2, partially healed; and 1 showed no healing. One meniscal tear in the red-on-red zone appeared healed. At an average follow-up of 4.3 +/- 3.1 years, 36 of the 43 (83.7%) white-on-white meniscal repairs remained asymptomatic; all repairs in the other zones remained asymptomatic. CONCLUSION: Locked bucket-handle meniscal tears heal at a high rate when repaired as an isolated procedure, even when full weightbearing and activity before reconstruction is allowed and when the tear is in the white-on-white zone.     

Relationship between bone bruise volume and the presence of meniscal tears in acute anterior cruciate ligament rupture

Purpose

To determine whether there is a relationship between the size of the bone bruise volume after an acute anterior cruciate ligament (ACL) rupture and the presence of meniscal tears in the medial and lateral compartment.

Methods

Following Institutional Review Board approval, 50 patients with an acute ACL rupture and MRI imaging within 30 days of injury were identified. Two musculoskeletal radiologists evaluated the lateral and medial menisci and graded them as one of the following: no meniscal tear, tear of one meniscus (medial or lateral) or tear of both menisci (medial and lateral). Sagittal T2 fat-suppressed images were used to calculate bone bruise volume. The relationship between bone bruise volume and the presence of a meniscus tear was calculated.

Results

Forty-three (86 %) patients had a bone bruise, 16 (32 %) patients had no tear, 7 (14 %) patients had lateral meniscus tear, 13 (26 %) patients had medial tear and 14 (28 %) patients had medial and lateral tears. There was a statistically significant difference in femoral bone bruise volume when comparing no meniscal tear to medial and lateral tears as well as when comparing medial or lateral tears to medial and lateral tears.

Conclusion

There is a statistically significant relationship between femoral bone bruise volume and the presence of meniscal tears in ACL injury, especially in the setting of medial and lateral pathology.

Level of evidence

Retrospective cohort study, Level III.     

Diagnosis of acute and chronic anterior cruciate ligament tears

The diagnosis of acute and chronic injuries of the ACL has been reviewed. Attention has been given to the history, physical examination, and other diagnostic tools available for evaluation of the ligamentous injury. Clinical correlations have been highlighted. Finally, our recommendations for surgical intervention have been presented.     

Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

Objective

To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns.

Methods

Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI.

Results

Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p?=?0.008). Collateral ligament (p?≤?0.05) and osseous injuries (p?=?0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees.

Conclusion

ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries.

Key Points

? ALL injuries are fairly common in patients with acute ACL rupture. ? ALL injuries are highly associated with lateral meniscal and osseous injuries. ? MRI assessment of ACL-injured knees should include evaluation of the ALL.

     

Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees

Through the retrospective study of 1103 reconstructions of the anterior cruciate ligament (ACL) performed between 1984 and 1993, we try to outline the natural history of meniscal tears in acute lesions and in chronic insufficiency of the ACL. According to a more accurate evaluation of the clinical evolution, ACL-deficient knees can be classified into four different stages: acute, subacute, subchronic and properly chronic laxities. While acute injuries show a higher rate of lateral meniscus tears, chronic laxities are very frequently associated with severe medial meniscus lesions. Subacute and subchronic stages seem therefore to be the most favourable phases for ACL reconstruction, because of the lower percentage of severe associated meniscus tears and the minor risk of arthrofibrosis.     

Magnetic resonance imaging of double-bundle anterior cruciate ligament reconstruction

Reconstruction of the anterior cruciate ligament (ACL) using the double-bundle technique is getting highly increasing attention. This surgical approach uses two separate tendon grafts with the intention to reconstruct both anatomic bundles in order to restore the full biomechanical function of the original ligament. With the increasing popularity of this technique, radiologists will be more frequently confronted with patients who underwent this surgical procedure. The aims of this essay are to briefly describe the basic biomechanical and surgical principles and to summarize the magnetic resonance imaging findings of the knee after double-bundle ACL reconstruction. Grants or Funding None.     

Osseous injury associated with acute tears of the anterior cruciate ligament.

Multiplanar spin-echo magnetic resonance imaging was performed on 54 patients with acute complete anterior cruciate ligament tears. Imaging was done within 45 days of index anterior cruciate ligament injury. Spin-echo T1- and T2-weighted images were used to determine the lesion morphology and location. Only the T2-weighted sagittal images were used for the incidence assessment; T2-weighted spin-echo imaging reflects free water shifts and best indicates the acute edema and inflammatory changes from injury. Eighty-three percent (45 of 54) of the knees had an osseous contusion directly over the lateral femoral condyle terminal sulcus. The lesion was highly variable in size and imaging intensity; however, the most intense signal was always contiguous with the subchondral plate. Posterolateral joint injury was seen in 96% (43 of 45) of the knees that had a terminal sulcus osseous lesion determined by magnetic resonance imaging. This posterolateral lesion involves a spectrum of injury, including both soft tissue (popliteus-arcuate capsuloligamentous complex) and hard tissue (posterolateral tibial plateau) injuries. The consistent location of the osseous and soft tissue injuries underscores a necessary similar mechanism of injury associated with these acute anterior cruciate ligament tears. Based on these characteristic findings, several proposed mechanisms of injury are discussed.     

Patellotibial contusions in anterior cruciate ligament tears

Bone contusions are an important ancillary finding of many knee injuries. Not only are they a source of pain, they may suggest a mechanism of injury or a specific derangement of the knee joint. We have encountered a small number of patients being evaluated for anterior cruciate ligament (ACL) tears with unexplained patellar and tibial edema at magnetic resonance (MR) imaging. We present three individuals with contusions of the inferior patella with a corresponding contusion of the anteromedial tibial plateau. Internal derangements in these patients were similar to other individuals with acute ACL tears, however osseous contusions were more widespread. In conclusion, patellotibial contusions are rare and may indicate an injury with forces greater than usually encountered in most ACL tears. A careful search for uncommon associated injuries is prudent in these high-energy knee injuries.     

Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee Arthroscopic analysis

Arthroscopic diagnosis was used to determine the incidence of the most frequent injuries to the knee’s internal structures associated with ACL tear as well as ones without ACL tear. The most frequent finding associated with a recent ACL tear was the LM tear (72.7%). There is a statistically significant incidence of recent LM tear in knees with a recent ACL tear compared with recently injured knees without an ACL tear (P < 0.001). A statistically significant incidence of longitudinal LM tear was found in knees with a recent ACL tear compared with recently injured knees without an ACL tear (P < 0.001). Longitudinal tears were present in 63.6% of the knees with a recent ACL tear or in 87.5% of all knees with a recent LM tear. No statistically significant difference was found in the incidence of LM tear in the knees with a recent ACL tear compared to the incidence of LM tear in knees with an old ACL tear (P > 0.05). The posterior horn was most frequently injured (71.5% vs 64.0%). A significant difference between the findings in the various patient groups studied supports the hypothesis that longitudinal LM tears in an ACL-deficient knee do not involve secondary meniscal pathology but that their onset derives from a primary recent injury. Most probably, the recent LM lesion does not evolve in meniscal length and depth. This hypothesis needs thorough investigation. Received: 25 May 1996 Accepted: 7 April 1997     

Patterns of meniscal injury associated with acute anterior cruciate ligament injury in skiers.

To determine if the incidence and patterns of meniscal injury associated with acute anterior cruciate ligament injury in skiers are different from those seen in individuals injured in nonskiing athletic activities, we reviewed the records of 150 patients with acute anterior cruciate ligament injuries. All patients had undergone arthroscopic evaluation within 21 days from the time of injury. There were 75 individuals who were injured while skiing and 75 individuals who sustained an injury in some other high-load athletic activity. Associated meniscal injury was documented at the time of arthroscopy and characterized by location, region, zone, depth, shape, size, and stability. Thirty-one of 75 skiers had an associated meniscal injury as compared to 47 of 75 of the nonskiers. This suggested a strong trend of decreased incidence of meniscal injury in the skier group, but the nonskiers had a higher incidence of major meniscal tears that required repair or partial meniscectomy. The location of the meniscal tear was also significantly different. The incidence of isolated lateral meniscal injury in skiers was higher than in nonskiers. There was a strong trend of increased incidence of medial meniscal involvement in the nonskiers than in the skiers. While there was no difference in the zone or region of tear between the two groups, the skier group was more likely to have a longitudinal tear of the posterior horn of the lateral meniscus. In both groups, lateral meniscal tears were more likely to require conservative treatment or partial meniscectomy while medial meniscal tears were more likely to be repaired than excised.     

前交叉韧带断裂的MRI征象研究

目的 研究前交叉韧带(ACL)断裂的MRI表现,探讨其直接征象和间接征象的产生机制及诊断价值.方法 本组男37例,女3例;年龄16～49岁,平均33岁.急性期断裂28例,慢性期断裂12例,均经关节镜检查和手术证实.采用1.5 T西门子MRI扫描仪,SE或TSE序列T1、12、质子压脂、medic和横断位、矢状位、冠状位多方位成像.组织3名高年资医师进行回顾分析,对ACL断裂的MRI直接征象和间接征象进行统计分析.结果 ACL断裂4|D例中完全性断裂35例,部分断裂5例.急性期断裂的28例直接征象分别为信号中断或不连续24例(86%),信号不均匀18例(64%),韧带肿胀增厚10例(36%);而慢性期断裂的12例分别韧带增厚11例(92%),信号中断或不连续9例(75%),信号不均匀7例(58%),其中韧带增厚征象主要见于慢性期的ACL断裂(P＜0.01).完全性断裂的35例中,28例(80%)发生在中段,上端、下端发生率低;5例部分断裂均发生在前内侧束.ACL断裂的间接征象中,后交叉韧带(PCL)"7"字变形34例(85%);半月板外露26例,其中外侧半月板外露16例(62%);骨损伤15例,其中胫骨撕裂骨折8例(53%);关节间隙增宽9例,其中78%属于慢性断裂;胫骨前移23例(57%).本组40例中,术前正确诊断37例,正确率为92%;3例部分断裂术前未能诊断,漏诊率为8%.结论 根据ACL断裂的直接征象和间接征象,结合外伤史,术前诊断比较容易.     

Magnetic resonance imaging of anterior cruciate ligament tears: evaluation of standard orthogonal and tailored paracoronal images

PURPOSE: To evaluate the three standard orthogonal imaging planes and a paracoronal imaging plane for anterior cruciate ligament (ACL) tears. MATERIAL AND METHODS: Ninety patients (91 knees; 29 F and 61 M) aged between 15 and 84 years (mean 36.9 +/- 16.4 years) underwent magnetic resonance imaging (MRI) of the knee prior to arthroscopy. At surgery, 32 knees had an intact ACL, 4 a partial tear, and 55 a complete ACL tear. In all patients, axial, sagittal, coronal, and paracoronal T2-weighted turbo-SE images were acquired. The ACL was classified as intact, partially, or completely torn. Partial and complete tears were combined for statistical evaluation. RESULTS: Partial ACL tears (four cases) were not correctly diagnosed at MRI except in one knee by one observer on coronal images. Sensitivity in detecting ACL tears was 95%/63% (reader1/reader2) in the axial, 93%/95% in the sagittal, 93%/86% in the coronal, and 100%/93% in the paracoronal plane. Specificity was 75%/81% in the axial, 72%/81% in the sagittal, 78%/94% in the coronal, and 78%/88% in the paracoronal plane. CONCLUSION: ACL tears can be diagnosed accurately with each of the standard orthogonal planes. Based on reader confidence and interobserver agreement paracoronal images may be useful in equivocal cases.