Trabecular trauma of the talus and medial malleolus concurrent with lateral collateral ligamentous injuries of the ankle: evaluation with MR imaging

 Objective. The objective of this study was to elucidate the relationship between lateral collateral ligamentous injuries of the ankle (ankle sprain) and bone bruise (trabecular trauma) of the talus and/or malleoli in the patients with twisting injuries of the ankle. Design. Magnetic resonance studies of the ankle were retrospectively reviewed, focusing on the presence or absence of lateral collateral ligamentous injuries and the location of bone bruise in the talus and/or malleoli. Patients. Thirty-five patients with acute twisting injuries of the ankle were studied. Results and conclusion. Four patterns of bone bruise were found in 14 patients: (1) bone bruise in the talar dome equivalent to osteochondral fracture in two patients, (2) bone bruise in the posteromedial aspect of the talus and the medial malleolus singly or in combination in four, (3) bone bruise in the anteromedial aspect of the talus in six, and (4) bone bruise with a combination of the second and third patterns in two. The second pttern was associated with tear of the anterior talofibular (ATAF) ligament in all patients and injury of the calcaneofibular (CF) ligament in one out of four. The third and fourth patterns were associated with tears of both ATAF and CF ligaments in all patients. The identification of bone bruise was of value in indicating lateral collateral ligamentous injuries.     

Gamekeeper thumb: Diagnosis of ulnar collateral ligament injury using magnetic resonance imaging,magnetic resonance arthrography and stress radiography

Ulnar collateral ligament (UCL) tears may be nondisplaced or displaced relative to the adductor pollicis aponeurosis. Nondisplaced tears typically heal with immobilization whereas displaced tears require surgery. Nineteen patients with UCL injuries were evaluated using MR imaging (MRI), MR arthrography, and stress radiography (SR) to determine the efficacy of these techniques in differentiating nondisplaced from displaced UCL tears. Nineteen patients with UCL injuries were evaluated. MRI was utilized in 5 patients, and MR arthrography in 14, with 12 of these 14 undergoing SR. They were followed until resolution of symptoms; those without relief, and those with suspected displaced UCL tears were surgically explored. Surgery and imaging was correlated. Eight patients underwent surgical repair. SR was abnormal in six patients treated surgically, but was negative in four of six conservatively treated patients with MR findings of nondisplaced tears. All patients with MR or MR arthrographic findings interpreted as being normal or as having a nondisplaced tear improved after conservative treatment. Based on surgical findings and clinical follow-up, MR arthrography accurately diagnosed 13 of 14 UCL injuries, with one false-positive interpretation. SR is often falsely negative. MR imaging with or without intra-articular contrast injection proved to be accurate in a small series of patients with UCL injuries.     

两种不同磁共振线圈对肘部正常尺神经扩散张量成像的影响

目的:探讨使用膝关节专用线圈(Ex)和表面阵列线圈(Fl)对肘部正常尺神经扩散张量(DTI)成像的影响.方法:分别使用Ex线圈和Fl线圈采集31名志愿者肘部尺神经图像并建立扩散示踪图(DTT).比较两种线圈成像时,尺神经各向异性分数(FA值)、表观扩散系数(ADC值)、神经纤维束长度和DTI图像质量的差异.结果:共分析了50例尺神经.使用Ex线圈和Fl线圈时,肘部尺神经的FA值、ADC值均无明显统计学差异(P值分别为0.482、0.263),且两者尺神经DTT评分相当(P值分别为0.615、0.704),而Ex线圈采集的DTI图像质量优于F1线圈(P=0.004),DTT尺神经纤维束较长(P=0.000).结论:使用Ex线圈和Fl线圈对肘部尺神经DTI成像时均能获得稳定可靠的扩散测量参数,但Ex线圈得到的图像质量更高.     

MR imaging of ulnar collateral ligament injury in baseball players: value for predicting rehabilitation outcome

Background

To compare the MR findings of the ulnar collateral ligament (UCL) injury in baseball players between rehabilitation and reconstruction surgery.

Materials and methods

Thirty nine baseball players with clinical evidence of a UCL injury based on medial elbow pain and valgus instability were included. All patients received the rehabilitation treatment for more than six weeks. The elbow MR images of 27 patients not responding to rehabilitation treatment were reviewed that consequently had reconstruction surgery; in addition to 12 patients with improved symptoms with only rehabilitation treatment. The MR imaging was compared between the two treatment groups using the Pearson's chi-square test, and linear-by-linear association for the following features: the degree, signal intensity and site of the UCL injury on fat suppressed T2-weighted images.

Results

High-grade partial tears and complete tears were more commonly seen in the group that had surgery (14 out of 27 patients, 52%; 8 out of 27 patients, 30%), and low-grade partial tears and intact continuity were more common in the group that had rehabilitation only (5 out of 12 patients, 42%; 5 out of 12 patients, 42%) (p = 0.001). The injured UCL showed a fluid-like bright high or intermediate high signal intensity in the group that had surgery more frequently (14 out of 27 patients, 52%; 12 out of 27 patients, 44%), and intermediate high or low signal intensity was more frequent in the rehabilitation group (7 out of 12 patients, 58%; 3 out of 12 patients, 25%) (p = 0.013). The UCL injury at the origin site was most commonly seen in both groups (23 out of 27 patients, 85%; 11 out of 12 patients, 92%, respectively) (p = 0.496).

Conclusion

Preoperative MR imaging is useful for predicting the rehabilitation outcome of UCL injuries in baseball players.     

膝关节外侧副韧带MRI定位方法研究

目的改进膝关节磁共振成像（MRI）中膝关节外侧副韧带的定位方法,提高膝关节外侧副韧带（1ateral col-1atera lligament,LCL）的全程显示率和诊断膝关节外侧副韧带损伤的正确率。方法2010年11月～2012年7月我院212例患者共217个膝关节随机人组研究,记录在膝关节MRI外侧矢状面测量所得的腓骨长轴与膝关节间隙平面之间的夹角度数。在正中矢状面以该夹角度数来完成膝关节MRI斜冠状面定位。获得与腓骨长轴平行的膝关节斜冠状面MRIT2WI图像,观察外侧副韧带在斜冠状面上的显示情况。I级为韧带在单一层面全程显示,Ⅱ级为韧带在两个连续层面显示,Ⅲ级为韧带在两个以上层面显示。运用SPSS16．0统计软件进行卡方检验,分析膝关节外侧副韧带显示结果与性别、年龄、左右侧及定位角度之间的关系。结果用与腓骨长轴平行的膝关节斜冠状面MRIT2WI来显示膝关节外侧副韧带,LCLI级显示203个,LCLⅡ级显示13个,LCLnl级显示1个,定位角度71°～88°,平均78．30°±3．87°;膝关节外侧副韧带I级显示率与性别（P=285）、年龄（P=0．065）、左右侧（P=0．277）及定位角度（P=0．433）相关性均无统计学意义。结论与腓骨长轴平行的膝关节MRI斜冠状面是显示膝关节外侧副韧带的最佳层面,利用腓骨长轴与关节间隙平面的夹角定位,方法简单、结果准确。     

兔肘关节尺侧副韧带急性损伤手术与非手术治疗后的生物力学比较

目的 比较兔急性肘关节尺侧副韧带损伤后手术修复与非手术治疗效果的差异.方法 选取新西兰兔81只,完全随机分为三组,27只暴露出右尺侧副韧带后,但不切断,作为正常对照组(A);27只为切断右肘尺侧副韧带后随即缝合韧带,称为韧带缝合组(B);27只切断尺侧副韧带后不缝合,称为韧带不缝合组(C).分别在术后3,6,12周三个阶段取材,进行生物力学检测.结果 术后12周,B组断裂时的位移为(6.06±0.48)mm,C组为(7.72±0,44)mm(P＜0.05),B组位移接近A组[(5.87±0.46)mm](P＞0.05);B组的最大载荷为(68.23±5.64)N,C组为(42.45±3.66)N(P＜0.05),B组接近A组[(72.86±2.99)N](P＞0.05);B组的轴向刚度为(11.33±1.52)N/mm,C组为(5.52±0.67)N/nan(P＜0.05),B组接近A组[(12.49±1.44)N/mm](P＞0.05);B组的功耗为(0.206±0.017)J,C组为(0.163±0.013)J(P＜0.05),B组接近A组[(0.213±0.010)J](P＞0.05).结论 肘关节尺侧副韧带急性损伤后手术治疗明显优于非手术治疗.     

Evolution of the treatment options of ulnar collateral ligament injuries of the elbow

Ulnar collateral ligament (UCL) insufficiency is potentially a career threatening, or even a career ending, injury, particularly in overhead throwing athletes. The evolution of treating modalities provides afflicted athletes with the opportunity to avoid premature retirement. There have been several clinical and basic science research efforts which have investigated the pathophysiology of UCL disruption, the biomechanics specific to overhead throwing, and the various types of treatment modalities. UCL reconstruction is currently the most commonly performed surgical treatment option. An in depth analysis of the present treatment options, both non-operative and operative, as well as their respective results and biomechanical evaluation, is lacking in the literature to date. This article provides a comprehensive current review and comparative analysis of these modalities. Over the last 30 years there has been an evolution of the original UCL reconstruction. Yet, despite the variability in modifications, such as the docking technique, interference screw fixation, and use of suture anchors, the unifying concepts of UCL reconstruction are that decreased dissection of the flexor-pronator mass and decreased handling of the ulnar nerve leads to improved outcomes.     

MR arthrography for evaluation of the acetabular labrum

MR arthrography of the hip has provided new insights into the lesions underlying mechanical hip pain. Until now evaluation of these structures, especially the acetabular labrum, has been limited. With the joint distention provided by MR arthrography, labral detachments and intrasubstance tears can be identified and differentiated from the many varied appearances of the asymptomatic labrum. This article reviews the normal anatomy of the hip, the clinical presentation of internal derangement and the technique for performing MR arthrography. The variations in morphology and signal of the asymptomatic labrum are reviewed as well as the appearance of the abnormal labrum. Received: 16 January 2001 Revision requested: 21 January 2001 Revision received: 19 April 2001 Accepted: 19 April 2001     

MR imaging of tibial collateral ligament injury: comparison with clinical examination

We sought to clarify the capability of routine magnetic resonance (MR) imaging of the knee to detect and grade tibial collateral ligament (TCL) injury. We also wanted to define the exact MR findings that were the most important for diagnosis. Sixty-three patients were clinically evaluated for TCL injury prior to MR imaging of the knee on a 1.5-tesla system. MR studies were scored with respect to multiple direct and indirect findings. By discriminant analysis, the overall accuracy of classification (into clinical grades 1, 2, 3 and normal) on the basis of MR was 65%. Accuracy for detection of abnormal TCLs was 87%. The most useful MR findings for detection and grading of TCL injury were direct signs: subcutaneous edema over the TCL, focal disruption of the TCL, increased signal in the TCL on T2-weighted images, and longitudinal striations within the TCL. Indirect signs such as trabecular trauma were less useful for TCL evaluation. The presence of a tear of the anterior cruciate ligament, however, correlated with TCL injury of a higher grade. T2-weighted coronal images, by better depicting intraligamentous edema and fiber disruption, improved the MR assessment of the TCL.     

膝关节内侧副韧带损伤的MRI诊断价值

目的:探讨MRI对膝关节内侧副韧带损伤的诊断价值。方法:对59例临床拟诊膝关节内侧副韧带损伤的病例进行了MRI检查,分析其MRI表现,并与30例正常膝关节进行对比研究。结果:59例中,临床确诊为内侧副韧带损伤43例;MRI诊断为内侧副韧带损伤的共有37例,其中Ⅰ级损伤9例,Ⅱ级损伤15例,Ⅲ级损伤13例。MRI诊断膝关节内侧副韧带损伤的敏感度与特异性分别为81.4%和87.5%;对于手术治疗的20例Ⅱ、Ⅲ级的病例,MRI诊断的敏感度达100%。结论:MRI能够准确判断膝关节内侧副韧带有无损伤和损伤的程度及并发症,是较为理想的非创伤性检查方法。     

MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm

Magnetic resonance (MR) imaging provides useful information in the evaluation of peripheral nerves. Recent advances in MR imaging allow for detailed depiction of the soft tissue structures of the elbow joint. Three major nerves are present about the elbow. Six cadaveric elbows were imaged to depict the normal anatomy of these nerves and to determine the best plane and position of the elbow for optimal visualization of each nerve. Axial images of the elbow in full extension with the forearm in supination allow identification of all major nerves. Axial images with the elbow in full flexion allow accurate assessment of the cubital tunnel and the ulner nerve. Axial images of the elbow in full extension with the forearm in pronation are helpful for assessment of the median and radial nerves in the forearm.     

MR diagnosis of traumatic tear of the spring ligament in a pole vaulter

 The spring ligament is a significant contributor to the stability of the talar head and longitudinal arch of the foot, lending importance to accurate radiologic diagnosis of injury. Using MR, we diagnosed a spring ligament tear with associated navicular dorsal subluxation, confirmed intraoperatively. To our knowledge, there are no previous reports of MR diagnosis of tear of the spring ligament.     

肘关节疾病的MRI研究

目的探讨MRI在肘关节病变的应用价值。方法154例有肘关节疼痛、活动障碍或不适患者行肘关节MR检查,包括冠状位、矢状位及横断位成像,序列包括T1wI自旋回波（T,WISE）,T2WI自旋回波压脂（T：WIFS）,质子密度加权成像自旋回波压脂（PDWIFS）。俯卧位108例,仰卧位46例,使用膝关节线圈及表面线圈。结果154例患者中,关节正常表现25例,关节异常患者129例（83．8％）。其中炎性疾病38例（29．5％）,包括骨性关节炎32例,风湿性关节炎5例,关节结核1例。肿瘤或肿瘤样疾病28例（21．7％）,包括滑膜软骨瘤病4例,腱鞘巨细胞瘤1例,神经鞘瘤3例,腱鞘囊肿5例,滑膜囊肿15例。损伤性疾病63例（48．8％）,包括韧带损伤24例,肌腱损伤28例,尺神经损伤11例。结论磁共振对肘部疾病的诊断具有很好的价值。     

Intra-articular entrapment of the medial collateral ligament: radiographic and MRI findings

Displacement of the medial collateral ligament (MCL) into the medial knee joint is an extremely rare finding associated with MCL tears, and is easily diagnosed on magnetic resonance imaging. A case of intra-articular interposition of the MCL during a severe knee injury is presented. A radiolucent ”fat stripe” sign and adjacent skin dimpling on radiographs may be relatively specific indicators of this injury. Received: 18 March 1999 Revision requested: 17 May 1999 Revision received: 1 July 1999 Accepted: 2 July 1999     

Ulnar collateral ligament injury in the overhead athlete

The ulnar collateral ligament (UCL), particularly the anterior portion of the anterior oblique ligament, is the primary static contributor to elbow valgus stability. UCL injuries are most common in athletes participating in overhead sports. Acute and chronic injuries to the UCL result in valgus instability, which may predispose the athlete to the development of disabling secondary elbow conditions. Provocative physical examination maneuvers include the valgus abduction test, the modified milking maneuver, and the moving valgus stress test. Plain radiographs and magnetic resonance imaging are the most common imaging modalities, although ultrasonography and computed tomography arthrograms can alternatively be used. UCL injuries can be treated initially with rest, anti-inflammatory medications, bracing, and/or physical therapy. Acute avulsion injuries can be repaired, especially in those under 20 years of age, but most UCL tears are now treated with reconstruction. Modifications of the Jobe figure-of-8 technique, and now the Altchek docking technique, are the most common reconstruction techniques. Many new and hybrid techniques have been described with limited clinical experience in the literature. Current techniques offer the athlete a greater than 90% chance of return to play at their preinjury level.     

Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears

Objective. To describe the MR features of mucoid degeneration of the anterior cruciate ligament (ACL) in a series of patients with MRI findings that were mistaken for tears in the majority of cases but who were found to have an intact ligament at arthroscopy. We will suggest a pathologic entity corresponding to this finding and describe some characteristic features that can be used to identify this entity on MRI. Design. A retrospective analysis of 10 MRI examinations of the knee was performed after arthroscopic evaluation. Prearthroscopic MRI findings had been interpreted as a tear in six patients prospectively and in the remaining four the diagnosis of mucoid degeneration was suggested and ultimately proven. All patients had an intact ACL by preoperative clinical examination, examination under anesthesia, and at arthroscopy. Results. MRI examinations demonstrated an ill-defined ACL, greater in girth than the normal ligament and characterized by increased signal on all sequences. The high-signal ligament was oriented in the normal direction of the ACL. The overall appearance of the ligament was retrospectively described as like a celery stalk. Arthroscopy demonstrated mechanically intact ligaments with a normal to expanded external appearance. Probing of three of the ligaments caused a material to be expressed and pathologic evaluation resulted in the diagnosis of cystic, mucoid degeneration. Conclusion. Mucoid degeneration and an intact ACL can be suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences is identified in a patient with a clinically intact ligament. Received: 10 April 2000 Revision requested: 18 July 2000 Revision received: 13 November 2000 Accepted: 27 November 2000     

Lateral ulnar collateral ligament of the elbow: optimization of evaluation with two-dimensional MR imaging

PURPOSE: To compare, in a cadaveric model, magnetic resonance (MR) imaging techniques with differing contrast and spatial resolution properties in the evaluation of disruption of the lateral ulnar collateral ligament (LUCL) at the elbow. MATERIALS AND METHODS: LUCL tears were surgically created in eight of 28 cadaveric elbow specimens. All specimens underwent 1.5-T MR imaging with the following pulse sequences: T1-weighted spin echo (SE), intermediate-weighted fast SE, fat-suppressed T2-weighted fast SE, gradient-recalled echo (GRE) with high spatial resolution, intermediate-weighted fast SE with high spatial resolution, and fat-suppressed T1-weighted SE with intraarticular administration of gadopentetate dimeglumine (MR arthrography). All images were obtained in the oblique coronal plane. Two radiologists independently graded the LUCL with separate and side-by-side assessment. RESULTS: Areas under the receiver operating characteristic curve were as follows for readers A and B, respectively: T1-weighted SE imaging, 0.64 and 0.62; intermediate-weighted fast SE imaging, 0.87 and 0.67; T2-weighted fast SE imaging, 0.68 and 0.69; GRE imaging, 0.56 and 0.68; MR arthrography, 0.84 and 0.85; and intermediate-weighted imaging with high spatial resolution, 0.92 and 0.88. Interobserver reliability was poor with T1-weighted SE imaging (kappa = 0.13) and GRE imaging (kappa = 0.18), fair with T2-weighted fast SE imaging (kappa = 0.36), and moderate with MR arthrography (kappa = 0.46), intermediate-weighted fast SE imaging (kappa = 0.55), and intermediate-weighted imaging with high spatial resolution (kappa = 0.59). CONCLUSION: Intermediate-weighted imaging with high spatial resolution and MR arthrography showed the greatest overall ability to enable the diagnosis of LUCL tears.     

肩关节MR造影对肩关节前方盂唇病变的诊断价值

目的明确肩关节造影MR对肩关节前方盂唇病变的诊断价值，并比较中立位肩关节造影MR和外展外旋（abduction and external rotation, ABER）造影MR的价值。方法回顾性分析经证实的44例肩关节造影MR资料，以肩关节镜检查结果为金标准，对比中立位肩关节造影MR和ABER造影MR对肩关节前方盂唇病变的诊断价值。结果中立位肩关节造影MR对前方盂唇的诊断敏感度为79．3％（23／29），特异度为100％（15／15），准确度为86．4％（38／44）；ABER造影MR的敏感度为93．1％（27／29），特异度为100％（15／15），准确度为95．5％（42／44）。ABER造影MR显著提高了前方盂唇病变的诊断敏感度（P=0．037）。结论ABER造影MR可以提高肩关节前方盂唇病变的诊断敏感度。     

Accuracy of MRI patterns in evaluating anterior cruciate ligament tears

 The purpose of this study was to determine the different patterns of anterior cruciate ligament (ACL) tears on MRI and the prevalence and accuracy of these patterns. Images were obtained on high-tesla and low-tesla units and the results compared to determine whether field strength affects the interpretation using the grading system. In 172 patients who underwent knee MRI (109 knees with high-tesla units and 63 knees with low-tesla units) and arthroscopy, there was a total of 91 arthroscopically proven ACL tears. Five patterns of ACL tears were observed and designated as type 1 (diffuse increase in signal on T2-weighted images and enlargement of the ligament, 48%); type 2 (horizontally oriented ACL, 21%); type 3 (nonvisualization of the ACL, 18%); type 4 (discontinuity of the ACL, 11%); and type 5 (vertically oriented ACL, 2%). The positive predictive value (PPV) for type 2, 4, and 5 patterns was 100% for both field strengths; for type 3 PPV was just above 80% for both field strengths. The PPV value for type 1 was 90% for the high-tesla unit and 79% for the low-tesla, unit, which was not statistically significant. Combining the results of both field strengths, the overall sensitivity and specificity were 93% and 89%, respectively. Arthroscopic results were also used to determine the association between meniscal and ACL tears. Only 13% of ACL tears were isolated, the rest being associated with meniscal tears. Forty-five percent of medial meniscal and 50% of lateral meniscal tears were associated with an ACL tear, and 94% of ACLs were torn when both menisci were torn.