Dynamic magnetic resonance imaging

Among the devices helping with an accurate diagnosis, neither MRI nor arthroscopy is perfect; both delineate pathology in the knee joint with reasonable sensitivity and specificity. MRI, as a noninvasive and nonionizing modality, has made a significant contribution to the understanding of musculoskeletal disturbances. Static images through the patellofemoral joint in different degrees of flexion reveal only the degree of patellar tilt or subluxation, parameters that can be measured also on the axial view of conventional radiography. The accuracy of patellar position on static axial MRI is limited by the absence of muscle contraction, movement, and loading. Dynamic axial images of patellofemoral articulation can demonstrate the degree of flexion where patellar malalignment is maximal and assess whether or not it reduces. Arthroscopy, aside from its diagnostic values, provides the opportunity for treatment of intra-articular changes contributing to knee joint disturbances, but it is an invasive technique with potential risks of complications. The performed cost-effectiveness analysis of MRI is based mainly on estimation of intra-articular pathology of the acutely-injured knee [49,52,56]. There are scarce data on the cost-effectiveness of MRI of patellofemoral alignment in patellofemoral pain knees. Total examination time for active movement dynamic MRI procedure is approximately 8 to 10 minutes, thus it can be performed during routine MRI examination of the knee. In cases of suspected patellofemoral malalignment with symptoms that mimic other types of internal derangement of the knee joint, dynamic MRI can be a procedure of choice for detection of transient patellar dislocation, whereas a single clinical examination cannot differentiate from other internal knee pathologies. Dynamic MRI, although in an experimental phase, gives us a new perspective for dynamic study of the patellofemoral joint.