Skip to main content
SpringerLink
Log in

MRT des Kniegelenks unter besonderer Berücksichtigung der Patellaluxation

The role of MRI in dislocations of the patella and other knee pathologies

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die Magnetresonanztomographie (MRT) stellt neben dem Röntgen und der Sonographie einen zentralen Pfeiler in der bildgebenden Diagnostik des Kniegelenks dar. Kniebinnenschäden, wie Kreuzbandverletzung, Seitenbandenverletzung sowie Knorpel- und Meniskusschäden können sicher erkannt werden. Das intraartikuläre Verletzungsmuster, einschließlich des medialen patellofemoralen Ligaments (MPFL), wird bei der akuten traumatischen Patellaluxation beschrieben und Risikofaktoren für Reluxationen bestimmt. Hieraus kann die notwendige konservative oder operative Therapie abgeleitet werden.

Ziel dieses Artikels ist es, dem Leser einen Überblick über Standardschichten, Sequenzen und Anwendungen des MRT zur Diagnostik von Erkrankungen und Verletzungen des Kniegelenks zu geben. Besondere Berücksichtigung hierbei soll die Patellaluxation finden, da im Gegensatz zu anderen Bildgebungsverfahren das MRT in dieser Situation ein wertvolles Instrument bei der Diagnostik der klinisch oft schwer quantifizierbaren Problematik darstellt.

Abstract

In addition to ultrasound and conventional x-ray, magnetic resonance imaging (MRI) plays an important role in the visualization of lesions of the knee. It allows the orthopaedic surgeon to safely detect ruptures of the cruciate ligaments, the meniscus, osteochondral lesions and other ligamentary structures such as the collateral ligaments and the medial patellofemoral ligament (MPFL). In patellar dislocations, risk factors for recurrent dislocations can be determined and the therapy can be adjusted accordingly.

This articles aims to give the reader a comprehensive overview on current concepts and techniques in the use of MRI for lesions of the knee. It focuses on patellar dislocations, where MRI plays a dominant role in supporting decision making for the best therapeutic strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 13
Abb. 14
Abb. 15
Abb. 16

Literatur

  1. Araujo P, Eck CF van, Torabi M, Fu FH (2012) How to optimize the use of MRI in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 21(7):1495–501

    Article  PubMed Central  PubMed  Google Scholar 

  2. Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21(3):499–519

    Article  PubMed  Google Scholar 

  3. Balcarek P, Ammon J, Frosch S et al (2010) Magnetic resonance imaging characteristics of the medial patellofemoral ligament lesion in acute lateral patellar dislocations considering trochlear dysplasia, patella alta, and tibial tuberosity – trochlear groove distance. Arthroscopy 26(7):926–935

    Article  PubMed  Google Scholar 

  4. Balcarek P, Walde TA, Frosch S et al (2012) MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first-time patellar dislocations. Knee Surg Sports Traumatol Arthrosc 20(8):1575–1580

    Article  PubMed Central  PubMed  Google Scholar 

  5. Baysal O, Baysal T, Alkan A et al (2004) Comparison of MRI graded cartilage and MRI based volume measurement in knee osteoarthritis. Swiss Med Wkly 134(19–20):283–288

    Google Scholar 

  6. Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14(8):707–712

    Article  PubMed  Google Scholar 

  7. Camanho GL, Viegas Ade C, Bitar AC et al (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25(6):620–625

    Article  PubMed  Google Scholar 

  8. Carrillon Y, Abidi H, Dejour D et al (2000) Patellar instability: assessment on mr images by measuring the lateral trochlear inclination – initial experience. Radiology 216(2):582–585

    Article  CAS  PubMed  Google Scholar 

  9. Christiansen SE, Jakobsen BW, Lund B, Lind M (2008) Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy 24(8):881–887

    Article  PubMed  Google Scholar 

  10. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg 90(12):2751–2762

    Article  PubMed  Google Scholar 

  11. Dejour H, Walch G, Neyret P, Adeleine P (1989) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76(1):45–54

    Google Scholar 

  12. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26

    Article  CAS  PubMed  Google Scholar 

  13. Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30(4):961–981

    Article  PubMed  Google Scholar 

  14. Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225(3):736–743

    Article  PubMed  Google Scholar 

  15. Fritz RC (2003) MR imaging of meniscal and cruciate ligament injuries. Magn Reson Imaging Clin North Am 11(2):283–293

    Article  Google Scholar 

  16. Frosch S, Balcarek P, Walde T et al (2011) The treatment of patellar dislocation: a systematic review. Z Orthop Unfall 149(6):630

    CAS  PubMed  Google Scholar 

  17. Goutallier D, Bernageau J, Lecudonnec B (1977) The measurement of the tibial tuberosity. Patella groove distanced technique and results (author’s transl). Rev Chir Orthop Reparatrice Appar Mot 64(5):423–428

    Google Scholar 

  18. Grelsamer RP, Proctor CS, Bazos AN (1994) Evaluation of patellar shape in the sagittal plane a clinical analysis. Am J Sports Med 22(1):61–66

    Article  CAS  PubMed  Google Scholar 

  19. Haas JP, Collins MS, Stuart MJ (2012) The „sliver sign“: a specific radiographic sign of acute lateral patellar dislocation. Skeletal Radiol 41(5):595–601

    Article  PubMed  Google Scholar 

  20. Hingelbaum S, Best R, Huth J et al (2013) The TTTG index: a new measurement of the lateralisation of the patella. Am J Sports Med (Epub ahead of print)

  21. Khanna AJ, Cosgarea AJ, Mont MA et al (2001) Magnetic resonance imaging of the knee current techniques and spectrum of disease. J Bone Joint Surg 83(Suppl2):128–141

    PubMed  Google Scholar 

  22. LaPrade RF, Engebretsen AH, Ly TV et al (2007) The anatomy of the medial part of the knee. J Bone Joint Surg 89(9):2000–2010

    Article  PubMed  Google Scholar 

  23. Lin Y-F, Lin J-J, Jan M-H et al (2008) Role of the vastus medialis obliquus in repositioning the patella a dynamic computed tomography study. Am J Sports Med 36(4):741–746

    Article  PubMed  Google Scholar 

  24. Madry H, Wolfgang Grün U, Knutsen G (2011) MEDIZIN-Übersichtsarbeit-Knorpelrekonstruktion und Gelenkerhalt-Medikamentöse und operative Möglichkeiten. Dtsch Ärztebl 108(40):669

    Google Scholar 

  25. Mashoof AA, Scholl MD, Lahav A et al (2005) Osteochondral injury to the mid-lateral weight-bearing portion of the lateral femoral condyle associated with patella dislocation. Arthroscopy 21(2):228–232

    Article  PubMed  Google Scholar 

  26. Miller T, Staron R, Feldman F (1996) Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol 167(2):339–341

    Article  CAS  PubMed  Google Scholar 

  27. Mulford J, Wakeley C, Eldridge J (2007) Assessment and management of chronic patellofemoral instability. J Bone Joint Surg Br 89(6):709–716

    Article  CAS  PubMed  Google Scholar 

  28. Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop 76(5):699–704

    Article  PubMed  Google Scholar 

  29. Nomura E, Inoue M, Kurimura M (2003) Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy 19(7):717–721

    Article  PubMed  Google Scholar 

  30. Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13(7):510–515

    Article  PubMed  Google Scholar 

  31. Outerbridge R, Dunlop J (1975) The problem of chondromalacia patellae. Clin Orthop Relat Res 110:177–196

    Article  PubMed  Google Scholar 

  32. Palmu S, Kallio PE, Donell ST et al (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg 90(3):463–470

    Article  PubMed  Google Scholar 

  33. Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216(3):858–864

    Article  CAS  PubMed  Google Scholar 

  34. Rosslenbroich S, Raschke M, Petersen W (2012) Akute osteochondrale Läsionen nach Patellaluxation. Unfallchirurg 115(5):392–396

    Article  CAS  PubMed  Google Scholar 

  35. Schoettle PB, Zanetti M, Seifert B et al (2006) The tibial tuberosity – trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13(1):26–31

    Article  PubMed  Google Scholar 

  36. Seeley MA, Knesek M, Vanderhave KL (2013) Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop 33(5):511–518

    Article  PubMed  Google Scholar 

  37. Sillanpää PJ, Mattila VM, Mäenpää H et al (2009) Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study. J Bone Joint Surg 91(2):263–273

    Article  PubMed  Google Scholar 

  38. Sillanpää PJ, Peltola E, Mattila VM et al (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men a mean 7-year nonoperative follow-up study. Am J Sports Med 37(8):1513–1521

    Article  PubMed  Google Scholar 

  39. Vollnberg B, Koehlitz T, Jung T et al (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22(11):2347–2356

    Article  PubMed  Google Scholar 

  40. Waterman BR, Belmont PJ, Owens BD (2012) Patellar dislocation in the United States: role of sex, age, race, and athletic participation. J Knee Surg 25(01):051–058

    Article  Google Scholar 

  41. White BJ, Sherman OH (2009) Patellofemoral instability. Bull NYU Hosp Jt Dis 67(1):22

    PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. F. Mauch, B. Ammann und M. Kraus geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Sektion Obere Extremität/Kernspintomographie (MRT), Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Deutschland

    F. Mauch M.A.

  2. Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Ulm, Ulm, Deutschland

    B. Ammann

  3. Klinik für Wirbelsäulentherapie, Endoprothetik und orthopädische Onkologie, Hessing-Stiftung Augsburg, Augsburg, Deutschland

    M. Kraus

Authors
  1. F. Mauch M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Ammann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Kraus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Mauch M.A..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mauch, F., Ammann, B. & Kraus, M. MRT des Kniegelenks unter besonderer Berücksichtigung der Patellaluxation. Unfallchirurg 117, 211–220 (2014). https://doi.org/10.1007/s00113-013-2401-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-013-2401-6

Schlüsselwörter

Keywords

Search

Navigation