Effect of elbow MRI with axial traction on articular cartilage visibility—a feasibility study



Accurate evaluation of the articular cartilage of the elbow using MRI is sometimes challenging because of its anatomical complexity and relatively small size. Moreover, the articular cartilage of the humerus is in close contact with the opposing cartilage surfaces. Magnetic resonance arthrography with traction was reported to resolve this issue; however, less invasive methods are desirable. This study aimed to assess the effect of MRI with axial traction (without arthrography) on joint space widening and cartilage outline visibility of the elbow.

Materials and methods

We enrolled 10 volunteers (female = 1; mean age, 36.7 ± 8.6; range 28–56) and performed MRI with and without axial traction on the elbow. Joint space widths were measured, and the humeral articular cartilage outline visibility was evaluated at the radiocapitellar joint and lateral one-third and medial one-third of the ulnohumeral joints. Measurements were compared using the Wilcoxon signed-rank test. Significance was set at p < 0.05. Volunteers scored pain and discomfort during MRI with traction using the visual analog scale in a questionnaire format.


Traction significantly increased joint space width at the radiocapitellar joint. Humeral articular cartilage outline visibility also significantly improved at the radiocapitellar joint. Pain and discomfort scores during traction MRI were low.


MRI of the elbow with traction widens joint space and enables better articular cartilage visibility at the radiocapitellar joint. Anatomical features of the elbow might have affected these results. Therefore, it would be safe and useful for evaluating elbow injuries involving articular cartilage lesions.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7


  1. 1.

    Sampath SC, Sampath SC, Bredella MA. Magnetic resonance imaging of the elbow: a structured approach. Sports Health. 2013;5:34–9.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    van Bergen CJ, van den Ende KI, Ten Brinke B, Eygendaal D. Osteochondritis dissecans of the capitellum in adolescents. World J Orthop. 2016;7:102–8.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Itsubo T, Murakami N, Uemura K, et al. Magnetic resonance imaging staging to evaluate the stability of capitellar osteochondritis dissecans lesions. Am J Sports Med. 2014;42:1972–7.

    PubMed  Google Scholar 

  4. 4.

    Iwasaki N, Kamishima T, Kato H, Funakoshi T, Minami A. A retrospective evaluation of magnetic resonance imaging effectiveness on capitellar osteochondritis dissecans among overhead athletes. Am J Sports Med. 2012;40:624–30.

    PubMed  Google Scholar 

  5. 5.

    Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. 2007;89:1205–14.

    PubMed  Google Scholar 

  6. 6.

    Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum: diagnosis and treatment. Clin Sports Med. 2001;20:565–90.

    CAS  PubMed  Google Scholar 

  7. 7.

    Osbahr DC, Dines JS, Rosenbaum AJ, Nguyen JT, Altchek DW. Does posteromedial chondromalacia reduce rate of return to play after ulnar collateral ligament reconstruction? Clin Orthop Relat Res. 2012;470:1558–64.

    PubMed  Google Scholar 

  8. 8.

    Jeon IH, Min WK, Micic ID, Cho HS, Kim PT. Surgical treatment and clinical implication for posterolateral rotatory instability of the elbow: Osborne-Cotterill lesion of the elbow. J Trauma. 2011;71:E45–9.

    PubMed  Google Scholar 

  9. 9.

    Nalbantoglu U, Gereli A, Kocaoglu B, Aktas S, Turkmen M. Capitellar cartilage injuries concomitant with radial head fractures. J Hand Surg Am. 2008;33:1602–7.

    PubMed  Google Scholar 

  10. 10.

    De Smet AA, Fisher DR, Burnstein MI, Graf BK, Lange RH. Value of MR imaging in staging osteochondral lesions of the talus (osteochondral dissecans): results in 14 patients. AJR Am J Roentogenol. 1990;154:555–8.

    Google Scholar 

  11. 11.

    Dipaola JD, Nelson DW, Colville MR. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991;7:101–4.

    CAS  PubMed  Google Scholar 

  12. 12.

    Kijowski R, De Smet AA. MRI findings of osteochondritis dissecans of the capitellum with surgical correlation. AJR Am J Roentgenol. 2005;185:1453–9.

    PubMed  Google Scholar 

  13. 13.

    Jans LB, Ditchfield M, Anna G, Jaremko JL, Verstraete KL. MR imaging findings and MR criteria for instability in osteochondritis dissecans of the elbow in children. Eur J Radiol. 2012;81:1306–10.

    PubMed  Google Scholar 

  14. 14.

    Kohyama S, Ogawa T, Mamizuka N, Hara Y, Yamazaki M. A magnetic resonance imaging-based staging system for osteochondritis dissecans of the elbow. A validation study against the international cartilage repair society classification. Orthop J Sports Med. 2018;6:2325967118794620.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Churchill RW, Munoz J, Ahmad CS. Osteochondritis dissecans of the elbow. Curr Rev Musculoskelet Med. 2016;9:232–9.

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Lee RK, Griffith JF, Yuen BT, Ng AW, Yeung DK. Elbow MR arthrography with traction. Br J Radiol. 2016;89:20160378.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Palhais NS, Guntern D, Kagel A, Wettstein M, Mouhsine E, Theumann N. Direct magnetic resonance arthrography of the knee: utility of axial traction. Eur Radiol. 2009;19:2225–31.

    CAS  PubMed  Google Scholar 

  18. 18.

    Baumgarten TE, Andrews JR, Satterwhite YE. The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum. Am J Sports Med. 1998;26:520–3.

    CAS  PubMed  Google Scholar 

  19. 19.

    Satake H, Takahara M, Harada M, Maruyama M. Preoperative imaging criteria for unstable osteochondritis dissecans of the capitellum. Clin Orthop Relat Res. 2013;471:1137–43.

    PubMed  Google Scholar 

  20. 20.

    Brittberg M, Aglietti P, Gambardella USA, et al. ICRS Cartilage Injury Evaluation Package, 2000 [Internet]. Accessed 11 July 2017. Available from http://www.cartilage.org/_files/contentmanagement/ICRS_evaluation.pdf.

  21. 21.

    Shahabpour M, Kichouh M, Laridon E, Gielen JL, De Mey J. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol. 2008;65:194–200.

    CAS  PubMed  Google Scholar 

  22. 22.

    Becce F, Richarme D, Omoumi P, et al. Direct MR arthrography of the shoulder under axial traction: feasibility study to evaluate the superior labrum-biceps tendon complex and articular cartilage. J Magn Reson Imaging. 2013;37:1228–33.

    PubMed  Google Scholar 

  23. 23.

    Izadpanah K, Winterer J, Vicari M, et al. A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities. J Magn Reson Imaging. 2013;37:1486–92.

    PubMed  Google Scholar 

  24. 24.

    Chan KK, Muldoon KA, Yeh L, et al. Superior labral anteroposterior lesions: MR arthrography with arm traction. AJR Am J Roentgenol. 1999;173:1117–22.

    CAS  PubMed  Google Scholar 

  25. 25.

    Guntern D, Becce F, Richarme D, Palhais NS, Meuli R, Theumann N. Direct magnetic resonance arthrography of the wrist with axial traction: a feasibility study to assess joint cartilage. J Magn Reson Imaging. 2011;34:239–44.

    PubMed  Google Scholar 

  26. 26.

    Lee RK, Griffith JF, Ng AW, Nung RC, Yeung DK. Wrist traction during MR arthrography improves detection of triangular fibrocartilage complex and intrinsic ligament tears and visibility of articular cartilage. AJR Am J Roentgenol. 2016;206:155–61.

    PubMed  Google Scholar 

  27. 27.

    Leventhal EL, Moore DC, Akelman E, Wolfe SW, Crisco JJ. Conformational changes in the carpus during finger trap distraction. J Hand Surg Am. 2010;35:237–44.

    PubMed  PubMed Central  Google Scholar 

  28. 28.

    Cerny M, Marlois R, Theumann N, et al. 3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears. Eur J Radiol. 2013;82:e582–9.

    PubMed  Google Scholar 

  29. 29.

    Spies CK, Unglaub F. Comment on “3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears”. Cerny M et al Eur J Radiol. 2013;82:e909.

    CAS  Google Scholar 

  30. 30.

    Becce F, Bollmann C. Response to “Comment on: 3-T direct MR arthrography of the wrist: value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears.” Eur J Radiol 2013;82:e910.

  31. 31.

    Kirchgesner T, Pesquer L, Larbi A, et al. Axial traction in magnetic resonance arthrography of the wrist: how to do? Diagn Interv Imaging. 2015;96:519–22.

    CAS  PubMed  Google Scholar 

  32. 32.

    Dallaudière B, Meyer P, Larbi A, et al. Magnetic resonance arthrography of the wrist with axial traction: an iconographic review. Diagn Interv Imaging. 2015;96:1307–12.

    PubMed  Google Scholar 

  33. 33.

    Shepherd SM, Chang EY, Rutledge JL, Huang B, Trudell D, Resnick DL. Cartilage assessment of the metacarpophalangeal joints: cadaveric study with magnetic resonance arthrography and finger traction. Clin Imaging. 2013;37:718–22.

    PubMed  Google Scholar 

  34. 34.

    Cerezal L, Carro LP, Llorca J, et al. Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries. Skelet Radiol. 2015;44:1585–95.

    Google Scholar 

  35. 35.

    Schmaranzer F, Klauser A, Kogler M, et al. MR arthrography of the hip with and without leg traction: assessing the diagnostic performance in detection of ligamentum teres lesions with arthroscopic correlation. Eur J Radiol. 2016;85:489–97.

    PubMed  Google Scholar 

  36. 36.

    Suter A, Dietrich TJ, Maier M, Dora C, Pfirrmann CW. MR findings associated with positive distraction of the hip joint achieved by axial traction. Skelet Radiol. 2015;44:787–95.

    Google Scholar 

  37. 37.

    Schmaranzer F, Klauser A, Kogler M, et al. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol. 2015;25:1721–30.

    PubMed  Google Scholar 

  38. 38.

    Schmaranzer F, Klauser A, Kogler M, et al. Improving visualization of the central compartment of the hip with direct MR arthrography under axial leg traction: a feasibility study. Acad Radiol. 2014;21:1240–7.

    PubMed  Google Scholar 

  39. 39.

    Llopis E, Cerezal L, Kassarjian A, Higueras V, Fernandez E. Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. AJR Am J Roentgenol. 2008;190:1124–8.

    PubMed  Google Scholar 

  40. 40.

    Jungmann PM, Baum T, Schaeffeler C, et al. 3.0T MR imaging of the ankle: axial traction for morphological cartilage evaluation, quantitative T2 mapping and cartilage diffusion imaging-a preliminary study. Eur J Radiol. 2015;84:1546–54.

    PubMed  Google Scholar 

  41. 41.

    Baer TE, Stolley MP, Thedens DR, Brown TD, Saltzman CL. Clinical tip: development of an ankle distraction device compatible with MRI and radiography. Foot Ankle Int. 2006;27:472–4.

    PubMed  PubMed Central  Google Scholar 

  42. 42.

    Lepage-Saucier M, Linda DD, Chang EY, et al. MRI of the metatarsophalangeal joints: improved assessment with toe traction and MR arthrography. AJR Am J Roentgenol. 2013;200:868–71.

    PubMed  Google Scholar 

  43. 43.

    Saupe N, Zanetti M, Pfirrmann CW, Wels T, Schwenke C, Hodler J. Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients. Radiology. 2009;250:830–8.

    PubMed  Google Scholar 

  44. 44.

    Newberg AH, Munn CS, Robbins AH. Complications of arthrography. Radiology. 1985;155:605–6.

    CAS  PubMed  Google Scholar 

  45. 45.

    Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep. 1966;19:3–11.

    CAS  PubMed  Google Scholar 

  46. 46.

    Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Google Scholar 

  47. 47.

    Fleiss JL, Cuzick J. The reliability of dischotomous judgements: unequal numbers of judges per subject. Appl Psychol Meas. 1979;3:537–42.

    Google Scholar 

  48. 48.

    McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22:276–82.

    Google Scholar 

  49. 49.

    Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.

    CAS  PubMed  Google Scholar 

  50. 50.

    Morrey BF, Llusá-Pérez M, Ballesteros-Betancourt JR. Anatomy of the elbow joint. In: Morrey BF, Sotelo JS, Morrey ME, editors. Morrey’s the elbow and its disorders. 5th ed. Philadelphia: Elsevier; 2018. p. 9–32.

    Google Scholar 

  51. 51.

    Bryce CD, Armstrong AD. Anatomy and biomechanics of the elbow. Orthop Clin N Am. 2008;39:141–54.

    Google Scholar 

  52. 52.

    Marshall KW, Marshall DL, Busch MT, Williams JP. Osteochondral lesions of the humeral trochlea in the young athlete. Skelet Radiol. 2009;38:479–91.

    Google Scholar 

Download references


We would like to thank Editage for the English language editing.

Author information



Corresponding author

Correspondence to Sho Kohyama.

Ethics declarations

All procedures performed in this study were in accordance with the ethical standards of the institutional review board of a general hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kohyama, S., Tanaka, T., Shimasaki, K. et al. Effect of elbow MRI with axial traction on articular cartilage visibility—a feasibility study. Skeletal Radiol 49, 1555–1566 (2020). https://doi.org/10.1007/s00256-020-03455-3

Download citation


  • Elbow
  • Magnetic resonance imaging (MRI)
  • Traction