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MRI Laxity Assessment

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Rotatory Knee Instability

Abstract

Knee laxity, by definition, is a dynamic and multifactorial condition. MRI evaluation, due to its known capacity in achieving high soft tissue contrast (e.g., meniscus, synovia, ligaments, cartilage) and multiplanar joint assessment without ionizing radiation, has contributed to its popularity in the last decades. However, “traditional” MRI studies provide static evaluation, thus requiring careful correlation to clinical findings, particularly when dealing with functional ligament stability. This work aims to describe the most important features of current MRI studies when dealing with anterior cruciate ligaments injuries, while also presenting the evolving possibilities of dynamic and objective MRI assessment of knee instability.

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References

  1. Araujo PH, Kfuri Junior M, Ohashi B, Hoshino Y, Zaffagnini S, Samuelsson K, Karlsson J, Fu F, Musahl V (2014) Individualized ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22(9):1966–1975. doi:10.1007/s00167-014-2928-2

    Article  PubMed  Google Scholar 

  2. Arilla FV, Yeung M, Bell K, Rahnemai-Azar AA, Rothrauff BB, Fu FH, Debski RE, Ayeni OR, Musahl V (2015) Experimental execution of the simulated Pivot-Shift Test: a systematic review of techniques. Arthrosc 31:2445–2454. doi:10.1016/j.arthro.2015.06.027

    Article  Google Scholar 

  3. Behairy NH, Dorgham MA, Khaled SA (2009) Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop 33(4):961–967. doi:10.1007/s00264-008-0580-5

    Article  PubMed  Google Scholar 

  4. Benjaminse A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36(5):267–288. doi:10.2519/jospt.2006.2011

    Article  PubMed  Google Scholar 

  5. Bjornsson H, Desai N, Musahl V, Alentorn-Geli E, Bhandari M, Fu F, Samuelsson K (2015) Is double-bundle anterior cruciate ligament reconstruction superior to single-bundle? a comprehensive systematic review. Knee Surg Sports Traumatol Arthrosc 23(3):696–739. doi:10.1007/s00167-013-2666-x

    Article  PubMed  Google Scholar 

  6. Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthrosc 22(8):894–899. doi:10.1016/j.arthro.2006.04.098

    Article  Google Scholar 

  7. Brandser EA, Riley MA, Berbaum KS, el-Khoury GY, Bennett DL (1996) MR imaging of anterior cruciate ligament injury: independent value of primary and secondary signs. AJR Am J Roentgenol 167((1):121–126. doi:10.2214/ajr.167.1.8659355

    Article  CAS  PubMed  Google Scholar 

  8. Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D (2001) Pathogenesis of the segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology 219(2):381–386. doi:10.1148/radiology.219.2.r01ma23381

    Article  CAS  PubMed  Google Scholar 

  9. Chan WP, Peterfy C, Fritz RC, Genant HK (1994) MR diagnosis of complete tears of the anterior cruciate ligament of the knee: importance of anterior subluxation of the tibia. AJR Am J Roentgenol 162(2):355–360. doi:10.2214/ajr.162.2.8310927

    Article  CAS  PubMed  Google Scholar 

  10. Citak M, Suero EM, Rozell JC, Bosscher MR, Kuestermeyer J, Pearle AD (2011) A mechanized and standardized pivot shifter: technical description and first evaluation. Knee Surg Sports Traumatol Arthrosc 19(5):707–711. doi:10.1007/s00167-010-1289-8

    Article  PubMed  Google Scholar 

  11. DeFranco MJ, Bach BR Jr (2009) A comprehensive review of partial anterior cruciate ligament tears. J Bone Joint Surg Am 91(1):198–208. doi:10.2106/JBJS.H.00819

    Article  PubMed  Google Scholar 

  12. Espregueira-Mendes J, Pereira H, Sevivas N, Passos C, Vasconcelos JC, Monteiro A, Oliveira JM, Reis RL (2012) Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device. Knee Surg Sports Traumatol Arthrosc 20(4):671–678. doi:10.1007/s00167-012-1914-9

    Article  PubMed  Google Scholar 

  13. Falchook FS, Tigges S, Carpenter WA, Branch TP, Stiles RG (1996) Accuracy of direct signs of tears of the anterior cruciate ligament. Can Assoc Radiol J (Journal l’Association canadienne des radiologistes) 47(2):114–120

    CAS  Google Scholar 

  14. Fitzgerald SW, Remer EM, Friedman H, Rogers LF, Hendrix RW, Schafer MF (1993) MR evaluation of the anterior cruciate ligament: value of supplementing sagittal images with coronal and axial images. AJR Am J Roentgenol 160(6):1233–1237. doi:10.2214/ajr.160.6.8498224

    Article  CAS  PubMed  Google Scholar 

  15. Fruensgaard S, Johannsen HV (1989) Incomplete ruptures of the anterior cruciate ligament. J Bone Joint Surg 71(3):526–530

    CAS  Google Scholar 

  16. Giaconi JC, Allen CR, Steinbach LS (2009) Anterior cruciate ligament graft reconstruction: clinical, technical, and imaging overview. Top Magn Reson Imaging : TMRI 20(3):129–150. doi:10.1097/RMR.0b013e3181d657a7

    Article  PubMed  Google Scholar 

  17. Grzelak P, Podgorski MT, Stefanczyk L, Domzalski M (2015) Ultrasonographic test for complete anterior cruciate ligament injury. Indian J Orthop 49(2):143–149. doi:10.4103/0019-5413.152432

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hoshino Y, Kuroda R, Nagamune K, Araki D, Kubo S, Yamaguchi M, Kurosaka M (2012) Optimal measurement of clinical rotational test for evaluating anterior cruciate ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 20(7):1323–1330. doi:10.1007/s00167-011-1643-5

    Article  PubMed  Google Scholar 

  19. Hoshino Y, Musahl V, Irrgang JJ, Lopomo N, Zaffagnini S, Karlsson J, Kuroda R, Fu FH (2015) Quantitative evaluation of the Pivot Shift - relationship to clinical Pivot Shift Grade: a prospective international multicenter study. Orthop J Sports Med 3(2 suppl):56–72. doi:10.1177/2325967115s00108

    Article  Google Scholar 

  20. Isberg J, Faxen E, Brandsson S, Eriksson BI, Karrholm J, Karlsson J (2006) KT-1000 records smaller side-to-side differences than radiostereometric analysis before and after an ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 14(6):529–535. doi:10.1007/s00167-006-0061-6

    Article  PubMed  Google Scholar 

  21. Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75(5):594–599. doi:10.1080/00016470410001484

    Article  PubMed  Google Scholar 

  22. Juhng SK, Lee JK, Choi SS, Yoon KH, Roh BS, Won JJ (2002) MR evaluation of the “arcuate” sign of posterolateral knee instability. AJR Am J Roentgenol 178(3):583–588. doi:10.2214/ajr.178.3.1780583

    Article  PubMed  Google Scholar 

  23. Kato Y, Maeyama A, Lertwanich P, Wang JH, Ingham SJ, Kramer S, Martins CQ, Smolinski P, Fu FH (2013) Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(4):816–823. doi:10.1007/s00167-012-1951-4

    Article  PubMed  Google Scholar 

  24. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634

    Article  PubMed  Google Scholar 

  25. Kothari A, Haughom B, Subburaj K, Feeley B, Li X, Ma CB (2012) Evaluating rotational kinematics of the knee in ACL reconstructed patients using 3.0 Tesla magnetic resonance imaging. Knee 19(5):648–651. doi:10.1016/j.knee.2011.12.001

    Article  PubMed  Google Scholar 

  26. Kuroda R, Hoshino Y, Kubo S, Araki D, Oka S, Nagamune K, Kurosaka M (2011) Similarities and Differences of Diagnostic Manual Tests for Anterior Cruciate Ligament Insufficiency: A Global Survey and Kinematics Assessment. Am J Sports Med. doi:10.1177/0363546511423634, 0363546511423634 [pii]

    PubMed  Google Scholar 

  27. Lane CG, Warren R, Pearle AD (2008) The pivot shift. J Am Acad Orthop Surg 16(12):679–688, doi: 16/12/679 [pii]

    Article  PubMed  Google Scholar 

  28. Lawrance JA, Ostlere SJ, Dodd CA (1996) MRI diagnosis of partial tears of the anterior cruciate ligament. Injury 27(3):153–155

    Article  CAS  PubMed  Google Scholar 

  29. Lee K, Siegel MJ, Lau DM, Hildebolt CF, Matava MJ (1999) Anterior cruciate ligament tears: MR imaging-based diagnosis in a pediatric population. Radiology 213(3):697–704. doi:10.1148/radiology.213.3.r99dc26697

    Article  CAS  PubMed  Google Scholar 

  30. Lee SY, Matsui N, Yoshida K, Doi R, Matsushima S, Wakami T, Fujii M, Yoshiya S, Kurosaka M, Yamamoto T (2005) Magnetic resonance delineation of the anterior cruciate ligament of the knee: flexed knee position within a surface coil. Clin Imaging 29(2):117–122. doi:10.1016/j.clinimag.2004.04.024

    PubMed  Google Scholar 

  31. Leitze Z, Losee RE, Jokl P, Johnson TR, Feagin JA (2005) Implications of the pivot shift in the ACL-deficient knee. Clin Orthop Relat Res 436:229–236

    Article  PubMed  Google Scholar 

  32. Mellado JM, Calmet J, Olona M, Gine J, Sauri A (2004) Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle. Knee Surg Sports Traumatol Arthrosc 12(3):217–224. doi:10.1007/s00167-003-0431-2

    Article  CAS  PubMed  Google Scholar 

  33. Mink JH, Levy T, Crues JV 3rd (1988) Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology 167(3):769–774. doi:10.1148/radiology.167.3.3363138

    Article  CAS  PubMed  Google Scholar 

  34. Muller B, Hofbauer M, Rahnemai-Azar AA, Wolf M, Araki D, Hoshino Y, Araujo P, Debski RE, Irrgang JJ, Fu FH, Musahl V (2015) Development of computer tablet software for clinical quantification of lateral knee compartment translation during the pivot shift test. Comput Methods Biomech Biomed Engin 19:1–12. doi:10.1080/10255842.2015.1006210

    Google Scholar 

  35. Murphy BJ, Smith RL, Uribe JW, Janecki CJ, Hechtman KS, Mangasarian RA (1992) Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign? Radiology 182(1):221–224. doi:10.1148/radiology.182.1.1727286

    Article  CAS  PubMed  Google Scholar 

  36. Musahl V, Voos J, O’Loughlin PF, Stueber V, Kendoff D, Pearle AD (2010) Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 18(9):1208–1213. doi:10.1007/s00167-009-1004-9

    Article  PubMed  Google Scholar 

  37. Noyes FR, Mooar LA, Moorman CT 3rd, McGinniss GH (1989) Partial tears of the anterior cruciate ligament. progression to complete ligament deficiency. J Bone Joint Surg 71(5):825–833

    CAS  Google Scholar 

  38. Ochi M, Adachi N, Deie M, Kanaya A (2006) Anterior cruciate ligament augmentation procedure with a 1-incision technique: anteromedial bundle or posterolateral bundle reconstruction. Arthroscopy 22(4):463 e461–465. doi:10.1016/j.arthro.2005.06.034, S0749-8063(05)01560-4 [pii]

    Article  Google Scholar 

  39. Ohashi B, Ward J, Araujo P, Kfuri M, Pereira H, Espregueira-Mendes J, Musahl V (2014) Partial ACL Ruptures: knee laxity measurements and Pivot Shift. In: Doral MN, Karlsson J (eds) Sports injuries. Springer, Berlin/Heidelberg, pp 1–16. doi:10.1007/978-3-642-36801-1_85-1

    Google Scholar 

  40. Pereira H, Fernandes M, Pereira R, Jones H, Vasconcelos JC, Oliveira JM, Reis RL, Musahl V, Espregueira-Mendes J (2014) ACL injuries identifiable for Pre-participation imagiological analysis: risk factors. In: Doral MN, Karlsson J (eds) Sports injuries. Springer, Berlin/Heidelberg, pp 1–15. doi:10.1007/978-3-642-36801-1_80-1

    Google Scholar 

  41. Pereira H, Sevivas N, Pereira R, Monteiro A, Oliveira JM, Reis RL, Espregueira-Mendes J (2012) New tools for diagnosis, assessment of surgical outcome and follow-up. In: Hernández JA, Monllau JC (eds) Lesiones ligamentosas de la rodilla. Marge Médica Books Barcelona, Spain, pp 185–198

    Google Scholar 

  42. Pereira H, Sevivas N, Pereira R, Monteiro A, Sampaio R, Oliveira J, Reis R, Espregueira-Mendes J (2014) Systematic approach from Porto School. In: Siebold R, Dejour D, Zaffagnini S (eds) Anterior cruciate ligament reconstruction. Springer, Berlin/Heidelberg, pp 367–386. doi:10.1007/978-3-642-45349-6_34

    Chapter  Google Scholar 

  43. Prince JS, Laor T, Bean JA (2005) MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. AJR Am J Roentgenol 185(3):756–762. doi:10.2214/ajr.185.3.01850756

    Article  PubMed  Google Scholar 

  44. Prins M (2006) The Lachman test is the most sensitive and the pivot shift the most specific test for the diagnosis of ACL rupture. Aust J Physiother 52(1):66. doi:http://dx.doi.org/10.1016/S0004-9514(06)70069-1

  45. Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF (1992) Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiogr Rev Publ Radiol Soc N Am, Inc 12(5):901–915. doi:10.1148/radiographics.12.5.1529133

    CAS  Google Scholar 

  46. Resnick D (1995) Diagnosis of bone and joint disorders. 3rd edn. WB Saunders Co, Philadelphia

    Google Scholar 

  47. Robertson PL, Schweitzer ME, Bartolozzi AR, Ugoni A (1994) Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology 193(3):829–834. doi:10.1148/radiology.193.3.7972833

    Article  CAS  PubMed  Google Scholar 

  48. Roychowdhury S, Fitzgerald SW, Sonin AH, Peduto AJ, Miller FH, Hoff FL (1997) Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images. AJR Am J Roentgenol 168(6):1487–1491. doi:10.2214/ajr.168.6.9168712

    Article  CAS  PubMed  Google Scholar 

  49. Rubin DA, Kettering JM, Towers JD, Britton CA (1998) MR imaging of knees having isolated and combined ligament injuries. AJR Am J Roentgenol 170(5):1207–1213. doi:10.2214/ajr.170.5.9574586

    Article  CAS  PubMed  Google Scholar 

  50. Sonnery-Cottet B, Lavoie F, Ogassawara R, Scussiato RG, Kidder JF, Chambat P (2010) Selective anteromedial bundle reconstruction in partial ACL tears: a series of 36 patients with mean 24 months follow-up. Knee Surg Sports Traumatol Arthrosc 18(1):47–51. doi:10.1007/s00167-009-0855-4

    Article  PubMed  Google Scholar 

  51. Staubli HU, Noesberger B, Jakob RP (1992) Stress radiography of the knee. Cruciate ligament function studied in 138 patients. Acta Orthop Scand Suppl 249:1–27

    CAS  PubMed  Google Scholar 

  52. Stoller D (1997) Magnetic resonance imaging in orthopaedics and sports medicine. 2nd edn. Lippincott-Raven, Philadelphia

    Google Scholar 

  53. Swain MS, Henschke N, Kamper SJ, Downie AS, Koes BW, Maher CG (2014) Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review. Chiropr Man Therap 22:25. doi:10.1186/s12998-014-0025-8

    Article  PubMed  PubMed Central  Google Scholar 

  54. Terzidis IP, Christodoulou AG, Ploumis AL, Metsovitis SR, Koimtzis M, Givissis P (2004) The appearance of kissing contusion in the acutely injured knee in the athletes. Br J Sports Med 38(5):592–596. doi:10.1136/bjsm.2003.006718

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Toye LR, Cummings DP, Armendariz G (2002) Adult tibial intercondylar eminence fracture: evaluation with MR imaging. Skeletal Radiol 31(1):46–48. doi:10.1007/s00256-001-0440-5

    Article  PubMed  Google Scholar 

  56. Tung GA, Davis LM, Wiggins ME, Fadale PD (1993) Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology 188(3):661–667. doi:10.1148/radiology.188.3.8351329

    Article  CAS  PubMed  Google Scholar 

  57. Vahey TN, Broome DR, Kayes KJ, Shelbourne KD (1991) Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging. Radiology 181(1):251–253. doi:10.1148/radiology.181.1.1887042

    Article  CAS  PubMed  Google Scholar 

  58. Van Dyck P, De Smet E, Veryser J, Lambrecht V, Gielen JL, Vanhoenacker FM, Dossche L, Parizel PM (2012) Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 20(2):256–261. doi:10.1007/s00167-011-1617-7

    Article  PubMed  Google Scholar 

  59. Van Dyck P, Vanhoenacker FM, Gielen JL, Dossche L, Van Gestel J, Wouters K, Parizel PM (2011) Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears? Skeletal Radiol 40(6):701–707. doi:10.1007/s00256-010-1044-8

    Article  PubMed  Google Scholar 

  60. Van Dyck P, Vanhoenacker FM, Lambrecht V, Wouters K, Gielen JL, Dossche L, Parizel PM (2013) Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL. J Bone Joint Surg Am 95(10):916–924. doi:10.2106/JBJS.L.01195

    Article  PubMed  Google Scholar 

  61. Winters K, Tregonning R (2005) Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. N Z Med J 118(1209):U1301

    PubMed  Google Scholar 

  62. Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S (2011) Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 1: basic science. Am J Sports Med 39(8):1789–1799. doi:10.1177/0363546511402659

    Article  PubMed  Google Scholar 

  63. Yu JS, Goodwin D, Salonen D, Pathria MN, Resnick D, Dardani M, Schweitzer M (1995) Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. AJR Am J Roentgenol 164(1):135–139. doi:10.2214/ajr.164.1.7998526

    Article  CAS  PubMed  Google Scholar 

  64. Zaffagnini S, Bignozzi S, Martelli S, Imakiire N, Lopomo N, Marcacci M (2006) New intraoperative protocol for kinematic evaluation of ACL reconstruction: preliminary results. Knee Surg Sports Traumatol Arthrosc 14(9):811–816. doi:10.1007/s00167-006-0057-2

    Article  CAS  PubMed  Google Scholar 

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Pereira, H. et al. (2017). MRI Laxity Assessment. In: Musahl, V., Karlsson, J., Kuroda, R., Zaffagnini, S. (eds) Rotatory Knee Instability. Springer, Cham. https://doi.org/10.1007/978-3-319-32070-0_5

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