| 1. Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T. Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series). [Review]. Emergency Medicine Australasia. 2017 Dec 15. |
Review/Other-Dx |
54 articles |
To investigate best practice for the assessment and management of common knee injuries in the emergency department (ED) |
Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 2250 articles, of which 54 were included in the review (n = 8 primary articles, n = 28 systematic reviews, n = 18 guidelines). |
4 |
| 2. Stiell IG, Wells GA, McDowell I, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995;2(11):966-973. |
Observational-Dx |
1,967 retrospective review; 1,040 prospective study; 120 patients examined by 2 physicians |
To study: 1) the efficiency of the current use of radiography in acute knee injuries, 2) the judgments and attitudes of experienced clinicians in their use of knee radiography, and 3) the potential for decision rules to improve efficiency. |
Of the 1,967 patients seen in the first stage, 74.1% underwent radiography but only 5.2% were found to have fractures. Of the 1,727 knee and patella radiographic series ordered, 92.4% were negative for fracture. In the second stage, experienced physicians predicted the probability of fracture to be 0 or 0.1 for 75.6% of the patients. The kappa value for this response was 0.51 (95% CI 0.34 to 0.68). The physicians also indicated that they would have been comfortable or very comfortable in not ordering radiography for 55.5% of the patients. The area under the receiver operating characteristics curve for the physicians' prediction of fracture was 0.87 (95% CI 0.82 to 0.91), reflecting good discrimination between fracture and nonfracture cases. Likelihood ratios for the physicians' prediction ranged from 0.09 at the 0 level to 42.9 at the 0.9-1.0 level. |
3 |
| 3. Weber JE, Jackson RE, Peacock WF, Swor RA, Carley R, Larkin GL. Clinical decision rules discriminate between fractures and nonfractures in acute isolated knee trauma. Ann Emerg Med. 1995;26(4):429-433. |
Observational-Dx |
242 patients |
To develop criteria that optimize clinical decision-making in the use of radiography after isolated knee trauma in adults. |
We constructed a clinical decision model, calculating sensitivity, specificity, and odds ratios. Twenty-eight patients (11.6%) had fractures, with the patella the most commonly fractured osseous structure. Patients able to walk without limping had not experienced a fracture, nor had patients with twist injuries without effusion. Sensitivity of this model for detecting fracture was 1.0 (99% confidence interval, .97 to 1.0), and specificity was .337 (99% confidence interval, .26 to .42). |
3 |
| 4. Gage BE, McIlvain NM, Collins CL, Fields SK, Comstock RD. Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008. Acad Emerg Med. 19(4):378-85, 2012 Apr. |
Review/Other-Dx |
N/A |
To examine the epidemiology of knee injuries presenting to EDs in the United States from 1999 through 2008. |
An estimated 6,664,324 knee injuries presented to U.S. EDs from 1999 through 2008, for a rate of 2.29 knee injuries per 1,000 population. Those 15 to 24 years of age had the highest injury rate (3.83), while children younger than 5 years had the lowest rate (0.55). The most common diagnoses were strains and sprains (42.1%), contusions and abrasions (27.1%), and lacerations and punctures (10.5%). The most common general product categories causing injury were sports and recreation (49.3%), home structures (30.2%), and home furnishings (13.6%). Several sex and age group differences were identified. For example, males sustained a higher proportion of basketball-related injuries (11.1%) than females (3.6%; injury proportion ratio [IPR] = 3.11, 95% confidence interval [CI] = 2.79 to 3.46, p < 0.001). Additionally, individuals 65 years and older sustained a higher proportion of injury due to stairs, ramps, landings, and floors (42.0%), compared to all other ages (20.1%; IPR = 2.09, 95% CI = 1.95 to 2.23, p < 0.001). |
4 |
| 5. Konan S, Zang TT, Tamimi N, Haddad FS. Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics?. Annals of the Royal College of Surgeons of England. 95(3):188-91, 2013 Apr. |
Observational-Dx |
106 Patients |
To study the role of the Ottawa and Pittsburgh rules to reduce the unnecessary use of radiographs following knee injury. |
The Ottawa and Pittsburgh rules were applied to individual patients to evaluate the need for radiography. One hundred and one patients (95%) had radiography of their knee. Five patients (5%) had a fracture of their knee and in all cases, the Ottawa and Pittsburgh knee rules were fulfilled. Using the Ottawa rules, 27 radiographs (25%) could have been avoided without missing a fracture. Using the Pittsburgh rules, 32 radiographs (30%) could have been avoided. |
2 |
| 6. Cheung TC, Tank Y, Breederveld RS, Tuinebreijer WE, de Lange-de Klerk ES, Derksen RJ. Diagnostic accuracy and reproducibility of the Ottawa Knee Rule vs the Pittsburgh Decision Rule. American Journal of Emergency Medicine. 31(4):641-5, 2013 Apr. |
Observational-Dx |
90 injuries |
To compare the diagnostic accuracy and reproducibility of 2 clinical decision rules (the Ottawa Knee Rules and Pittsburgh Decision Rules) developed for selective use of radiographs in the evaluation of isolated knee trauma. |
90 injuries were assessed. 7 injuries concerned fractures (7.8%). For the Ottawa Knee Rules, the pooled sensitivity and specificity were 0.86 (95% CI, 0.57–0.96) and 0.27 (95% CI, 0.21–0.35), respectively. The Pittsburgh Decision Rules had a pooled sensitivity and specificity of 0.86 (95% CI, 0.57–0.96) and 0.51 (95% CI, 0.44–0.59). The Pittsburgh Decision Rules was significantly (P=0.002) more specific. The kappa values for the Ottawa Knee Rules and Pittsburgh Decision Rules were 0.51 (95% CI, 0.32–0.71) and 0.71 (95% CI, 0.57–0.86), respectively. |
1 |
| 7. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 8. Jenny JY, Boeri C, El Amrani H, et al. Should plain X-rays be routinely performed after blunt knee trauma? A prospective analysis. J Trauma. 2005;58(6):1179-1182. |
Review/Other-Dx |
138 (1st stage); 178 (2nd stage) |
To test the hypothesis that it is possible to decrease the number of performed x-rays after a knee trauma without delayed fracture diagnosis by using the Ottawa knee rules. |
One hundred thirty-eight patients were included in the first stage; 57 had negative Ottawa criteria (no fracture was observed). The Ottawa rules indicated that 41% of the x-ray studies could have been avoided. One hundred seventy-eight patients were included in the second stage; 63 patients had negative Ottawa criteria (no fracture was diagnosed during the follow-up). Thirty-five percent of the x-ray studies were avoided. |
4 |
| 9. Moore BR, Hampers LC, Clark KD. Performance of a decision rule for radiographs of pediatric knee injuries. J Emerg Med. 28(3):257-61, 2005 Apr. |
Observational-Dx |
146 patients |
To prospectively assess the performance of a decision rule for radiographs in children presenting with acute knee injuries.Three criteria were evaluated: 1) inability to bear weight, 2) inability to flex the knee to 90 degrees, 3) presence of bony tenderness. |
A total of 146 patients were enrolled (65% male, mean age 11.6 years). Of these, 15 (10.3%) had a fracture on their radiograph, 6 of which were related to trampoline use. 77 (53%) were negative for criterion 1 (ie, able to bear weight immediately after the accident and in the ED), none (0%) of whom had fractures. The NPV of this criterion was 1.0 (95% CI, 0.94–1.0). The PPV was 0.22 (95% CI, 0.13v0.34). The sensitivity was 1.0 (95% CI, 0.82–1.0). The specificity was 0.59 (95% CI, 0.50–0.67). Three patients negative for criterion 3 (i.e. bony tenderness) were found to have fractures. The proximal tibia was the most common fracture site (47%). |
2 |
| 10. Stiell IG, Greenberg GH, Wells GA, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA. 1996;275(8):611-615. |
Observational-Dx |
1,096 adults |
To validate a previously derived decision rule for the use of radiography in patients with acute knee injury. |
The decision rule had a sensitivity of 1.0 (95% confidence interval [CI], 0.94 to 1.0) for identifying 63 clinically important fractures. Physicians correctly interpreted the rule in 96% of cases, and the k value for interpretation was 0.77 (95% CI, 0.65 to 0.89). The potential relative reduction in use of radiography was estimated to be 28%. The probability of fracture, if the decision rule were "negative," is estimated to be 0% (95% CI, 0% to 0.4%). Attempts to refine the rule led to a model with improved specificity but with an unacceptable loss of sensitivity. |
3 |
| 11. Teh J, Kambouroglou G, Newton J. Investigation of acute knee injury. Bmj. 2012;344:e3167. |
Review/Other-Dx |
1 patient |
To provide an update on the best use of different imaging methods for common or important clinical presentations. |
MRI confirmed an acute rupture of the ACL and also showed a lateral meniscal tear; there was no posterolateral corner injury. |
4 |
| 12. Mustonen AO, Koskinen SK, Kiuru MJ. Acute knee trauma: analysis of multidetector computed tomography findings and comparison with conventional radiography. Acta Radiol. 2005;46(8):866-874. |
Observational-Dx |
415 images from 409 patients |
To evaluate MDCT by comparing findings from MDCT to those from the primary knee radiographs for patients presenting with acute knee trauma. |
Overall sensitivity of radiography was 83%, while NPV was 49%. In severely injured patients, diagnostically sufficient radiographs are difficult to obtain, and therefore a negative radiograph is not reliable in ruling out a fracture. MDCT is a fast and accurate exam and is recommended in patients with tibial plateau fractures or complex knee injuries in order to evaluate the fracture adequately. |
3 |
| 13. Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? Skeletal Radiol. 2007;36(2):145-151. |
Observational-Dx |
41 patients |
To (1) determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture, and to (2) evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. |
CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Receiver-operator characteristic analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. |
3 |
| 14. Peltola EK, Koskinen SK. Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma. Skeletal Radiology. 44(9):1295-301, 2015 Sep. |
Observational-Dx |
18 patients |
To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. |
A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79% and 100%, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. |
3 |
| 15. Heffernan EJ, Moran DE, Gerstenmaier JF, McCarthy CJ, Hegarty C, McMahon CJ. Accuracy of 64-section MDCT in the diagnosis of cruciate ligament tears. Clin Radiol. 72(7):611.e1-611.e8, 2017 Jul. |
Observational-Dx |
40 Patients |
To evaluate the accuracy of non-arthrographic 64-section multidetector computed tomography (CT) in the assessment of cruciate ligament tears. A secondary goal was to determine its accuracy in the diagnosis of additional soft-tissue injuries around the knee. |
The sensitivity of MDCT for ACL tears was 87.5-100%, with a specificity of 100%. The presence of one or more secondary signs of ACL tears on MDCT had a sensitivity of 50-87.5% with a specificity of 100%. The sensitivity of MDCT for PCL tears was 0-25% with a specificity of 100%. The sensitivity for meniscal tears was 9.1-23.1% with a specificity of 96.3-100% |
4 |
| 16. Pache G, Bulla S, Baumann T, et al. Dose reduction does not affect detection of bone marrow lesions with dual-energy CT virtual noncalcium technique. Acad Radiol. 2012;19(12):1539-1545. |
Observational-Dx |
50 patients |
To evaluate if a dose-reduced, dose-neutral dual-energy CT virtual noncalcium technique can equally detect posttraumatic bone marrow lesions of the knee. |
MRI depicted 170 bone marrow lesions (35 femoral, 135 tibial). Mean age, number of fractures, attenuation values and number of regions with bone marrow lesions were not significantly different between the groups. Visual rating revealed overall areas under the curves of 0.983 and 0.979 for observers 1 and 2, respectively. Visual judgment was superior to attenuation measurements for femoral regions regardless of the dose applied. Analysis of variance of all CT values revealed a significant influence for the presence of edema (P<.001) but no differences for the radiation dose used (P=.424). Interobserver agreement was excellent (kappa = 0.944). |
2 |
| 17. Pache G, Krauss B, Strohm P, et al. Dual-energy CT virtual noncalcium technique: detecting posttraumatic bone marrow lesions--feasibility study. Radiology. 2010;256(2):617-624. |
Observational-Dx |
21 patients |
To evaluate traumatized bone marrow with a dual-energy CT virtual noncalcium technique. |
After exclusion of 16 regions owing to artifacts, MRI revealed 59 bone bruises in the remaining 236 regions (19/114 femoral, 40/122 tibial). Fractures were present in 8 patients. Visual rating revealed areas under the curve of 0.886 and 0.897 in the femur and 0.974 and 0.953 in the tibia for observers 1 and 2, respectively. For CT numbers, the respective areas under the curve were 0.922 and 0.974. If scores of 1 and 2 (strong or mild bone bruise) were counted as positive, sensitivities were 86.4% and 86.4% and specificities were 94.4% and 95.5% for observers 1 and 2, respectively. The kappa statistic demonstrated good to excellent agreement (femur, kappa = 0.78; tibia, kappa = 0.87). |
1 |
| 18. Cao JX, Wang YM, Kong XQ, Yang C, Wang P. Good interrater reliability of a new grading system in detecting traumatic bone marrow lesions in the knee by dual energy CT virtual non-calcium images. European Journal of Radiology. 84(6):1109-15, 2015 Jun. |
Observational-Dx |
32 patients |
To evaluate the capacity of dual-energy computed tomography (DECT) virtual non-calcium (VNCa) images in detecting post-traumatic bone marrow lesions (BMLs) in the knee with a new grading system. |
Bone marrow rating by the two radiologists showed very good consistency (?=0.850 and 0.869 for VNCa and MR images, respectively). VNCa and MR images had good consistency (?=0.799 for lower end of the femur; ?=0.659 for upper end of the tibia). When Grade 3-4 bone marrow was regarded as a positive result, the sensitivity, specificity, positive predictive value, and negative predictive value of VNCa images for detection of BMLs in the lower end of the femur were 73.5%, 98.6%, 94.7%, and 91.6%, respectively, and the values in the upper end of the tibia were 91.0%, 100.0%, 100.0%, and 95.4%, respectively. The CT values of bone marrow were (-52.5 ± 31.3) HU in positive area and (-91.2 ± 16.9) HU in negative area for the lower end of the femur, and those were (-51.3 ± 30.2) HU in positive area and (-104.7 ± 17.5) HU in negative area for the upper end of the tibia (all p values<0.0001). The areas under the ROC curve of VNCa images for detection of BMLs were 0.875 for the lower end of the femur and 0.939 for the upper end of the tibia. |
2 |
| 19. Blum MR, Goldstein LB. Practical Pain Management. Need for More Accurate ER Diagnoses of ACL Injuries. Available at: http://www.practicalpainmanagement.com/pain/acute/sports-overuse/need-more-accurateer-diagnoses-acl-injuries. Accessed December 17, 2013. |
Review/Other-Dx |
N/A |
To review the anatomy of the knee, mechanism of injury, signs and symptoms, physical examination and diagnostic testing, risk factors associated with ACL injury and treatment. |
The Lachman test is the best physical examination test and, when followed by an MRI, is the gold standard to confirm the diagnosis. ACL injuries may be managed operatively or nonoperatively, depending on the patient’s activity level, age, and concurrent injuries. Regardless of the treatment, an extensive rehabilitation program is imperative. |
4 |
| 20. Griffin JW, Miller MD. MRI of the knee with arthroscopic correlation. Clin Sports Med. 2013;32(3):507-523. |
Review/Other-Dx |
N/A |
To understand how MRI and arthroscopy can enhance treatment of ligamentous and soft tissue injuries of the knee. |
T2-weighted MRI is key in examining which structures have been damaged in the posterolateral corner on T2 imaging and arthroscopically manifests as a drive-through sign. |
4 |
| 21. Van Dyck P, Vanhoenacker FM, Lambrecht V, et al. Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL. J Bone Joint Surg Am. 2013;95(10):916-924. |
Observational-Dx |
200 patients |
To assess the accuracy of 1.5 and 3.0-T MRI of the knee, in the same individuals, for diagnosing meniscal pathology and ACL tears, utilizing arthroscopy as the reference standard. |
For medial meniscal tears, the mean sensitivity and specificity for the 2 readers were 93% and 90%, respectively, at 1.5 T and 96% and 88%, respectively, at 3.0 T. For lateral meniscal tears, the mean sensitivity and specificity were 77% and 99%, respectively, at 1.5 T and 82% and 98%, respectively, at 3.0 T. For ACL tears, the mean sensitivity and specificity were 78% and 100%, respectively, at 1.5 T and 80% and 100%, respectively, at 3.0 T. None of the values for either reader differed significantly between the 1.5 and 3.0-T MRI protocols. Inter-reader agreement was almost perfect to perfect (kappa = 0.82 to 1.00). |
2 |
| 22. Frobell RB, Lohmander LS, Roos HP. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scand J Med Sci Sports. 2007;17(2):109-114. |
Review/Other-Dx |
159 patients |
To determine the incidence of ACL injuries in the general population; the pathology associated with a knee sprain verified by MRI; and the agreement between clinical findings and MRI. |
The annual incidence of MRI verified ACL injuries were 0.81/1,000 inhabitants aged 10–64 years. 56% (n=89) of those included had sustained an ACL injury of whom 38% had an associated medial meniscus tear. There was a poor agreement between initial clinical antero-posterior laxity and MRI verified presence of an ACL tear (kappa=0.281). Every second patellar dislocation was diagnosed as a ligament injury. Findings indicate that the incidence of ACL injuries is higher than previously described. Study also shows that the first clinical examination after an acute knee trauma has low diagnostic value. |
4 |
| 23. Nikken JJ, Oei EH, Ginai AZ, et al. Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial. Radiology. 2005; 236(3):958-967. |
Experimental-Dx |
472 patients: 237 allocated to MRI strategy (MRI plus radiography), and 235 allocated to radiography alone |
To assess prospectively if a short imaging examination performed with low-field-strength dedicated MRI in addition to radiography is effective and cost saving compared with the current diagnostic imaging strategy (radiography alone) in patients with recent acute traumatic injury of the wrist, knee, or ankle. |
In the intervention group, quality of life for patients with knee injuries was significantly higher during the first 6 weeks, and time to completion of diagnostic workup was significantly shorter (mean, 3.5 days for intervention group vs 17.3 days for reference group). The number of additional diagnostic procedures was significantly lower in the intervention group vs the reference group (9 vs 35, respectively) for patients with knee injuries. Patients with knee injuries showed the largest difference in costs (intervention group, €1820 [$1,966]; reference group, €2231 [$2,409]) owing to a reduction in productivity loss. Costs were higher in patients with wrist injuries and almost equal in patients with ankle injuries. All cost differences, however, were not significant. |
1 |
| 24. Oei EH, Nikken JJ, Ginai AZ, et al. Costs and effectiveness of a brief MRI examination of patients with acute knee injury. Eur Radiol. 2009;19(2):409-418. |
Review/Other-Dx |
208 patients |
To assess the costs and effectiveness of selective short MRI in patients with acute knee injury. |
QoL was lowest (EuroQol at 6 weeks 0.61 (95% CI, 0.54-0.67)); duration of diagnostic workup, absence from work, and time to convalescence were longest; and the number of diagnostic examinations was largest with radiography only. These outcomes were more favorable for both MRI strategies (EuroQol at 6 weeks 0.72 (95% CI, 0.67–0.77) for both). Mean total costs were 2,593 Euros (95% CI, 1,815–3,372) with radiography only, 2,116 Euros (95% CI, 1,488–2,743) with radiography plus MRI, and 1,973 Euros (95% CI, 1,401–2,543) with selective MRI. Selective use of a short MRI examination saves costs and potentially increases effectiveness in patients with acute knee injury without a fracture on radiography. |
4 |
| 25. Cecava ND, Dieckman S, Banks KP, Mansfield LT. Traumatic knee injury: correlation of radiographic effusion size with the presence of internal derangement on magnetic resonance imaging. Emergency Radiology. 25(5):479-487, 2018 Oct. |
Review/Other-Dx |
198 patients |
To test the hypothesis that patients with suprapatellar joint effusion greater than 10 mm anteroposterior diameter on lateral radiograph have a high likelihood of knee internal derangement on magnetic resonance imaging. |
Logistic regression showed a positive correlation between radiographic effusion size and the presence of internal derangement on magnetic resonance exams (p value <?0.001). Radiographic effusion >?10 mm was established as a positive test, yielding test sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 55, 96, 93, 71, and 77%, respectively. Statistical analysis showed the radiographic anteroposterior effusion diameter most closely approximated the magnetic resonance effusion diameter at the lateral patellofemoral recess. |
4 |
| 26. Magee T, Williams D. 3.0-T MRI of meniscal tears. AJR Am J Roentgenol. 2006;187(2):371-375. |
Observational-Dx |
100 patients; 2 reviewers |
To evaluate the sensitivity and specificity of 3.0-T MRI compared with arthroscopy in the detection of meniscal tears. |
MRI of the knee at 3.0-T is sensitive (96%) and specific (97%) compared with arthroscopy in the detection of meniscal tears. Findings at 3.0-T compare favorably with results at 1.5-T or lower field strength. |
3 |
| 27. Berger N, Andreisek G, Karer AT, et al. Association between traumatic bone marrow abnormalities of the knee, the trauma mechanism and associated soft-tissue knee injuries. European Radiology. 27(1):393-403, 2017 Jan. |
Observational-Dx |
220 patients |
To determine the association between traumatic bone marrow abnormalities, the knee injury mechanism, and associated soft tissue injuries in a larger cohort than those in the published literature. |
One hundred and forty-four valgus injuries, 39 pivot shift injuries, 25 lateral patellar dislocations, 8 hyperextensions, and 4 dashboard injuries were included. Valgus and pivot shift injuries showed traumatic bone marrow abnormalities in the posterolateral regions of the tibia. Abnormalities after patellar dislocation were found in the anterolateral and centrolateral femur and patella. Hyperextension injuries were associated with abnormalities in almost all regions, and dashboard injuries were associated with changes in the anterior regions of the tibia and femur. |
4 |
| 28. Song GY, Zhang H, Wang QQ, Zhang J, Li Y, Feng H. Bone Contusions After Acute Noncontact Anterior Cruciate Ligament Injury Are Associated With Knee Joint Laxity, Concomitant Meniscal Lesions, and Anterolateral Ligament Abnormality. Arthroscopy. 32(11):2331-2341, 2016 Nov. |
Observational-Dx |
193 cases |
To examine the associated findings with bone contusions in patients after acute noncontact anterior cruciate ligament (ACL) injuries. |
Among the 697 consecutive cases, 193 were finally selected. Prevalence of bone contusions seen on MRI was as follows: 60.6% LFC, 73.1% LTP, 6.2% MFC, and 21.2% MTP. Presence of bone contusions at LFC and LTP were significantly associated with high-grade (grade II and III) pivot-shift (ORLFC, 7.39; 95% CI, 1.99, 27.44; ORLTP, 2.52; 95% CI, 1.02, 6.24), concomitant lateral meniscal lesions (ORLFC, 3.23; 95% CI, 1.93, 11.31; ORLTP, 10.17; 95% CI, 1.86, 55.47), and ALL abnormality (ORLFC, 3.79; 95% CI, 1.46, 9.84; ORLTP, 4.47; 95% CI, 1.28, 15.58). However, none of the above associated findings was correlated with the presence of bone contusions at MFC and MTP. Furthermore, moderate/severe lateral bone contusions were still found to be significantly associated with high-grade (grade II and III) pivot-shift (ORLFC, 14.89; 95% CI, 2.71, 82.11; ORLTP, 6.76; 95% CI, 1.27, 36.06), concomitant lateral meniscal lesions (ORLFC, 17.34; 95% CI, 3.91, 76.87; ORLTP, 22.01; 95% CI, 5.08, 95.42), and ALL abnormality (ORLFC, 4.02; 95% CI, 1.33, 12.09; ORLTP, 2.57; 95% CI, 1.09, 6.04). |
3 |
| 29. Klengel A, Stumpp P, Klengel S, Bottger I, Ronisch N, Kahn T. Detection of Traumatic Bone Marrow Lesions after Knee Trauma: Comparison of ADC Maps Derived from Diffusion-weighted Imaging with Standard Fat-saturated Proton Density-weighted Turbo Spin-Echo Sequences. Radiology. 283(2):469-477, 2017 05. |
Observational-Dx |
97 Patients |
To compare single-shot echo-planar diffusion-weighted imaging-derived apparent diffusion coefficient (ADC) maps with fat-saturated (FS) proton density (PD)-weighted turbo spin-echo (TSE) imaging in the detection of bone marrow lesions (BMLs) after knee trauma. |
Significantly more patients showed at least one BML on ADC maps (98%, 95 of 97 patients) than on FS PD-weighted TSE images (86%, 84 of 97 patients) (P < .001). Of the affected regions detected on FS PD-weighted TSE images, 97% (170 of 175 regions) were identified consistently on ADC maps. Only 58% of the affected regions detected on ADC maps (170 of 293 regions) were identified on FS PD-weighted TSE images (P < .001). Median volume of concordant major BML was approximately two times larger on ADC maps (81 cm3) than on FS PD-weighted TSE images (39 cm3) (P < .001). The ADC values of intact bone marrow and BMLs did not overlap. |
3 |
| 30. Koster IM, Oei EH, Hensen JH, et al. Predictive factors for new onset or progression of knee osteoarthritis one year after trauma: MRI follow-up in general practice. Eur Radiol. 2011;21(7):1509-1516. |
Observational-Dx |
117 patients |
To prospectively evaluate prognostic factors for new onset or progression of degenerative change on follow-up MRI 1 year after knee trauma and the association with clinical outcome. |
On follow-up MRI 15% of patients with pre-existing knee osteoarthritis showed progression and 26% of patients demonstrated new degenerative change. The only statistically significant prognostic variable in the multivariate analysis was bone marrow oedema on initial MRI (OR 5.29 (95% CI, 1.64–17.1), P=0.005). A significant association between new or progressive degenerative change and clinical outcome was found (P=0.003). |
2 |
| 31. Helito CP, Helito PVP, Leao RV, Demange MK, Bordalo-Rodrigues M. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy. 25(4):1140-1148, 2017 Apr. |
Review/Other-Dx |
228 Knees |
To determine the frequency of anterolateral ligament (ALL) injuries in patients with acute ACL rupture and to analyse its associated knee lesions. |
Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. |
4 |
| 32. Kosy JD, Schranz PJ, Patel A, Anaspure R, Mandalia VI. The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture. Skeletal Radiology. 46(9):1193-1200, 2017 Sep. |
Review/Other-Dx |
280 MRIs
(277 patients) |
To study the incidence of injury to the anterolateral ligament (ALL) and the pattern of this injury on MRI. |
Injury to the ALL was identified (by at least one observer) in only 10.7% of cases (2.50% full thickness, 7.50% partial thickness, and 0.71% avulsion fracture). There was an almost perfect level of interobserver agreement for both the identification of an injury (? = 0.854) and grading of injury (? = 0.858). The MRI incidence of ALL injury was significantly greater within 6 weeks of the knee injury (18.5 vs. 8.37%; p < 0.05). |
4 |
| 33. Temponi EF, de Carvalho Junior LH, Saithna A, Thaunat M, Sonnery-Cottet B. Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture. Skeletal Radiology. 46(8):1063-1070, 2017 Aug. |
Review/Other-Dx |
162 Patients |
To determine the incidence and MRI characteristics of the spectrum of posterolateral corner (PLC) injuries occurring in association with anterior cruciate ligament (ACL) rupture. |
One hundred sixty-two patients with MRI following ACL rupture were evaluated. Thirty-two patients (19.7%) had an injury to at least one structure of the PLC, including the inferior popliteomeniscal fascicle (n = 28), arcuate ligament (n = 20), popliteus tendon (n = 20), superior popliteomeniscal fascicle (n = 18), lateral collateral ligament (n = 8), popliteofibular ligament (n = 7), biceps tendon (n = 4), iliotibial band (n = 3), and fabellofibular ligament (n = 1). Seventy-five percent of all patients with combined ACL and PLC injuries had bone contusions involving the lateral compartment of the knee. The presence of these contusions strongly correlated with superior popliteomeniscal fascicle lesions (p < 0.05). There was no correlation between injuries to other structures of the PLC and other intra-articular lesions. |
4 |
| 34. van der List JP, Mintz DN, DiFelice GS. The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging. Orthopaedic Journal of Sports Medicine. 5(6):2325967117709966, 2017 June. |
Observational-Dx |
353 patients |
To propose a magnetic resonance imaging (MRI) classification system for different tear types based on clinical relevance and to assess the distribution of these different ACL tear types. |
A total of 353 patients (57% male; mean age, 37.1 years; range, 18.1-81.2 years) were included. Interobserver reliability was 0.670 (95% confidence interval, 0.505-0.836), and intraobserver reliability ranged from 0.741 to 0.934. Incidence of type I tears was 16%, type II tears 27%, type III tears 52%, type IV tears 1%, and type V tears 3% (2.5% with bony avulsion). Type I tears were more common in patients older than 35 years compared with those younger than 35 years (23% vs 8%; P < .001). |
3 |
| 35. Helmark IC, Neergaard K, Krogsgaard MR. Traumatic knee extension deficit (the locked knee): can MRI reduce the need for arthroscopy? Knee Surg Sports Traumatol Arthrosc. 2007;15(7):863-868. |
Observational-Dx |
50 patients |
To examine the validity of MRI and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluate whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. |
Assuming arthroscopy as the gold standard, the following results were calculated for the overall appearance of a lesion able to cause locking: PPV = 0.85, NPV = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (1 bucket-handle lesion and 1 pathological synovial plica). MRI of the knee with acute, traumatic extension deficit is in the acute or subacute phase a safe method to identify the patients that have a mechanical reason for locking and therefore can benefit from arthroscopic treatment. |
2 |
| 36. McNally EG, Nasser KN, Dawson S, Goh LA. Role of magnetic resonance imaging in the clinical management of the acutely locked knee. Skeletal Radiol. 2002;31(10):570-573. |
Observational-Dx |
42 patients |
To explore prospectively the hypothesis that MRI of the acutely locked knee can alter surgical decision-making. |
Sensitivity 96%, specificity100%, accuracy 98%. MRI should precede arthroscopy in this clinical setting. |
3 |
| 37. Even-Sapir E, Arbel R, Lerman H, Flusser G, Livshitz G, Halperin N. Bone injury associated with anterior cruciate ligament and meniscal tears: assessment with bone single photon emission computed tomography. Invest Radiol. 2002;37(9):521-527. |
Observational-Dx |
94 patients |
To assess the role of SPECT by comparing its results with those from arthroscopy, MRI, or both. |
There was considerable concordance between SPECT results and those of other modalities so authors suggest that bone SPECT is valuable in acute knee trauma for assessment of ACL, meniscal tears, or both and for detection of associated bone injury. |
3 |
| 38. Siegel Y, Golan H, Thein R. 99mTc-methylene diphosphonate single photon emission tomography of the knees: intensity of uptake and its correlation with arthroscopic findings. Nucl Med Commun. 2006;27(9):689-693. |
Observational-Dx |
42 patients |
To examine whether SPECT can determine the severity of knee pathology, based on intensity of uptake and, therefore, possibly substituting this technique for more invasive and expensive diagnostic procedures, such as arthroscopy, in certain patient populations. |
41 patients were included in the study. A positive and statistically significant correlation was found between the intensity of uptake on the SPECT and the severity of the arthroscopic findings in the menisci and medial femoral condyle. |
2 |
| 39. Wertman M, Milgrom C, Agar G, Milgrom Y, Yalom N, Finestone AS. Comparison of knee SPECT and MRI in evaluating meniscus injuries in soldiers. Israel Medical Association Journal: Imaj. 16(11):703-6, 2014 Nov. |
Observational-Dx |
193 subjects |
To examine the accuracy of knee SPECT as a tool to identify meniscus tears versus that of MRI as compared to the gold standard of arthroscopy. |
The subjects' age was 21.3 ± 3.9. The agreement between SPECT and arthroscopy was 0.14 forthe medial meniscus and 0.29 for the lateral meniscus. The agreement between MRI and arthroscopy was 0.59 for the medial meniscus and 0.69 for the lateral meniscus. SPECT scan was found to be 61% sensitive, 54% specific and 58% accurate in detecting common knee pathology, whereas MRI was found to be 95% sensitive, 67% specific and 85% accurate. |
3 |
| 40. Bonnefoy O, Diris B, Moinard M, Aunoble S, Diard F, Hauger O. Acute knee trauma: role of ultrasound. Eur Radiol. 2006;16(11):2542-2548. |
Observational-Dx |
48 patients |
Prospective review of patients with conventional radiography, US, and CT to determine the diagnostic accuracy of high spatial resolution US in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. |
The sensitivity, specificity, PPV, NPV of US for the diagnosis of lipohemarthrosis was 97%, 100%, 100% and 94%, respectively, compared with 55%, 100%, 100% and 55% with radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, PPV and NPV of US for early detection of intra-articular knee fractures was 94%, 94%, 97% and 89%, respectively, compared with 84%, 88%, 93% and 75% with radiographs. |
2 |
| 41. Klos B, Scholtes M, Konijnenberg S. High prevalence of all complex Segond avulsion using ultrasound imaging. Knee Surgery, Sports Traumatology, Arthroscopy. 25(4):1331-1338, 2017 Apr. |
Review/Other-Dx |
87 Patients |
To determine the prevalence of a Segond avulsion fractures in acute ACL tears with ultrasound and to investigate whether other injuries can predict the avulsion. |
In 25/87 (29%) of the patients with an ACL tear, a Segond avulsion was observed in ultrasound. Lateral femoral condyle (LFC) impaction showed the strongest individual association with a Segond avulsion and was the best predicting variable. LFC impaction, sustained during low-risk pivoting sport, shows a stronger association with a Segond avulsion, as compared to LFC impaction sustained during high-risk pivoting sports. |
4 |
| 42. Foley R, Fessell D, Yablon C, Nadig J, Brandon C, Jacobson J. Sonography of traumatic quadriceps tendon tears with surgical correlation. Journal of Ultrasound in Medicine. 34(5):805-10, 2015 May. |
Observational-Dx |
239 sonographic reports of the knee |
To assess the ability of sonography to detect quadriceps tendon tears that require surgical treatment (high-grade partial tears and complete ruptures), using surgical correlation as the reference standard. |
On the retrospective consensus review, the sensitivity (23 of 23), specificity (16 of 16), and accuracy (39 of 39) were 100% for identifying high-grade partial tearsor complete ruptures versus a normal quadriceps tendon. For the original, nonretrospective sonographic reports, 22 of 23 high-grade partial tears or complete ruptures (96%) were correctly diagnosed. |
3 |
| 43. Wang CY, Wang HK, Hsu CY, Shieh JY, Wang TG, Jiang CC. Role of sonographic examination in traumatic knee internal derangement. Arch Phys Med Rehabil. 2007;88(8):984-987. |
Observational-Dx |
30 consecutive patients (19 men, 11 women) with traumatic knee injury |
Prospective blinded study to define the accuracy (compared with MRI) of US examination in detecting knee effusion and to determine whether the presence of knee effusions in patients with traumatic knee injury can predict knee internal derangement as assessed by MRI. |
The sensitivity of US examination for detecting knee effusion was 79.1%, and specificity was 50%. PPV was 86.3% and NPV was 37.5%. The PPV of US effusion to internal derangement was 90.9%, and the NPV was 37.5%.US examination can accurately detect effusion of the knee. The detection of knee effusion in patients with traumatic knee injury by sonographic examination is highly indicative of internal knee derangement. |
3 |
| 44. Wareluk P, Szopinski KT. Value of modern sonography in the assessment of meniscal lesions. Eur J Radiol. 2012;81(9):2366-2369. |
Observational-Dx |
160 menisci evaluated in 80 patients |
To assess the accuracy of modern US in diagnostic imaging of meniscal tears. |
The overall sensitivity, specificity, PPV and NPV of US examination in the assessment of meniscal tears amounted to 85.4%, 85.7%, 67.3% and 94.4%, respectively. The statistical parameters were not statistically different in medial and lateral menisci. Age, sex, body mass index, weight, physical activity, mechanism on injury, and time lapse from injury did not have a statistically significant impact on the usefulness of US. The highest sensitivity (>90%) was obtained in medial menisci and in patients with a body mass index >25. The highest specificity (>90%) was obtained in lateral menisci, in patients after twisting injuries, in sports injuries, and in recent injuries (time lapse from the injury <1 month). The PPV of US examination was higher than 90% only in recent injuries (<1 month), however, the NPV of US is high, being < 90% in males with lesions of lateral menisci and in sequelae of sports injuries. |
3 |
| 45. Alizadeh A, Babaei Jandaghi A, Keshavarz Zirak A, Karimi A, Mardani-Kivi M, Rajabzadeh A. Knee sonography as a diagnostic test for medial meniscal tears in young patients. European journal of orthopaedic surgery & traumatologie. 23(8):927-31, 2013 Dec. |
Observational-Dx |
74 Patients |
To prospectively evaluate whether age of patient affects diagnostic accuracy of sonography and magnetic resonance imaging (MRI) in the diagnosis of medial meniscal tears. |
The sensitivity, specificity, positive and negative predictive values and accuracy of ultrasonography in detecting medial meniscal tears in group A were 100, 88.9, 96.5, 100, 97.3% and in group B were 83.3, 71.4, 92.6, 50, 81.1%, respectively. The sensitivity, specificity, positive and negative predictive values and accuracy of MRI in group A were 100, 88.9, 96.5, 100, 97.3% and in group B were 96.7, 85.7, 96.7, 85.7, 94.6%, respectively. |
2 |
| 46. Dai H, Huang ZG, Chen ZJ, Liu JX. Diagnostic accuracy of ultrasonography in assessing meniscal injury: meta-analysis of prospective studies. [Review]. Journal of Orthopaedic Science. 20(4):675-81, 2015 Jul. |
Meta-analysis |
7 Studies |
To establish the role of ultrasonography in the diagnosis of meniscal injury by analyzing the data from prospectively designed studies. |
Seven prospective studies with 551 patients were eligible for the meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies scores for the included studies ranged from 10-13. The summary estimates of the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ultrasonography in the diagnosis of meniscal injury were 0.88 (95 % CI 0.84-0.91), 0.90 (95 % CI 0.86-0.93), 7.07 (95 % CI 4.34-11.52), 0.17 (95 % CI 0.10-0.26) and 58.13 (95 % CI 24.38-138.62), respectively. There was moderate to significant heterogeneity across the above measures (P < 0.05). The area under the curve of the SROC was 0.948, indicating a high overall diagnostic accuracy. No publication bias was noted across the studies (P = 0.393), which suggested little influence of publication bias on the overall results. |
Good |
| 47. Wang J, Wu H, Dong F, et al. The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: A systematic review and meta-analysis. European Journal of Sport Science EJSS : Official Journal of the European College of Sport Science. 18(4):579-586, 2018 May. |
Meta-analysis |
4 studies, 246 Patients |
To evaluate the value of ultrasonography in the diagnosis of anterior cruciate ligament injury (ACL injury) by conducting a systematic review and meta-analysis. |
A total of 4 studies involving 246 patients were eventually included in the analysis. In these four studies, the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, post-test probability and DOR were 90.0% (95% CI: 77-96), 97% (95% CI: 90-99), 31.08 (95% CI: 8.75-110.41), 0.11 (95% CI: 0.05-0.24), 89% (3%) and 288.81 (95% CI: 78.51-1062.48), respectively. The area under the SROC curve was 0.98 (95% CI: 0.97-0.99). |
Good |
| 48. Cavaignac E, Faruch M, Wytrykowski K, et al. Ultrasonographic Evaluation of Anterolateral Ligament Injuries: Correlation With Magnetic Resonance Imaging and Pivot-Shift Testing. Arthroscopy. 33(7):1384-1390, 2017 Jul. |
Observational-Dx |
30 Patients |
(1) To compare the diagnostic ability of ultrasonography (US) and magnetic resonance imaging (MRI) to detect anterolateral ligament (ALL) injuries in anterior cruciate ligament (ACL)-deficient patients, and (2) to evaluate the correlation between ALL injury status (as determined by US and MRI) and the knee's rotational stability. |
On US, the ALL was identified and visible over its entire length in 100% of patients (30 of 30, ? = 1). The ALL was injured in 63% of patients (19 of 30, ? = 0.93). On MRI, the ALL was identified in 96% of patients (29 of 30, ? = 0.91). The ALL appeared injured in 53% of cases (16 of 30, ? = 0.93). An ALL that appeared injured on US was more often associated with a positive pivot shift than was an uninjured ALL (75% vs 39%, ?2 = 13.7, P < .05). The interobserver agreement was high for both US (? = 0.91-1) and MRI (? = 0.76-1). |
4 |
| 49. Wang LY, Yang TH, Huang YC, Chou WY, Huang CC, Wang CJ. Evaluating posterior cruciate ligament injury by using two-dimensional ultrasonography and sonoelastography. Knee Surgery, Sports Traumatology, Arthroscopy. 25(10):3108-3115, 2017 Oct. |
Observational-Dx |
66 Patients |
To elucidate the diagnostic criteria for posterior cruciate ligament (PCL) injury using ultrasonography |
Good to excellent reliabilities were noted for 2D US and red pixel intensity on sonoelastography. In injured knees, PCL thicknesses were significantly greater, and red pixel intensities were significantly lower, compared to non-injured knees of patients and healthy controls. This indicates increased swelling and softness in injured PCLs. The area under the PCL thickness ROC curve was 0.917 (p < 0.001), and the best diagnostic criterion was a thickness =6.5 mm (90.6 % sensitivity and 86.7 % specificity). Thickness correlated with red pixel intensity, International Knee Documentation Committee examination grade, and MRI severity grading. In addition, effusions were detected on 2D US in all knees with "tears" of other structures on MRI. |
4 |
| 50. Spiro AS, Regier M, Novo de Oliveira A, et al. The degree of articular depression as a predictor of soft-tissue injuries in tibial plateau fracture. Knee Surg Sports Traumatol Arthrosc. 2013;21(3):564-570. |
Review/Other-Dx |
54 patients |
To determine whether the amount of tibial plateau fracture depression on MDCT scans correlates with the incidence of associated soft-tissue injuries on MRI. |
Logistic regression revealed a significant impact of increasing tibial plateau fracture depression on the incidence of meniscus lateralis tears (P=0.025) and ACL lesions (P=0.018). Analysis of covariance demonstrated a significant correlation between the amount of articular depression and absolute number of soft-tissue injuries (P=0.001). |
4 |
| 51. Tang HC, Chen IJ, Yeh YC, et al. Correlation of parameters on preoperative CT images with intra-articular soft-tissue injuries in acute tibial plateau fractures: A review of 132 patients receiving ARIF. Injury. 48(3):745-750, 2017 Mar. |
Observational-Dx |
132 Patients |
To test the hypothesis that parameters of CT imaging can predict intra-articular soft-tissue injuries. |
One-hundred and thirty-two patients were enrolled in the study. The average age was 45.7 ± 13.1 years (range: 18–75 years). Lateral tibial plateau depressions >11 mm were significantly associated with increased risk of lateral meniscus tears ( p = 0.001). However, there was no significant threshold of lateral tibial plateau widening that could be used to predict lateral meniscus tear. Greater risk of anterior cruciate ligament (ACL) avulsion fracture was observed in younger patients, patients with high-energy-pattern tibial plateau fractures, patients with fractures involving anteromedial or posterolateral columns, and patients with medial tibial plateau displacement >3 mm ( p < 0.05). |
3 |
| 52. Chang SM, Zhang YQ, Yao MW, Du SC, Li Q, Guo Z. Schatzker type IV medial tibial plateau fractures: a computed tomography-based morphological subclassification. Orthopedics. 37(8):e699-706, 2014 Aug. |
Review/Other-Dx |
42 Patients |
To propose a new subclassification of Schatzker type IV fracture patterns based on 2-dimensional (2-D) computed tomography and three-dimensional (3-D) reconstruction. |
Twelve (29%) cases involved only the medial condyle, and 30 (71%) involved both the medial and lateral condyles. Twenty-nine (69%) cases demonstrated posterior coronal fractures. The most common patterns were bicondylar posteromedial plateau fractures with posterolateral quadrant depression (bicondylar posterior fractures: 14 cases, 33%) and total/subtotal medial condyle fractures with posterolateral quadrant depression (13 cases, 31%). The isolated unicondylar posteromedial split fracture was uncommon (2 cases, 5%). |
4 |
| 53. Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF. Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol. 1993;161(1):109-113. |
Review/Other-Dx |
26 patients; 1,450 MR exams; 4 reviewers |
Retrospective study of MRI exams to determine if MRI is useful in establishing the diagnosis of transient lateral patellar dislocation. |
Specific components of the constellation of MR findings included disruption or sprain of the medial retinaculum in 25 (96%) of 26 patients, lateral patellar tilt or subluxation in 24 patients (92%), lateral femoral condyle contusion in 21 patients (81%), osteochondral injury in 15 patients (58%), and joint effusion in all 26 patients (100%). Concomitant injury to major ligaments or menisci was present in 8 (31%). Findings suggest that patients with transient lateral patellar subluxation have a distinctive constellation of MR findings that can be used to distinguish this entity from other common knee injuries. |
4 |
| 54. Paakkala A, Sillanpaa P, Huhtala H, Paakkala T, Maenpaa H. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months. Skeletal Radiol. 2010;39(7):675-682. |
Observational-Dx |
23 patients |
To assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by MRI and resolving resolution of bruises in follow-up MRI. |
In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm(3) and of the patellar bruise 2,832 mm(3). At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm(3) and 1,380 mm(3), respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r = 0.389, P=0.074) and the follow-up (r = 1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. |
2 |
| 55. Sanders TG, Paruchuri NB, Zlatkin MB. MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol. 2006;187(5):1332-1337. |
Review/Other-Dx |
25 patients |
To determine the incidence and location of lateral femoral condyle osteochondral injuries after transient lateral dislocation of the patella. |
Osteochondral defects of the lateral femoral condyle are common sequela injuries after transient lateral dislocation of the patella. A significant number of osteochondral injuries involve the midlateral weight-bearing portion more posterior than would be expected. |
4 |
| 56. Boisrenoult P, Lustig S, Bonneviale P, et al. Vascular lesions associated with bicruciate and knee dislocation ligamentous injury. Orthop Traumatol Surg Res. 2009;95(8):621-626. |
Review/Other-Dx |
67 patients |
To analyze data extracted from the prospective series of the 2008 SOFCOT Symposium (dedicated to management of bicruciate knee lesions) and from an analysis of the literature, with emphasis on developing a diagnostic strategy for vascular lesions associated with bicruciate lesions. |
67 patients were included. Mean dislocation reduction time was 2 hrs 45 min (max, 21 hrs). There were 9 vascular lesions (12%). Absence of vascular lesion could be confirmed in 58/59 patients exhibiting presence of peripheral pulses at initial examination. In 1 case, a vascular lesion was found on early imaging, but with no clinical consequence. In all 8 cases with associated clinical pulse abnormality, complementary vascular check-up confirmed the presence of a vascular lesion. Angioscan induced no error of vascular assessment in this series, with no false positives or false negatives. 1 patient underwent amputation for critical ischemia. 3 patients had vascular surgical treatment, 2 not undergoing secondary ligament surgery. 4 of the 5 patients whose vascular lesion was conservatively managed by simple observation were able to undergo the scheduled treatment for their ligament lesions. |
4 |
| 57. Johnson ME, Foster L, DeLee JC. Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med. 2008;36(12):2448-2462. |
Review/Other-Dx |
N/A |
To explore the types, mechanisms, and classifications of common neurovascular complications of knee ligament injuries, discusses their diagnosis, and review the therapeutic options available to optimize patient outcomes. |
Popliteal artery injuries require immediate intervention to help prevent limb loss. Peroneal and tibial nerve injuries can be a significant cause of morbidity and, therefore, require an understanding of their natural history, anatomy, and pathophysiologic implications to maximize functionality. |
4 |
| 58. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury. 2011;42(11):1198-1204. |
Review/Other-Dx |
N/A |
To present a comprehensive review of the recent literature on the evaluation and management of traumatic knee dislocations. |
No results stated in abstract. |
4 |
| 59. Fleiter TR, Mervis S. The role of 3D-CTA in the assessment of peripheral vascular lesions in trauma patients. Eur J Radiol. 2007;64(1):92-102. |
Review/Other-Dx |
N/A |
Review roles of diagnostic angiography and CTA in a trauma center. |
3D-CTA with multislice CT can be used to replace the diagnostic angiography in patients with blunt or penetrating extremity injuries. |
4 |
| 60. Rieger M, Mallouhi A, Tauscher T, Lutz M, Jaschke WR. Traumatic arterial injuries of the extremities: initial evaluation with MDCT angiography. AJR Am J Roentgenol. 2006;186(3):656-664. |
Observational-Dx |
87 patients |
Retrospectively assess the accuracy of MDCT angiography as the initial diagnostic technique to describe arterial injury in patients with extremity trauma. Presence of arterial involvement was examined prospectively by a radiologist and retrospectively by 2 independent radiologists. |
MDCT angiography yielded high accuracy in detection and characterization of traumatic arterial injuries and in recognizing an underlying dissection. Prospective sensitivity and specificity were 95% and 87%, respectively, and retrospective sensitivity and specificity were 99% and 87%, respectively. MDCT angiography provides significant and reproducible technique for the detection and characterization of arterial injuries. |
2 |
| 61. Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL. Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma. 2002;16(5):330-339. |
Review/Other-Dx |
21 patients |
Retrospective search was performed to evaluate MRI and MRA in detecting soft tissue, neurovascular, and bony injury after multiple ligament knee injury, including knee dislocation. |
6 patients had both conventional angiograms and MRA with 100% agreement between the studies. MRI is an accurate method of assessing soft tissue, osseous, and neural damage after knee dislocation. |
4 |
| 62. Tocci SL, Heard WM, Fadale PD, Brody JM, Born C. Magnetic resonance angiography for the evaluation of vascular injury in knee dislocations. J Knee Surg. 2010;23(4):201-207. |
Observational-Dx |
16 patients |
To determine whether it may be prudent and convenient to obtain an MR angiogram at the same time as an MRI scan, with less morbidity and discomfort than with conventional angiography. |
16 patients with frank and occult knee dislocations were prospectively evaluated over 2 years. After reduction, a physical exam was performed including ankle brachial index (ABI). With ankle brachial index <0.90, emergent vascular surgery consult and angiogram was performed. Patients with ankle brachial index >0.90 were observed for 3 days with serial physical exams, and MRI/MRA was performed as soon as possible. 16 dislocations were identified. 2/16 (12.5%) had abnormal ABIs and received an angiogram and subsequent revascularization. 2 had normal exams, but refused MRA. 12 had normal exams and received MRI/MRA showing a normal popliteal artery with no adverse events. Ankle brachial index had 100% sensitivity for vascular injury; however, there remains concern among treating surgeons about missing an occult injury such as an intimal tear. |
3 |
| 63. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
