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Anterior cruciate ligament tear: reliability of MR imaging to predict stability after conservative treatment.

Chung HW, Ahn JH, Ahn JM, Yoon YC, Hong HP, Yoo SY, Kim S - Korean J Radiol (2007 May-Jun)

Bottom Line: The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL.The MR findings were not significantly different between the different KT-2000 groups.MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. chung@amc.seoul.kr

ABSTRACT

Objective: The aim of this study is to evaluate the reliability of MR imaging to predict the stability of the torn anterior cruciate ligament (ACL) after complete recovery of the ligament's continuity.

Materials and methods: Twenty patients with 20 knee injuries (13 males and 7 females; age range, 20-54) were enrolled in the study. The inclusion criteria were a positive history of acute trauma, diagnosis of the ACL tear by both the physical examination and the MR imaging at the initial presentation, conservative treatment, complete recovery of the continuity of the ligament on the follow up (FU) MR images and availability of the KT-2000 measurements. Two radiologists, who worked in consensus, graded the MR findings with using a 3-point system for the signal intensity, sharpness, straightness and the thickness of the healed ligament. The insufficiency of ACL was categorized into three groups according to the KT-2000 measurements. The statistic correlations between the grades of the MR findings and the degrees of ACL insufficiency were analyzed using the Cochran-Mantel-Haenszel test (p < 0.05).

Results: The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL. The MR findings were not significantly different between the different KT-2000 groups.

Conclusion: MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

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Related in: MedlinePlus

A 54-year-old man with partial tear of anterior cruciate ligament that was confirmed by arthroscopy.A, B. Sagittal (A) and oblique coronal (B) proton density-weighted images 15 days after the trauma show complete tear at the proximal anterior cruciate ligament and marrow contusion at the posterior aspect of the proximal tibia.C, D. Four-months later, the sagittal (C) and oblique coronal (D) images demonstrate restored continuity of anterior cruciate ligament, which shows a band-like high signal intensity within the ligament, a partly obscure contour, mild sagging and an increased thickness. Partial tear of the anterior cruciate ligament was confirmed during arthroscopy 5-months later. The side-to-side difference of the KT-2000 measurement was 5 mm at the time of arthroscopy.
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Figure 2: A 54-year-old man with partial tear of anterior cruciate ligament that was confirmed by arthroscopy.A, B. Sagittal (A) and oblique coronal (B) proton density-weighted images 15 days after the trauma show complete tear at the proximal anterior cruciate ligament and marrow contusion at the posterior aspect of the proximal tibia.C, D. Four-months later, the sagittal (C) and oblique coronal (D) images demonstrate restored continuity of anterior cruciate ligament, which shows a band-like high signal intensity within the ligament, a partly obscure contour, mild sagging and an increased thickness. Partial tear of the anterior cruciate ligament was confirmed during arthroscopy 5-months later. The side-to-side difference of the KT-2000 measurement was 5 mm at the time of arthroscopy.

Mentions: We retrospectively reviewed the initial and follow up (FU) MR images of 92 patients' 92 knee joints from 1998 to 2004. The inclusion criteria for the study were : a positive history of acute recent trauma on presentation, diagnosis of ACL tear by both the physical examination and the MR imaging at the initial presentation, complete recovery of the ACL continuity on the FU MR images (Figs. 1, 2), and the availability of the KT-2000 measurements. Disruption of all the fibers revealed by the MR images, including both the obligue coronal and oblique sagittal scans along the course of ACL, was diagnosed as a complete tear of the ACL. There were neither avulsion injuries nor partial tears of the ACL, and no injuries to the contralateral knee joints. All of the injured knees were treated using a brace without reconstruction surgery; and each case was followed up by one experienced orthopaedic surgeon. Finally, twenty patients (13 males and 7 females, age range: 20-54 years, mean age: 32 years) with 20 knee injuries were selected for the review. Among them, arthroscopy was performed in eight patients due to the anterior instability of the knee joint (6/8), knee locking by the torn medial meniscus (1/8) and the knee joint contracture (1/8). The mean time interval between the FU MR and arthroscopy was 4 months 3 days ± 2 months 18 days (range 0-170 days). Our institutional review board approved this study protocol, and informed consents were not required from the patient.


Anterior cruciate ligament tear: reliability of MR imaging to predict stability after conservative treatment.

Chung HW, Ahn JH, Ahn JM, Yoon YC, Hong HP, Yoo SY, Kim S - Korean J Radiol (2007 May-Jun)

A 54-year-old man with partial tear of anterior cruciate ligament that was confirmed by arthroscopy.A, B. Sagittal (A) and oblique coronal (B) proton density-weighted images 15 days after the trauma show complete tear at the proximal anterior cruciate ligament and marrow contusion at the posterior aspect of the proximal tibia.C, D. Four-months later, the sagittal (C) and oblique coronal (D) images demonstrate restored continuity of anterior cruciate ligament, which shows a band-like high signal intensity within the ligament, a partly obscure contour, mild sagging and an increased thickness. Partial tear of the anterior cruciate ligament was confirmed during arthroscopy 5-months later. The side-to-side difference of the KT-2000 measurement was 5 mm at the time of arthroscopy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627415&req=5

Figure 2: A 54-year-old man with partial tear of anterior cruciate ligament that was confirmed by arthroscopy.A, B. Sagittal (A) and oblique coronal (B) proton density-weighted images 15 days after the trauma show complete tear at the proximal anterior cruciate ligament and marrow contusion at the posterior aspect of the proximal tibia.C, D. Four-months later, the sagittal (C) and oblique coronal (D) images demonstrate restored continuity of anterior cruciate ligament, which shows a band-like high signal intensity within the ligament, a partly obscure contour, mild sagging and an increased thickness. Partial tear of the anterior cruciate ligament was confirmed during arthroscopy 5-months later. The side-to-side difference of the KT-2000 measurement was 5 mm at the time of arthroscopy.
Mentions: We retrospectively reviewed the initial and follow up (FU) MR images of 92 patients' 92 knee joints from 1998 to 2004. The inclusion criteria for the study were : a positive history of acute recent trauma on presentation, diagnosis of ACL tear by both the physical examination and the MR imaging at the initial presentation, complete recovery of the ACL continuity on the FU MR images (Figs. 1, 2), and the availability of the KT-2000 measurements. Disruption of all the fibers revealed by the MR images, including both the obligue coronal and oblique sagittal scans along the course of ACL, was diagnosed as a complete tear of the ACL. There were neither avulsion injuries nor partial tears of the ACL, and no injuries to the contralateral knee joints. All of the injured knees were treated using a brace without reconstruction surgery; and each case was followed up by one experienced orthopaedic surgeon. Finally, twenty patients (13 males and 7 females, age range: 20-54 years, mean age: 32 years) with 20 knee injuries were selected for the review. Among them, arthroscopy was performed in eight patients due to the anterior instability of the knee joint (6/8), knee locking by the torn medial meniscus (1/8) and the knee joint contracture (1/8). The mean time interval between the FU MR and arthroscopy was 4 months 3 days ± 2 months 18 days (range 0-170 days). Our institutional review board approved this study protocol, and informed consents were not required from the patient.

Bottom Line: The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL.The MR findings were not significantly different between the different KT-2000 groups.MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. chung@amc.seoul.kr

ABSTRACT

Objective: The aim of this study is to evaluate the reliability of MR imaging to predict the stability of the torn anterior cruciate ligament (ACL) after complete recovery of the ligament's continuity.

Materials and methods: Twenty patients with 20 knee injuries (13 males and 7 females; age range, 20-54) were enrolled in the study. The inclusion criteria were a positive history of acute trauma, diagnosis of the ACL tear by both the physical examination and the MR imaging at the initial presentation, conservative treatment, complete recovery of the continuity of the ligament on the follow up (FU) MR images and availability of the KT-2000 measurements. Two radiologists, who worked in consensus, graded the MR findings with using a 3-point system for the signal intensity, sharpness, straightness and the thickness of the healed ligament. The insufficiency of ACL was categorized into three groups according to the KT-2000 measurements. The statistic correlations between the grades of the MR findings and the degrees of ACL insufficiency were analyzed using the Cochran-Mantel-Haenszel test (p < 0.05).

Results: The p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL. The MR findings were not significantly different between the different KT-2000 groups.

Conclusion: MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

Show MeSH
Related in: MedlinePlus