Cruciate and Posterolateral Corner Injuries in the Athlete: Clinical and Magnetic Resonance Imaging Features

Lawrence M. White; Anthony Miniaci

doi:10.1055/s-2004-823018

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2004; 8(1): 111-131
DOI: 10.1055/s-2004-823018

Cruciate and Posterolateral Corner Injuries in the Athlete: Clinical and Magnetic Resonance Imaging Features

Lawrence M. White¹ , Anthony Miniaci²

¹Cleveland Clinic Sports Health, Cleveland Clinic Foundation, Cleveland, OH
²Department of Surgery, Toronto Western Hospital, The University Health Network, University of Toronto, Toronto, Canada

Abstract

With an increasing number of people participating in recreational and competitive sporting activities, sports-related injuries of the knee and knee ligaments have increased in incidence. The extent and severity of such injuries may have important impliations with regard to potential return to atheletic pursuits as well as impacting upon activities of daily life. This article discusses the MR imaging and clinical features of sports-related injuries of the cruciate ligaments and posterolateral corner of the knee, highlighting the implications of such injuries on joint function. MR imaging has the potential to accurately identify these ligamentous injuries, as well as other potential associated combined injuries of the knee, with information from MR imaging examination assisting in decision-making and planning with regard to potential clinical and/or surgical patient management.

KEYWORDS

Knee - sports - injury - MR imaging - anterior cruciate ligament - posterior cruciate ligament - posterolateral corner

Full Text

References

REFERENCES

1 Girgis F G, Marshall J L, Manajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop. 1975; 106 216-231
2 Arnoczky S P, Warren R F. Anatomy of the cruciate ligaments. In: Feagin JA Jr The Crucial Ligaments. New York; Churchill Livingstone 1994: 269-288
3 Arnoczky S P, Matyas J R, Buckwalter J A, Ameil D. Anatomy of the anterior cruciate ligament. In: Jackson DW The Anterior Cruciate Ligament: Current and Future Concepts. New York; Raven Press 1993: 5-22
4 Stoller D W, Cannon Jr W D, Anderson L J. The knee. In: Stoller DW Magnetic Resonance Imaging in Orthopedics and Sports Medicine. 2nd ed. Philadelphia, PA; Lippincott-Raven 1997: 203-442
5 Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens. AJR Am J Roengenol. 1992; 159 357-360
6 Resnick D, Kang H S. The knee. In: Resnick D, Kang HS Internal Derangements of Joints: Emphasis on MR Imaging. Philadelphia, PA; WB Saunders 1997: 555-785
7 Boden B, Dean G, Feagin Jr J A, Garrett Jr W E. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000; 23 573-578
8 Griffin L Y, Albohm M J, Arendt E A et al.. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000; 8 141-150
9 Howe J, Johnson R J. Knee injuries in skiing. Clin Sports Med. 1982; 1 277-288
10 Ho C P, Marks P H, Steadman R J. MR imaging of knee anterior cruciate ligament and associated injuries in skiers. Magn Reson Imaging Clin N Am. 1999; 7 117-130
11 Kirkendall D T, Garrett Jr W E. The anterior cruciate ligament enigma. Injury mechanisms and prevention. Clin Orthop. 2000; 372 64-68
12 Fithian D C, Paxton L W, Goltz D H. Fate of the anterior cruciate ligament-injured knee. Orthop Clin North Am. 2002; 33 621-636
13 Binfield P M, Maffulli N, King J B. Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury. 1993; 24 557-561
14 Traina S M, Bromberg D M. ACL injury patterns in women. Orthopedics. 1997; 20 545-549
15 Arendt E D. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of the literature. Am J Sports Med. 1995; 23 694-701
16 Wojtys E M, Huston L J, Boynton M D, Spindler K P, Lindenfeld T N. The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels. Am J Sports Med. 2002; 30 182-188
17 Bomberg B C, McGinty J B. Acute hemarthrosis of the knee: indications for diagnostic arthroscopy. Arthroscopy. 1990; 6 221-225
18 Maffulli N, Binfield P M, King J B et al.. Acute hemarthrosis of the knee in athletes. A prospective study of 106 cases. J Bone Joint Surg Br. 1993; 75 945-949
19 Noyes F R, Bassett R W, Grood E S et al.. Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am. 1980; 62 687-695
20 Daniel D M, Stone M L. Diagnosis of knee ligament injury: tests and measurement of knee motion limits. In: Feagin JA Jr The Crucial Ligaments. New York; Churchill Livingstone 1994: 269-288
21 Liu S H, Osti L, Henry M, Bocchi L. The diagnosis of acute complete tears of the anterior cruciate ligament: comparison of MRI, arthrometry, and clinical examination. J Bone Joint Surg Br. 1995; 77 586-588
22 Johnson D L, Warner J J. Diagnosis for ACL surgery. Clin Sports Med. 1993; 12 671-684
23 Noyes F R, Mooar P A, Matthews D S, Butler D L. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am. 1983; 65 154-162
24 Lerman J E, Gray D S, Schweitzer M E, Bartolozzi A. MR evaluation of the anterior cruciate ligament: value of axial images. J Comput Assist Tomogr. 1995; 19 604-607
25 Fitzgerald S W, Remer E M, Friedman H, Rogers L F, Hendrix R W, Schafer M F. MR evaluation of the anterior cruciate ligament: value of supplementing sagittal images with coronal and axial images. AJR Am J Roengenol. 1993; 160 1233-1237
26 Remer E M, Fitzgerald S W, Friedman H, Rogers L F, Hendrix R W, Schafer M F. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics. 1992; 12 901-915
27 Mink J H, Levy T, Crues III J V. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology. 1988; 167 769-774
28 Lee J K, Yao L, Phelps C T, Wirth C R, Czajka J, Lozman J. Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology. 1988; 166 861-8614
29 Vahey T N, Meyer S F, Shelbourne K D, Klootwyk T E. MR imaging of anterior cruciate ligament injuries. Magn Reson Imaging Clin N Am. 1994; 2 365-380
30 Tung G A, Davis L M, Wiggins M E, Fadale P D. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology. 1993; 188 661-667
31 Leach W J, King J B. Posterior reattachment of the torn anterior cruciate ligament. J Bone Joint Surg Br. 1994; 76 159-160
32 Vahey T N, Broome D R, Kayes K J, Shelbourne K D. Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging. Radiology. 1991; 181 251-253
33 Murphy B J, Smith R L, Uribe J W, Janecki C J, Hechtman K S, Mangasarian R A. Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign?. Radiology. 1992; 182 221-224
34 Kaplan P A, Walker C W, Kilcoyne R F, Brown D E, Tusek D, Dussault R G. Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging. Radiology. 1992; 183 835-838
35 Kaplan P A, Gehl R H, Dussault R G, Anderson M W, Diduch D R. Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology. 1999; 211 747-753
36 Snearly W N, Kaplan P A, Dussault R G. Lateral-compartment bone contusions in adolescents with intact anterior cruciate ligaments. Radiology. 1996; 198 205-208
37 Yao L, Lee J K. Avulsion of the posteromedial tibial plateau by the semimembranosus tendon: diagnosis with MR imaging. Radiology. 1989; 172 513-514
38 Chan K K, Resnick D, Goodwin D, Seeger L L. Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging. Radiology. 1999; 211 754-758
39 Andrish J T. Anterior cruciate ligament injuries in the skeletally immature patient. Am J Orthop. 2001; 30 103-110
40 Robertson P L, Schweitzer M E, Bartolozzi A R, Ugoni A. Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology. 1994; 193 829-834
41 Gentili A, Seeger L L, Yao L, Do H M. Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology. 1994; 193 835-840
42 McCauley T R, Moses M, Kier R, Lynch J K, Barton J W, Jokl P. MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings. AJR Am J Roengenol. 1994; 162 115-119
43 Schweitzer M E, Cervilla V, Kursunoglu-Brahme S, Resnick D. The PCL line: an indirect sign of anterior cruciate ligament injury. Clin Imaging. 1992; 16 43-48
44 Daniel D M, Fritschy D. Anterior cruciate ligament injuries. In: DeLee JC, Drez D Jr Orthopedic Sports Medicine: Principles and Practice. Philadelphia, PA; WB Saunders 1994: 1313
45 Noyes F R, Mooar L A, Moorman C T, McGinniss G H. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Joint Surg Br. 1989; 71 825-833
46 Umans H, Wimpfheimer O, Haramati N, Applbaum Y H, Adler M, Bosco J. Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. AJR Am J Roengenol. 1995; 165 893-897
47 Yao L, Gentili A, Petrus L, Lee J K. Partial ACL rupture: an MR diagnosis?. Skeletal Radiol. 1995; 24 247-251
48 Roychowdhury S, Fitzgerald S W, Sonin A H, Peduto A J, Miller F H, Hoff F L. Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images. AJR Am J Roengenol. 1997; 168 1487-1491
49 Daniel D M. Selecting patients for ACL Surgery. In: Jackson DW The Anterior Cruciate Ligament: Current and Future Concepts. New York; Raven Press 1993: 251-258
50 Fu F H, Bennett C H, Ma C B, Menetrey J, Lattermann C. Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med. 2000; 28 124-130
51 Lo I K, Kirkley A, Fowler P J, Miniaci A. The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy. 1997; 13 627-634
52 Khan A S, Sherman O H, DeLay B. Thermal treatment of anterior cruciate ligament injury and laxity with its imaging characteristics. Clin Sports Med. 2002; 21 701-711
53 Harner C D, Baek G H, Vogrin T M, Carlin G J, Kashiwaguchi S, Woo S L. Quantitative analysis of human cruciate ligament insertions. Arthroscopy. 1999; 15 741-749
54 Harner C D, Xerogeanes J W, Livesay G A et al.. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995; 23 736-745
55 Grood E S, Stowers S F, Noyes F R. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am. 1988; 70 88-97
56 Gollehon D L, Torzilli P A, Warren R F. The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am. 1987; 69 233-242
57 Margheritini F, Rihn J, Musahl V, Mariani P P, Harner C. Posterior cruciate ligament injuries in the athlete: an anatomical, biomechanical and clinical review. Sports Med. 2002; 32 393-408
58 Fowler P J, Messieh S S. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med. 1987; 15 553-557
59 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients: Part II. Arthroscopy. 1995; 11 526-529
60 Covey C D, Sapega A A. Injuries of the posterior cruciate ligament. J Bone Joint Surg Am. 1993; 75 1376-1386
61 Grover J S, Bassett L W, Gross M L, Seeger L L, Finerman G A. Posterior cruciate ligament: MR imaging. Radiology. 1990; 174 527-530
62 Hunter J C, Chapman J R. Isolated avulsion of the posterior cruciate ligament: an uncommon dashboard injury. AJR Am J Roengenol. 1995; 164 1190
63 Sonin A H, Fitzgerald S W, Friedman H, Hoff F L, Hendrix R W, Rogers L F. Posterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiology. 1994; 190 455-458
64 Potter H G. The dislocated knee: imaging of the multiple-ligament injured knee. Clin Sports Med. 2000; 19 425-441
65 Miller M D, Johnson D L, Harner C D, Fu F H. Posterior cruciate ligament injuries. Orthop Rev. 1993; 22 1201-1210
66 Parolie J M, Bergfeld J A. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med. 1986; 14 35-38
67 Cosgara A J, Jay P R. Posterior cruciate ligament injuries: evaluation and management. J Am Acad Orthop Surg. 2001; 9 297-307
68 Bergfeld J A, McAllister D R, Parker R D, Valdevit A D, Kambic H E. A biomechanical comparison of posterior cruciate ligament reconstruction techniques. Am J Sports Med. 2001; 29 129-136
69 Veltri D M, Deng X H, Torzilli P A, Warren R F, Maynard M J. The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med. 1995; 23 436-443
70 LaPrade R F, Terry G C. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997; 25 433-438
71 Hughston J C, Jacobson K E. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1985; 67 351-359
72 Baker C L, Norwood L A, Hughston J C. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med. 1984; 12 204-208
73 Yu J S, Salonen D C, Hodler J, Haghighi P, Trudell D, Resnick D. Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. Radiology. 1996; 198 199-204
74 Miller T T, Gladden P, Staron R B, Henry J H, Feldman F. Posterolateral stabilizers of the knee: anatomy and injuries assessed with MR imaging. AJR Am J Roengenol. 1997; 169 1641-1647
75 Juhng S K, Lee J K, Choi S S, Yoon K H, Roh B S, Won J J. MR evaluation of the “arcuate” sign of posterolateral knee instability. AJR Am J Roengenol. 2002; 178 583-588
76 Andrews J R, Baker C L, Curl W W, Clancy W G. Surgical repair of acute and chronic lesions of the lateral capsular ligamentous complex of the knee. In: Feagin JA Jr The Crucial Ligaments. New York; Churchill Livingstone 1994: 605-622

Lawrence M WhiteM.D.

Department of Medical Imaging, Mount Sinai Hospital and the University Health Network

600 University Avenue

Toronto, Ontario, Canada, M5G 1X5

Email: lwhite@mtsinai.on.ca