Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000070.xml
Download PDF
Semin Musculoskelet Radiol 2017; 21(02): 063-074
DOI: 10.1055/s-0037-1599208
DOI: 10.1055/s-0037-1599208
Review Article
Multiligamentous Injury of the Knee: MRI Diagnosis and Injury Patterns
Further Information
Publication History
Publication Date:
29 March 2017 (online)
Abstract
Anterior cruciate and posterior cruciate injuries rarely occur in isolation and are often associated with injuries to the secondary or supporting structures that provide stability against rotational forces. These structures include the posterolateral and posteromedial corner ligaments and tendons, as well as the anterolateral ligament. If injuries to these secondary structures are not appreciated at the time of cruciate ligament reconstruction, an isolated cruciate ligament reconstruction may be predisposed to early failure. Thus it is crucial for radiologists interpreting knee magnetic resonance imaging to understand and report on injury to these ligaments and tendons at the time of initial injury to help the orthopaedic surgeon plan a comprehensive approach to ligament reconstruction. This strategy will ultimately result in improved patient outcomes.
-
References
- 1 Chahla J, Moatshe G, Dean CS, LaPrade RF. Posterolateral corner of the knee: current concepts. Arch Bone Jt Surg 2016; 4 (2) 97-103
- 2 Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: surgical treatment of acute injuries. Am J Sports Med 2016; 44 (5) 1336-1342
- 3 Moulton SG, Geeslin AG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 2: surgical treatment of chronic injuries. Am J Sports Med 2016; 44 (6) 1616-1623
- 4 LaPrade MD, Kennedy MI, Wijdicks CA, LaPrade RF. Anatomy and biomechanics of the medial side of the knee and their surgical implications. Sports Med Arthrosc Rev 2015; 23 (2) 63-70
- 5 Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF. Injuries to the
medial collateral ligament and associated medial structures of the knee. J Bone Joint
Surg Am 2010; 92 (5) 1266-1280
MissingFormLabel
- 6 LaPrade RF, Wijdicks CA. Surgical technique: development of an anatomic medial knee reconstruction. Clin Orthop Relat Res 2012; 470 (3) 806-814
- 7 Rochecongar G, Plaweski S, Azar M , et al; French Society for Arthroscopy (Société française d'arthroscopie, SFA). Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review. Orthop Traumatol Surg Res 2014; 100 (8, Suppl): S371-S378
- 8 Mabvuure NT, Malahias M, Haddad B, Hindocha S, Khan WS. State of the art regarding the management of multiligamentous injuries of the knee. Open Orthop J 2014; 8: 215-218
- 9 Gimber LH, Hardy JC, Melville DM, Scalcione LR, Rowan A, Taljanovic MS. Normal magnetic resonance imaging anatomy of the capsular ligamentous supporting structures of the knee. Can Assoc Radiol J 2016; 67 (4) 356-367
- 10 Jadhav SP, More SR, Riascos RF, Lemos DF, Swischuk LE. Comprehensive review of the anatomy, function, and imaging of the popliteus and associated pathologic conditions. Radiographics 2014; 34 (2) 496-513
- 11 Geiger D, Chang EY, Pathria MN, Chung CB. Posterolateral and posteromedial corner injuries of the knee. Magn Reson Imaging Clin N Am 2014; 22 (4) 581-599
- 12 Pedersen RR. The medial and posteromedial ligamentous and capsular structures of the knee: review of anatomy and relevant imaging findings. Semin Musculoskelet Radiol 2016; 20 (1) 12-25
- 13 Dietrich TJ, Fucentese SF, Pfirrmann CW. Imaging of individual anatomic risk factors for patellar instability. Semin Musculoskelet Radiol 2016; 20 (1) 65-73
- 14 Dirim B, Haghighi P, Trudell D, Portes G, Resnick D. Medial patellofemoral ligament: cadaveric investigation of anatomy with MRI, MR arthrography, and histologic correlation. AJR Am J Roentgenol 2008; 191 (2) 490-498
- 15 Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 2010; 30 (4) 961-981
- 16 Crespo B, James EW, Metsavaht L, LaPrade RF. Injuries to posterolateral corner of the knee: a comprehensive review from anatomy to surgical treatment. Rev Bras Ortop 2014; 50 (4) 363-370
- 17 Djian P. Posterolateral knee reconstruction. Orthop Traumatol Surg Res 2015; 101 (1, Suppl): S159-S170
- 18 Vinson EN, Major NM, Helms CA. The posterolateral corner of the knee. AJR Am J Roentgenol 2008; 190 (2) 449-458
- 19 El-Dieb A, Yu JS, Huang GS, Farooki S. Pathologic conditions of the ligaments and tendons of the knee. Radiol Clin North Am 2002; 40 (5) 1061-1079
- 20 Malone WJ, Koulouris G. MRI of the posterolateral corner of the knee: normal appearance and patterns of injury. Semin Musculoskelet Radiol 2006; 10 (3) 220-228
- 21 Pacholke DA, Helms CA. MRI of the posterolateral corner injury: a concise review. J Magn Reson Imaging 2007; 26 (2) 250-255
- 22 Beall DP, Googe JD, Moss JT , et al. Magnetic resonance imaging of the collateral ligaments and the anatomic quadrants of the knee. Radiol Clin North Am 2007; 45 (6) 983-1002 , vi
- 23 Hayes CW, Brigido MK, Jamadar DA, Propeck T. Mechanism-based pattern approach to classification of complex injuries of the knee depicted at MR imaging. Radiographics 2000; 20 (Spec No) S121-S134
- 24 Haims AH, Medvecky MJ, Pavlovich Jr R, Katz LD. MR imaging of the anatomy of and injuries to the lateral and posterolateral aspects of the knee. AJR Am J Roentgenol 2003; 180 (3) 647-653
- 25 Theodorou DJ, Theodorou SJ, Fithian DC, Paxton L, Garelick DH, Resnick D. Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation. Acta Radiol 2005; 46: 297-305
- 26 Munshi M, Pretterklieber ML, Kwak S, Antonio GE, Trudell DJ, Resnick D. MR imaging, MR arthrography, and specimen correlation of the posterolateral corner of the knee: an anatomic study. AJR Am J Roentgenol 2003; 180 (4) 1095-1101
- 27 Yu JS, Salonen DC, Hodler J, Haghighi P, Trudell D, Resnick D. Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique. Radiology 1996; 198 (1) 199-204
- 28 LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 2003; 31 (6) 854-860
- 29 Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A. The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy 2005; 21 (7) 826-833
- 30 Rosas HG. Unraveling the posterolateral corner of the knee. Radiographics 2016; 36 (6) 1776-1791
- 31 Kweon C, Lederman ES, Chhabra A. Anatomy and biomechanics of the cruciate ligaments and their surgical implications. In: Fanelli GC, , ed. The Multiple Ligament Injured Knee: A Practical Guide to Management. New York, NY: Springer Science and Business Media; 2013: 17-27
- 32 LaPrade CM, Civitarese DM, Rasmussen MT, LaPrade RF. Emerging updates on the posterior cruciate ligament: a review of the current literature. Am J Sports Med 2015; 43 (12) 3077-3092
- 33 Levy BA, Dajani KA, Whelan DB , et al. Decision making in the multiligament-injured
knee: an evidence-based systematic review. Arthroscopy 2009; 25 (4) 430-438
MissingFormLabel
- 34 Bencardino JT, Rosenberg ZS, Brown RR, Hassankhani A, Lustrin ES, Beltran J. Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging. Radiographics 2000; 20 (Spec No): S103-S120
- 35 LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD. A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 2007; 23 (12) 1341-1347
- 36 Fornalski S, McGarry MH, Csintalan RP, Fithian DC, Lee TQ. Biomechanical and anatomical assessment after knee hyperextension injury. Am J Sports Med 2008; 36 (1) 80-84
- 37 Tibor LM, Marchant Jr MH, Taylor DC, Hardaker Jr WT, Garrett Jr WE, Sekiya JK. Management of medial-sided knee injuries, part 2: posteromedial corner. Am J Sports Med 2011; 39 (6) 1332-1340
- 38 Marchant Jr MH, Tibor LM, Sekiya JK, Hardaker Jr WT, Garrett Jr WE, Taylor DC. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med 2011; 39 (5) 1102-1113
- 39 Huang GS, Yu JS, Munshi M , et al. Avulsion fracture of the head of the fibula (the “arcuate” sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol 2003; 180 (2) 381-387
- 40 Geeslin AG, LaPrade RF. Location of bone bruises and other osseous injuries associated with acute grade III isolated and combined posterolateral knee injuries. Am J Sports Med 2010; 38 (12) 2502-2508
- 41 Sanders TG, Medynski MA, Feller JF, Lawhorn KW. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics 2000; 20 (Spec No): S135-S151
- 42 Juhng SK, Lee JK, Choi SS, Yoon KH, Roh BS, Won JJ. MR evaluation of the “arcuate” sign of posterolateral knee instability. AJR Am J Roentgenol 2002; 178 (3) 583-588
- 43 Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64 (4) 536-541
- 44 Sferopoulos NK, Rafailidis D, Traios S, Christoforides J. Avulsion fractures of the lateral tibial condyle in children. Injury 2006; 37 (1) 57-60
- 45 LaPrade RF, Wijdicks CA. The management of injuries to the medial side of the knee. J Orthop Sports Phys Ther 2012; 42 (3) 221-233
- 46 Griffith CJ, LaPrade RF, Johansen S, Armitage B, Wijdicks C, Engebretsen L. Medial knee injury: Part 1, static function of the individual components of the main medial knee structures. Am J Sports Med 2009; 37 (9) 1762-1770
- 47 Wijdicks CA, Griffith CJ, LaPrade RF , et al. Medial knee injury: Part 2, load sharing between the posterior oblique ligament and superficial medial collateral ligament. Am J Sports Med 2009; 37 (9) 1771-1776
- 48 Wijdicks CA, Ewart DT, Nuckley DJ, Johansen S, Engebretsen L, LaPrade RF. Structural properties of the primary medial knee ligaments. Am J Sports Med 2010; 38 (8) 1638-1646
- 49 Wijdicks CA, Michalski MP, Rasmussen MT , et al. Superficial medial collateral ligament anatomic augmented repair versus anatomic reconstruction: an in vitro biomechanical analysis. Am J Sports Med 2013; 41 (12) 2858-2866
- 50 Bonasia DE, Bruzzone M, Dettoni F , et al. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. Iowa Orthop J 2012; 32: 173-183
- 51 DeLong JM, Waterman BR. Surgical repair of medial collateral ligament and posteromedial corner injuries of the knee: a systematic review. Arthroscopy 2015; 31 (11) 2249-55.e5
- 52 House CV, Connell DA, Saifuddin A. Posteromedial corner injuries of the knee. Clin Radiol 2007; 62 (6) 539-546
- 53 Lundquist RB, Matcuk Jr GR, Schein AJ , et al. Posteromedial corner of the knee: the neglected corner. Radiographics 2015; 35 (4) 1123-1137
- 54 Robinson JR, Sanchez-Ballester J, Bull AM, Thomas RdeW, Amis AA. The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 2004; 86 (5) 674-681
- 55 Benninger B, Delamarter T. The “oblique popliteal ligament”: a macro- and microanalysis to determine if it is a ligament or a tendon. Anat Res Int 2012; 2012: 151342
- 56 LaPrade RF, Morgan PM, Wentorf FA, Johansen S, Engebretsen L. The anatomy of the posterior aspect of the knee. An anatomic study. J Bone Joint Surg Am 2007; 89 (4) 758-764
- 57 Beltran J, Matityahu A, Hwang K , et al. The distal semimembranosus complex: normal MR anatomy, variants, biomechanics and pathology. Skeletal Radiol 2003; 32 (8) 435-445
- 58 De Maeseneer M, Shahabpour M, Lenchik L , et al. Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation. Skeletal Radiol 2014; 43 (6) 781-791
- 59 Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 2004; 32 (2) 337-345
- 60 Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 1982; 64 (6) 883-888
- 61 Petersen W, Loerch S, Schanz S, Raschke M, Zantop T. The role of the posterior oblique ligament in controlling posterior tibial translation in the posterior cruciate ligament-deficient knee. Am J Sports Med 2008; 36 (3) 495-501
- 62 Kim SJ, Lee DH, Kim TE, Choi NH. Concomitant reconstruction of the medial collateral and posterior oblique ligaments for medial instability of the knee. J Bone Joint Surg Br 2008; 90 (10) 1323-1327
- 63 Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol 1997; 26 (9) 553-555
- 64 De Maeseneer M, Shahabpour M, Pouders C. MRI spectrum of medial collateral ligament injuries and pitfalls in diagnosis. JBR-BTR 2010; 93 (2) 97-103
- 65 Porrino Jr J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS. The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol 2015; 204 (2) 367-373
- 66 Van Dyck P, De Smet E, Lambrecht V , et al. The anterolateral ligament of the knee: what the radiologist needs to know. Semin Musculoskelet Radiol 2016; 20 (1) 26-32
- 67 Hartigan DE, Carroll KW, Kosarek FJ, Piasecki DP, Fleischli JF, D'Alessandro DF. Visibility of anterolateral ligament tears in anterior cruciate ligament-deficient knees with standard 1.5-tesla magnetic resonance imaging. Arthroscopy 2016; 32 (10) 2061-2065
- 68 Rasmussen MT, Nitri M, Williams BT , et al. An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 2016; 44 (3) 585-592
- 69 Nitri M, Rasmussen MT, Williams BT , et al. An in vitro robotic assessment of the anterolateral ligament, part 2: anterolateral ligament reconstruction combined with anterior cruciate ligament reconstruction. Am J Sports Med 2016; 44 (3) 593-601
- 70 Daggett M, Ockuly AC, Cullen M , et al. Femoral origin of the anterolateral ligament: an anatomic analysis. Arthroscopy 2016; 32 (5) 835-841
- 71 Kennedy MI, Claes S, Fuso FA , et al. The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med 2015; 43 (7) 1606-1615
- 72 Kosy JD, Mandalia VI, Anaspure R. Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skeletal Radiol 2015; 44 (11) 1647-1653
- 73 Milch H. Cortical avulsion fracture of the lateral tibial condyle. J Bone Joint Surg Am 1936; 18: 159-164
- 74 Stijak L, Bumbaširević M, Radonjić V , et al. Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24 (7) 2083-2088
- 75 Zens M, Niemeyer P, Ruhhammer J , et al. Length changes of the anterolateral ligament during passive knee motion: a human cadaveric study. Am J Sports Med 2015; 43 (10) 2545-2552
- 76 Parsons EM, Gee AO, Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 2015; 43 (3) 669-674
- 77 Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma 2013; 27 (4) 226-231
- 78 Kohl S, Stock A, Ahmad SS , et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury 2015; 46 (4) 724-728
- 79 Schenck Jr RC, Richter DL, Wascher DC. Knee dislocations: lessons learned from 20-year follow-up. Orthop J Sports Med 2014; 2 (5) 2325967114534387
- 80 Ibrahim SA, Ghafar S, Salah M , et al. Surgical management of traumatic knee dislocation with posterolateral corner injury. Arthroscopy 2013; 29 (4) 733-741
- 81 King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical outcomes of medial versus lateral multiligament-injured, dislocated knees. Arthroscopy 2016; 32 (9) 1814-1819
- 82 McDonough Jr EB, Wojtys EM. Multiligamentous injuries of the knee and associated
vascular injuries. Am J Sports Med 2009; 37 (1) 156-159
MissingFormLabel
- 83 Kapur S, Wissman RD, Robertson M, Verma S, Kreeger MC, Oostveen RJ. Acute knee dislocation: review of an elusive entity. Curr Probl Diagn Radiol 2009; 38 (6) 237-250
- 84 Brautigan B, Johnson DL. The epidemiology of knee dislocations. Clin Sports Med 2000; 19 (3) 387-397
- 85 Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol 2008; 37 (7) 653-661
- 86 Gimber LH, Scalcione LR, Rowan A, Hardy JC, Melville DM, Taljanovic MS. Multiligamentous injuries and knee dislocations. Skeletal Radiol 2015; 44 (11) 1559-1572
- 87 Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59 (2) 236-239
- 88 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
- 89 Van Wulftten Palthe AF, Musters L, Sonnega RJ, van der Sluijs HA. Dislocation of proximal tibiofibular joint, do not miss it. BMJ Case Rep 2015; 2015: 1-3
- 90 Forster BB, Lee JS, Kelly S , et al. Proximal tibiofibular joint: an often-forgotten cause of lateral knee pain. AJR Am J Roentgenol 2007; 188 (4) W359–W366
- 91 Resnick D, Newell JD, Guerra Jr J, Danzig LA, Niwayama G, Goergen TG. Proximal tibiofibular joint: anatomic-pathologic-radiographic correlation. AJR Am J Roentgenol 1978; 131 (1) 133-138