Knee MR Images: What the Orthopaedic Surgeon Needs to Know

ABSTRACT

Ideally, the orthopaedic surgeon works together with the radiologist in order to understand and contextualize the data obtained from a knee magnetic resonance imaging study. In this article we review the information most useful to the practice of orthopaedic surgery obtained from these MRI scans, including sections on ligaments, menisci, articular cartilage, limb alignment, bone, and surrounding soft tissues. We place special emphasis on evaluating the postoperative knee, ligament grafts, cartilage integrity, and other conditions that present challenges to both orthopaedic surgeons and radiologists.

KEYWORDS

Magnetic resonance imaging - knee pathology - meniscal tear - anterior cruciate ligament graft - postoperative imaging

REFERENCES

• 1 Glynn N, Morrison W B, Parker L, Schweitzer M E, Carrino J A. Trends in utilization: has extremity MR imaging replaced diagnostic arthroscopy?.  Skeletal Radiol. 2004;  33 272-276
• 2 Recht M P, Pardker R D, Irirzarry J M. Second time around: evaluating the postoperative anterior cruciate ligament.  Magn Reson Imaging Clin N Am. 2000;  8 285-297
• 3 Eriksson E. Single-bundle, double-bundle or triple-bundle?.  Knee Surg Sports Traumatol Arthosc. 2006;  14 503-504
• 4 Furman W, Marshall J L, Girgis F G. The anterior cruciate ligament: a functional analysis based on postmortem studies.  J Bone Joint Surg Am. 1976;  58 179-185
• 5 Ochi M, Adachi N, Deie M, Kanaya A. Anterior cruciate ligament augmentation procedure with a 1-incision technique: anteromedial bundle or posterolateral bundle reconstruction.  Arthroscopy. 2006;  22 463
• 6 Ahn J H, Yoo J C, Yang H S, Kim J H, Wang J H. Second-look arthroscopic findings of 208 patients after ACL reconstruction.  Knee Surg Sports Traumatol Arthrosc. 2007;  15 242-248
• 7 Scarvell J M, Smith P N, Refshauge K M, Galloway H R, Woods K R. Association between abnormal kinematics and degenerative change in knees of people with chronic anterior cruciate ligament deficiency: a magnetic resonance imaging study.  Aust J Physiother. 2005;  51 233-240
• 8 Larkin J J, Barber-Westin S D. The effect of injury chronicity and progressive rehabilitation on single-incision arthroscopic anterior cruciate ligament reconstruction.  Arthroscopy. 1998;  14 15-22
• 9 Fowler P J, Messieh S S. Isolated posterior cruciate ligament injuries in athletes.  Am J Sports Med. 1987;  15 553-557
• 10 Robinson J R, Bull A MJ, Thomas R R, Amis A A. The role of the medial collateral ligament and posteromedial capsule in controlling knee laxity.  Am J Sports Med. 2006;  34 1815-1823
• 11 Bennett D L, George M J, El-Khoury G Y, Stanley M D, Sundaram M. Anterior rim tibial plateau fractures and posterolateral corner knee injury.  Emerg Radiol. 2003;  10 76-83
• 12 Harish S, O'Donnell P, Connell D, Saifuddin A. Imaging of the posterolateral corner of the knee.  Clin Radiol. 2006;  61 457-466
• 13 Murphy K P, Helgeson M D, Lehman Jr R A. Surgical treatment of acute lateral collateral ligament and posterolateral corner injuries.  Sports Med Arthrosc. 2006;  14 23-27
• 14 Stannard J P, Brown S L, Farris R C, McGwin G, Volgas D A. The posterolateral corner of the knee: repair vs reconstruction.  Am J Sports Med. 2005;  33 881-888
• 15 Strum G M, Friedman M J, Fox J M et al.. Acute anterior cruciate ligament reconstruction: analysis of complications.  Clin Orthop Relat Res. 1990;  253 184-189
• 16 Harner C D, Irrgang J J, Paul J, Dearwater S, Fu F H. Loss of motion after anterior cruciate ligament reconstruction.  Am J Sports Med. 1992;  20 499-506
• 17 Jaureguito J W, Paulos L E. Why grafts fail.  Clin Orthop Relat Res. 1996;  (325) 25-41
• 18 Howell S M, Barad S J. Knee extension and its relationship to the slope of the intercondylar roof: implications for positioning the tibial tunnel in anterior cruciate ligament reconstructions.  Am J Sports Med. 1995;  23 288-294
• 19 Gersoff W K, Clancy Jr W G. Diagnosis of acute and chronic anterior cruciate ligament tears.  Clin Sports Med. 1988;  7 727-738
• 20 Metcalf R W, Burks R T, Metcalf M S, McGinty J B. Arthroscopic meniscectomy. In: McGinty JB, Caspari RB, Jackson RW, Poehling GG Operative Arthroscopy. 2nd ed. Philadelphia; Lippincott-Raven 1996: 263-297
• 21 De Smet A A, Graft B K. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears.  AJR Am J Roentgenol. 1994;  162 905-911
• 22 Shelbourne K D, Patel D V, Adsit W S, Porter D A. Rehabilitation after meniscal repair.  Clin Sports Med. 1996;  15 595-612
• 23 Kobayashi Y, Kimura M, Higuchi H, Terauchi M, Shirakura K, Takagishi K. Juxta-articular bone marrow signal changes on magnetic resonance imaging following arthroscopic meniscectomy.  Arthroscopy. 2002;  18 238-245
• 24 Bronstein R, Kirk P, Hurley J. The usefulness of MRI in evaluating menisci after meniscus repair.  Orthopedics. 1992;  15 149-152
• 25 Muellner T, Egkher A, Nikolic A, Funovics M, Metz V. Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years.  Am J Sports Med. 1999;  27 16-20
• 26 Lim P S, Schweitzer M E, Bhatia M et al.. Repeat tear of postoperative meniscus: potential MR imaging signs.  Radiology. 1999;  210 183-188
• 27 Toms A P, White L M, Marshall T J, Donell S. Imaging the post-operative meniscus.  Eur J Radiol. 2005;  54 189-198
• 28 White L M, Schweitzer M E, Weishaupt D, Kramer J, Davis A, Marks P H. Diagnosis of recurrent meniscal tears: prospective evaluation for conventional MR imaging, indirect MR arthrography, and direct MR arthrography.  Radiology. 2002;  222 421-429
• 29 Elias D A, White L M, Fithian D C. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella.  Radiology. 2002;  225 736-743
• 30 Elias D A, White L M. Imaging of patellofemoral disorders.  Clin Radiol. 2004;  59 543-557
• 31 Sonin A H, Pensy R A, Mulligan M E, Hatem S. Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression.  AJR Am J Roentgenol. 2002;  179 1159-1166
• 32 Kuikka P I, Kiuru M J, Niva M H, Kroger H, Pihlajamaki H K. Sensitivity of routine 1.0-Tesla magnetic resonance imaging versus arthroscopy as gold standard in fresh traumatic chondral lesions of the knees in young adults.  Arthroscopy. 2006;  22 1033-1039
• 33 Browne J E, Branch T P. Surgical alternatives for treatment of articular cartilage lesions.  J Am Acad Orthop Surg. 2000;  8 180-189
• 34 Maletius W, Messner K. The effect of partial meniscectomy on the long-term prognosis of knees with localized severe chondral damage: a twelve- to fifteen-year follow-up.  Am J Sports Med. 1996;  24 258-262
• 35 Hangody L, Kish G, Karpati Z, Udvarhelyi I, Szigeti I, Bely M. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice.  Orthopedics. 1998;  21 751-756
• 36 Minas T. Autologous chondrocyte implantation for focal chondral defects of the knee.  Clin Orthop Relat Res. 2001;  (391 suppl) S349-S361
• 37 Recht M P, Goodwin D W, Winalski C S, White L M. MRI of articular cartilage: revisiting current status and future directions.  AJR Am J Roentgenol. 1994;  163 283-290
• 38 Trattnig S, Millington S A, Szomolanyi P, Marlovitx S. MR imaging of osteochondral grafts and autologous chondrocyte implantation.  Eur Radiol. 2007;  17 103-118
• 39 Polster J, Recht M. Postoperative MR evaluation of chondral repair in the knee.  Eur J Radiol. 2005;  54 206-213
• 40 Sanders T G, Medynski M A, Feller J F, Lawhorn K W. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury.  Radiographics. 2000;  20 S135-S151
• 40a Ahlback S, Bauer G C, Bohne W H. Spontaneous osteonecrosis of the knee.  Arthritis Rheum. 1968;  11 705-733
• 41 Gil H C, Levine S M, Zoga A C. MRI findings in the subchondral bone marrow: a discussion of conditions including transient osteoporosis, transient bone marrow edema syndrome, SONK, and shifting bone marrow edema of the knee.  Semin Musculoskelet Radiol. 2006;  10 177-186
• 42 Yamamoto T, Bullough P G. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture.  J Bone Joint Surg Am. 2000;  82 858-866
• 43 Cahill B R. Osteochondritis dissecans of the knee: treatment of juvenile and adult forms.  J Am Acad Orthop Surg. 1995;  3 237-247
• 44 Jurgensen I, Bachmann G, Schleicher I, Haas H. Arthroscopic versus conservative treatment of osteochondritis dissecans of the knee: value of magnetic resonance imaging in therapy, planning and follow-up.  Arthroscopy. 2002;  18 378-386
• 45 O'Connor M A, Palaniappan M, Kahn N, Bruce C E. Osteochondritis desiccans of the knee in children a comparison of MRI and arthroscopic findings.  J Bone Joint Surg Br. 2002;  84 258-261
• 46 Pill S G, Ganley T J, Milam R A et al.. Role of magnetic resonance imaging and clinical criteria in predicting successful nonoperative treatment of osteochondritis dissecans in children.  J Pediatr Orthop. 2003;  23 102-108
• 47 Bredella M A, Tirman P F, Wischer T K, Belzer J, Taylor A, Genant H K. Reactive synovitis of the knee joint: MR imaging appearance with arthroscopic correlation.  Skeletal Radiol. 2000;  29 577-582
• 48 Conaghan P G, Felson D, Gold G, Lohmander S, Totterman S, Altman R. MRI and non-cartilaginous structures in knee osteoarthritis.  Osteoarthritis Cartilage. 2006;  14(suppl A) A87-A94
• 49 Garcia-Valtuille R, Abascal F, Cerezal L et al.. Anatomy and MR imaging of synovial plicae of the knee.  Radiographics. 2002;  22 775-784