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Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?

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Abstract

Purpose

To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee.

Materials and methods

MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears. MR images were interpreted by two blinded reviewers and scored with respect to previously reported primary and secondary MR signs of ACL injury. Based on a comprehensive assessment of all the MR findings, ACLs were categorized as being stable or unstable. MR accuracy was calculated considering only primary MR signs and considering both primary and secondary MR signs of ACL injury, separately. Accuracy of each individual primary and secondary MR sign was calculated.

Results

Considering only primary MR signs, sensitivity, specificity, and accuracy of MR were 77, 92, and 82%, respectively. Considering both primary and secondary MR signs, sensitivity, specificity, and accuracy of MR were 59, 81, and 67%, respectively. Of all MR signs, discontinuity and abnormal orientation had highest test accuracy (79 and 87%, respectively). Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL were only seen in unstable ACLs (specificity 100%), but these secondary findings had low sensitivity (23%). Bone contusion around the lateral knee compartment was seen in both unstable and stable ACLs (accuracy 64%).

Conclusion

Previously reported MR imaging signs do not allow accurate distinction between clinically stable and unstable ACL injuries. Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL, if present, are helpful signs in the diagnosis of an unstable tear. The presence of bone marrow edema around the lateral knee compartment is not predictive of ACL insufficiency.

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References

  1. Lee JK, Yao L, Phelps CT, Wirth CR, Czajka J, Lozman J. Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology. 1988;166:861–4.

    PubMed  CAS  Google Scholar 

  2. Mink JH, Levy T, Crues JV III. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology. 1988;167:769–74.

    PubMed  CAS  Google Scholar 

  3. Umans H, Wimpfheimer O, Haramati N, Applbaum YH, Adler M, Bosco J. Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. AJR Am J Roentgenol. 1995;165:893–7.

    PubMed  CAS  Google Scholar 

  4. Yao L, Gentili A, Petrus L, Lee JK. Partial ACL rupture: an MR diagnosis? Skeletal Radiol. 1995;24:247–51.

    Article  PubMed  CAS  Google Scholar 

  5. Lawrance JA, Ostlere SJ, Dodd CA. MR diagnosis of partial tears of the anterior cruciate ligament. Injury. 1996;27:153–15.

    Article  PubMed  CAS  Google Scholar 

  6. Roychowdhury S, Fitzgerald SW, Sonin AH, Peduto AJ, Miller FH, Hoff FL. Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images. AJR Am J Roentgenol. 1997;168:1487–91.

    PubMed  CAS  Google Scholar 

  7. Colombet P, Dejour D, Panisset J-C, Siebold R, the French Arthroscopy Society. Current concept of partial anterior cruciate ligament ruptures. Orthop Traumatol Surg Res. 2010;96S:S109–18.

    Article  Google Scholar 

  8. DeFranco MJ, Bach BR Jr. A comprehensive review of partial anterior cruciate ligament tears. J Bone Joint Surg Am. 2009;91:198–208.

    Article  PubMed  Google Scholar 

  9. Noyes FR, Mooar LA, Moorman CT III, McGinniss GH. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Joint Surg Br. 1989;71:825–33.

    PubMed  CAS  Google Scholar 

  10. McNally EG. Knee: ligaments. In: Vanhoenacker FM, Maas M, Gielen JL, editors. Imaging of orthopedic sports injuries. Berlin, Heidelberg, New York: Springer; 2007. p. 284–92.

    Google Scholar 

  11. Chan WP, Peterfy C, Fritz RC, Genant HK. MR diagnosis of complete tears of the anterior cruciate ligament of the knee: importance of anterior subluxation of the tibia. AJR Am J Roentgenol. 1994;162:355–60.

    PubMed  CAS  Google Scholar 

  12. Tung GA, Davis LM, Wiggins ME, Fadale PD. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology. 1993;188:661–7.

    PubMed  CAS  Google Scholar 

  13. Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics. 1992;12:901–15.

    PubMed  CAS  Google Scholar 

  14. Brandser EA, Riley MA, Berbaum KS, El-Khoury GY, Bennett DL. MR imaging of anterior cruciate ligament injury: independent value of primary and secondary signs. AJR Am J Roentgenol. 1996;167:121–6.

    PubMed  CAS  Google Scholar 

  15. American Medical Association Subcommittee on Classification of Sports Injuries and Committee on the Medical Aspects of Sports. Standard nomenclature of athletic injuries. Chicago: American Medical Asociation; 1968. p. 99–100.

    Google Scholar 

  16. Petersen W, Zantop T. Partial rupture of the anterior cruciate ligament. Arthroscopy. 2006;11:1143–5.

    Google Scholar 

  17. Tsai KJ, Chiang H, Jiang CC. Magnetic resonance imaging of anterior cruciate ligament rupture. BMC Musculoskelet Disord. 2004;5:21.

    Article  PubMed  Google Scholar 

  18. Turner DA, Prodromos CC, Petasnick JP, Clark JW. Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology. 1985;154:717–22.

    PubMed  CAS  Google Scholar 

  19. Gallimore GW, Harms SE. Knee injuries: high-resolution MR imaging. Radiology. 1986;160:457–61.

    PubMed  Google Scholar 

  20. Reicher RA, Hartzman S, Bassett LW, Mandelbaum B, Duckwiler G, Gold RH. MR imaging of the knee. I. Traumatic disorders. Radiology. 1987;162:547–51.

    PubMed  CAS  Google Scholar 

  21. Leach WJ, King JB. Posterior reattachment of the torn anterior cruciate ligament. J Bone Joint Surg Br. 1994;76:159–60.

    PubMed  CAS  Google Scholar 

  22. Snearly WN, Kaplan PA, Dussault RG. Lateral-compartment bone contusions in adolescents with intact anterior cruciate ligaments. Radiology. 1996;198:205–8.

    PubMed  CAS  Google Scholar 

  23. Lintner DM, Kamaric E, Moseley JB, Noble PC. Partial tears of the anterior cruciate ligament. Are they clinically detectable? Am J Sports Med. 1995;23:111–8.

    Article  PubMed  CAS  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Pieter Van Dyck.

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Van Dyck, P., Gielen, J.L., Vanhoenacker, F.M. et al. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?. Skeletal Radiol 41, 273–280 (2012). https://doi.org/10.1007/s00256-011-1169-4

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  • DOI: https://doi.org/10.1007/s00256-011-1169-4

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