Skip to main content
SpringerLink
Log in

Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD).

Methods

High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury.

Results

Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR.

Conclusions

Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD.

Key Points

• High-frequency ultrasound and MR were able to detect MPFL lesions after acute lateral patellar dislocation.

• High-frequency ultrasound and MR showed similarly high accuracy in diagnosing MPFL lesions.

• Interobserver agreement was very good for high-frequency ultrasound and good for MR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Casteleyn PP, Handelberg F (1989) Arthroscopy in the diagnosis of occult dislocation of the patella. Acta Orthop Belg 55:381–383

    CAS  PubMed  Google Scholar 

  2. Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743

    Article  PubMed  Google Scholar 

  3. Vollnberg B, Koehlitz T, Jung T et al (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22:2347–2356

    Article  PubMed  Google Scholar 

  4. Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693

    CAS  PubMed  Google Scholar 

  5. Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65

    CAS  PubMed  Google Scholar 

  6. Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg (Br) 87:577–582

    Article  CAS  Google Scholar 

  7. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762

    Article  PubMed  Google Scholar 

  8. Fithian DC, Paxton EW, Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 17:47–56

    PubMed  Google Scholar 

  9. Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101

    Article  PubMed  Google Scholar 

  10. Sillanpää PJ, Mäenpää HM (2012) First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc 20:128–135

    Article  PubMed  Google Scholar 

  11. Köhlitz T, Scheffler S, Jung T et al (2013) Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol 23:1067–1074

    Article  PubMed  Google Scholar 

  12. Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60

    Article  CAS  PubMed  Google Scholar 

  13. Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr 25:957–962

    Article  CAS  PubMed  Google Scholar 

  14. Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143

    Article  CAS  PubMed  Google Scholar 

  15. Trikha SP, Acton D, O’Reilly M, Curtis MJ, Bell J (2003) Acute lateral dislocation of the patella: correlation of ultrasound scanning with operative findings. Injury 34:568–571

    Article  CAS  PubMed  Google Scholar 

  16. O’Reilly MA, O’Reilly PM, Bell J (2003) Sonographic appearances of medial retinacular complex injury in transient patellar dislocation. Clin Radiol 58:636–641

    Article  PubMed  Google Scholar 

  17. Felus J, Kowalczyk B, Lejman T (2008) Sonographic evaluation of the injuries after traumatic patellar dislocation in adolescents. J Pediatr Orthop 28:397–402

    Article  PubMed  Google Scholar 

  18. Felus J, Kowalczyk B (2012) Age-related differences in medial patellofemoral ligament injury patterns in traumatic patellar dislocation: case series of 50 surgically treated children and adolescents. Am J Sports Med 40:2357–2364

    Article  PubMed  Google Scholar 

  19. Zhang GY, Zheng L, Shi H, Qu SH, Ding HY (2013) Sonography on injury of the medial patellofemoral ligament after acute traumatic lateral patellar dislocation: Injury patterns and correlation analysis with injury of articular cartilage of the inferomedial patella. Injury 44:1892–1898

    Article  PubMed  Google Scholar 

  20. Phornphutkul C, Sekiya JK, Wojtys EM, Jacobson JA (2007) Sonographic imaging of the patellofemoral medial joint stabilizing structures: findings in human cadavers. Orthopedics 30:472–478

    PubMed  Google Scholar 

  21. De Maeseneer M, Marcelis S, Boulet C et al (2014) Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures. Skelet Radiol 43:1025–1039

    Article  Google Scholar 

  22. Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H (2008) Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 36:2301–2309

    Article  PubMed  Google Scholar 

  23. Reider B, Marshall JL, Koslin B, Ring B, Girgis FG (1981) The anterior aspect of the knee joint. J Bone Joint Surg Am 63:351–356

    CAS  PubMed  Google Scholar 

  24. Tuxøe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140

    Article  PubMed  Google Scholar 

  25. Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227

    Article  PubMed  Google Scholar 

  26. Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513

    Article  PubMed  Google Scholar 

  27. Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13:510–515

    Article  PubMed  Google Scholar 

  28. Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12

    Article  PubMed  Google Scholar 

  29. Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37:2355–2361

    Article  PubMed  Google Scholar 

  30. Ahmad CS, Stein BE, Matuz D, Henry JH (2000) Immediate surgical repair of the medial patella stabilizers for acute patellar dislocation: a review of eight cases. Am J Sports Med 28:804–810

    CAS  PubMed  Google Scholar 

  31. Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21:499–519

    Article  PubMed  Google Scholar 

  32. Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med 15:62–66

    Article  PubMed  Google Scholar 

  33. Fukushima K, Horaguchi T, Okano T, Yoshimatsu T, Saito A, Ryu J (2004) Patellar dislocation: arthroscopic patellar stabilization with anchor sutures. Arthroscopy 20:761–764

    Article  PubMed  Google Scholar 

  34. Haspl M, Cicak N, Klobucar H, Pecina M (2002) Fully arthroscopic stabilization of the patella. Arthroscopy 18:E2

    Article  PubMed  Google Scholar 

  35. Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg (Br) 87:36–40

    CAS  Google Scholar 

  36. Nomura E, Inoue M, Osada N (2005) Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:346–351

    Article  PubMed  Google Scholar 

  37. Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study. Am J Sports Med 37:1513–1521

    Article  PubMed  Google Scholar 

  38. Kang HJ, Wang F, Chen BC, Zhang YZ, Ma L (2013) Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns. Knee Surg Sports Traumatol Arthrosc 21:325–331

    Article  PubMed  Google Scholar 

  39. Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25:620–625

    Article  PubMed  Google Scholar 

  40. Sillanpää PJ, Mattila VM, Mäenpää H, Kiuru M, Visuri T, Pihlajamäki H (2009) Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study. J Bone Joint Surg Am 91:263–273

    Article  PubMed  Google Scholar 

  41. Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop 76:699–704

    Article  PubMed  Google Scholar 

  42. Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 90:463–470

    Article  PubMed  Google Scholar 

  43. Christiansen SE, Jakobsen BW, Lund B, Lind M (2008) Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy 24:881–887

    Article  PubMed  Google Scholar 

  44. Balcarek P, Walde TA, Frosch S, Schüttrumpf JP, Wachowski MM, Stürmer KM (2012) MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first-time patellar dislocations. Knee Surg Sports Traumatol Arthrosc 20:1575–1580

    Article  PubMed Central  PubMed  Google Scholar 

  45. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31

    CAS  PubMed  Google Scholar 

  46. Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23:260–263

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  47. Aragão JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadaver. Clinics 63:541–544

    Article  PubMed Central  PubMed  Google Scholar 

  48. Jung JY, Kim GU, Lee HJ, Jang EC, Song IS, Ha YC (2013) Diagnostic value of ultrasound and computed tomographic arthrography in diagnosing anterosuperior acetabular labral tears. Arthroscopy 29:1769–1776

    Article  PubMed  Google Scholar 

  49. Jeong WK, Ah Ryu J, Choi SH et al (2013) Shoulder sonography after intraarticular fluid injection for evaluation of anterior labral tears: comparison with conventional sonography. J Clin Ultrasound 41:94–100

    Article  PubMed  Google Scholar 

  50. Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW (2013) Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med 61:9–17

    Article  PubMed  Google Scholar 

  51. Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW (2013) Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics 131:e1757–e1764

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Hao Shi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution. Guang-Ying Zhang and Lei Zheng each contributed equally to this study.

Author information

Authors and Affiliations

  1. Department of Ultrasonography, Qianfoshan Hospital, Shandong University, Jinan, 250014, China

    Guang-Ying Zhang & Hong-Yu Ding

  2. Department of Radiology, Shandong Provincial Corps Hospital, Chinese People’s Armed Police Force, Jinan, China, 250014

    Lei Zheng & Bai-Sheng Sun

  3. Department of Ultrasonography, Jinan Third People’s Hospital, Jinan, China, 250132

    En-Miao Li

  4. Department of Radiology, Qianfoshan Hospital, Shandong University, 16766 Jingshi Road, Lixia District, Jinan, China, 250014

    Hao Shi

Authors
  1. Guang-Ying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lei Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong-Yu Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. En-Miao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bai-Sheng Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hao Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hao Shi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, GY., Zheng, L., Ding, HY. et al. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR. Eur Radiol 25, 274–281 (2015). https://doi.org/10.1007/s00330-014-3407-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3407-3

Keywords

Search

Navigation