Use of Diagnostic Imaging for Possible ACL & PCL Injury

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Anterior and Posterior Cruciate Ligament Injuries :

Anterior and Posterior Cruciate Ligament Injuries Elena Black Katelyn Hornby Paige Van Drew Abby Crone Chelsea McTigue Lauren Redig Josh Duran Casey Kurzejewski

Objectives:

Objectives Understand pathophysiology, S&S, risk factors and other characteristics associated with a possible ACL/PCL injury Understand the evaluation of a possible ACL/PCL injury using radiographic and MRI views Apply ABCs search pattern to the structure of a knee joint for possible ACL/PCL injury

Overview:

Overview ACL and PCL form an “X” Control flexion and extension Ligament Injury Classification: Complete or Incomplete Grading Scale: Grade I Grade II Grade III

ACL Injury:

ACL Injury Mechanism of Injury: External rotation of femur relative to a fixed tibia Internal rotation of tibia relative to the femur Hyperextension of knee

ACL Injury:

ACL Injury Incidence: 200,000 ACL injuries reported annually Non-Contact Injury = 70% Contact Injury = 30% Females > Males Risk Factors: High-Risk Sports Female Athlete Physical conditioning Muscular strength Neuromuscular control Alignment Previous injury

ACL Injury:

ACL Injury Clinical Presentation: Swelling Loss of full ROM Decreased strength and endurance of quadriceps and hamstring muscles Pain and/or tenderness along joint line Discomfort during ambulation Special Tests: (+) Lachman’s test (+) Pivot Shift test

PCL Injury:

PCL Injury Mechanism of Injury: High-velocity trauma MVA Low-velocity trauma Sports Twisting or hyperextension

PCL Injury:

PCL Injury Incidence: 3-23% of all knee injuries 40% of knee ligamentous injuries in a trauma setting Not as common as ACL injuries Risk Factors: High-Risk Sports MVA Previous Injury

PCL Injury:

PCL Injury Clinical Presentation: Pain with swelling Stiffness of knee joint Decreased ROM Difficulty with ambulation Feeling the knee is “unstable” Special Tests: (+) Posterior Drawer (+) Posterior Sag (+) Reverse Pivot Shift

MRI of Cruciate Injuries:

MRI of Cruciate Injuries Multiplanar views ACL is best evaluated with oblique sagittal T2-weighted MRI PCL is best evaluated with sagittal T2-weighted MRI Sensitivity and specificity of >95%

MRI of Intact Cruciate Ligaments:

MRI of Intact Cruciate Ligaments PCL

Diagnosis of ACL Dysfunction:

Diagnosis of ACL Dysfunction Complete Partial

Diagnosis of ACL Dysfunction:

Diagnosis of ACL Dysfunction

Diagnosis of PCL Dysfunction:

Diagnosis of PCL Dysfunction Complete Partial

Physical Therapy Management:

Physical Therapy Management Clinical tests for diagnosis: Lachman’s Pivot Shift Posterior Sag Imaging guides initial plan of care and prognosis Conservative care vs. Reconstruction

Ségond Fracture An indirect sign of an ACL tear:

Ségond Fracture An indirect sign of an ACL tear This is a AP view radiograph of a Segond fracture. A Segond fracture is a curvilinear or elliptic bone fragment projected parallel to the lateral aspect of the tibial plateau. This avulsion fracture results from internal rotation and varus stress of the knee and is represented in 75% of ACL cases. The ABCs search pattern is demonstrated in the notes section to assess the image. http://www.orthopaedicsone.com/display/Main/Segond+Fracture

Possible biomechanical and physical impairments based on radiographic findings:

Possible biomechanical and physical impairments based on radiographic findings Associated with ligamentous injury Impaired knee function and stability Increased anterior translation of tibia relative to femur Decreased restraint to tibial rotation and varus /valgus rotation Joint effusion may alter knee range of motion

MRI of ACL Tear ABCs Search Pattern :

MRI of ACL Tear ABCs Search Pattern

MRI of PCL Tear:

MRI of PCL Tear

References:

References American Academy of Orthopedic Surgeons (AAOS). ACL injury: Does it Require surgery? http://orthoinfo.aaos.org/topic.cfm?topic=a00297 . Remer EM, Fitzgerald SW, Friedman H, Hendrix RW, and Schafer MF. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics 1992 15 (5): 901-915. American Academy of Orthopedic Surgeons (AAOS). Posterior cruciate ligament injuries. http://orthoinfo.aaos.org/topic.cfm?topic=a00420 . Rigby JM, Porter KM. Posterior cruciate ligament injuries. Trauma 2010 12: 175-181. Colvin AC, Meislin RJ. Posterior cruciate ligament injuries in the athlete. Bulletin of the NYU hospital for joint diseases 2009 67 (1) 45-51.

References:

References Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, and Schafer MF. Anterior Cruciate Ligament Injury: MR Imaging Diagnosis and Patterns of Injury. RadioGraphics . 1992; 12: 901-915 . Kam CK, Chee DWY, and Peh WCG. Magnetic Resonance Imaging of Cruciate Ligaments Injuries of the Knee. CARJ. 2010; 61: 80-89 . Guenoun et al. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Diagnostic and Interventional Imaging . 2012; 93: 331-341 . McKinnis LN. Fundamentals of Muscoloskeletal Imaging. 3 rd Ed. F.A Davis Company. Philadelphia, PA: 2010.

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