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Knee MRI

Categories
  • Knee
  • Knee Radiology
  • Medical
Tags
  • Knee
  • Knee Radiology
  • MRI
  • Radiology
mri

Knee MRI

Knee Anatomy: Muscles around the Knee

Anterior surface anatomy

Anterior surface anatomy

Knee Muscle Anterior

Anterior thigh muscles

Posterior surface anatomy

Posterior surface anatomy

Knee Muscle Posterior

Posterior thigh muscles

Muscle and Tendon Attachments around the Knee

Knee muscle
Tendon attachments
Muscle and Tendon Attachments around the Knee
Muscle and Tendon Attachments around the Knee

Meniscus

Meniscus Structure

Introduction

  • The knee is one of the commonest joint imaged
  • MRI is useful for soft tissues and bone assessment
  • Technique
  • Review areas
  • Common pathology

Technique

  • Dedicated knee coil
  • Don’t angle for ACL
  • Routine protocol and then assess
  • Sagittal PD (TE<30) and fat sat PD (TE36) FOV14, slice 3mm
    • ACL, PCL, menisci, cartilage Coronal T1 and fast STIR (or fat sat PD)
  • Coronal T1 and Fast STIR (or fat sat PD) FOV14
    • LCLC, MCL, menisci, cartilage
  • Axial STIR FOV14
    • Confirm, support especially ACL, MCL and posterolateral corner pathology
    • Patellofemoral joint
  • Review areas
  • Common pathology

Review areas

Review areas
Review areas
  • Menisci
  • Bone
  • Cartilage: each compartment
  • Ligaments: ACL, PCL, Collateral ligaments, capsule
  • Extensor mechanism
Miscellaneous:
  • Loose bodies
  • Synovium/plicas
  • Masses and cysts

Menisci

Menisci
Menisci
  • Bow ties: at least two
  • Morphology
    • Blunted apex – Surgery
    • Discoid
    • Bucket handle tear
    • Flipped meniscus
    • Cyst
Meniscus Vascular Anatomy
Meniscus Vascular Anatomy
Menisci
  • Signal change – Meniscus windows
    • Grade 1-3
    • 2=enclosed tear
    • 3=tear
    • Sag > Cor to pick up tears
  • Pitfalls
    • Transverse meniscus ligament
    • Popliteal tendon
    • Ligament of Humphrey

Transverse meniscus ligament

Transverse meniscus ligament
Ligament of Humphrey
Popliteus tendon pitfall

Meniscus Tears

Meniscus tests
Horizontal cleavage tear medial meniscus
Horizontal cleavage tear medial meniscus
Horizontal cleavage tear medial meniscus
Vertical peripheral tear of MM
Peripheral tear MM with ACL tear
Medial meniscocapsular separation with ACL tear
Unstable longitudinal tear of medial meniscus
Bucket handle tear of medial meniscus
Bucket handle tear of medial meniscuss
Bucket handle tear of medial meniscuss
Peripheral longitudinal tear of LM
Radial and horizontal cleavage tear of LM
Radial tear of lateral meniscus
Peripheral tear of LM involving capsular struts
Flipped meniscus sign of LM
Discoid lateral meniscus with tear
Instrameniscal cystic degeneration
Lateral meniscal cyst
Medial meniscal tear and cyst
Medial meniscal tear and cyst
Medial meniscal cyst
Unusual leaking meniscal cyst
Post partial meniscectomy
Post partial meniscectomy
Post partial meniscectomy - subchondral fracture
Post partial meniscectomy - subchondral fracture

Recurrent Tear

Recurrent Tear
  • Type 3 change
  • Abnormal morphology
  • Fluid signal intensity on all sequences

Osteochondral abnormalities

Bone

  • Bone bruise
  • Subchondral infraction
  • OCD
  • SONK
  • Subchondral cysts

Cartilage

  • Femorotibial compartments
  • Look for subchondral bone changes
  • Look for subchondral bone changes
Occult fibular fracture
Medial tibial plateau fracture
Tibial stress fracture

Osteochondral injuries

  • Spectrum of injuries
    • Bone bruise
    • Osteochondral fracture
    • Osteochondritis dissecans
  • Stable, unstable in-situ, loose
  • Instability
    • High SI beneath fragment
    • Subchondral cyst
    • Cartilage fracture
    • Displaced fragment
Osteochondral injuries
Early osteochondritis dissencans
Early osteochondritis dissencans
OCD - Stable fragment
OCD with discoid lateral meniscus
Osteochondritis dissecans-loose in situ fragment
OCD-Loose in fragment inverted
Post OCD Repair
Post traumatic cartilage injury
Chondral defect - Lat femoral condyle
Loose chondral fragment
Mosacoplasty - Osteochondral grafting
Donor site
Spontaneous osteonecrosis of knee
Tibial insufficiency fracture

Ligament injuries

      • Sprain: clinical grading
      • Partial vs full-thickness tears
      • Tell tale bone contusions to reflect the mechanism of injury
      • Healing/repair can be followed
      • Ganglion formation
      • Some joints: see ligaments better with intra-articular contrast (wrist, elbow, shoulder)
Normal ACL and PCL

ACL mechanism of injury

ACL mechanism of injury

Football/skiing

  • External rotation/abduction/hyperextension
  • Direct anterior tibia displacement
  • Internal rotation, tibia hyperextension (isolated)
  • Valgus or varus stresses
  • Valgus in extension rotation (MC)
  • Deceleration pivot and internal rotation femur

ACL Tear primary signs

Complete

  • Proximal segment
  • ⇧ SI
  • Angled/wavy fragments
  • Cloud, oedema/blood
  • Complete absence

Accuracy

  • > 90%

ACL secondary signs of tear

  • Bone contusions
    • Post lat tibia and lat fem condyle
    • Post med tibia
  • Segond fracture
  • Anterior drawer
  • Uncovered meniscus
  • Buckled PCL
  • Absent ACL, coronal
  • Fluid in the notch on axial
  • Meniscus tear (70%) especially LM
  • Ligament (MCL 30 %) or capsule tears (post-lat)
ACL rupture
ACL avulsion
Anterior translation of the tibia

ACL tear bone contusion

Bone Bruise

  • Microfracture with haemorrhage in the subchondral bone
  • Second “pop” felt at time of injury
    Persists for 6-12 weeks
  • Pain proportional to size of bone bruise
  • Geographic better prognosis than focal
  • Major prognostic indicator- treat as fracture and don’t weight bear
  • Career ending injury- osteoarthritis (die is cast)
ACL tear bone contusion
ACL tear - Focal bone impaction
ACL tear - Focal bone impaction
Old impaction injury - Cartilage loss
Partial ACL tear
Segond fracture

ACL graft

  • Patellar tendon
  • More recently hamstring
  • Notch width and osteophytes
  • Arthrofibrosis/cyclops lesion
  • Graft impingement
  • Re-rupture
ACL graft

Cyclops lesion

  • Arthrofibrosis post ACL reconstruction
  • May limit extension and cause locking
  • Easily surgically removed
Cyclops lesion
ACL graft impingement
ACL graft re-tear

PCL tear

  • PCL discontinuity
  • Focal or diffuse SI, size
  • Anterolateral fem/tib contusions
  • Tibial avulsion fx
  • MRI > 90% accurate
  • Associated MCL, ACL tears common

PCL mechanism of injury

PCL mechanism of injury
  • Major stresses: athletic, MVA
  • Knee: hyperextension, hyperflexion
  • Post tibial displacement, knee flexed (dashboard injury)
ACL ganglion

MCL mechanism of injury

MCL
MCL
  • Valgus stress to flexed knee
  • Clinical grading system: MRI findings
  • Partial, complete MCL tears
    • Peripheral medial meniscus tear
    • Meniscocapsular separation
MCL mechanism of injury
Complete MCL tear and bone contusion

LCL complex

LCL ligament
LCL ligament
Popliteus
Popliteus
  • Valgus stress to flexed knee
  • Clinical grading system: MRI findings
  • Partial, complete MCL tears
    • Peripheral medial meniscus tear
    • Meniscocapsular separation
LCL complex
Posterior lateral corner injury
Posterior capsular tear
Iliotibial bad friction syndrome

Extensor Mechanism

  • Patellar tendon
    • Sag and ax-uniform thickness and black
    • Tendinosis often asymptomatic
  • Hoffa’s fat
    • Fat pad impingement
    • Old surgery fibrosis
  • Patellar cartilage
    • Chondromalacia
    • softening, fissuring and defects
Muscle and tendon attachments
Intact extensor mechanism allow knee range of motion
MCL mechanism of injury

Tendinopathy

  • Tenosynovitis peritendinitis
  • Tendinosis
  • Partial thickness tear
  • Full thickness tear
  • Complete tear ± retraction

 

Patellar tendinosis
Patellar tendinosis with partial thickness tear
Sinding Larsen-Johansson changes
Knee Injury
Patellar tendon rupture (with ACL tear)
Hoffa's fat pad impingement
Hoffa's fat pad impingement
Post operative Hoffa's fat pad scarring
Medial suprapatellar plica
Normal cartilage
Front View Knee
Chondromalacia patellae
Chondromalacia patellae
Follow-up cartilage lesion

Patellar dislocation

  • Common cause of haemarthrosis
  • Present after relocation
  • Associated with osteochondral fractures
  • Bone contusion present: lateral femoral condyle & medial patellar
  • Partial/complete tears of the medial retinaculum
Patellar dislocation
Patellar dislocation
Patellar dislocation-bone bruises
Patellar dislocation-osteochondral injury
Quadricepts tendon rupture

Miscellaneous

  • Loose bodies
    • Axials & sag
    • Suprapatella pouch, ant recess and popliteal cyst
  • Tendinosis
    • PVNS, erosions
  • Masses and cysts
    • Popliteal cyst
    • Bursitis
    • Ganglion
Popliteal cyst
PVNS - Anterior impingement
PVNS - Diffuse joint involvement
Pes anserinus bursitis

Contributor:

Dr Richard de Villiers

Learn More

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