Ces radiol. 2015, 69(1):67-74 | DOI: 10.55095/CesRadiol2015/010

The contribution of MRI to the diagnosis of the direct and indirect signs of a lesion of the anterior cruciate ligament of the knee jointReview article

Boris Pauček^1,2, David Smékal², Radomír Holibka³, Jana Zapletalová⁴

¹ Pracoviště magnetické rezonance Medihope VN, Olomouc

² Katedra fyzioterapie FTK UP, Olomouc

³ Ortopedická klinika LF UP a FN, Olomouc

⁴ Ústav lékařské biofyziky LF UP, Olomouc

Aim: To characterize the direct and indirect signs of damage to the anterior cruciate ligament in the knee joint during magnetic resonance imaging examination. To determine the scope and context of damage to the knee joint structures in relation to a lesion of the anterior cruciate ligament.

Method: We retrospectively evaluated a group of 199 patients, including 139 men (69.8%) and 60 women (30.2%) with lesions of the anterior cruciate ligament (ACL). We evaluated the following changes: the increase in the synovial fluid, bone edema of the lateral femoral condyle, medial femoral condyle, medial tibial condyle and lateral tibial condyle, the lesions of the medial meniscus and of the lateral meniscus, distension of the lateral collateral ligament and of the medial collateral ligament, Hoffa's fat pad syndrome, filling of the Baker pseudocysts, a lesion of the cruciate posterior ligament, the orientation and size of the Blumensaat's angle, empty femoral fossa symptoms and partial or complete rupture of the ACL. The patients were evaluated by means of HDxT Signa 1.5T magnetic resonance (GE Healthcare, Milwaukee, USA) using the HD 1.5T knee coil. The data were analyzed using the SPSS statistical software, version 15 (SPSS Inc., Chicago, USA).

Results: In the evaluation of ACL lesions of the first stage, we diagnosed ligament edema (100%), an increase in the synovial fluid (72.2%), bone edema symptoms (27.8%), tibial condyle edema (7.6%), a lesion of the lateral meniscus (53.2%) and Hoffa's fat pad syndrome (19.0%). In the evaluation of the ACL lesions of the second stage (partial ruptures), we found partial ruptures of the ligament fibers (100%), an increase in the synovial fluid (69.8%), edema of the lateral condyle of the tibia (15.1%), a lesion of the lateral meniscus (45.3%), Hoffa's fat pad syndrome (32.1%) and an increase in the Blumensaat's angle (100%). In the evaluation of the ACL lesions of the third stage (complete rupture), we diagnosed rupture of the ligament fibers (100%), an increase in the synovial fluid (92.5%), edema of the lateral condyle of the tibia (43.3%), Hoffa's fat pad syndrome (40.3%), empty femoral fossa (64.2%) and an increase in the Blumensaat's angle (100%).

Conclusion: If magnetic resonance imaging is used for the examination of suspected lesions of the anterior cruciate ligament of the knee joint, it is crucial to reach a reliable differentiation between distension and a partial or complete rupture of the ACL. The evaluation of direct and indirect symptoms of ACL lesions helps to particularize the diagnostics of the ACL lesions. Direct symptoms of an ACL rupture include a discontinuity of the ligament fibrils, an increase in the Blumensaat's angle and an empty femoral fossa. Indirect symptoms of ACL lesions include the medullary bone edema of the lateral condyle of the tibia, a lesion of the lateral meniscus, especially of the back corner, Hoffa's fat pad syndrome and an increase in the Blumensaat's angle.

Keywords: cross ligaments, knee joint, rupture of the anterior cruciate ligament, magnetic resonance imaging

Accepted: January 10, 2015; Published: March 1, 2015  Show citation