Typical MRI findings of ACL tear include partial or complete discontinuity of the ligament and abnormal morphology on T1- weighted image2,3). Direct signs in T1- and T2-wighted images and indirect signs including meniscus injury, the collateral ligament injury, cartilage damage or osteoarthritis, kissing contusion, Notch syndrome and abnormal posterior cruciate ligament (PCL) and other indirect signs were evaluated. However, the diagnosis of PCL insufficiency by only inspection of the ligament's appearance on MRI may be inadequate in the setting of chronic tears, as the sensitivity of MRI for detecting PCL … The estimated sensitivity and specificity of several PCL thicknesses (7 mm and greater, 8 mm and greater, and 9 mm and greater) in the diagnosis of PCL tear are summarized in Table 1. Would you like email updates of new search results? The diagnosis of incomplete acute and chronic posterior cruciate ligament (PCL) tears can be challenging with conventional magnetic resonance (MR) imaging, particularly for injuries in which the ligament appears continuous as occurs with chronic PCL tears that have scarred in continuity. MRI scanning of the PCL with the knee flexed at 90° may help in differentiating partial and complete ruptures of the PCL and identifying elongation of the PCL in chronic injuries. This scarring leads to the acute angulation of the ligament. All imaging studies were performed over a 4-year period on a 1.5-T unit (Signa, GE Healthcare) according to our standard knee MRI protocol: sagittal fat-suppressed spin-echo proton-density images (TR/TE, 1,500–2,000/20) and sagittal, axial, and coronal fat-suppressed fast spin-echo T2-weighted images (2,000–5,000/57–80). In the acute phase of a tear, physical examination of the PCL can be difficult because of the presence of a hemarthrosis, pain, and concomitant ligamentous injuries [3]. However, in some series, ... and 41%–75% of acute knee injuries with a hemarthrosis have an ACL tear. There were significant differences in medial compartment PTT on MRI for acute versus chronic injuries ( P = .025) and acute versus graft injuries ( P = .007). FOIA The spectrum of PCL injuries includes partial tear or intrasubstance injury, complete ligamentous rupture, and avulsion of the PCL insertion site on the posterior tibia. To evaluate the magnetic resonance imaging (MRI) features of chronic injury of posterior cruciate ligament(PCL) and to consider its clinical significance (PCL injury, particularly in chronic cases, has known to show normal appearance on MRI, however, there is no detailed MR description about chronic PCL injury.) Background: The diagnosis of incomplete acute and chronic posterior cruciate ligament (PCL) tears can be challenging with conventional magnetic resonance (MR) imaging, particularly for … A field of view of appropriate size should be used to maximize the resolution, typically 16 cm. Patients typically present with symptoms of knee instability, usually after acute trauma. There is relatively little in the radiology literature regarding the MRI appearance of PCL tears [7–9]. The proton-density sequence, however, should not be used for obtaining the anteroposterior measurement of the ligament because the intrasubstance signal intensity of the torn PCL on the proton-density images often approximates that of the adjacent edematous soft tissues, making the margins of the ligament difficult to discern. Two PCLs that appeared as one continuous structure at MRI were described as completely disrupted at surgery. 2019 May 28;6(1):22. doi: 10.1186/s40634-019-0188-2. The mean measurement of torn PCLs in that study was 15.6 mm (range, 12–22 mm). a T2 fat-suppressed image shows … with acute ACL tear and 217 cases with chronic ACL tear. Institutional review board approval was obtained for this study. Indirect signs of PCL tears include increased girth of the vertical portion of the PCL, increased intrasubstance signal, and ligamentous laxity The incidence of PCL injuries is difficult to assess because of the large percentage that remain undiagnosed in the acute setting, a reported 1–44% [10]. Five of the 11 PCL tears were precipitated by fall or athletic injury and 6 were the result of MVA. Magnetic resonance follow-up of 10 cases and a proposal for modification of Gross classification]. In cases of disruption or avulsion of the PCL, the site was noted. Seven experienced musculoskeletal radiologists subsequently reviewed the scans. J Exp Orthop. Sixty patients had acute tears … The PCL may look normal and seem to have healed completely, but the knee may still be PCL-deficient (Figure 19) . Posterior cruciate ligament (PCL) injuries include a partial tear or intra-substance injury, complete ligamentous rupture, and avulsion of the PCL from its femoral or tibial attachment.1, 2 In the acute phase of a traumatic injury, physical examination can usually determine an acute tear of the PCL, and patients rarely describe hearing the “pop” at the time of injury… MRI sensitivity was 100% for acute primary PCL tears, The patient group consisted of 23 men (68%) and 11 women (32%) with an average age of 35.2 years (range, 15–69 years). MRI sensitivity was 100% for acute primary PCL tears, 62.5% for chronic primary PCL tears, and 18.1% for PCL graft tears. All of the patients had significant improvement ( p = 0.0001) in their Lysholm, Tegner, and Hospital for Special Surgery knee scores postoperatively with no significant difference in functional outcomes between acute and chronic tears. One patient had an unknown mechanism of injury. We postulate that, in the case of a chronic PCL injury, healing in continuity may occur, producing an intact but lax ligament. This retrospective study compared the magnetic resonance imaging (MRI) findings in 87 patients with acute and chronic anterior cruciate ligament (ACL) tears. Surgeons, however, consider many variables when evaluating PCL injuries for possible reconstruction, such as associated ligament, chondral, and meniscal injuries and subjective instability [11]. apply stress to anterior tibia with the knee flexed to 70° asymmetric posterior tibial displacement indicates PCL injury; contralateral knee differences >12 mm on stress views suggest a combined PCL and PLC injury This finding corroborates those of Cho et al. The anterior cruciate ligament (ACL), sits just in front of the PCL.The ACL is much better known, in part because ACL tears are much more commonly diagnosed than injuries to the PCL. Similar findings of ligament continuity were discussed by Akisue et al. Bone contusions with PCL tear are not as consistent as with ACL tear; however, meniscal injuries near the meniscal roots either medially or laterally may occur Retraction of the PCL with complete tear is rare 8 Posterior Cruciate Ligament: Evaluations and Pitfalls of Injuries on MRI Atrophy, common with chronic injuries Schultz et al. 2016 Sep 5;17(1):384. doi: 10.1186/s12891-016-1232-3. 8600 Rockville Pike Although the significance and presence of such an injury may not be immediately recognized, the late onset of instability and arthritis resulting from … Magnetic resonance imaging of the posterior cruciate ligament in flexion With use of sagittal T2-weighted images, a 7-mm or greater anteroposterior measurement of the vertical portion of the PCL can be considered evidence of a torn PCL with a high degree of certainty. Meniscal tears are best evaluated with MRI. All observations and measurements of the study and control patients were made in consensus by unblinded observers. The echo-train length was 8–10 for the fast spin-echo sequences. Also, in 32 of the 34 cases, the anteroposterior diameter of the distal half of the ligament increased with no relation to the location of the tear. Careers. MRI sensitivity was 100% for acute primary PCL tears, 62.5% for chronic primary PCL tears, and 18.1% for PCL graft tears. 2021. Hayashi S, Nakasa T, Matsuoka Y, Akiyama Y, Ishikawa M, Nakamae A, Awai K, Adachi N. Asia Pac J Sports Med Arthrosc Rehabil Technol. Three major mechanisms of trauma that involves the PCL are posterior displacement of the tibia in a flexed knee, hyperextension, and rotation combined with an adduction or abduction force. This is an important … We postulate that, in the case of a chronic PCL injury, healing in continuity may occur, producing an intact but lax ligament. MRI readily demonstrates acute high-grade injuries to the PCL (Figs. Diffuse thickening (more than 7 mm on sagittal plane) with low or intermediate signal, often seen as focal changes of the PCL, is suggestive for chronic PCL tear . [14], who evaluated acutely torn PCLs clinically and with MRI. The average time from date of injury to imaging was 54.8 days (range, 1–529 days) for 33 of the patients. The number of signals acquired was two for fast spin-echo sequences and one for proton-density sequences. As we found in this investigation, an acutely torn PCL usually maintains continuity as a single structure and is typically injured as a result of stretching deformity. The thickness of the distal half of the PCL increased whether the tear occurred proximally or distally. In the 200 consecutive control MRI examinations of the knee, 184 PCLs (92%) measured 6 mm or less in anteroposterior diameter (Fig. Your doctor may also want to do an arteriogram to check for any damage to veins in the leg. Thus, although MRI may be reliable in diagnosing acute PCL injury, MRI is not so reliable in evaluating chronic injuries. Sports-related PCL injuries are significantly more likely to be isolated and more likely to be diagnosed in the acute phase [5, 11]. Injury. 2: ACL injury mechanism. Your doctor will also want to use tests to diagnose PCL injury, such as an x-ray, MRI, bone scan, or ultrasound. Our study is the first to establish that posterior translation measurements are a valid indicator of acute PCL tear on MRI and a valid indicator of acute or chronic PCL tear on routine MRI with the knee routinely positioned in passive extension. protected weight bearing & rehab. Images from the preoperative MRI examinations of the knee were retrospectively evaluated in consensus by three musculoskeletal radiologists. 7.6). In 75% (36 of 48) of their cases of torn PCL, the PCL maintained continuity as one structure on MRI. A search of databases of knee MR examinations over 4.5 years with reported ACL tears yielded 19,726 studies. MRI analysis of tibial PCL attachment in a large population of adult patients: reference data for anatomic PCL reconstruction. Chronic partial tears of the ACL are sometimes difficult to diagnose by MRI because no edema is seen. In 94% of our 34 patients with PCL tear, the PCL measured 7 mm or greater. 2021 Feb 17;24:35-40. doi: 10.1016/j.asmart.2021.01.004. CONCLUSION. A contusion involving the anterior proximal tibia is a known common finding related to a direct blow [16, 17]. [13] in a sonographic investigation. MR imaging assessment of chronic posterior cruciate ligament (PCL) injuries is less reliable than assessment of acute injury, as continuity of PCL fibers in chronic injuries can be mistaken for a partial tear … It is not unusual for the findings at physical examination to be normal after acute tear of the PCL [4], and patients rarely describe hearing the pop common with ACL tears [1]. 2008 Jun;27(6):1336-40. doi: 10.1002/jmri.21333. Two independent reviewers retrospectively evaluated the MRI images of 377 patients with ACL tear confirmed by arthroscopy. 2021. If this is seen on a scan with the PCL in continuity, it may serve as an adjunctive sign of a previous PCL tear that has healed with PCL laxity (Fig. Evaluation of the degenerative pattern of PCL in osteoarthritis patients using UTE-T2 mapping. Quantitative mapping of acute and chronic PCL pathology with 3 T MRI: a prospectively enrolled patient cohort. Thus, although MRI may be reliable in diagnosing acute PCL injury, MRI is not so reliable in evaluating chronic injuries. Paucity of fibers in femoral foot print of ACL. The incidence of posterior cruciate ligament (PCL) tears is considerably less common, accounting for 3% of all knee injuries in the general population. In 30 of the 34 PCL tears (88%), the PCL intrasubstance signal intensity on the proton-density images was higher than that on T2-weighted images. On the basis of a sensitivity of 94% and specificity of 92%, we advocate using 6 mm as the upper limit of normal PCL thickness, thicknesses of 7 mm and greater being suggestive of a tear. Recognition of these findings should improve radiologists' ability to diagnose PCL tears preoperatively. MRI of Rectal Cancer: An Overview and Update on Recent Advances, Review. Hyperflexion injury has been described as a less-common mechanism of PCL injury [3, 11]. Smith et al compared Arthrex® TightRope Attachable Button System (ABS) fixation of the GraftLink ACL construct to standard interference screw (IF) fixation. Sixteen of the injuries (47.1%) were the result of a motor vehicle collision, seven (20.6%) were the result of a sports injury, and four (11.8%) were the result of falls. Teng Y, Guo L, Wu M, Xu T, Zhao L, Jiang J, Sheng X, Xu L, Zhang B, Ding N, Xia Y. BMC Musculoskelet Disord. Posterior cruciate ligament (PCL) injuries account for up to 23% of all knee ligament injuries in the general population and are most commonly seen as a result of Unrepaired injury of the PCL can lead to chronic instability and early joint degeneration. There were significant differences in medial compartment PTT on MRI … Address correspondence to E. N. Vinson ([email protected]). Imaging Diagnosis of Solitary Tumors of the Phalanges and Metacarpals of the Hand, MR Imaging Differentiation of Soft-Tissue Hemangiomas from Malignant Soft-Tissue Masses. Many studies have shown that magnetic resonance imaging (MRI) is useful for diagnosis of acute PCL inju-ries (9–12), while use of MRI to evaluate chronic PCL injuries has been described in only a few reports. The normal appearance of the PCL on MR images is a well-defined continuous band of low signal intensity in all pulse sequences. MRI is the radiologic study of choice in diagnosing acute PCL tears [ 7 ]. Associated injuries include injury of other ligaments, meniscal tear, bone injury, and joint effusion. Many patients will be asymptomatic and their clinical examination is unremarkable. MRI Principles. In 62% of the 34 cases of PCL tear in this study, the PCL maintained continuity as a single structure on images. The purpose of this study was to describe the MRI appearance of surgically proven PCL tears and to emphasize previously unreported signs. Background. Laxity to probing at arthroscopy is diagnostic of a tear. Magnetic resonance imaging (MRI) is widely believed to be highly accurate in diagnosing injuries of the posterior cruciate ligament (PCL). The mechanism of injury was dashboard type in 35%, fall on a flexed knee (blow to the anterior proximal tibia) with the foot plantar-flexed in 24%, and hyperextension in 12% of cases. medial and patellofemoral compartment arthrosis may be present with chronic injuries; lateral stress view . Magnetic resonance imaging (MRI) of the knee is a highly sensitive and specific method for diagnosing acute posterior cruciate ligament (PCL) tears, with a reported accuracy of 96% to 100%. 0.25-0.65: 0.333: NR: Patients with ACL injury on MRI do not have a tear of the ALL. 3 However, magnetic resonance imaging (MRI) has revealed that the PCL is more often subject to injuries than was previously believed. We found the proton-density (short TE) sequence extremely important in the diagnosis of PCL injuries. For direct signs on MRI, no significant … Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. 1 The TightRope/GraftLink construct outperformed IF screw fixation in both yield and ultimate load and was statistically equivalent in cyclic displacement. The posterior cruciate ligament (PCL) of the knee has received little attention in the radiology literature, but its importance in knee stability has come under close scrutiny in recent years. The images of a group of control patients (108 men, 92 women; average age, 42.5 years; range, 17–81 years) without a history of trauma who underwent 200 consecutive MRI examinations of the knee over a 2-month period were retrospectively evaluated for signal intensity of the PCL on proton density– and T2-weighted images and for anteroposterior diameter of the vertical segment of the PCL measured on sagittal T2-weighted images. Unrepaired injury of the PCL can lead to chronic instability and early joint degeneration. Of the 21 cases without complete disruption, intrasubstance fluid signal intensity within the PCL on the T2-weighted images was present in only four cases (19% of the 21). Eight of these patients had avulsion of the ligament from either the femur or the tibia. On sagittal T2-weighted images, an anteroposterior diameter of 7 mm or more is highly suggestive of a torn PCL. 6.14). 4). Fig. return to sports in 2-4 weeks; relative immobilization in extension for 4 weeks. This is a very common appearance of a chronic ACL tear. The forced hyperextension can injure the ACL (and the external ligaments). Those investigators found that most of the injuries were related to traffic accidents (45%) and sports injuries (40%). Table 1 2006 Jun;37(6):485-501. doi: 10.1016/j.injury.2005.08.003. MRI sensitivity was 100% for acute primary PCL tears, 62.5% for chronic primary PCL tears, and 18.1% for PCL graft tears. To our knowledge, abnormal thickening of a torn PCL on MR images has not been previously described. PCL posterior cruciate ligament. Preferred examination MRI is the preferred examination for evaluating posterior cruciate ligament (PCL) injuries. [5] retrospectively studied the epidemiologic characteristics of 494 cases of PCL insufficiency. However, as opposed to the ACL, where intact fibres on MRI indicate an intact ACL, intact fibres in the PCL do not mean that the knee is PCL intact. In 88% of our cases, the signal intensity on proton-density images was increased relative to the signal intensity on T2-weighted images. An MRI can find the exact location of a tear. Interestingly, it is thought that PCL injuries account for up to 20 percent of … Their accuracy in diagnosing a PCL injury was 57% (40-80%). Inexperience with this injury is compounded by difficulty in clinical identification of tears. MRI was performed on 10 knees with a clinical and arthroscopic diagnosis of a PCL injury sustained at least 6 months previously. Unable to load your collection due to an error, Unable to load your delegates due to an error. A tear of the ALL was defined as complete or partial discontinuity, abnormal morphology and intrinsic signal intensity, or an avulsion fracture (Segond fracture) at its insertion site. As a result, many PCL tears remain undiagnosed during the initial clinical evaluation. The PCL -- similar to the anterior cruciate ligament (ACL) -- connects the thigh bone (femur) to your shin bone (tibia). The diagnosis of incomplete acute and chronic posterior cruciate ligament (PCL) tears can be challenging with conventional magnetic resonance (MR) imaging, particularly for injuries in which the ligament appears continuous as occurs with chronic PCL tears that have scarred in continuity. In some cases, scar tissue can simulate an intact ligament (Figure 11). There were one ACL/PCL tear, 10 ACL/PCL/PLC tears, seven ACL/PCL/MCL tears, and two ACL/PCL/MCL/PLC tears in this study. J Belg Soc Radiol. Five of the 13 ligaments (15% of the total) that appeared completely disrupted or avulsed were avulsed from the femoral attachment, five (15%) tears were midsubstance, and three ligaments (9%) were avulsed from the tibial attachment. Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing. They have scarred together. A chronic tear can occasionally mimic an intact ligament if the bridging fibrous scar appears as a continuous band with low signal intensity that bridged the expected origin and insertion of the ACL. In evaluation of the PCL, the negative predictive value of MRI performed with a short-TE sequence is reported to approach 100% [9].
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