Imaging following acute knee trauma

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C. G Peterfy, M. D. Ph. D. , A Guermazi, M. D. , S Zaim, M. D. , P. F

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Presentation transcript:

Imaging following acute knee trauma R. Kijowski, F. Roemer, M. Englund, C.J. Tiderius, P. Swärd, R.B. Frobell Osteoarthritis and Cartilage Volume 22, Issue 10, Pages 1429-1443 (October 2014) DOI: 10.1016/j.joca.2014.06.024 Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 26-year-old male who sustained an acute rotational knee injury. (A) Sagittal fat-suppressed T2-weighted fast spin-echo image showing a complete ACL tear (small solid white arrow), a large knee joint effusion (large solid white arrow), and a displaced meniscus fragment within the intercondylar notch (black outlined arrow). (B) Corresponding coronal fat-suppressed T2-weighted fast spin-echo image showing extensive traumatic bone marrow lesions on the posterior medial and lateral tibial plateau (small solid white arrows) and a posterior horn lateral meniscus tear (large solid white arrow) with a displaced meniscus fragment within the intercondylar notch (black outlined arrow). (C) Baseline flexion anterior–posterior radiograph performed following ACL reconstruction and partial lateral meniscectomy showing normal lateral joint space width (small arrow). Note the suboptimal almost vertical orientation of the femoral tunnel (large arrow). (D) Follow-up flexion anterior–posterior radiograph performed 5 years after surgery shows narrowing of the lateral joint space (arrow) indicating the onset of osteoarthritis. Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 23-year-old male who sustained an acute rotational knee injury. (A) Coronal intermediate-weighted fast spin-echo image showing tear and extrusion of the body of the lateral meniscus (arrow). (B) Follow-up coronal intermediate-weighted fast spin-echo image performed 5 years after injury showing incident osteophytes on the medial and lateral femoral condyles (arrows) indicating the onset of early osteoarthritis. Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Bone surfaces generated by active appearance model search of images from a single individual at six time points after acute ACL injury. Bone from later time points (increasingly dark green color) lie outside the baseline image indicating where bone is added over time. The area of added bone is primarily seen in the outer halves of the articular surfaces. Note that this method cannot visualize where bone shrinks below the baseline articular surface. Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 19-year-old female who sustained an acute rotational knee injury. (A) Lateral radiograph showing depression of the anterior weight-bearing surface of the lateral femoral condyle (small arrow) with an associated knee joint effusion (large arrow). (B) Corresponding sagittal fat-suppressed T2-weighted fast spin-echo image showing a cortical depression fracture involving the anterior weight-bearing surface of the lateral femoral condyle (small arrow) with an adjacent traumatic bone marrow lesion (large arrow). Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 23-year-old male who sustained an acute rotational knee injury. (A) Coronal fat-suppressed intermediate-weighted fast spin-echo image showing large traumatic bone marrow lesions on the posterior medial and lateral tibial plateau (arrows). (B) Follow-up coronal fat-suppressed intermediate-weighted fast spin-echo image performed 1 year after injury showing complete resolution of the bone marrow lesions (arrows). Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 23-year-old male who sustained an acute rotational knee injury. (A) Coronal fat-suppressed T2-weighted fast spin-echo image showing large traumatic bone marrow lesions on the lateral femoral condyle and lateral tibial plateau (arrows). (B) Follow-up coronal fat-suppressed T2-weighted fast spin-echo image performed 5 years after injury showing complete resolution of the post-traumatic bone marrow lesions (small solid white arrows). However, there is now a focal full-thickness cartilage defect on the central medial femoral condyle (black outlined arrow) with an adjacent degenerative bone marrow lesion (large solid white arrow). Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 7 23-year-old male who was evaluated 3 years after ACL reconstruction. (A) Sagittal fat-suppressed spoiled gradient-echo image showing normal cartilage morphology on the medial tibial plateau (arrow). (B) Corresponding T2 map showing increased T2 relaxation time on the posterior medal tibial plateau (arrow illustrating loss of normal low T2 relaxation time, scaled in red, in the deep cartilage layer) indicating early cartilage degeneration. (C) Corresponding T1-rho map showing increased T1-rho relaxation time on the posterior medal tibial plateau (arrow illustrating loss of normal low T1-rho relaxation time, scaled in red, in the deep cartilage layer) indicating early cartilage degeneration. Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 8 22-year-old male who sustained an acute rotational knee injury. (A) Sagittal fat-suppressed T2-weighted fast spin-echo image showing a cortical depression fracture involving the articular surface of the lateral tibial plateau (small arrow) with an adjacent large traumatic bone marrow lesion (large arrow). (B) Follow-up sagittal fat-suppressed T2-weighted fast spin-echo image performed 5 years after injury showing healing of the fracture (small solid white arrow) with complete resolution of the bone marrow lesion (large solid white arrows). However, there is now a focal partial-thickness cartilage defect on the posterior lateral tibial plateau (black outlined arrow) in the area of acute cartilage injury. Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 9 29-year-old male who was evaluated 2 years after ACL reconstruction and partial medial meniscectomy. (A) Sagittal fat-suppressed T2-weighted fast spin-echo image showing normal cartilage morphology on the posterior medial femoral condyle (small arrow). Also note the deformed posterior horn of the medial meniscus (large arrow) from prior partial resection. (B) Corresponding T1-rho map showing increased T1-rho relaxation time on the posterior lateral femoral condyle (arrow illustrating loss of normal low T1-rho relaxation time, scaled in red and yellow, in the deep cartilage layer) indicating early cartilage degeneration. Osteoarthritis and Cartilage 2014 22, 1429-1443DOI: (10.1016/j.joca.2014.06.024) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions