Evaluation of knee joint by MRI in 65 patients.

Aim: To evaluate the features, pattern and extension of the different pathologies affecting the knee joint with help of MRI scans Materials and methods: This study was performed using MRI scan 1.5 tesla of knee joint in 65 patients. Routine blood investigations were documented in all patients. Results: Distribution of pathologies according to patient's age,sex, site of environment and etiology was observed and p-value of knee joint tears by using MRI as gold standard was calculated. Conclusion: MRI scans have proved to be successful modality in evaluating the knee joint; MRI results increased the physician’s confidence in the diagnosis. MRI is an excellent noninvasive modality in imaging of the knee and a noninvasive replacement for arthrography and non-theapeutic arthroscopy.

Posterior Laxity after Conservative Treatment of the Acute Injured Posterior Cruciate Ligament

PURPOSE: This study analyzed the contributing factors on posterior stability after conservative treatment for the posterior cruciate ligament(PCL) injury. MATERIALS AND METHODS: During the period from June 1996 to February 2002, 16 cases had been followed for more than 12 months after conservative treatment for acute PCL injury. We analyzed associated injury, continuity and location of PCL injury by magnetic resonance imaging(MRI) also subjective scores and serial stress radiogram. RESULTS: The average posterior displacement after conservative treatment was 4.0 mm. At last follow up, posterior drawer radiogram showed average 3.3 mm in isolated PCL injury, 4.6 mm in associated injuries. In serial posterior drawer radiogram, side to side difference was average 9.1 mm at injured time, 6.0 mm at 3 months after injury, 4.5 mm at 9 months after injury, 4.0 mm at 12 months after injury. In MRI findings, twelve cases showed interstitial tear of PCL, four cases complete disrupted, respectively and their posterior displacement was at last follow op 3.7 mm, 5.0 mm. The PCL tear location was in the proximal third in 3 cases, the middle third in 8 cases, and the distal third in 5 cases. Lysholm knee score improved from 73.3 points at 6 months after injury to 86.1 points at final follow up. Lysholm knee score was 84.6 points in patients > 5 mm posterior tibial translation, 86.1 points in patients < 5 mm posterior tibial translation. CONCLUSION: The isolated PCL injury usually heals with some residual knee laxity which increase with associated injury. we recommend to protect the injured PCL for healing period, because significant improvement was found in serial stress radiogram until 6 months after injury. We also recommend aggressive treatment of associated injury.

The Significance of the Femoral Tunnel Position in PCL Reconstruction Using the Bone-Patellar tendon - Bone Graft

PURPOSE: We compared the clinical and radiological RESULTS of two patient-groups who had had PCL reconstruction for grade III PCL injury using the autogenous bone-patellar tendon-bone graft at the isometric point and at the anatomical point of femoral condyle. MATERIALS AND METHODS: Of 31 patients who were involved in this study, 20 patients had consecutive isometric PCL reconstructions between June 1993 and May 1995(group 1), And 11 patients had anatomi- cal PCL reconstructions between 1995 and 1997(group 2). We evaluated the clinical results using the Lysholm knee scoring system and measured the posterior translation of the tibial condyle on the posterior stress lateral radiographs. RESULT: The average posterior translation at the final follow-up was 7mm in group 1 and 5.9mm in group 2. The Lysholm knee score was 89 points in group 1, and 92 point in group 2. However, there wasn't any statistically significant difference in clinieal and radiological results between the two groups. SUMMARY: The clinical and radiological results can be influenced by several factors inherent to arthro-scopically assisted PCL reconstruction. Although it seems that initial knee kinematics can be improved by more distal PCL graft placement, there may be little effect to the final clinical and radiological results according to the femoral tunnel positions.

Clinical Implications of Bone Bruises on MRI in Acute Traumatic ACL or PCL Injury / 대한정형외과학회잡지

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.

A Comparison Study between Conservative Treatment and Reconstruction with Autogenous BPTB Augmented with Kennedy LAD in the Injuries of PCL

The posterior cruciate ligament is the primary static restraint to posterior translation of the tibia and provides proprioception within the knee. The goals of treatment in the injuries of PCL are restoration of normal tibiofemoral stability and reduction of long term osteoarthrosis of the knee. The purpose of this study is to cornpare functional outcome, muscle power, and posterior stability between conservative treatment and reconstruction with autogenous RPTB augmented with Kennedy LAD in PCL injuries. Twenty-seven patients with PCL rupture who have been treated from November 1990 to May 1996 were reviewed. The patiens were divided into conservative group and reconstruction group. Conservative treatment was done in 15 patients and reconstruction by autogenous bone patellar tendon bone with Kennedy LAD was performed in 12 patients. All patients were evaluated with posterior stress x-ray films, KT-2000 knee ligament arthrometer, Cybex 340 isokinetic dynamometer, subjective Cincinnati symptom rating scale and Lysholm knee score, complication. The results were as follows; 1. Mild and moderate posterior instability was remained in spite of BPTB graft and need more stable fixation technique and vigorous rehabilitation program. 2. At the angular velocity of 90 degree/sec and 180 degree/sec, the muscle strenth of quadriceps was decreased after PCL injury in both group in the test of Cybex 340 isokinetic exercises. The power of hamstrings were not changed after PCL injuries. 3. Average Lysholm knee score was 89 points in reconstruction group and 78 points in conservative group and average Cincinnati symptom-rating scale was 8.4 points in reconstruction group and 7.1 points in conservative group. More satisfied functional results and subjective symptoms were revealed in the reconstruction group and statiscal significancy (p<0.05) was showed when comparing conservative group with reconstruction poup. 4. Good clinical results did not always coincidence with lesser posterior instability and clinical results were influenced by associated injury of the knee. The more combined ligament injury of the knee, the worse clinical results.