Skip to main content
SpringerLink
Log in

MRI appearance of the distal insertion of the anterior cruciate ligament of the knee: an additional criterion for ligament ruptures

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

Anterior cruciate ligament tears are frequent and if not diagnosed may lead to relevant patient disability. Magnetic resonance imaging is the method of choice for the non-invasive diagnosis of these tears. Despite the high performance of this method some cases are challenging and the criteria described in the literature are not sufficient to reach a diagnosis. We propose a systematic method for the evaluation of anterior cruciate ligament tears based on the aspect of its distal portion.

Materials and methods

Magnetic resonance studies of 132 knees were evaluated in correlation with arthroscopy. The performance of the proposed method was compared with that of classic imaging signs of anterior cruciate ligament tear. The impact of image quality and reader expertise on the proposed method and the classic signs of tear were taken into account.

Results

This method had a sensitivity and specificity of 91.1% and 82.9% for the detection of abnormal ACLs. The interobserver agreement (kappa) of the proposed method was significantly higher than that of the classic signs at all levels of expertise (0.89 vs 0.76). This method was not influenced by image quality. Distal ACL analysis identified more partial tears and synovialization (granulation scar tissue) than the conventional method (71% vs 58.5% for partial tears and 83.5% vs 58.5% for synovialization).

Conclusion

The proposed classification has a high performance and reproducibility for the identification of abnormal anterior cruciate ligament. The results were influenced neither by the level of expertise of the readers nor by the image quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Palle L, Reddy B, Reddy J. Sensitivity and specificity of vertically oriented lateral collateral ligament as an indirect sign of anterior cruciate ligament tear on magnetic resonance imaging. Skeletal Radiol. 2010;39:1123–7.

    Article  PubMed  Google Scholar 

  2. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39:1338–44.

    Article  PubMed  Google Scholar 

  3. Tandogan RN, Taser O, Kayaalp A, Taskiran E, Pinar H, Alparslan B, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc. 2004;12:262–70.

    Article  PubMed  Google Scholar 

  4. Rayan F, Bhonsle S, Shukla DD. Clinical, MRI, and arthroscopic correlation in meniscal and anterior cruciate ligament injuries. Int Orthop. 2009;33:129–32.

    Article  PubMed  CAS  Google Scholar 

  5. Kocabey Y, Tetik O, Isbell WM, Atay OA, Johnson DL. The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy. 2004;20:696–700.

    PubMed  Google Scholar 

  6. Kim A, Khoury L, Schweitzer M, Jazrawi L, Ishak C, Meislin R, et al. Effect of specialty and experience on the interpretation of knee MRI scans. Bull NYU Hosp Jt Dis. 2008;66:272–5.

    PubMed  Google Scholar 

  7. Krampla W, Roesel M, Svoboda K, Nachbagauer A, Gschwantler M, Hruby W. MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament? Eur Radiol. 2009;19:1519–28.

    Article  PubMed  CAS  Google Scholar 

  8. Robertson PL, Schweitzer ME, Bartolozzi AR, Ugoni A. Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology. 1994;193:829–34.

    PubMed  CAS  Google Scholar 

  9. Brandser EA, Riley MA, Berbaum KS, el-Khoury GY, Bennett DL. MR imaging of anterior cruciate ligament injury: independent value of primary and secondary signs. AJR Am J Roentgenol. 1996;167:121–6.

    PubMed  CAS  Google Scholar 

  10. Tung GA, Davis LM, Wiggins ME, Fadale PD. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging. Radiology. 1993;188:661–7.

    PubMed  CAS  Google Scholar 

  11. Mellado JM, Calmet J, Olona M, Gine J, Sauri A. Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle. Knee Surg Sports Traumatol Arthrosc. 2004;12:217–24.

    Article  PubMed  CAS  Google Scholar 

  12. McCauley TR, Moses M, Kier R, Lynch JK, Barton JW, Jokl P. MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings. AJR Am J Roentgenol. 1994;162:115–9.

    PubMed  CAS  Google Scholar 

  13. Van Dyck P, Gielen JL, Vanhoenacker FM, Wouters K, Dossche L, Parizel PM. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis? Skeletal Radiol. 2011. doi:10.1007/s00256-011-1169-4.

    Google Scholar 

  14. Van Dyck P, Vanhoenacker FM, Gielen JL, Dossche L, Van Gestel J, Wouters K, et al. Three Tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears? Skeletal Radiol. 2011;40:701–7.

    Article  PubMed  Google Scholar 

  15. Kwon JW, Yoon YC, Kim YN, Ahn JH, Choe BK. Which oblique plane is more helpful in diagnosing an anterior cruciate ligament tear? Clin Radiol. 2009;64:291–7.

    Article  PubMed  CAS  Google Scholar 

  16. Petersen W, Zantop T. Partial rupture of the anterior cruciate ligament. Arthroscopy. 2006;22:1143–5.

    Article  PubMed  Google Scholar 

  17. Katahira K, Yamashita Y, Takahashi M, Otsuka N, Koga Y, Fukumoto T, et al. MR imaging of the anterior cruciate ligament: value of thin slice direct oblique coronal technique. Radiat Med. 2001;19:1–7.

    PubMed  CAS  Google Scholar 

  18. Lawrance JA, Ostlere SJ, Dodd CA. MRI diagnosis of partial tears of the anterior cruciate ligament. Injury. 1996;27:153–5.

    Article  PubMed  CAS  Google Scholar 

  19. Chen WT, Shih TT, Tu HY, Chen RC, Shau WY. Partial and complete tear of the anterior cruciate ligament. Acta Radiol. 2002;43:511–6.

    Article  PubMed  Google Scholar 

  20. Roychowdhury S, Fitzgerald SW, Sonin AH, Peduto AJ, Miller FH, Hoff FL. Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images. AJR Am J Roentgenol. 1997;168:1487–91.

    PubMed  CAS  Google Scholar 

  21. Higueras Guerrero V, Torregrosa Andres A, Marti-Bonmati L, Casillas C, Sanfeliu M. Synovialisation of the torn anterior cruciate ligament of the knee: comparison between magnetic resonance and arthroscopy. Eur Radiol. 1999;9:1796–9.

    Article  PubMed  CAS  Google Scholar 

  22. Roberts CC, Towers JD, Spangehl MJ, Carrino JA, Morrison WB. Advanced MR imaging of the cruciate ligaments. Magn Reson Imaging Clin N Am. 2007;15:73–86.

    Article  PubMed  Google Scholar 

  23. Sonnery-Cottet B, Barth J, Graveleau N, Fournier Y, Hager JP, Chambat P. Arthroscopic identification of isolated tear of the posterolateral bundle of the anterior cruciate ligament. Arthroscopy. 2009;25:728–32.

    Article  PubMed  Google Scholar 

  24. Huang GS, Lee CH, Chan WP, Lee HS, Chen CY, Yu JS. Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance. Radiology. 2002;225:537–40.

    Article  PubMed  Google Scholar 

  25. Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology. 1992;184:855–8.

    PubMed  CAS  Google Scholar 

  26. Blum A, Feldmann L, Bresler F, Jouanny P, Briancon S, Regent D. Value of calculation of the kappa coefficient in the evaluation of an imaging method. J Radiol. 1995;76:441–3.

    PubMed  CAS  Google Scholar 

  27. Panisset JC, Duraffour H, Vasconcelos W, Colombet P, Javois C, Potel JF, et al. [Clinical, radiological and arthroscopic analysis of the ACL tear. A prospective study of 418 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:362–8.

    Article  PubMed  Google Scholar 

  28. Poellinger A, Scheffler S, Hamm B, Asbach P. Magnetic resonance imaging of double-bundle anterior cruciate ligament reconstruction. Skeletal Radiol. 2009;38:309–15.

    Article  PubMed  Google Scholar 

  29. Remer EM, Fitzgerald SW, Friedman H, Rogers LF, Hendrix RW, Schafer MF. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics. 1992;12:901–15.

    PubMed  CAS  Google Scholar 

  30. Buckwalter KA, Pennes DR. Anterior cruciate ligament: oblique sagittal MR imaging. Radiology. 1990;175:276–7.

    PubMed  CAS  Google Scholar 

  31. Murao H, Morishita S, Nakajima M, Abe M. Magnetic resonance imaging of anterior cruciate ligament (ACL) tears: diagnostic value of ACL-tibial plateau angle. J Orthop Sci. 1998;3:10–7.

    Article  PubMed  CAS  Google Scholar 

  32. Ben Hamida F, Mourali S, Ben Lakhdar Z, Hadjsalah M. [Anatomical risk factors for anterior cruciate-ligament rupture. Comparative study]. J Traumatol Sport. 2008;25:144–7.

    Article  Google Scholar 

  33. Hohmann E, Bryant A, Reaburn P, Tetsworth K. Does posterior tibial slope influence knee functionality in the anterior cruciate ligament-deficient and anterior cruciate ligament-reconstructed knee? Arthroscopy. 2010;26:1496–502.

    Article  PubMed  Google Scholar 

  34. Barry KP, Mesgarzadeh M, Triolo J, Moyer R, Tehranzadeh J, Bonakdarpour A. Accuracy of MRI patterns in evaluating anterior cruciate ligament tears. Skeletal Radiol. 1996;25:365–70.

    Article  PubMed  CAS  Google Scholar 

  35. Tavernier T, Cotten A. High- versus low-field MR imaging. Radiol Clin N Am. 2005;43:673–81.

    Article  PubMed  Google Scholar 

  36. Sanal HT, Cardoso F, Chen L, Chung C. Office-based versus high-field strength MRI: diagnostic and technical considerations. Sports Med Arthrosc. 2009;17:31–9.

    Article  PubMed  Google Scholar 

  37. Kijowski R, Davis KW, Woods MA, Lindstrom MJ, De Smet AA, Gold GE, et al. Knee joint: comprehensive assessment with 3D isotropic resolution fast spin-echo MR imaging—diagnostic performance compared with that of conventional MR imaging at 3.0 T. Radiology. 2009;25:486–95.

    Article  Google Scholar 

  38. Nishikawa H, Imanaka Y, Sekimoto M, Ikai H. Verification bias in assessment of the utility of MRI in the diagnosis of cruciate ligament tears. AJR Am J Roentgenol. 2010;195:W357–64.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank Professor Coudane (ATOL, CHU Nancy) for his assistance and his advice in the writing of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Service d’imagerie Guilloz, CHU Nancy, Av De Lattre de Tassigny, 54000, Nancy, France

    G. Oldrini, P. Gondim Teixeira, A. Chanson, B. Osemont, M. Louis & A. Blum

  2. Service Epidémiologie et Evaluation Cliniques, CHU Nancy, Hôpitaux de Brabois Allée du Morvan, 54500, Vandoeuvre-lès-Nancy, France

    M. L. Erpelding

Authors
  1. G. Oldrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Gondim Teixeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Chanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. L. Erpelding
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. Osemont
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Louis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Blum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Oldrini.

Additional information

The two first authors have worked in equal measure on the production of this manuscript and we hereby request a joint first authorship

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oldrini, G., Teixeira, P.G., Chanson, A. et al. MRI appearance of the distal insertion of the anterior cruciate ligament of the knee: an additional criterion for ligament ruptures. Skeletal Radiol 41, 1111–1120 (2012). https://doi.org/10.1007/s00256-012-1363-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-012-1363-z

Keywords

Search

Navigation