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Evaluating posterior cruciate ligament injury by using two-dimensional ultrasonography and sonoelastography

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to elucidate the diagnostic criteria for posterior cruciate ligament (PCL) injury using ultrasonography.

Methods

Thirty-three patients with clinically suspected PCL injuries and 30 normal control subjects were recruited. Both groups were assessed using sonographic examination with reliability testing. Patients also underwent posterior stress radiography and magnetic resonance imaging (MRI). PCL thickness on two-dimensional ultrasonography (2D US), pixel intensity on sonoelastography, displacement on posterior stress view, and severity grading using MRI were analysed. Receiver operating characteristic (ROC) curves were plotted using MRI as the gold standard. Correlation coefficients among variables were calculated.

Results

Good to excellent reliabilities were noted for 2D US and red pixel intensity on sonoelastography. In injured knees, PCL thicknesses were significantly greater, and red pixel intensities were significantly lower, compared to non-injured knees of patients and healthy controls. This indicates increased swelling and softness in injured PCLs. The area under the PCL thickness ROC curve was 0.917 (p < 0.001), and the best diagnostic criterion was a thickness ≥6.5 mm (90.6 % sensitivity and 86.7 % specificity). Thickness correlated with red pixel intensity, International Knee Documentation Committee examination grade, and MRI severity grading. In addition, effusions were detected on 2D US in all knees with “tears” of other structures on MRI.

Conclusions

2D US is a useful tool to diagnose PCL injury, and PCL thickness ≥6.5 mm is the recommended diagnostic criterion.

Level of evidence

II.

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Acknowledgments

This work was supported by a grant from the Ministry of Science and Technology in Taiwan, ROC. (NSC 102-2628-B-182A-006).

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Author notes

    Authors and Affiliations

    1. Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, ROC

      Lin-Yi Wang, Tsung-hsun Yang & Yu-Chi Huang

    2. Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC

      Lin-Yi Wang, Tsung-hsun Yang, Yu-Chi Huang, Wen-Yi Chou, Chung-Cheng Huang & Ching-Jen Wang

    3. Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosong District, Kaohsiung City, Taiwan, ROC

      Wen-Yi Chou & Ching-Jen Wang

    4. Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, 123, Dapi Road, Niaosong District, Kaohsiung City, Taiwan, ROC

      Chung-Cheng Huang

    5. Medical Mechatronic Engineering Program, Cheng Shiu University, Kaohsiung City, Taiwan, ROC

      Lin-Yi Wang & Wen-Yi Chou

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    Correspondence to Chung-Cheng Huang or Ching-Jen Wang.

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    The authors declare that they have no competing interests.

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    Lin-Yi Wang and Tsung-hsun Yang have contributed equally to this work.

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    Wang, LY., Yang, Th., Huang, YC. et al. Evaluating posterior cruciate ligament injury by using two-dimensional ultrasonography and sonoelastography. Knee Surg Sports Traumatol Arthrosc 25, 3108–3115 (2017). https://doi.org/10.1007/s00167-016-4139-5

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    • DOI: https://doi.org/10.1007/s00167-016-4139-5

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