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Positional MR imaging of normal and injured knees

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

This study uses a practical positional MRI protocol to evaluate tibiofemoral translation and rotation in normal and injured knees.

Methods

Following ethics approval, positional knee MRI of both knees was performed at 35° flexion, extension, and hyperextension in 34 normal subjects (mean age 31.1 ± 10 years) and 51 knee injury patients (mean age 36.4 ± 11.5 years, ACL tear n = 23, non-ACL injury n = 28). At each position, tibiofemoral translation and rotation were measured.

Results

Normal knees showed 8.1 ± 3.3° external tibial rotation (i.e., compatible with physiological screw home mechanism) in hyperextension. The unaffected knee of ACL tear patients showed increased tibial anterior translation laterally (p = 0.005) and decreased external rotation (p = 0.002) in hyperextension compared to normal knees. ACL-tear knees had increased tibial anterior translation laterally (p < 0.001) and decreased external rotation (p < 0.001) compared to normal knees. Applying normal thresholds, fifteen (65%) of 23 ACL knees had excessive tibial anterior translation laterally while 17 (74%) had limited external rotation. None (0%) of 28 non-ACL-injured knees had excessive tibial anterior translation laterally while 13 (46%) had limited external rotation. Multidirectional malalignment was much more common in ACL-tear knees.

Conclusions

Positional MRI shows (a) physiological tibiofemoral movement in normal knees, (b) aberrant tibiofemoral alignment in the unaffected knee of ACL tear patients, and (c) a high frequency of abnormal tibiofemoral malalignment in injured knees which was more frequent, more pronounced, more multidirectional, and of a different pattern in ACL-tear knees than non-ACL-injured knees.

Key Points

• Positional MRI shows physiological tibiofemoral translation and rotation in normal knees.

• Positional MRI shows a different pattern of tibiofemoral alignment in the unaffected knee of ACL tear patients compared to normal control knees.

• Positional MRI shows a high prevalence of abnormal tibiofemoral alignment in injured knees, which is more frequent and pronounced in ACL-tear knees than in ACL-intact injured knees.

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Abbreviations

3D:

Three-dimensional

ACL:

Anterior cruciate ligament

ANOVA:

Analysis of variance

FOV:

Field of view

ICC:

Intraclass correlation coefficient

MRI:

Magnetic resonance imaging

NSA:

Number of signal averages

ROC:

Receiver operating characteristic

SPSS:

Statistical Product and Service Solutions

TE:

Time to echo

TR:

Repetition time

VISTA:

Volume isotropic turbo-spin echo acquisition

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China

    James F. Griffith, Cynthia T. P. Leung, Jeremiah C. H. Lee & David K. W. Yeung

  2. Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China

    Jason C. S. Leung

  3. Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China

    Patrick S. H. Yung

Authors
  1. James F. Griffith
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  2. Cynthia T. P. Leung
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  3. Jeremiah C. H. Lee
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  4. Jason C. S. Leung
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  5. David K. W. Yeung
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Corresponding author

Correspondence to James F. Griffith.

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Guarantor

The scientific guarantor of this publication is Prof James F Griffith

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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• prospective

• case-control study

• performed at one institution

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Griffith, J.F., Leung, C.T.P., Lee, J.C.H. et al. Positional MR imaging of normal and injured knees. Eur Radiol 33, 1553–1564 (2023). https://doi.org/10.1007/s00330-022-09198-0

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  • DOI: https://doi.org/10.1007/s00330-022-09198-0

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