Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(04): 505-509
DOI: 10.1055/s-0042-1755253
Original Article

Lateral Femoral Condyle CRATER sign of BRIK an Ancillary Sign of Lateral Patellar Dislocation

Karthikeyan P. Iyengar 
1   Departments of Orthopedics, Southport and Ormskirk NHS trust, Southport, United Kingdom
,
Kanaka Durga Prasad Bhamidipaty
2   Departments of Radiology, GITAM Institute of Medical Sciences & Research (GIMSR), Vizag, India
,
Rajesh Botchu
3   Departments of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Acute lateral patellar dislocation is a common knee injury pattern. However, coincidental osseous defect may be present in normal knees.

Purpose Evaluate the characteristics of osseous bone defect and describe a new ancillary sign associated with lateral patellar dislocation.

Materials and Methods Magnetic resonance imaging (MRI) of 50 consecutive patients referred following a traumatic lateral patellar dislocation of the knee joint and 50 patients with knee pain without MR features of patellar dislocation were obtained for evaluation over a 7-year period. They were analyzed for location of bony defects in the periarticular region.

Results Of the 50 patients who underwent MRI following a reduced traumatic lateral patellar dislocation, 3 patients had an osseous “crater” of more than 2 mm in depth on the non-articular surface of the lateral femoral condyle. None of control group of patients had an osseous defect measuring more than 2 mm in depth.

Conclusion This associated finding of an osseous “crater” of more than 2 mm on the non-articular surface of the lateral femoral condyle following traumatic lateral patellar dislocation is a rare occurrence. We highlight this as an ancillary sign of lateral patellar dislocation necessitating careful evaluation (Crater sign of Bhamidipaty Rajesh Iyengar Kartik [BRIK]). The presence of lateral femoral condyle “CRATER” sign of BRIK on MRI undertaken for other reasons in the knee, in the absence of osseous edema may suggest a past episode of severe, reduced patellar dislocation.

Keywords

knee joint - knee injuries - patellar dislocation - radiology - magnetic resonance imaging


Publication History

Article published online:
30 August 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Guerrero P, Li X, Patel K, Brown M, Busconi B. Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 2009; 1 (01) 17
    CrossrefPubMedSearch in Google Scholar
  • 2 Grelsamer RP, Klein JR. The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther 1998; 28 (05) 286-298
    CrossrefPubMedSearch in Google Scholar
  • 3 Stefancin JJ, Parker RD. First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 2007; 455 (455) 93-101
    CrossrefPubMedSearch in Google Scholar
  • 4 Krebs C, Tranovich M, Andrews K, Ebraheim N. The medial patellofemoral ligament: Review of the literature. J Orthop 2018; 15 (02) 596-599
    CrossrefPubMedSearch in Google Scholar
  • 5 Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26 (01) 59-65
    CrossrefPubMedSearch in Google Scholar
  • 6 Placella G, Tei M, Sebastiani E. et al. Anatomy of the medial patello-femoral ligament: a systematic review of the last 20 years literature. Musculoskelet Surg 2015; 99 (02) 93-103
    CrossrefPubMedSearch in Google Scholar
  • 7 Lowe M, Meta M, Tetsworth K. Irreducible lateral dislocation of patella with rotation. J Surg Case Rep 2012; 2012 (03) 10
    CrossrefPubMedSearch in Google Scholar
  • 8 Johnson DS, Turner PG. Management of the first-time lateral patellar dislocation. Knee 2019; 26 (06) 1161-1165
    CrossrefPubMedSearch in Google Scholar
  • 9 Duthon VB. Acute traumatic patellar dislocation. Orthop Traumatol Surg Res 2015; 101 (1, Suppl) S59-S67
    CrossrefPubMedSearch in Google Scholar
  • 10 Rund JM, Hinckel BB, Sherman SL. Acute patellofemoral dislocation: controversial decision-making. Curr Rev Musculoskelet Med 2021; 14 (01) 82-87
    CrossrefPubMedSearch in Google Scholar
  • 11 Pope Jr TL. MR imaging of patellar dislocation and relocation. Semin Ultrasound CT MR 2001; 22 (04) 371-382
    CrossrefPubMedSearch in Google Scholar
  • 12 Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 2002; 225 (03) 736-743
    CrossrefPubMedSearch in Google Scholar
  • 13 Earhart C, Patel DB, White EA, Gottsegen CJ, Forrester DM, Matcuk Jr GR. Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options. Emerg Radiol 2013; 20 (01) 11-23
    CrossrefPubMedSearch in Google Scholar
  • 14 Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF. Transient lateral patellar dislocation: diagnosis with MR imaging. Am J Roentgenol 1993; 161 (01) 109-113
    CrossrefPubMedSearch in Google Scholar
  • 15 Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 2010; 30 (04) 961-981 Erratum in: Radiographics. 2011 Mar-Apr;31(2):624
    CrossrefPubMedSearch in Google Scholar
  • 16 Lodewijks PCAM, Delawi D, Bollen TL, Dijkhuis GR, Wolterbeek N, Zijl JAC. The lateral femoral notch sign: a reliable diagnostic measurement in acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2019; 27 (02) 659-664
    CrossrefPubMedSearch in Google Scholar
  • 17 Pao DG. The lateral femoral notch sign. Radiology 2001; 219 (03) 800-801
    CrossrefPubMedSearch in Google Scholar
  • 18 Saad A, Almeer G, Azzopardi C, Gupta H, Botchu R. New secondary sign of ACL tear – the medial femoral notch sign (Gupta-Botchu sign) . Indian J Med Sci 2021; 73 (01) 124-126
    CrossrefSearch in Google Scholar
  • 19 Kransdorf MJ, Peterson JJ, Bancroft LW. MR imaging of the knee: incidental osseous lesions. Magn Reson Imaging Clin N Am 2007; 15 (01) 13-24
    CrossrefPubMedSearch in Google Scholar
  • 20 Longo UG, Ciuffreda M, Locher J, Berton A, Salvatore G, Denaro V. Treatment of primary acute patellar dislocation: systematic review and quantitative synthesis of the literature. Clin J Sport Med 2017; 27 (06) 511-523
    CrossrefPubMedSearch in Google Scholar
  • 21 Nakagawa S, Arai Y, Inoue H. et al. Two patients with osteochondral injury of the weight-bearing portion of the lateral femoral condyle associated with lateral dislocation of the patella. Case Rep Orthop 2014; 2014: 876410
    CrossrefPubMedSearch in Google Scholar
  • 22 Jain NP, Khan N, Fithian DC. A treatment algorithm for primary patellar dislocations. Sports Health 2011; 3 (02) 170-174
    CrossrefPubMedSearch in Google Scholar
  • 23 Kapur S, Wissman RD, Robertson M, Verma S, Kreeger MC, Oostveen RJ. Acute knee dislocation: review of an elusive entity. Curr Probl Diagn Radiol 2009; 38 (06) 237-250
    CrossrefPubMedSearch in Google Scholar
  • 24 Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 2011; 19 (01) 8-16
    CrossrefPubMedSearch in Google Scholar
  • 25 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
    CrossrefPubMedSearch in Google Scholar
  • 26 Batailler C, Neyret P. Trochlear dysplasia: imaging and treatment options. EFORT Open Rev 2018; 3 (05) 240-247
    CrossrefPubMedSearch in Google Scholar