Cruciate and Posterolateral Corner Injuries in the Athlete: Clinical and Magnetic Resonance Imaging Features

With an increasing number of people participating in recreational and competitive sporting activities, sports-related injuries of the knee and knee ligaments have increased in incidence. The extent and severity of such injuries may have important impliations with regard to potential return to atheletic pursuits as well as impacting upon activities of daily life. This article discusses the MR imaging and clinical features of sports-related injuries of the cruciate ligaments and posterolateral corner of the knee, highlighting the implications of such injuries on joint function. MR imaging has the potential to accurately identify these ligamentous injuries, as well as other potential associated combined injuries of the knee, with information from MR imaging examination assisting in decision-making and planning with regard to potential clinical and/or surgical patient management.

KEYWORDS

Knee - sports - injury - MR imaging - anterior cruciate ligament - posterior cruciate ligament - posterolateral corner

REFERENCES

• 1 Girgis F G, Marshall J L, Manajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis.  Clin Orthop. 1975;  106 216-231
• 2 Arnoczky S P, Warren R F. Anatomy of the cruciate ligaments. In: Feagin JA Jr The Crucial Ligaments. New York; Churchill Livingstone 1994: 269-288
• 3 Arnoczky S P, Matyas J R, Buckwalter J A, Ameil D. Anatomy of the anterior cruciate ligament. In: Jackson DW The Anterior Cruciate Ligament: Current and Future Concepts. New York; Raven Press 1993: 5-22
• 4 Stoller D W, Cannon Jr W D, Anderson L J. The knee. In: Stoller DW Magnetic Resonance Imaging in Orthopedics and Sports Medicine. 2nd ed. Philadelphia, PA; Lippincott-Raven 1997: 203-442
• 5 Hodler J, Haghighi P, Trudell D, Resnick D. The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens.  AJR Am J Roengenol. 1992;  159 357-360
• 6 Resnick D, Kang H S. The knee. In: Resnick D, Kang HS Internal Derangements of Joints: Emphasis on MR Imaging. Philadelphia, PA; WB Saunders 1997: 555-785
• 7 Boden B, Dean G, Feagin Jr J A, Garrett Jr W E. Mechanisms of anterior cruciate ligament injury.  Orthopedics. 2000;  23 573-578
• 8 Griffin L Y, Albohm M J, Arendt E A et al.. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.  J Am Acad Orthop Surg. 2000;  8 141-150
• 9 Howe J, Johnson R J. Knee injuries in skiing.  Clin Sports Med. 1982;  1 277-288
• 10 Ho C P, Marks P H, Steadman R J. MR imaging of knee anterior cruciate ligament and associated injuries in skiers.  Magn Reson Imaging Clin N Am. 1999;  7 117-130
• 11 Kirkendall D T, Garrett Jr W E. The anterior cruciate ligament enigma. Injury mechanisms and prevention.  Clin Orthop. 2000;  372 64-68
• 12 Fithian D C, Paxton L W, Goltz D H. Fate of the anterior cruciate ligament-injured knee.  Orthop Clin North Am. 2002;  33 621-636
• 13 Binfield P M, Maffulli N, King J B. Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes.  Injury. 1993;  24 557-561
• 14 Traina S M, Bromberg D M. ACL injury patterns in women.  Orthopedics. 1997;  20 545-549
• 15 Arendt E D. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of the literature.  Am J Sports Med. 1995;  23 694-701
• 16 Wojtys E M, Huston L J, Boynton M D, Spindler K P, Lindenfeld T N. The effect of the menstrual cycle on anterior cruciate ligament injuries in women as determined by hormone levels.  Am J Sports Med. 2002;  30 182-188
• 17 Bomberg B C, McGinty J B. Acute hemarthrosis of the knee: indications for diagnostic arthroscopy.  Arthroscopy. 1990;  6 221-225
• 18 Maffulli N, Binfield P M, King J B et al.. Acute hemarthrosis of the knee in athletes. A prospective study of 106 cases.  J Bone Joint Surg Br. 1993;  75 945-949
• 19 Noyes F R, Bassett R W, Grood E S et al.. Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries.  J Bone Joint Surg Am. 1980;  62 687-695
• 20 Daniel D M, Stone M L. Diagnosis of knee ligament injury: tests and measurement of knee motion limits. In: Feagin JA Jr The Crucial Ligaments. New York; Churchill Livingstone 1994: 269-288
• 21 Liu S H, Osti L, Henry M, Bocchi L. The diagnosis of acute complete tears of the anterior cruciate ligament: comparison of MRI, arthrometry, and clinical examination.  J Bone Joint Surg Br. 1995;  77 586-588
• 22 Johnson D L, Warner J J. Diagnosis for ACL surgery.  Clin Sports Med. 1993;  12 671-684
• 23 Noyes F R, Mooar P A, Matthews D S, Butler D L. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals.  J Bone Joint Surg Am. 1983;  65 154-162
• 24 Lerman J E, Gray D S, Schweitzer M E, Bartolozzi A. MR evaluation of the anterior cruciate ligament: value of axial images.  J Comput Assist Tomogr. 1995;  19 604-607
• 25 Fitzgerald S W, Remer E M, Friedman H, Rogers L F, Hendrix R W, Schafer M F. MR evaluation of the anterior cruciate ligament: value of supplementing sagittal images with coronal and axial images.  AJR Am J Roengenol. 1993;  160 1233-1237
• 26 Remer E M, Fitzgerald S W, Friedman H, Rogers L F, Hendrix R W, Schafer M F. Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury.  Radiographics. 1992;  12 901-915
• 27 Mink J H, Levy T, Crues III J V. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation.  Radiology. 1988;  167 769-774
• 28 Lee J K, Yao L, Phelps C T, Wirth C R, Czajka J, Lozman J. Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests.  Radiology. 1988;  166 861-8614
• 29 Vahey T N, Meyer S F, Shelbourne K D, Klootwyk T E. MR imaging of anterior cruciate ligament injuries.  Magn Reson Imaging Clin N Am. 1994;  2 365-380
• 30 Tung G A, Davis L M, Wiggins M E, Fadale P D. Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging.  Radiology. 1993;  188 661-667
• 31 Leach W J, King J B. Posterior reattachment of the torn anterior cruciate ligament.  J Bone Joint Surg Br. 1994;  76 159-160
• 32 Vahey T N, Broome D R, Kayes K J, Shelbourne K D. Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging.  Radiology. 1991;  181 251-253
• 33 Murphy B J, Smith R L, Uribe J W, Janecki C J, Hechtman K S, Mangasarian R A. Bone signal abnormalities in the posterolateral tibia and lateral femoral condyle in complete tears of the anterior cruciate ligament: a specific sign?.  Radiology. 1992;  182 221-224
• 34 Kaplan P A, Walker C W, Kilcoyne R F, Brown D E, Tusek D, Dussault R G. Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging.  Radiology. 1992;  183 835-838
• 35 Kaplan P A, Gehl R H, Dussault R G, Anderson M W, Diduch D R. Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging.  Radiology. 1999;  211 747-753
• 36 Snearly W N, Kaplan P A, Dussault R G. Lateral-compartment bone contusions in adolescents with intact anterior cruciate ligaments.  Radiology. 1996;  198 205-208
• 37 Yao L, Lee J K. Avulsion of the posteromedial tibial plateau by the semimembranosus tendon: diagnosis with MR imaging.  Radiology. 1989;  172 513-514
• 38 Chan K K, Resnick D, Goodwin D, Seeger L L. Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging.  Radiology. 1999;  211 754-758
• 39 Andrish J T. Anterior cruciate ligament injuries in the skeletally immature patient.  Am J Orthop. 2001;  30 103-110
• 40 Robertson P L, Schweitzer M E, Bartolozzi A R, Ugoni A. Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging.  Radiology. 1994;  193 829-834
• 41 Gentili A, Seeger L L, Yao L, Do H M. Anterior cruciate ligament tear: indirect signs at MR imaging.  Radiology. 1994;  193 835-840
• 42 McCauley T R, Moses M, Kier R, Lynch J K, Barton J W, Jokl P. MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings.  AJR Am J Roengenol. 1994;  162 115-119
• 43 Schweitzer M E, Cervilla V, Kursunoglu-Brahme S, Resnick D. The PCL line: an indirect sign of anterior cruciate ligament injury.  Clin Imaging. 1992;  16 43-48
• 44 Daniel D M, Fritschy D. Anterior cruciate ligament injuries. In: DeLee JC, Drez D Jr Orthopedic Sports Medicine: Principles and Practice. Philadelphia, PA; WB Saunders 1994: 1313
• 45 Noyes F R, Mooar L A, Moorman C T, McGinniss G H. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency.  J Bone Joint Surg Br. 1989;  71 825-833
• 46 Umans H, Wimpfheimer O, Haramati N, Applbaum Y H, Adler M, Bosco J. Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging.  AJR Am J Roengenol. 1995;  165 893-897
• 47 Yao L, Gentili A, Petrus L, Lee J K. Partial ACL rupture: an MR diagnosis?.  Skeletal Radiol. 1995;  24 247-251
• 48 Roychowdhury S, Fitzgerald S W, Sonin A H, Peduto A J, Miller F H, Hoff F L. Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images.  AJR Am J Roengenol. 1997;  168 1487-1491
• 49 Daniel D M. Selecting patients for ACL Surgery. In: Jackson DW The Anterior Cruciate Ligament: Current and Future Concepts. New York; Raven Press 1993: 251-258
• 50 Fu F H, Bennett C H, Ma C B, Menetrey J, Lattermann C. Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations.  Am J Sports Med. 2000;  28 124-130
• 51 Lo I K, Kirkley A, Fowler P J, Miniaci A. The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child.  Arthroscopy. 1997;  13 627-634
• 52 Khan A S, Sherman O H, DeLay B. Thermal treatment of anterior cruciate ligament injury and laxity with its imaging characteristics.  Clin Sports Med. 2002;  21 701-711
• 53 Harner C D, Baek G H, Vogrin T M, Carlin G J, Kashiwaguchi S, Woo S L. Quantitative analysis of human cruciate ligament insertions.  Arthroscopy. 1999;  15 741-749
• 54 Harner C D, Xerogeanes J W, Livesay G A et al.. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation.  Am J Sports Med. 1995;  23 736-745
• 55 Grood E S, Stowers S F, Noyes F R. Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures.  J Bone Joint Surg Am. 1988;  70 88-97
• 56 Gollehon D L, Torzilli P A, Warren R F. The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study.  J Bone Joint Surg Am. 1987;  69 233-242
• 57 Margheritini F, Rihn J, Musahl V, Mariani P P, Harner C. Posterior cruciate ligament injuries in the athlete: an anatomical, biomechanical and clinical review.  Sports Med. 2002;  32 393-408
• 58 Fowler P J, Messieh S S. Isolated posterior cruciate ligament injuries in athletes.  Am J Sports Med. 1987;  15 553-557
• 59 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients: Part II.  Arthroscopy. 1995;  11 526-529
• 60 Covey C D, Sapega A A. Injuries of the posterior cruciate ligament.  J Bone Joint Surg Am. 1993;  75 1376-1386
• 61 Grover J S, Bassett L W, Gross M L, Seeger L L, Finerman G A. Posterior cruciate ligament: MR imaging.  Radiology. 1990;  174 527-530
• 62 Hunter J C, Chapman J R. Isolated avulsion of the posterior cruciate ligament: an uncommon dashboard injury.  AJR Am J Roengenol. 1995;  164 1190
• 63 Sonin A H, Fitzgerald S W, Friedman H, Hoff F L, Hendrix R W, Rogers L F. Posterior cruciate ligament injury: MR imaging diagnosis and patterns of injury.  Radiology. 1994;  190 455-458
• 64 Potter H G. The dislocated knee: imaging of the multiple-ligament injured knee.  Clin Sports Med. 2000;  19 425-441
• 65 Miller M D, Johnson D L, Harner C D, Fu F H. Posterior cruciate ligament injuries.  Orthop Rev. 1993;  22 1201-1210
• 66 Parolie J M, Bergfeld J A. Long-term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete.  Am J Sports Med. 1986;  14 35-38
• 67 Cosgara A J, Jay P R. Posterior cruciate ligament injuries: evaluation and management.  J Am Acad Orthop Surg. 2001;  9 297-307
• 68 Bergfeld J A, McAllister D R, Parker R D, Valdevit A D, Kambic H E. A biomechanical comparison of posterior cruciate ligament reconstruction techniques.  Am J Sports Med. 2001;  29 129-136
• 69 Veltri D M, Deng X H, Torzilli P A, Warren R F, Maynard M J. The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study.  Am J Sports Med. 1995;  23 436-443
• 70 LaPrade R F, Terry G C. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability.  Am J Sports Med. 1997;  25 433-438
• 71 Hughston J C, Jacobson K E. Chronic posterolateral rotatory instability of the knee.  J Bone Joint Surg Am. 1985;  67 351-359
• 72 Baker C L, Norwood L A, Hughston J C. Acute combined posterior cruciate and posterolateral instability of the knee.  Am J Sports Med. 1984;  12 204-208
• 73 Yu J S, Salonen D C, Hodler J, Haghighi P, Trudell D, Resnick D. Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique.  Radiology. 1996;  198 199-204
• 74 Miller T T, Gladden P, Staron R B, Henry J H, Feldman F. Posterolateral stabilizers of the knee: anatomy and injuries assessed with MR imaging.  AJR Am J Roengenol. 1997;  169 1641-1647
• 75 Juhng S K, Lee J K, Choi S S, Yoon K H, Roh B S, Won J J. MR evaluation of the “arcuate” sign of posterolateral knee instability.  AJR Am J Roengenol. 2002;  178 583-588
• 76 Andrews J R, Baker C L, Curl W W, Clancy W G. Surgical repair of acute and chronic lesions of the lateral capsular ligamentous complex of the knee. In: Feagin JA Jr The Crucial Ligaments. New York; Churchill Livingstone 1994: 605-622