Diagnostic Accuracy of Ultrasonography in the Evaluation of Knee Joint Injuries Compared to Magnetic Resonance Imaging and Arthroscopy

The aim is to calculate sensitivity, specificity and diagnostic accuracy of Ultrasonography (USG) as a screening modality in evaluation of Menisco- Ligamentous injuries of knee joint with Magnetic Resonance Imaging (MRI)as gold standard for comparison.Patients with clinically suspected Menisco-Ligamentous injurieswere evaluated by USG initially followed by MRI on the same day. A total of 60 patients (50 males, 10 females) underwent USG and MRI. USG was done using high frequency probe (9-14 Hz) and all the injuries noted. USG of the normal knee was done for comparison. MRI with trauma protocol sequences was done on the same day. The accuracy of USG and MRI in diagnosis of menisco-ligamentous injuries was compared. Majority of the patients (50%) belonged to age group of 21-40 years. Most common injuries seen were medial meniscal tear followed by medial collateral ligament injury. The strength of agreement between USG and MRI was good with Diagnostic accuracy of USG ranging from 83.3% to 95% for different meniscal/ligamentous injuries.USG is an effective imaging modality with high accuracy in diagnosing menisco-ligamentous injuries. USG can act as an effective screening modality in closed knee trauma for evaluation of menisco- ligamentous injuries especially in resource constrained regions owing to its easy availability, portability and lower cost. MRI can be reserved for patients with suspicious USG and clinical findings.

Introduction: The knee joint is the largest joint in the human body, with complex intrinsic tissues involving ligaments and meniscal structures crucial for stability and mobility. MRI has multiple advantages over other imaging modalities in assessing traumatic knee injuries due to its specific and clear soft tissue resolution and ability to capture images from multiple planes. This study aims to evaluate traumatic knee injuries using MRI. Material and Methods: 100 patients with history of knee injuries referred to department of Radiodiagnosis, Krishna Vishwa Vidyapeeth, Karad for MRI knee. MRI images are studied to look for injuries to the cruciate, menisci ligaments, collateral ligaments, tendons around the knee joint, fluid collections, bony contusions and soft tissue injuries. Machine: Siemens Magnetom Avanto (Tim + Dot) 1.5 Tesla. Results: Out of all the studied subjects, more than 3/4th were males and more than 50 % cases involving right knee joint. 81% of the patients were young (age group 21 to 40 years) who suffered knee injuries. ACL injury is most common injury and Medial menisci injury being the second. Conclusion: MRI has significant importance in diagnosing internal knee derangements, detecting patterns like bone marrow edema and occult fractures. It provides detailed evaluation of external and internal structures including osseous and non-osseous structures. In the present study, comparisons between MRI findings and clinical tests for ACL tear, PCL tear, MCL tear, LCL tear, medial meniscus tear, and lateral meniscus tear all showed significant associations, with each tear having a p-value <0.01. This underscores the strong correlation between MRI diagnostics and clinical examination in identifying these knee injuries accurately.

One of the most frequent issues humans have had to deal with from the beginning of time is a knee injury. Knee injuries caused by a variety of diseases, from acute to degenerative, can affect the articular cartilage. The trauma, infection, or inflammation caused this injury. In these circumstances, a full clinical examination is not possible since the patients are in too much pain to cooperate. Then non-invasive multiplanar imaging and MRI come into play. The objective of the current study was to assess knee joint injuries using MRI and correlate those findings with arthroscopy. A total number of 225 participants were involved in this study, among them, 175 had issues with a knee injury. The patients referred with a history of knee injury were imaged with a 1.5 Tesla MRI machine. Most patients were between the ages of 35-40 years. The most frequent injuries found in the study were bone contusions, joint effusions, anterior cruciate ligament tears, and tears of the posterior horn of the medial meniscus. The accuracy percentage of ACL, PCL, LCL and MCL were 93, 100, 94.02 and 91.34%, respectively. Due to its great soft tissue contrast resolution and multiplanar imaging capabilities, magnetic resonance imaging (MRI) is a superior non-invasive investigative method for knee injuries. This allows for the most thorough evaluation of a variety of soft tissue knee joint problems. Keywords: Knee joint injury; Magnetic resonance imaging; Arthroscopy;

Objective: To describe the MRI characteristics of traumatic lesions and to identify common knee joint lesions.Study Design: Cross sectional studyPlace and Duration of Study: This study was conducted at the Radiology Department of Kuwait Teaching Hospital between 1 July 2023 - 30st June 2024.Methods: The study was performed on 160 consecutively registered patients. It is a cross sectional descriptive study. Patients 16 yrs. and above with traumatic knee injury were included in this study. Non cooperative patients, those who have undergone prior surgical procedures, periarticular tumors or infections and contraindications to MRI were excluded from the study.Results: We analyzed MRI scans of total of 160 patients with knee joint injuries. The age of patient was grouped in clusters of 10 years. Majority of the patients (35%) were found in 26-35 years’ age group. Out of total 160 patients; majority of them were male comprising 126 patients and 34 were female. They underwent MR imaging within 6 months of their injury. Right knee was involved in 55% and left knee in 45% cases. Among cruciate ligaments partial tear of ACL was most commonly seen. In one-third of our cases bone contusions were present.Conclusion: Based on the current study's data, it can be said that MRI is the most effective method for evaluating internal knee joint derangement after injury. The most common findings were anterior cruciate ligament tears, medial meniscal tears, and joint effusions.

Introduction: Knee joint is one of the most commonly injured joints, as an isolated injury or a frequent component in a multiple trauma patient. Knee joint injury is a significant cause of morbidity in young and active individuals especially amongst sports person, laborers, soldiers and military recruits. Multiple imaging modalities are currently being used to evaluate various pathological conditions of the knee including conventional radiography, CT scan, sonography , nuclear medicine and MR Imaging. Multi planar imaging and excellent soft tissue contrast has made the MRI an ideal modality for imaging of complex anatomy of knee joint in trauma patient. Objective: To study the diagnostic accuracy & efficacy of MRI in evaluation of internal derangement of knee joint in trauma patient. Material & Method: 44 cases with history of trauma were evaluated by Siemens magnetom vision plus 1.5 tesla MRI machine. Results: Mean age of patient - 32.2 years. Count of male patients exceeded the count of female patients. ACL injury was observed in 81.8%, PCL injury in 6.8%, MCl in 11.3%, LCL in 2.3%, medial meniscal tear in 45.5%, joint effusion in 95%. Conclusion: MRI emerged as a front line investigation for the assessment of internal derangement of knee joint in trauma patient.

Introduction and Aim: Physical activity is one of the main risk factors for knee joint injuries, and the risk depends on the specific sport. Each part of the knee joint can be at different risk of injury. Diagnosis, treatment and rehabilitation are key to returning to full mobility, but vary depending on the type of injury. The purpose of this article is to present risk factors, diagnosis, treatment and prognosis in the most common knee joint injuries. Review Methods: 35 studies from PubMed and Google Scholar were analyzed to examine the relationship between physical activity and knee joint injuries. Joint anatomy, diagnosis, treatment and rehabilitation in the context of amateur and professional sports were considered. State of Knowledge: Knee joint injuries often result from sudden movements. ACL rupture is the most common injury, often non-contact. Diagnosis is based on history and imaging studies, such as magnetic resonance imaging (MRI) to evaluate soft structures and X-rays for bone injuries. Treatment depends on the type of injury: in mild cases rehabilitation is sufficient, in more serious cases surgery. Summary: Physical activity is a major risk factor for knee injuries, and the most common injury is an ACL injury. The risk depends on the mechanism of injury, age, weight and previous injuries. It is crucial to take a history, do a physical examination and perform imaging to make a diagnosis. Proper diagnosis allows for the selection of the appropriate treatment and rehabilitation method, which affects the patient's prognosis and return to full physical activity.

There are several common findings and contradictions noted in the research related to thigh muscle reflex inhibition and sequelae that occur with knee joint injury. Reflex inhibition may be measured directly by electromyography, or the sequelae of reflex inhibition may be measured, as commonly occurs in the clinic setting. Electromyography is useful in determining the causes of reflex inhibition. The most frequently cited causes of thigh muscle reflex inhibition in knee injury are pain, joint effusion and knee immobilisation. The other measurement methods described vary from thigh circumference measurement to muscle biopsy. These methods are useful in determining the magnitude and duration of the deleterious sequelae that affect the thigh muscles after reflex inhibition. Finally, there is selectivity of reflex inhibition after knee joint injury: the quadriceps versus the hamstrings, the different components of the quadriceps muscle group, and the different types of muscle fibres. In light of these findings, several suggestions have been offered for prevention of reflex inhibition and for techniques that can be applied to rehabilitate the most affected muscle group: the quadriceps femoris. Techniques used to prevent or limit the amount of reflex inhibition include cryotherapy, transcutaneous electrical nerve stimulation, iontophoresis, phonophoresis, joint mobilisation, rest and proper positioning of the knee in rest and exercise. Electromyostimulation, electromyographic biofeedback and traditional exercise training are 3 methods used to rehabilitate the quadriceps.

KeywordsAnterior cruciate ligament; Tear; Meniscus; Rupture; PatternsIntroductionAnterior cruciate ligament (ACL), as a primary stabilizing structure of knee is the most common disrupted ligament in acute trauma in the US every year [1,2]. On the other hand, the menisci play a crucial role in the dynamics of the knee. Their shape, attachment, and material properties contribute substantially to joint alignment and load transmission by distributing both tensile and compressive forces. Damage to the menisci can influence proprioception, stability, and mobility of the knee [3,4]. Risk factors for meniscal tears include prolonged or repeated deep knee bending, obesity, and sports [5]. Acute injury, as seen in alpine sports, involves complex dynamics, which can damage singular or multiple tissue structures of the knee [5,6]. Meniscal tears are typically thought to be initiated by coupled compression and twisting movements [7,8] which can accompany high-energy maneuvers such as cutting, jumping, and landing during sporting events [9].Meniscal injuries commonly occur in conjunction with ACL tears. A numerous studies have examined the occurrence of these injuries, with their presence being reported as 16% to 82% in knees with acute ligament tears and as high as 96% in knees with chronic ligament tears [10-14]. Magnetic resonance imaging (MRI) is valuable tool, preferred than diagnostic arthroscopy in most patients with ligamentous and meniscal tears because it avoids the surgical risks of arthroscopy, with better accuracy in medial and lateral meniscus and ACL [15].Lateral meniscal tears (LMTs) occur slightly more frequently than medial meniscal tears (MMTs) in knees with acute ACL injuries, 56% lateral versus 44% medial. [10,12]. MMTs however, are more common in chronic ACL deficiency [10,12,14]. This difference in tear occurrence is usually attributed to the anatomic and functional differences that exist between the two menisci, especially in the ACL deficient knee, the lateral meniscus relatively loosely attached to the tibial plateau which allows it to be quite mobile, whereas the medial meniscus, is firmly attached to the tibia, especially at the posterior horn [12,16,17]. This firm attachment allows the medial meniscus to act as a knee stabilizer, a significant restraint to anterior tibial translation in the ACL deficient knee [18-21]. The loss of ACL function increases tibial translation, allowing the meniscus to “engage” the femoral condyle and act as a wedge against the tibia [22,23], while others have suggested that mechanical trauma causes the MMTs in this setting [12,18,20]. Several studies have explored the relationship between ACL injury and meniscal tear [24-30]. Some showed preponderance of the LMTs in the acute setting and in osteoarthritis [24,25], others suggested the MMTs especially in acute reconstructions [26-29].This study was conducted to determine the patterns of meniscus damage associated with ACL rupture and identify the commonest type of meniscus damage in our population that is associated with ACL tear.MethodsMedical records of patients with ACL rupture covering a period of 16 years (January 1996 to December 2012) seen at the author’s institute were retrospectively reviewed. The collected data included the presence or absence of meniscal tear, the type of meniscal tear diagnosed by MRI or arthroscopy, the time of the initial ACL injury and the time of meniscal tear, the duration between ACL rupture and reconstruction surgery, age, gender, mode of injury and level of sports activity performed, height, weight.BMI is calculated according to the Patient’s height and weight, patient is considered obese if the BMI is above 30 according to the World Health Organization [31].Sports level was classified as: professional athletes: (practicing a sport activity as a job, e.g. member of a team), recreational Athlete (considered a person, who is practicing a sport activity that is involving running and pivotal movements at least once in a week not professionally), non athlete (a person who is not practicing any kind of sport), patients with no clear statement regarding their level of sport are considered as missing data.Mode of Injury is classified as direct (Injury was caused be a direct trauma to the patent, e.g. hit by another player, felt on his knees or road traffic accident) or non direct (Injury was caused without trauma, e.g. over rotating the knee while exercising).Patients who were diagnosed with ACL rupture using MRI within 3 months of the injury, underwent primary arthroscopic ACL reconstruction at our institution and found to have meniscal damage diagnosed by MRI or arthroscopy were included in the study. Patients who had a chronic ACL tear or had undergone prior ipsilateral knee arthroscopy or surgery, those with osteoarthritis, with rheumatoid arthritis and patients who had undergone ACL rupture revision were excluded from the study. All images were obtained by routine knee MRI.Types of Meniscal Tears were obtained from the reports of the MRI and Arthroscopy and were classified as (longitudinal, Degenerative, flap, radial, complex) as according to Tandogan et al. [32], De Smet [33].Data collected were entered and coded systematically into a Microsoft Excel worksheet and were imported to a Predictive analysis software (PASW) program version 18 (SPSS, IBM, Chicago, Illinois, USA). Oneway analysis of variation (ANOVA) was used to compare means between the three groups (LMTs, MMTs and both). Pearson correlation was conducted to determine the relationship between the outcome variables (age, gender and sport levels). Independent sample t -test was done to identify differences between the mean values of continuous variables. Chi square test was done to determine associations between categorical variables. A test result considered statistically significant if p< 0.05.ResultsA total of 294 patients satisfied the inclusion criteria of the current study from 1996 to 2012. Of these patients, 175 (59.5%) had MMTs, 91 (31%) had LMTs and 28 patients (9.5%) with both MMT and LMT (Table 1).Table 1: Demographic characteristics of all patients with ACL rupture with meniscus injury. Variables Age in years, mean (SD)27.98 (6.8)Weight in kg, mean (SD)80.80 (17.1)Height in cm, mean (SD)170.73 (7.7)BMI in kg/cm2, mean (SD)27.68 (5.6)Mode of injury Direct injury, n (%)125 (42.5)Non-direct injury, n (%)169 (57.4)Sports level Professional athletes, n (%)5 (1.7)Recreational athletes, n (%)196 (66.7)Non-athlete, n (%)28 (9.5)No available data, n (%)65 (22.1) Patients who had MMTs were significantly older (29.10 ± 7.0 years) compared to lateral (26.24 ± 5.9 years) and both (26.61 ± 6.7 years), p=0.002. There were no significant differences in the height, weight, and BMI, level of sport and mode of injury in between the three groups (MMTs, LMTs and both) (Table 2). Types of meniscal tears are shown in Table 3.Table 2: Comparison between MMT, LMT and both in 294 patients who hadACL tear. VariablesMMTn=175LMTn=91Bothn=28 p valuesAge in years, mean (SD)29.10 (7.0)26.24 (5.9)26.61 (6.7)0.002^Weight in kg. mean (SD)82.38 (17.5)79.14 (16.4)76.87 (16.3)0.165^Height in cm, mean (SD)170.40 (8.1)171.42 (6.6)170.49 (8.1)0.602^BMI, mean (SD)28.34 (5.6)26.83 (5.6)26.43 (5.2)0.062^Obesity, n (%)56 (32.0)22 (24.2)7 (25.0)0.294*Type of ACL tear Direct ACL tear, n (%)68 (38.9)32 (35.2)9 (32.1)0.425*Indirect ACL tear, n (%)65 (37.1)30 (33.0)8 (28.6)Level of sports Recreational athlete, n (%)105 (60.0)67 (73.6)22 (78.6)0.144*Professional athlete, n (%)3 (1.7)2 (2.2)1 (3.6)Note: ^ by ANOVA, * by Chi-square test Table 3: Types of meniscal tears by MRI & Arthroscopy. Types of Meniscal TearsMedialLateralTotalLongitudinal Tears152(75%)86(72%)238(74%)Degenerative Tears16(8%)10(8%)26(26%)Radical Tears8(4%)9(7%)17(5%)Complex Tears6(3%)2(2%)8(2.5%)FLAP6(3%)5(4%)11(3.5%)N/A15(7%)7(7%)22(7%)Total203119322DiscussionIn our study, the patients who had medial meniscal tearing were significantly older than those who had only lateral meniscal tear, and those who had both medial and lateral meniscal tears. No such relationship was significant between age and lateral meniscal tear. Our findings are in concordance with the findings of the study that was conducted in Turkey by Tandogan et al. [32], which showed preponderant injury to the medial meniscus than the lateral meniscus, they also found that the mean age of the patients with medial meniscal tears was 27.0 ± 7.6 years, significantly older than those who had no medial meniscal tearing (25.4 ± 6.7 years). Our patient’s mean age who had medial meniscal tearing was 29.10 ± 7.0 years, significantly older than 26.61 ± 6.7 years in those who did not have medial meniscal tearing. Sports level was not significantly correlated to the parameters we have studied or to the site of meniscal tear. This is probably because most of our patients (66.8%) were just recreational athletes.Our study was in contrast to the findings of Bellabarba et al. [10] ,Thompson et al. [12], Melissa [34] wherein they found that LMTs are more frequently encountered than MMTs, and that MMTs on the other hand are more common in chronic injuries. Our study showed more frequent MMTs than LMTs, of patients with acute ACL injuries. Again, this is probably due to the older age of our patients, which was significantly correlated with MMTs.Obesity, Mechanism of injury, Sport level as a risk factors of meniscal tear didn’t show any significance in determining a common pattern, which goes with the same results that was found in Kluczynski et al. [34] where different risk factors have been examined prospectively to see their effect on meniscal tears and chondral changes.The sensitivity of MRI in detecting meniscal pathology has been proven in several studies [10]. However, Oei in 2003 [35] pointed out the low sensitivity of MRI in detecting lateral meniscal pathology compared to detecting medial meniscal pathology with a sensitivity difference by as much as 14% (93.3% versus 79.3%), in an adult population, more so in the presence of ACL tears [36]. This window would probably explain the differences between the frequencies of LMTs and MMTs, more so in our findings, another point which could also explain our findings; is the common presentation of knee varus malalignment in Saudi population. In a comparison study between Saudi Arabian and Canadian cohorts by the same group, it was clearly found that in knee osteoarthritis patients Saudis had more varus alignment, showed by the Hip-Knee-Ankle angle parameter used to diagnose knee alignment disorders [37].A study addressing the Knee alignment in the Saudi Population Comparing the means of Tibiofemoral angle (TFA) of different age groups in Saudi population to those of corresponding age groups in Japanese and Australian Caucasians showed a statistically significant lower TFA difference in all age groups. Comparison of the means of TFA of different age groups in Saudi population to those of corresponding age groups in Japanese and Australian Caucasians showed a statistically significant difference in all age groups, also Comparison of the means of TFA of Saudi males and females to those of Europeans, Chinese and American Caucasians showed a significant difference from all of them [38].Genuvarus can result in added contact stresses on the medial compartment of the knee and possibly lead to accelerated wear and damage to the articular cartilage.Another explanation for the significant association of older age to MMTs is the association of the medial meniscus posterior horn with severity of the chondral lesion and arthritic changes according to the K-L radiographic score. There is usually accompanied chondral damage in MMTs [39].Secondary medial meniscal tears are considered as the main reason of osteoarthritis followed by ACL deficiency [40]. The aim of this study is to alert the surgeons about the existence of this common finding in order to decrease future osteoarthritis. There were a few limitations in the study mainly because of its retrospective nature; a lot of the Patient’s X-rays were not found in order to study the alignment of the knees. In addition we were not able to obtain detailed information about the chondral lesions in the MRI reports to augment our significant findings of MMTs among our older-aged population.ConclusionThe higher occurrence of medial meniscal tear in acute anterior cruciate tears could be attributed to the age related arthritic changes as well as to the common varus deformity in our population; this finding should be considered by the surgeons in order to decrease future osteoarthritis.ReferencesGriffin LY, Agel J, Albohm MJ, Arendt EA, Dick RW, et al. (2000) Noncontact anterior cruciate ligament injuries: Risk factors and prevention strategies. J Am Acad Orthop Surg 8: 141-150. 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Magnetic Resonance Imaging (MRI) is the most commonly used imaging modality in the evaluation of knee injuries. Aim Of Study: Was to demonstrate the diagnostic value of MRI in diagnosing the presence or absence of the most common injuries of the knee; the meniscus tears, the cruciate ligament ruptures and their relation with the age and sex of the patients in taif -hospital Saudi Arabia, and investigate role of the nurse in preparing patient for MRI. Methods: Retrospective study was performed in the period from Sep 2013 to Oct 2014. One hundred and fifty patients' medical records, who presented with various knee joint problems, referred from Orthopedic and Rheumatology Departments in king Abdul Aziz Specialist hospital after physical examination. Moreover, fifteen out of twenty ( 75 %) nurses working at the same above setting were included in the study. Tool Of Study: An observation checklist, for data collection from medical records, in addition , designed questioner for nurses' participated about MRI procedure . Results: The most common age 10-29 y, and male represent 72.7%. Swelling and pain (35.3%) more common Clinical diagnosis, followed by Joint effusion (24.7) , there are statistical significance difference between Clinical diagnosis and MRI finding P=0.00,Also statistical significance difference between MRI finding with age and sex P≤0.05. Most of nurses perform patient preparation before MRI reasonably , but more than half of the nurses have poor performance regarding patient preparation during and after procedure. Conclusion And Recommendation: MRI can accurately diagnose the ligament and meniscal injuries of knee joint, which is an ideal technique in the diagnosis of ligament injuries of knee joint. In service training is essential for all nurses working at KAASH.

BackgroundThe differential effects of various exercises on knee joint injury have not been well documented. Improper physical training can cause irreversible damage to the knee joint. MRI is generally used to precisely analyze morphological and biochemical changes in the knee cartilage. We compared the effects of long-walking and regular daily physical training on acute and chronic knee joint injuries as well as cartilage structure in freshmen students.MethodsA total of 23 young male college freshmen were recruited to participate in an 8-day 240 km long distance walk and a one-year daily training. 3D-DESSwe, 2D T2 mapping, DIXON, and T1WI of the right knee joint were performed using the MAGNETOM Spectra 3T MR scanner. The injury of meniscus, bone marrow edema, ligaments and joint effusion is graded. Cartilage volume, thickness and T2 values of 21 sub-regions of the knee cartilage were estimated using automatic cartilage segmentation prototype software. Friedman’s test and Wilcoxon paired rank-sum test were used to compare quantitative indices of knee cartilage in three groups.ResultsThe injury to the medial meniscus and anterior cruciate ligament of the knee joint, joint effusion, and bone marrow edema was significantly higher in the long-walking group compared to the baseline and daily groups. Furthermore, injury to the lateral meniscus was significantly worse in the long-walking group compared to the baseline group but was significantly better in the daily group compared to the baseline group. No significant changes to the posterior cruciate ligament were observed among the three groups. Knee cartilage volume was significantly increased, mainly in the stress surface of the femur, patella, and the lateral area of the tibial plateau. Regular daily training did not significantly change the thickness of the knee cartilage. Conversely, knee cartilage thickness decreased in the long-walking group, especially in the medial and lateral areas of the femur and tibial plateau. Moreover, no significant changes were observed in the knee cartilage volume of the long-walking group. Both long-walking and daily groups showed reduced T2 values of the knee joint compared to the baseline.ConclusionAmong freshmen students and the training of this experimental intensity, our results show that regular daily training does not cause high-level injury to the knee joint, but improve the knee joint function adaptability by increasing cartilage volume. Moreover, knee injury caused by short-term long walking can be reversible.

The purpose of this prospective study was to examine the prevalence of occult knee injuries in patients with ipsilateral tibial shaft fractures and determine their impact on clinical outcome. Preoperative knee MRI examination was performed in 41 patients (42 knees) with isolated tibial shaft fractures. Menisci, cruciate ligaments, collateral ligaments, extensor mechanism, osteochondral lesions, bone contusions and knee effusion were evaluated. All patients were treated with reamed and locked intra-medullary tibial nailing without an additional surgical procedure for knee injuries. All patients were followed to at least fracture union and were evaluated with knee examination and Lysholm knee score. Of the 42 knees, 41 (97.6 %) showed at least one defined injury around the knee. There was only one patient who had totally normal knee MRI findings. One or more ligamentous injuries of the knee were identified in 35 (83.3 %) of the knees. Five patents (11.9 %) had medial meniscal tear in posterior horn. Extensor mechanism injuries were seen in two patients. Mild to marked joint effusion was observed in 35 (81 %) knees. Twenty-two knees demonstrated bone bruise; femoral condyle (n = 7), tibial plateau (n = 12), patella (n = 2) and fibular head (n = 1). No patients had osteochondral lesion. Patients were followed with a mean of 13.2 ± 3.6 (range 8-22) months. Clinical knee examination revealed Grade II (+) anterior drawer test in two patients. The mean Lysholm knee score was 99.1 ± 2.14 (range 91-100) at the final follow-up. Ipsilateral intra-articular, extra-articular or combined knee injuries may occur at the time of injury with tibial shaft fractures. However, most of these injuries are not clinically relevant and heal without any sequel or remain asymptomatic late after fracture union. Routine use of preoperative knee MRI examination in patients with tibial shaft fractures is not necessary.

Introduction: The knee is a complex joint with numerous components and is susceptible to a wide range of injuries such as sprains, ligament rips, fractures, and dislocations.&#x0D; Objective: To characterize the knee joint injuries in traumatic patients using magnetic resonance imaging (MRI).&#x0D; Materials &amp; Methods: A descriptive study based on retrospective data was conducted within the Radiology Department of Private Hospital Lahore, Pakistan, from September 01, 2021, to January 30, 2022, on 85 patients with knee joint injuries resulting from road traffic accidents and falls from heights. The data were analyzed for descriptive statistics using SPSS version 20.&#x0D; Results: The highest frequency of trauma was in male patients of age group 21 to 30 years. The common knee injuries were Joint Effusion 32(26.2%), Anterior Cruciate Ligament Tear 26(21.3%), and Posterior Horn of Medial &amp; Lateral Meniscal Tear 16(13.1%). The most common cause for trauma was road traffic accidents.&#x0D; Conclusion: Magnetic Resonance Imaging was able to provide high quality images to diagnose knee joint status in patients suffering from traumatic injuries.

To explore the rehabilitation effect of acupuncture on motorcycle athletes’ knee injuries. Firstly, 60 city association motorcycle athletes with knee joint injuries were selected, and the control group and the experimental group were tested and compared by random grouping. The control group received a series of planned rehabilitation training followed by traditional Chinese massage to relax. The experimental group used acupuncture therapy plan for rehabilitation after rehabilitation training. After the control group and the experimental group have completed the test, the data is measured to compare the knee joint function score (Lyholm) grade differences and pain scores at several different time nodes and observe and analyze them. The Lysholm score and pain score of the control group at different time nodes are both Lower than the experimental group, the difference was statistically significant (P<0.05). Data experiments prove that acupuncture therapy is more effective for knee joint injury rehabilitation, and is better than general traditional Chinese massage therapy. For motorcycle athletes’ knee joint injury rehabilitation, acupuncture therapy combined with rehabilitation training can significantly reduce athlete’s knee joint pain, reduce the number of athletes’ injuries, speed up knee joint injury recovery, increase joint mobility, and improve rehabilitation efficacy.

HISTORY -A 40-year old professional mascot, was evaluated by the trainer and presented to the sports medicine clinic 8 days after a right knee injury. The patient was performing an air guitar routine for the home team with an adolescent participant. He jumped in the air and landed on his knees, as is his usual routine. This time, however, he was momentarily distracted and his full weight fell on his right proximal tibia. His pain caused him to limp off of the court. This posterior knee pain persisted but he was able to finish the game. His knee swelled over the next 24 hours. He noted decreased ROM, a “popping & bunching” and pain exacerbated by any axial load. His knee does not lock or catch but he had a sense of giving way and looseness. It had awakened him from sleep but this was relieved with Naproxen. PHYSICAL EXAMINATION -The patient had a slightly antalgic gait. He was unable to fully extend his right knee while standing. There was mild quad atrophy and a 1+ effusion. ROM was 0/5/125 compared with his left knee 0/0/145. He was tender to palpation in the mid-portion of his right politcal fossa. The anterior knee was not tender. The tibial sag sign was absent. The quadriceps active drawer test and Lachman were negative. The posterior drawer was slightly increase on the right with an equivocal end point when compared with the left. The pivot shift and reverse pivot shift were negative, although he was noted to have some guarding. The posterolateral drawer sign was negative. He had no meniscal signs. DIFFERENTIAL DIAGNOSIS: PCL tear Posterior lateral meniscal tear Lateral collateral ligament sprain and posterolateral corner injury Baker's cyst TESTS AND RESULTS: Right knee anterior-posterior, notch, lateral and sunrise radiographs - normal. Right knee MRI - Tear of the PCL.- No meniscal injury. - Joint effusion and Baker's cyst. FINAL/WORKING DIAGNOSIS: Posterior Cruciate Ligament Tear. TREATMENT: Cryotherapy, Ibuprofen 800 mg QD to BID PRN Rehabilitation quadriceps strengthening program. PCL stabilizing brace Return to full activity in 7–14 days.

Epidemiological profile of sports-related knee injuries in northern India: An observational study at a tertiary care centre.