MRI of the pediatric elbow: Assessment of ligaments, plicae, and cartilage in the clinical setting

Abstract

Elbow injuries in young athletes are becoming an increasing concern for orthopedic sports medicine specialists, but imaging is frequently complicated. The purpose of this study was to assess MRI in imaging ligaments, plicae, and cartilage in 65 pediatric and adolescent patients. 9 MRIs (13%) did not allow assessment because of poor quality. In skeletally mature patients, the radial and ulnar collateral ligament were clearly discernable in 94% and 77%, measuring 1.5 ± 0.6 mm and 1.9 ± 0.6, compared to 55% and 59% in the immature patients with a mean thickness of 1.1 ± 0.6 and 1.4 ± 0.6 mm (p<0.05). 12 patients (18%) revealed a cartilaginous pseudodefects, 5 (8%) had a true OCD. 23 (35%) showed a posterolateral plica with a maximum extension of 1.6 ± 1.7 mm. In OCD the plica was significantly larger compared to patients without OCD (p=0.001). While MRI is a helpful tool in assessing elbow injuries, its usefulness is restricted in pediatric and adolescent patients. 1 in 10 MRI studies was too distorted to be read. However, ligaments ad plicae could be well discerned in most patients. At 18% pseudodefects are much less common than in adults (85%).