Abstract
While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.
Highlights
Ligament injuries are common and constitute the majority of sports-related knee joint injuries [1,2]
At δ0, the anterior cruciate ligament (ACL) appeared heterogenous with slight intra- and peri-ligamentous signal increases yet without signs of fiber discontinuity or abnormal orientation
Structural and functional integrity of the ACL was confirmed during subsequent arthroscopy
Summary
Ligament injuries are common and constitute the majority of sports-related knee joint injuries [1,2]. National registries recording the incidence of anterior cruciate ligament (ACL)-injuries have reported mean incidences of 29–38 per 100,000 people [3]. Because of its excellent soft tissue contrast, non-invasiveness, lack of ionizing radiation, and substantial diagnostic capabilities, MRI is the imaging modality of choice in patients with suspected knee and ACL injuries. While complete ACL tears are identified with excellent sensitivity and specificity [4], partial. ACL tears are diagnosed with considerably poorer sensitivity and specificity [5,6], even if standard clinical MRI protocols are supplemented by oblique or 3D volume sequences [7,8].
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