Acute Knee Trauma Research Articles

The predictive value of point-of-care ultrasonography versus magnetic resonance imaging in assessing medial meniscal tears in patients with acute knee injury.

Musculoskeletal ultrasound is increasingly used as the modality of choice in diagnosing many medical situations. The present study aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to detect acute medial meniscus tears in knee. The prospective study was conducted on patients with suspected medial meniscus tears in knee. in the emergency department. In the absence of a knee fracture on x-ray, POCUS on the knee was performed. All patients underwent POCUS and MRI of the knee followed by arthroscopy. POCUS findings were then compared to MRI findings to diagnose medial meniscus tears. A final total of 157 patients with a mean age of 25.04±7.41 years was included. Out of 157 patients, 94 (59.9%) were male. Medial meniscus tears were detected in 89 patients (56.7%) using arthroscopy as the gold standard. The sensitivity, specificity, positive and negative predictive values, and accuracy of POCUS to detect medial meniscus tears were 88.8% (95% confidence interval [CI], 80.3%-94.5%), 89.7% (95% CI, 79.9%-95.8%), 91.9% (95% CI, 84.8%-95.8%), 85.9% (95% CI, 77.2%-91.7%), and 89.2% (95% CI, 83.3%-93.6%), respectively. The diagnostic accuracy of MRI to detect medial meniscus injury was 93.0% (95% CI, 87.8%- 96.4%). The present study demonstrated that POCUS is an accurate and reliable diagnostic tool alternative to MRI in detecting medial meniscal tears. POCUS had acceptable sensitivity, specificity, and accuracy in detecting meniscal injuries and could be performed as an effective immediate investigation to guide further modalities in patients with acute knee trauma.

Posteromedial Corner Injuries of the Knee: Imaging Findings.

The posteromedial corner (PMC) of the knee is an anatomical region formed by ligamentous structures (medial collateral ligament, posterior oblique ligament, oblique popliteal ligament), the semimembranosus tendon and its expansions, the posteromedial joint capsule, and the posterior horn of the medial meniscus. Injuries to the structures of the PMC frequently occur in acute knee trauma in association with other ligamentous or meniscal tears. The correct assessment of PMC injuries is crucial because the deficiency of these supporting structures can lead to anteromedial rotation instability or the failure of cruciate ligaments grafts. This article reviews the anatomy and biomechanics of the PMC to aid radiologists in identifying injuries potentially involving PMC components.

Diagnostic Accuracy of 128-Slice Single-Source CT for the Detection of Dislocated Bucket Handle Meniscal Tears in the Setting of an Acute Knee Trauma—Correlation with MRI and Arthroscopy

(1) Background: Meniscal tears are amongst the most common knee injuries. Dislocated bucket handle meniscal tears in particular should receive early intervention. The purpose of this study was to evaluate the diagnostic performance of CT in detecting dislocated bucket handle meniscal tears compared with the gold-standard MRI and arthroscopy. (2) Methods: Retrospectively, 96 consecutive patients underwent clinically indicated CT of the knee for suspected acute traumatic knee injuries (standard study protocol, 120 kV, 90 mAs). Inclusion criteria were the absence of an acute fracture on CT and a timely MRI (<6 months). Corresponding arthroscopy was assessed. Two experienced musculoskeletal radiologists analyzed the images for dislocated bucket handle meniscal tears, associated signs thereof (double posterior cruciate ligament sign, double delta sign, disproportional posterior horn sign), and subjective diagnostic confidence on a 5-point-Likert scale (1 = 'non-diagnostic image quality', 5 = 'very confident'). (3) Results: Dislocated bucket handle meniscal tears were detected on CT by standard three-plane bone kernel reconstructions with a sensitivity of 90.7% and a specificity of 99.3% by transferring the knowledge of established MRI signs. The additional use of soft-tissue kernel reconstructions in three planes increased the sensitivity by 4.0% to 94.7%, specificity to 100%, inter-rater agreement to 1.0, and the diagnostic confidence of both readers improved to a median 4/5 ('confident') in both readers. (4) Conclusions: Trauma CT scan of the knee with three-plane soft-tissue reconstructions delivers the potential for the detection of dislocated bucket handle meniscal tears with very high diagnostic accuracy.

Razlike u dijagnostičkoj snazi STIR i T1W sekvence kod Mr nalaza koštane modrice akutno traumatizovanog kolena

Objective. Increasing use of magnetic resonance imaging (MRI) in acute knee trauma has led to increased awareness of bone bruises (BB). Post-traumatic BB is the only predictor of early osteoarthritis. The aim of our research is to determine the way in which it is possible to observe and precisely determine the localization, size, and number of BBs, by the correct selection of Mr imaging sequences. Methods. Mr examinations of the knees performed during 2012-2013 in 100 subjects with an acute knee injury sustained during sports were retrospectively analyzed from the personal archive. All examinations were done in the first month after the trauma. Examinations were performed on an open-type MRI with a power of 0.3T. A standard protocol was used with sequences of spin echo T1-weighted in the sagittal plane, fat suppression T2-weighted in the sagittal, coronal, and axial planes, and Short Tau Inversion Recovery (STIR) in the coronal plane. The presence and arrangement of BB were analyzed. The difference in the frequency of BB findings in STIR compared to the T1W sequence and the assessment of the visibility of BB in both sequences were analyzed. Results. BB findings were observed in 51% of subjects. BB is, after effusion, the second, most frequent pathological finding on Mr examination in acute knee trauma. A significant statistical difference was determined by the Wilcoxon test (Z=-5.067, p=0.000) between the T1W and STIR sequence, which indicates that the STIR sequence is convincingly more sensitive than the T1W sequence for the diagnosis of BB. Conclusion. It was concluded that STIR sequence provides better visibility of BB compared to T1W sequence.

Point-Of-Care Ultrasonography for Diagnosis of Medial Collateral Ligament Tears in Acute Knee Trauma; a Diagnostic Accuracy Study

Introduction:The use of point-of-care ultrasonography (POCUS) for identifying medial collateral ligament (MCL) tears has increased in recent years. This study aimed to evaluate the diagnostic accuracy of POCUS in the diagnosis of acute MCL tears of the knee.Methods:This prospective cross-sectional study was performed on patients with suspected MCL tear of the knee in the emergency department (ED). After history taking and primary physical examination, radiographic imaging of the knee was done. If there was no fracture in the knee X-ray, the POCUS examination was done. All of the patients were asked to refer to an orthopedic clinic, 7-10 days after discharge from ED, for Magnetic Resonance Imaging (MRI) evaluation. The second POCUS was done in the orthopedic clinic. Finally, the findings of POCUS and MRI were compared in diagnosing MCL injury.Results:Two hundred and fifty patients with a mean age of 25.05 ± 9.12 years were analyzed (86.8% male). According to the MRI findings, as the gold standard, 55(22.0%) patients had MCL injury. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy of ultrasound in detection of MCL injury, in comparison with MRI were 83.64 (95% CI, 71.20 to 92.23), 94.36% (95% CI, 90.13 to 97.15), 80.70% (95% CI, 69.95 to 88.25), 95.34% (95% CI, 91.83 to 97.38), and 92.00% (95% CI, 87.92 to 95.05), respectively. The area under the receiver operating characteristic (ROC) curve of POCUS was 0.890 (95% CI, 0.844 to 0.926).Conclusion: It seems that POCUS can be applied in screening patients with MCL tears following blunt knee trauma.

A Morphological Study of the Meniscus, Cartilage and Subchondral Bone Following Closed-Joint Traumatic Impact to the Knee

Post-traumatic osteoarthritis (PTOA) is a debilitating disease that is a result of a breakdown of knee joint tissues following traumatic impact. The interplay of how these tissues influence each other has received little attention because of complex interactions. This study was designed to correlate the degeneration of the menisci, cartilage and subchondral bone following an acute traumatic event that resulted in anterior cruciate ligament (ACL) and medial meniscus tears. We used a well-defined impact injury animal model that ruptures the ACL and tears the menisci. Subsequently, the knee joints underwent ACL reconstruction and morphological analyses were performed on the menisci, cartilage and subchondral bone at 1-, 3- and 6-months following injury. The results showed that the morphological scores of the medial and lateral menisci worsened with time, as did the tibial plateau and femoral condyle articular cartilage scores. The medial meniscus was significantly correlated to the medial tibial subchondral bone at 1 month (p = 0.01), and to the medial tibial cartilage at 3 months (p = 0.04). There was only one significant correlation in the lateral hemijoint, i.e., the lateral tibial cartilage to the lateral tibial subchondral bone at 6 months (p = 0.05). These data may suggest that, following trauma, the observed medial meniscal damage should be treated acutely by means other than a full or partial meniscectomy, since that procedure may have been the primary cause of degenerative changes in the underlying cartilage and subchondral bone. In addition to potentially treating meniscal damage differently, improvements could be made in optimizing treatment of acute knee trauma.

The posterior oblique ligament in MRI of acute knee trauma

To identify the posterior oblique ligament and assess incidence and patterns of injury to the ligament on MRI of acute knee trauma. One hundred twenty-three MRI studies met the study criteria. For each case, the posterior oblique ligament was identified and scored as injured or normal. Incidence of proximal and distal posterior oblique ligament tears was calculated. Fisher's tests were employed to determine significance of association between tears of the posterior oblique ligament and components of the posteromedial corner and other capsuloligamentous structures of the knee. The posterior oblique ligament was reliably identified as a distinct structure in 123 MRI scans that met the criteria and was consistently labeled as intact or torn. Posterior oblique ligament tear was seen in 61.7% of knee trauma with proximal injury in 56.5% and distal injury in 97.3% of positive cases. Posterior oblique ligament disruption was a part of multiligamentous injury in 94.7% of positive cases. Posterior oblique ligament injuries (n = 76) had an extremely significant relationship with oblique popliteal ligament tears (n = 27) (p = 0.0001), semimembranosus tendon insertion tears (n = 15) (p = 0.0005), and medial collateral ligament tears (n = 15) (p = 0.0005) and a highly significant association with medial meniscus tears (n = 68) (p = 0.0049) and posterior cruciate ligament tears (n = 12) (p = 0.0033). The association with anterior cruciate ligament tears (n = 53) was not significant. The posterior oblique ligament is a distinct radiological entity consistently identified in acute trauma MRI. Disruptions of the distal posterior oblique ligament are frequent in complex knee injury, notably in association with oblique popliteal ligament, medial collateral ligament, and semimembranosus tendon tears.

Increased expression of cyclooxygenase-2 in synovium tissues and synovial fluid from patients with knee osteoarthritis is associated with downregulated microRNA-758-3p expression.

Cyclooxygenase-2 (COX-2) is a common factor in inflammation, and its specific regulatory mechanism has not been fully elucidated. The present study aimed to investigate COX-2 mRNA and protein expression levels in synovium tissues and synovial fluid from patients with knee osteoarthritis (KOA), and determine the molecular mechanism by which microRNA (miRNA/miR)-758 regulates KOA via COX-2. A total of 37 patients with KOA and 29 patients with acute knee trauma (control group) were enrolled in the present study. Reverse transcription-quantitative PCR analysis was performed to detect miR-758-3p and COX-2 mRNA expression, while western blotting and ELISA were performed to detect COX-2 protein expression in synovium and synovial fluid, respectively. The dual-luciferase reporter assay was performed to verify the interaction between miR-758-3p and the 3'-untraslated region (UTR) of COX-2 mRNA. Synovial cells were transfected with agomiR-758-3p, and the MTT assay was performed to assess cell proliferation. The results demonstrated that COX-2 expression was higher in patients with KOA than those with acute knee trauma. Conversely, miR-758-3p expression was lower in patients with KOA than those with acute knee trauma. Notably, miR-758-3p interacted with the 3'-UTR of COX-2 mRNA to regulate its expression. Overexpression of miR-758-3p inhibited the expression and release of COX-2, as well as the proliferation of human KOA synovial cells. Taken together, these results suggest that COX-2 expression is upregulated in synovium tissues and synovial fluid from patients with KOA, which is associated with downregulated miR-758-3p expression. In addition, miR-758-3p affects the proliferation of synovial cells and the expression of relevant proteins in these cells, thus promoting the occurrence and development of KOA.

Agreement Between Clinical Examination and Magnetic Resonance Imaging in Acute Knee Trauma With Hemarthrosis.

Hemarthrosis after knee trauma often indicates serious joint injury. Few studies have evaluated agreement between clinical examination and findings from magnetic resonance imaging (MRI). We aimed to describe the agreement between acute clinical examination and subacute MRI findings after acute knee trauma with hemarthrosis and the importance of the subspecialty of the examiner. Longitudinal cohort study. Agreement with MRI findings was evaluated by logistic regression. Helsingborg hospital. Thousand one hundred forty-five consecutive patients with hemarthrosis after knee trauma. Clinical examination and MRI. agreement between clinical examination and findings from MRI. We considered the radiologist's report as the gold standard. Median time (25th, 75th percentile) from injury to clinical examination was 2 (1, 7) days, and from injury to imaging was 8 (5, 15) days. The overall sensitivity and specificity of clinical examination versus MRI for major ligament injury or lateral patella dislocation (LPD) were 70% [95% confidence interval 67-73) and 66% (61-72), respectively. Orthopedic subspecialist knee had the highest agreement with anterior cruciate ligament rupture (adjusted odds ratios were 1.7 (95% confidence interval 1.2-2.3), 1.9 (1.2-3.0) and 5.9 (3.7-9.5) for orthopedic trainees, orthopedic subspecialists other, and orthopedic subspecialist knee, respectively]. For other ligament injuries and LPD, we did not find statistically significant differences. Clinical diagnosis after acute knee injury is relatively unreliable versus MRI findings even when performed by orthopedic specialists. However, the agreement is improved when the examination is performed by an orthopedic knee subspecialist.

ACL diagnosis – The correlation between Rolimeter and MRI

Summary Background Sports activities are the most common way to get an anterior cruciate ligament (ACL) injury. Correct diagnoses in the early phase after the knee injury is essential to establish a rehabilitation plan and, in the case of ACL-diagnosis, to avoid re-injuring the knee with increased risk of meniscal tears and/or osteoarthritis. The aim was to determine whether it is possible to confirm an ACL-injury with the Rolimeter measurements in the acute phase of a knee trauma, and if it correlates with magnetic resonance imaging (MRI) findings or arthroscopy. Material and Methods Thirty-four patients with an acute knee trauma, 20 women and 14 men, aged from 15–44 years, with a mean age of 24.8 (SD ± 7.3) participated. All were examined with the Rolimeter in the acute phase after a suspected ACL-injury. They also underwent MRI (n = 29) or arthroscopy (n = 5) wherein the injury was confirmed. Results A great consistency was seen in diagnosing the ACL-injuries with the Rolimeter measurement compared to MRI findings. The specificity (90.9%), sensitivity (91.3%), accuracy (91.2%), PPV (95.5%) and NPV (83.3%) were high in this study. Conclusions The Rolimeter measurement procedure is a safe and quick method in diagnosing an ACL-injury in the acute phase. Further studies should focus on larger cohorts and compare an early diagnosis to patient related outcome measures and societal/economical gains.

Ottawa Knee Rule: Investigating Use and Application in a Tertiary Teaching Hospital.

BackgroundKnee injuries are encountered commonly in the emergency departments (EDs) in Ireland. Validated clinical decision rules such as Ottawa knee rule (OKR) can be used in acute knee injury settings to reduce the number of unnecessary radiography. Clinical judgment can be used to distinguish between suspected fractures and non-fractures in many cases; however, radiography is still routinely requested.ObjectivesWe evaluated the OKRs in a high-volume tertiary teaching hospital in Ireland to determine whether the rule could be safely used to decide whether patients with acute blunt knee trauma should undergo radiography.MethodsThis was an observational study conducted in the ED over a three-month period in a tertiary referral hospital. A total of 110 patients with acute knee injuries were examined using OKR. Inclusion criteria included patients with acute knee injuries due to blunt trauma or twisting injury and patients with lacerations or contusions. Open fractures and fractures due to penetrating injury were excluded from the study.ResultsFractures were seen in 12 (13.2%) of the 110 patents who met the inclusion criteria. The OKR predicted all 12 fractures. Sensitivity was 100%, and specificity was 39%.ConclusionsThe OKR is highly sensitive for fracture in this setting and can be safely used to decide whether patients with acute blunt knee trauma should undergo radiography.

The anterolateral ligament in acute knee trauma: patterns of injury on MR imaging.

To delineate the spectrum of traumatic knee injuries associated with injury of the anterolateral ligament of the knee (ALL). A retrospective review of 200 MRI scans undertaken for acute knee trauma was performed. In each scan, the ALL was scored as normal, sprained or torn. The menisci, ligaments and tendons of each knee were also assessed. The mean age was 27.4years (range, 9-69years), and 71.5% (n= 143) of the patients were male. The anterolateral ligament (ALL) was graded as ruptured in 17 cases (8.5%), sprained in 58 cases (29%), normal in 116 cases (58%) and not visible in 9 cases (4.5%). Of cases with injury of the ALL (n= 75), there was associated injury of the anterior cruciate ligament (ACL) in 61 cases, medial collateral ligament (MCL) in 51 cases, popliteofibular ligament (PFL) in 29 cases, medial meniscus in 29 cases, lateral meniscus in 24 cases, lateral collateral ligament in 9 cases, posterior cruciate ligament in 8 cases, biceps femoris in 5 cases, popliteus tendon in 4 cases and fluid or oedema was seen adjacent to the iliotibial band in 59 cases. No cases of isolated ALL injury were seen. ALL injury is not uncommon in acute knee trauma and is typically associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, medial collateral ligament injury, meniscal tears and injury to the popliteofibular ligament.

Color-coded virtual non-calcium dual-energy CT for the depiction of bone marrow edema in patients with acute knee trauma: a multireader diagnostic accuracy study.

To evaluate the diagnostic accuracy of dual-energy computed tomography (CT) virtual non-calcium (VNCa) reconstructions for the depiction of traumatic knee bone marrow edema. Fifty-seven patients (mean age, 50years; range, 20-82years) with acute knee trauma further divided into 30 women and 27 men, who had undergone third-generation dual-source dual-energy CT and 3-T magnetic resonance imaging (MRI) within 7days between January 2017 and May 2018, were retrospectively analyzed. Six radiologists, blinded to clinical and MRI information, independently analyzed conventional grayscale dual-energy CT series for fractures; after 8weeks, readers evaluated color-coded VNCa reconstructions for the presence of bone marrow edema in six femoral and six tibial regions. Quantitative analysis of CT numbers on VNCa reconstructions was performed by a seventh radiologist. Two additional radiologists, blinded to clinical and CT information, analyzed MRI series in consensus to define the reference standard. Sensitivity, specificity, and the area under the curve (AUC) were the primary metrics of diagnostic accuracy. MRI revealed 197 areas with bone marrow edema (91/342 femoral, 106/342 tibial). In the qualitative analysis, VNCa showed high overall sensitivity (1108/1182 [94%]) and specificity (2789/2922 [95%]) for depicting bone marrow edema. The AUC was 0.96 (femur) and 0.97 (tibia). A cutoff value of - 51 Hounsfield units (HU) provided high sensitivity (102/106 [96%]) and specificity (229/236 [97%]) for differentiating tibial bone marrow edema. In both quantitative and qualitative analyses, dual-energy CT VNCa reconstructions yielded excellent diagnostic accuracy for depicting traumatic knee bone marrow edema compared with MRI. • Dual-energy CT (DECT) virtual non-calcium (VNCa) reconstructions are highly accurate in depicting bone marrow edema of the femur and tibia. • Diagnostic confidence, image noise, and image quality were rated as equivalent in VNCa reconstructions and MRI (magnetic resonance imaging) series. • VNCa images may serve as an alternative imaging approach to MRI.

Feasibility of point-of-care knee ultrasonography for diagnosing anterior cruciate and posterior cruciate ligament tears in the ED

ObjectiveTo evaluate the feasibility of point-of-care knee ultrasonography (POCUS) compared with knee magnetic resonance imaging (MRI) for diagnosing anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in patients with acute knee trauma. Material and methodsA prospective study was conducted in a tertiary hospital emergency department; acute (within 1-week) knee trauma patients with suspected ACL or PCL tear were recruited. Two POCUS performers (a board-certified emergency physician and a musculoskeletal radiologist) independently evaluated the ACL and PCL using POCUS. Findings were classified as normal appearance or ligament tear. Final radiology reports of knee MRI were used as the reference standard. We calculated the diagnostic values (sensitivity, specificity, and accuracy) for POCUS obtained by both POCUS performers. Kappa values (k) were calculated for inter-observer agreement between the two POCUS performers. ResultsSixty-two patients were enrolled. Compared with the reference standard, POCUS showed acceptable sensitivity (90.6–100%), specificity (90.0–97.7%), and accuracy (91.9–96.8%). Inter-observer agreement between the two POCUS performers was excellent (k = 0.853–0.903). ConclusionPOCUS demonstrates excellent precision as compared to MRI in the diagnosis of ACL and PCL tears. The findings of POCUS could be used for immediate diagnosis and further pre-operative imaging in patients with acute knee trauma.

10-MINUTE 3D MRI IN CHILDREN WITH ACUTE KNEE TRAUMA: ARTHROSCOPY-BASED DIAGNOSTIC ACCURACY FOR THE DIAGNOSIS OF INTERNAL DERANGEMENT

Background Magnetic resonance imaging (MRI) is often indicated in the diagnosis of pediatric knee trauma, but using traditional MRIs in children can be time-consuming, require anaesthesia, and sometimes cause discomfort. Recently, 3D turbo spin echo (TSE) MRIs with isotropic datasets have been found to reduce acquisition times substantially, but they have been little-studied in pediatric patients. The purpose of our study was to determine the arthroscopy-based diagnostic performance of 10-minute isotropic 3D TSE MRI for the detection of internal derangement in children with acute knee trauma. Methods Institutional review board approval was obtained for prospective data collection, and informed consent and assent were obtained from all parents and children, respectively. The final study group consisted of 60 children (38 boys, 22 girls; 11 (2-16) years-of-age) with acute knee trauma who underwent 10-minute isotropic 3D prototype CAIPIRINHA SPACE MRI at 3 T and subsequent arthroscopic knee surgery. Two fellowship-trained musculoskeletal radiologists retrospectively evaluated the MRI studies independently and resolved discrepancies through consensus. Outcome variables included image quality, motion artifacts, meniscal abnormalities, cruciate ligament tears, and cartilage lesions. Statistical analysis included the diagnostic performance of MRI with arthroscopy as the reference standard and inter-reader agreements using kappa statistics. Results All studies were suitable for diagnostic interpretation with good-to-very-good image quality and little-to-no motion degradation in the majority of cases. The sensitivities/specificities/accuracies of MRI were 0.93/0.93/0.93 for 15/60 (25%) medial meniscal tears, 0.95/0.90/0.92 for 21/60 (35%) lateral meniscal tears, 0.83/1.0/0.92 for 10/60 (17%) discoid menisci, 1.0/0.95/0.98 for 16/60 (27%) anterior cruciate ligament tears, 1.0/0.95/0.98 for 2/60 (3%) posterior cruciate ligament tears, 1.0/1.0/1.0 for 5/60 (8%) osteochondritis dissecans lesions, and 0.71/0.97/0.84 for 48 (13%) defects in 360 cartilage segments. The inter-reader agreements were overall good-to-very-good (kappa, 0.730 -1.00). Conclusion 10-minute isotropic 3D TSE MRI of the knee is feasible in children with acute knee trauma and yields high diagnostic accuracies for the diagnosis of internal knee derangement. Accuracies for the detection of meniscal tears, discoid menisci, anterior and posterior cruciate ligament tears, osteochondritis dissecans lesions, and cartilage defects ranged from 84-100%. Using previously published protocols for pediatric 2D MRI knee exams with total acquisition times of 25 minutes as a benchmark for traditional MRI, a 10-minute protocol could increase the efficiency by a factor of two or more, and thus substantially improve the availability of MRI and timely care for children with acute knee trauma. [Table: see text]

Acute knee trauma – Does a normal X-ray rule out significant injury? The sensitivity and specificity of X-rays in comparison to magnetic resonance imaging (MRI)

Acute knee trauma – Does a normal X-ray rule out significant injury? The sensitivity and specificity of X-rays in comparison to magnetic resonance imaging (MRI)

Test-retest reliability of repeated knee laxity measurements in the acute phase following a knee trauma using a Rolimeter.

The purpose was to examine the test-retest reliability of the Rolimeter measurement procedure in the acute time phase, following a substantial knee trauma. In total, 15 participants with acute knee trauma were examined by one single observer at three different time-points with the Rolimeter using a maximum force. The selected time-points were: baseline (0–7 days after the trauma), midpoint (3–4 weeks after the trauma), and endpoint (3–4 weeks after the trauma). The anterior-posterior displacement was recorded where the endpoint evaluation was used as the reference value. The mean anterior laxity scores remained constant over the measurement time-points for both knees, with an anterior laxity that was 2.7 mm higher (on average) in the injured than the noninjured knee (9.5 mm vs. 6.8 mm). The mean difference (i.e., bias) between laxity scores, for the injured knee, measured at endpoint versus baseline was 0.2±1.0 mm and −0.2±1.1 mm when measured at endpoint versus midpoint, with average typical errors of 0.7 and 0.8 mm and intra-class correlations that were very strong (both r=~0.93). For the same comparisons on the noninjured knee, systematic bias was close to zero (0.1±0.3 and −0.1±0.3 mm, respectively), and both the intra-class correlations were almost perfect (r=~0.99). The current study implicates that repeated Rolimeter measurements are relatively reliable for quantifying anterior knee laxity during the acute time-phases following knee trauma. Hence, the Rolimeter, in combination with manual tests, seems to be a valuable tool for identifying anterior cruciate ligament injuries.

High prevalence of all complex Segond avulsion using ultrasound imaging.

The aim of this study was to determine the prevalence of a Segond avulsion fractures in acute ACL tears with ultrasound and to investigate whether other injuries can predict the avulsion. One hundred thirty-eight ultrasound analyses of acute knee trauma were collected and scored for diagnosed injuries. The reports of patients with an ACL tear (N=87) were evaluated to determine possible increased prevalence of Segond avulsion fracture with ultrasound. The associations between the diagnosed injuries and presence of a Segond avulsion were scored. The sports carried out at the time of injury were evaluated as possible prognostic factor. In 25/87 (29%) of the patients with an ACL tear, a Segond avulsion was observed in ultrasound. Lateral femoral condyle (LFC) impaction showed the strongest individual association with a Segond avulsion and was the best predicting variable. LFC impaction, sustained during low-risk pivoting sport, shows a stronger association with a Segond avulsion, as compared to LFC impaction sustained during high-risk pivoting sports. Ultrasound shows a higher prevalence of Segond avulsions as literature shows with MRI or radiography. LFC impaction is the best variable in predicting this type of avulsion. Ultrasound examination should be considered, if this fracture was not diagnosed with MRI or radiographic analysis. IV.

Effects of Bone Bruise on Patients’ Pain after Acute Knee Trauma

Effects of Bone Bruise on Patients’ Pain after Acute Knee Trauma

KNEE LAXITY MEASUREMENT IN ACUTE KNEE TRAUMA AND ACL EVALUATION WITH THE ROLIMETER

The Rolimeter is an instrument that quantifies anterior knee laxity and has in previous studies showed satisfactory results regarding intra- and inter test reliability in subjects without injuries or with...