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European Radiology

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01-01-2015 | Musculoskeletal

Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

Authors: Guang-Ying Zhang, Lei Zheng, Hong-Yu Ding, En-Miao Li, Bai-Sheng Sun, Hao Shi

Published in: European Radiology | Issue 1/2015

Abstract

Objectives

The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD).

Methods

High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury.

Results

Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR.

Conclusions

Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD.

Key Points

• High-frequency ultrasound and MR were able to detect MPFL lesions after acute lateral patellar dislocation.

• High-frequency ultrasound and MR showed similarly high accuracy in diagnosing MPFL lesions.

• Interobserver agreement was very good for high-frequency ultrasound and good for MR.

Casteleyn PP, Handelberg F (1989) Arthroscopy in the diagnosis of occult dislocation of the patella. Acta Orthop Belg 55:381–383PubMed

Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743PubMedCrossRef

Vollnberg B, Koehlitz T, Jung T et al (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22:2347–2356PubMedCrossRef

Conlan T, Garth WP Jr, Lemons JE (1993) Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 75:682–693PubMed

Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65PubMed

Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg (Br) 87:577–582CrossRef

Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762PubMedCrossRef

Fithian DC, Paxton EW, Cohen AB (2004) Indications in the treatment of patellar instability. J Knee Surg 17:47–56PubMed

Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101PubMedCrossRef

10.

Sillanpää PJ, Mäenpää HM (2012) First-time patellar dislocation: surgery or conservative treatment? Sports Med Arthrosc 20:128–135PubMedCrossRef

11.

Köhlitz T, Scheffler S, Jung T et al (2013) Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol 23:1067–1074PubMedCrossRef

12.

Sallay PI, Poggi J, Speer KP, Garrett WE (1996) Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 24:52–60PubMedCrossRef

13.

Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG (2001) Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr 25:957–962PubMedCrossRef

14.

Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143PubMedCrossRef

15.

Trikha SP, Acton D, O’Reilly M, Curtis MJ, Bell J (2003) Acute lateral dislocation of the patella: correlation of ultrasound scanning with operative findings. Injury 34:568–571PubMedCrossRef

16.

O’Reilly MA, O’Reilly PM, Bell J (2003) Sonographic appearances of medial retinacular complex injury in transient patellar dislocation. Clin Radiol 58:636–641PubMedCrossRef

17.

Felus J, Kowalczyk B, Lejman T (2008) Sonographic evaluation of the injuries after traumatic patellar dislocation in adolescents. J Pediatr Orthop 28:397–402PubMedCrossRef

18.

Felus J, Kowalczyk B (2012) Age-related differences in medial patellofemoral ligament injury patterns in traumatic patellar dislocation: case series of 50 surgically treated children and adolescents. Am J Sports Med 40:2357–2364PubMedCrossRef

19.

Zhang GY, Zheng L, Shi H, Qu SH, Ding HY (2013) Sonography on injury of the medial patellofemoral ligament after acute traumatic lateral patellar dislocation: Injury patterns and correlation analysis with injury of articular cartilage of the inferomedial patella. Injury 44:1892–1898PubMedCrossRef

20.

Phornphutkul C, Sekiya JK, Wojtys EM, Jacobson JA (2007) Sonographic imaging of the patellofemoral medial joint stabilizing structures: findings in human cadavers. Orthopedics 30:472–478PubMed

21.

De Maeseneer M, Marcelis S, Boulet C et al (2014) Ultrasound of the knee with emphasis on the detailed anatomy of anterior, medial, and lateral structures. Skelet Radiol 43:1025–1039CrossRef

22.

Sillanpää PJ, Mäenpää HM, Mattila VM, Visuri T, Pihlajamäki H (2008) Arthroscopic surgery for primary traumatic patellar dislocation: a prospective, nonrandomized study comparing patients treated with and without acute arthroscopic stabilization with a median 7-year follow-up. Am J Sports Med 36:2301–2309PubMedCrossRef

23.

Reider B, Marshall JL, Koslin B, Ring B, Girgis FG (1981) The anterior aspect of the knee joint. J Bone Joint Surg Am 63:351–356PubMed

24.

Tuxøe JI, Teir M, Winge S, Nielsen PL (2002) The medial patellofemoral ligament: a dissection study. Knee Surg Sports Traumatol Arthrosc 10:138–140PubMedCrossRef

25.

Smirk C, Morris H (2003) The anatomy and reconstruction of the medial patellofemoral ligament. Knee 10:221–227PubMedCrossRef

26.

Steensen RN, Dopirak RM, McDonald WG 3rd (2004) The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 32:1509–1513PubMedCrossRef

27.

Nomura E, Inoue M, Osada N (2005) Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment. Knee Surg Sports Traumatol Arthrosc 13:510–515PubMedCrossRef

28.

Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12PubMedCrossRef

29.

Baldwin JL (2009) The anatomy of the medial patellofemoral ligament. Am J Sports Med 37:2355–2361PubMedCrossRef

30.

Ahmad CS, Stein BE, Matuz D, Henry JH (2000) Immediate surgical repair of the medial patella stabilizers for acute patellar dislocation: a review of eight cases. Am J Sports Med 28:804–810PubMed

31.

Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21:499–519PubMedCrossRef

32.

Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med 15:62–66PubMedCrossRef

33.

Fukushima K, Horaguchi T, Okano T, Yoshimatsu T, Saito A, Ryu J (2004) Patellar dislocation: arthroscopic patellar stabilization with anchor sutures. Arthroscopy 20:761–764PubMedCrossRef

34.

Haspl M, Cicak N, Klobucar H, Pecina M (2002) Fully arthroscopic stabilization of the patella. Arthroscopy 18:E2PubMedCrossRef

35.

Mountney J, Senavongse W, Amis AA, Thomas NP (2005) Tensile strength of the medial patellofemoral ligament before and after repair or reconstruction. J Bone Joint Surg (Br) 87:36–40

36.

Nomura E, Inoue M, Osada N (2005) Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation. Knee Surg Sports Traumatol Arthrosc 13:346–351PubMedCrossRef

37.

Sillanpää PJ, Peltola E, Mattila VM, Kiuru M, Visuri T, Pihlajamäki H (2009) Femoral avulsion of the medial patellofemoral ligament after primary traumatic patellar dislocation predicts subsequent instability in men: a mean 7-year nonoperative follow-up study. Am J Sports Med 37:1513–1521PubMedCrossRef

38.

Kang HJ, Wang F, Chen BC, Zhang YZ, Ma L (2013) Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns. Knee Surg Sports Traumatol Arthrosc 21:325–331PubMedCrossRef

39.

Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25:620–625PubMedCrossRef

40.

Sillanpää PJ, Mattila VM, Mäenpää H, Kiuru M, Visuri T, Pihlajamäki H (2009) Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study. J Bone Joint Surg Am 91:263–273PubMedCrossRef

41.

Nikku R, Nietosvaara Y, Aalto K, Kallio PE (2005) Operative treatment of primary patellar dislocation does not improve medium-term outcome: a 7-year follow-up report and risk analysis of 127 randomized patients. Acta Orthop 76:699–704PubMedCrossRef

42.

Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Joint Surg Am 90:463–470PubMedCrossRef

43.

Christiansen SE, Jakobsen BW, Lund B, Lind M (2008) Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy 24:881–887PubMedCrossRef

44.

Balcarek P, Walde TA, Frosch S, Schüttrumpf JP, Wachowski MM, Stürmer KM (2012) MRI but not arthroscopy accurately diagnoses femoral MPFL injury in first-time patellar dislocations. Knee Surg Sports Traumatol Arthrosc 20:1575–1580PubMedCentralPubMedCrossRef

45.

Burks RT, Desio SM, Bachus KN, Tyson L, Springer K (1998) Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 11:24–31PubMed

46.

Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop 23:260–263PubMedCentralPubMedCrossRef

47.

Aragão JA, Reis FP, de Vasconcelos DP, Feitosa VL, Nunes MA (2008) Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadaver. Clinics 63:541–544PubMedCentralPubMedCrossRef

48.

Jung JY, Kim GU, Lee HJ, Jang EC, Song IS, Ha YC (2013) Diagnostic value of ultrasound and computed tomographic arthrography in diagnosing anterosuperior acetabular labral tears. Arthroscopy 29:1769–1776PubMedCrossRef

49.

Jeong WK, Ah Ryu J, Choi SH et al (2013) Shoulder sonography after intraarticular fluid injection for evaluation of anterior labral tears: comparison with conventional sonography. J Clin Ultrasound 41:94–100PubMedCrossRef

50.

Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW (2013) Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med 61:9–17PubMedCrossRef

51.

Rabiner JE, Friedman LM, Khine H, Avner JR, Tsung JW (2013) Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics 131:e1757–e1764PubMedCrossRef

Title: Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR
Authors: Guang-Ying Zhang
Lei Zheng
Hong-Yu Ding
En-Miao Li
Bai-Sheng Sun
Hao Shi
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3407-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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