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Journal club ACL PCL.pptx
- 1. Journal club Imaging ACL & PCL with or without tear and after Reconstruction Presenter-Dr. Shubhanshu Guide-Dr. John
- 2. Tibial Avulsion Segond fracture Osteochondral Injury
- 3. ACL T2 Saggital T2 Coronal T1 Saggital
- 4. Bone Bruises
- 6. Patellar buckling sign and lateral femoral notch sign
- 7. Impression in the lateral femur after a twisting injury. There is also anterior translation of the tibia compared to the femur beyond 7mm
- 8. Sagittal T2-weighted MRI, complete disruption of the ACL fibres Avulsion of the tibial attachment of the ACL. Tibial Avulsion on CT.
- 9. Intraligamentous areas of increased signal Ganglion cyst (a, open arrow). T1-weighted MRI (arrows), which indicates mucoid degeneration. Mucoid degeneration may later evolve into cysts Celery stalk sign (mucoid degeneration)
- 10. Posterior cruciate ligament buckling and Posterior cruciate ligament line sign. Shearing of fat pad. Coronal whole posterior cruciate ligament and lateral collateral ligament sign in single coronal image.
- 11. O’ Donoghue’s triad Peripheral posterior horn meniscal tears, Acute or chronic ACL injuries, Medial collateral ligament tear Posterolateral corner injury Acute complete anterior cruciate ligament tear (white arrowhead). Lateral collateral ligament and partial disruption of the fibres are present at the femoral origin (L), Posterior capsule and the oblique popliteal ligament (OPL) also show thickening and oedematous change, Popliteofibular ligament is severely swollen and oedematous suggestive of high grade partial tear (curved blackarrow).
- 12. Bernard and Hertel grid
- 13. • German Arthroscopy Association (AGA) showed that MRI represents one of the decision-making criteria for return to sport activity in only 4% (Petersen W, Arch Orthop Trauma Surg 2013)
- 14. A. The graft is surrounded by an intermediate signal intensity tissue (red arrows), representing vascularization and synovialization. B. At the 12th month, the periligamentous signal has disappeared and the graft signal decreased resembling that of PCL. T2-Fast recovery sat-spin echo (FRFSE) MRI a hyperintense line within the graft body Healing Process
- 15. Sagittal T1-weighted and T2-weighted MRI showed a thickened graft with high signal at 9 months after operation. After two years the graft is dark and resembles the native ACL.
- 16. Intercondylar space is occupied by mixoid tissue with slightly hyperintense signal in proton density turbo-shin echo weighted images (white arrows). It is not possible to distinguish the regular course of the graft.
- 18. Tunnel Position B. Cyclops lesion C. Vertical Graft
- 19. Obliquity of graft A. 50-60 degree in sagittal B. Vertically positioned graft A. <75 degree in sagittal B. Vertically positioned graft
- 20. TUNNEL ENLARGEMENT A. tunnel diameter > 15 mm) B. Cyst with hyperintense signal
- 21. FIXATION DEVICES Interecho spacing or short tau inversion recovery (STIR) techniques, Proton density fat saturation
- 22. Localized area of low to intermediate signal intensity extending anterior to the distal anterior cruciate ligament graft consistent with local arthrofibrosis.
- 23. PCL Stress radiographs of the knees, show pathological translation on the right side. It was measured to 11m whereas the normal (physiologic) translation on the left side was 5mm.
- 24. Complete disruption of the PCL fibres. Avulsion of the PCL attachment on the tibia on T2- and T1- weighted MRI (arrows). Thick PCL >7mm, consistent with a ruptured PCL.
- 25. Post-operative tunnel placement after PCL reconstruction on volume rendering CT.
- 26. PCL graft six months postoperatively on a sagittal and coronal T2
Editor's Notes
- Segond fracture – Anterolateral fracture of knee capsule
- 4 steps: The initial avascular necrosis, the revascularization, cellular proliferation, and final remodeling
- It should be localized behind a line that is tangential to the Blumensaat line (line b); however, without going beyond the midpoint of the proximal tibia with the knee in full extension. The femoral tunnel should be located at the intersection of the posterior femoral cortex (line a) and the lateral wall of the intercondylar notch (line b). The position of the tibial tunnel entrance is measured as following: the total antero-posterior diameter of the tibial plateau (line c) is measured in the sagittal slice where the tibial entrance is better visualized. The location of the anterior margin of the tunnel is obtained dividing the distance from the anterior tibial plateau margin and the most anterior part of the tunnel entrance (point 1) for the total AP diameter (line c) and multiplying for 100. The location of the posterior margin (point 3) and the center of the tunnel (point 2) are obtained similarly (A). Sagittal view with a tibial tunnel positioned anterior to the midpoint of the tibial plateau diameter, resulting in an increased risk of impingement (B). Sagittal view with a tibial tunnel positioned too posterior, resulting in a vertical graft (C). The native ACL is located between the 31% and 63% of the tibial plateau diameter, with its center at 48%. ACL: Anterior cruciate ligament.
- Measurement of the sagittal obliquity of the graft. The inclination is calculated measuring the angle between the perpendicular line (line c and d) to the proximal tibial axis (line a and b), and the line which best defines the course of intra-articular part of the graft (line e and f). A high angle represents a vertical graft in the sagittal plane (A). Vertically positioned graft, with an angle of 78°, far higher than the normal range 50°-60° (B). Measurement of the coronal obliquity of the graft. The inclination is calculated measuring the angle between the tangent line to the tibial plateau (a and b) and the line which best defines the course of the intra-articular part of the graft (c and d). A high angle represents a vertical graft in the coronal plane (A). Vertically positioned graft, with an angle of 88°, far higher than the normal value < 75° (B).
- windshield wiper effect” “bungee cord effect