PDF herunterladen
Semin Musculoskelet Radiol 2009; 13(4): 384-401
DOI: 10.1055/s-0029-1242191
© Thieme Medical Publishers

MR Imaging of the Extensor Mechanism

Josef Kramer1 , Lawrence M. White2 , Michael P. Recht3
  • 1Inst. f. CT & MRI at Schillerpark, Linz, Austria
  • 2Joint Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, University Health Network, and Women's College Hospital, Toronto, Ontario, Canada
  • 3New York University Langone Medical Center, New York, New York
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
04. November 2009 (online)

Auch verfügbar auf
    Lizenzen und Reprints

ABSTRACT

Sports injuries of the knee involving the extensor mechanism are common. Specific conditions additionally affect the extensor mechanism in adolescents during growth and maturation, and in older patients as a result of degeneration. Prior to the advent of magnetic resonance (MR) imaging, the specific anatomical-pathological cause of anterior knee pain was often uncertain, with diagnosis limited to clinical examination and conventional radiographic assessment. MR imaging allows for the accurate and specific diagnosis of pathology of the extensor mechanism, impacting on decision making and clinical treatment of such conditions. In this article the anatomy, normal MR appearance, and common pathological conditions of the extensor mechanism of the knee are described.

KEYWORDS

Anterior knee pain - extensor mechanism - MR imaging

REFERENCES

  • 1 Calmbach W L, Hutchens M. Evaluation of patients presenting with knee pain: Part II. Differential diagnosis.  Am Fam Physician. 2003;  68(5) 917-922
    PubMedGoogle Scholar
  • 2 Egund N, Ryd L. Patellar and quadriceps mechanisms. In: Davies AM, Cassal-Pullicino VN Imaging of the Knee, Techniques and Applications. New York, NY; Springer 2002: 217-248
    PubMedGoogle Scholar
  • 3 Stephens B O, Anderson Jr G VJ. Simultaneous bilateral quadriceps tendon rupture: a case report and subject review.  J Emerg Med. 1987;  5(6) 481-485
    CrossrefPubMedGoogle Scholar
  • 4 Sherlock D A, Hughes A. Bilateral spontaneous concurrent rupture of the patellar tendon in the absence of associated local or systemic disease.  Clin Orthop Relat Res. 1988;  237(237) 179-183
    PubMedGoogle Scholar
  • 5 Fulkerson J P. Diagnosis and treatment of patients with patellofemoral pain.  Am J Sports Med. 2002;  30(3) 447-456
    CrossrefPubMedGoogle Scholar
  • 6 Bodne D, Quinn S F, Murray W T et al.. Magnetic resonance images of chronic patellar tendinitis.  Skeletal Radiol. 1988;  17(1) 24-28
    CrossrefPubMedGoogle Scholar
  • 7 Nance Jr E P, Kaye J J. Injuries of the quadriceps mechanism.  Radiology. 1982;  142(2) 301-307
    PubMedGoogle Scholar
  • 8 Zeiss J, Saddemi S R, Ebraheim N A. MR imaging of the quadriceps tendon: normal layered configuration and its importance in cases of tendon rupture.  AJR Am J Roentgenol. 1992;  159(5) 1031-1034
    CrossrefPubMedGoogle Scholar
  • 9 Stäubli H U, Schatzmann L, Brunner P, Rincón L, Nolte L P. Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults.  Knee Surg Sports Traumatol Arthrosc. 1996;  4(2) 100-110
    CrossrefPubMedGoogle Scholar
  • 10 Heegaard J, Leyvraz P F, Curnier A, Rakotomanana L, Huiskes R. The biomechanics of the human patella during passive knee flexion.  J Biomech. 1995;  28(11) 1265-1279
    CrossrefPubMedGoogle Scholar
  • 11 Huberti H H, Hayes W C, Stone J L, Shybut G T. Force ratios in the quadriceps tendon and ligamentum patellae.  J Orthop Res. 1984;  2(1) 49-54
    CrossrefPubMedGoogle Scholar
  • 12 Fox J M, Sherman O H, Pevsner D. Patellofemoral problems and malalignment. In: John MD, McGinty B Arthroscopic Surgery Update. Rockville, MD; Aspen 1985: 31-57
    PubMedGoogle Scholar
  • 13 Mink J H, Reicher M A, Crues III J V, Deutsch A L. MRI of the Knee. 2nd ed. New York, NY; Raven 1992: 189-236
    PubMedGoogle Scholar
  • 14 Grana W A, Larson R L. Functional and surgical anatomy. In: Larson RL, Grana WA The Knee: Form, Function, Pathology, and Treatment. Philadelphia, PA; Saunders 1993: 11-49
    PubMedGoogle Scholar
  • 15 Stoller D W. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Philadelphia, PA; Lippincott 1993: 277-306
    PubMedGoogle Scholar
  • 16 Sinclair D C. Muscles and fasciae. In: Romanes GJ Cunningham's Textbook of Anatomy. 12th ed. New York, NY; Oxford University Press 1981: 385-387
    PubMedGoogle Scholar
  • 17 Rogers L F. Radiology of Skeletal Trauma. 2nd ed. New York, NY; Churchill Livingstone 1992: 1199-1317
    PubMedGoogle Scholar
  • 18 Evans E J, Benjamin M, Pemberton D J. Variations in the amount of calcified tissue at the attachments of the quadriceps tendon and patellar ligament in man.  J Anat. 1991;  174 145-151
    PubMedGoogle Scholar
  • 19 Siwek C W, Rao J P. Ruptures of the extensor mechanism of the knee joint.  J Bone Joint Surg Am. 1981;  63(6) 932-937
    PubMedGoogle Scholar
  • 20 Scuderi C. Ruptures of the quadriceps tendon; study of twenty tendon ruptures.  Am J Surg. 1958;  95(4) 626-634
    CrossrefPubMedGoogle Scholar
  • 21 Larsen E, Lund P M. Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation.  Clin Orthop Relat Res. 1986;  213(213) 150-153
    PubMedGoogle Scholar
  • 22 Levy M, Goldstein J, Rosner M. A method of repair for quadriceps tendon or patellar ligament (tendon) ruptures without cast immobilization. Preliminary report.  Clin Orthop Relat Res. 1987;  218(218) 297-301
    PubMedGoogle Scholar
  • 23 Sonin A H, Fitzgerald S W, Bresler M E, Kirsch M D, Hoff F L, Friedman H. MR imaging appearance of the extensor mechanism of the knee: functional anatomy and injury patterns.  Radiographics. 1995;  15(2) 367-382
    CrossrefPubMedGoogle Scholar
  • 24 Schweitzer M E, Mitchell D G, Ehrlich S M. The patellar tendon: thickening, internal signal buckling, and other MR variants.  Skeletal Radiol. 1993;  22(6) 411-416
    CrossrefPubMedGoogle Scholar
  • 25 Resnick D, Kang H S. Knee: plate 16-9. In: Resnick D, Kang HS Internal Derangements of Joints: Emphasis on MR imaging. Philadelphia, PA; Saunders 1997: 555-785
    PubMedGoogle Scholar
  • 26 Sonin A H. Magnetic resonance imaging of the extensor mechanism.  Magn Reson Imaging Clin N Am. 1994;  2 401-411
    PubMedGoogle Scholar
  • 27 Mellado J M, Salvadó E, Ramos A, Camins A, Saurí A. Dorsal defect on a multi-partite patella: imaging findings.  Eur Radiol. 2001;  11(7) 1136-1139
    CrossrefPubMedGoogle Scholar
  • 28 Yu J S, Petersilge C, Sartoris D J, Pathria M N, Resnick D. MR imaging of injuries of the extensor mechanism of the knee.  Radiographics. 1994;  14(3) 541-551
    PubMedGoogle Scholar
  • 29 Goodfellow J, Hungerford D S, Zindel N. Patellofemoral joint mechanics and pathology.  J Bone Joint Surg Br. 1976;  58 287-290
    PubMedGoogle Scholar
  • 30 Fulkerson J P, Hungerford D S. Disorders of the Patellofemoral Joint. 2nd ed. Baltimore, MD; Williams & Wilkins 1990: 149-175
    PubMedGoogle Scholar
  • 31 van Holsbeeck M, Vandamme B, Marchal G, Martens M, Victor J, Baert A L. Dorsal defect of the patella: concept of its origin and relationship with bipartite and multipartite patella.  Skeletal Radiol. 1987;  16(4) 304-311
    CrossrefPubMedGoogle Scholar
  • 32 Sueyoshi Y, Shimozaki E, Matsumoto T, Tomita K. Two cases of dorsal defect of the patella with arthroscopically visible cartilage surface perforations.  Arthroscopy. 1993;  9(2) 164-169
    CrossrefPubMedGoogle Scholar
  • 33 Safran M R, McDonough P, Seeger L, Gold R, Oppenheim W L. Dorsal defect of the patella.  J Pediatr Orthop. 1994;  14(5) 603-607
    PubMedGoogle Scholar
  • 34 Mink J H, Deutsch A. The knee. In: Mink J, Deutsch A MRI of the Musculoskeletal System: A Teaching File. New York, NY; Raven Press 1990
    PubMedGoogle Scholar
  • 35 Yao L, Lee J K. Occult intraosseous fracture: detection with MR imaging.  Radiology. 1988;  167(3) 749-751
    PubMedGoogle Scholar
  • 36 Mink J H, Deutsch A L. Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging.  Radiology. 1989;  170(3 Pt 1) 823-829
    PubMedGoogle Scholar
  • 37 Warren L F, Marshall J L. The supporting structures and layers on the medial side of the knee: an anatomical analysis.  J Bone Joint Surg Am. 1979;  61(1) 56-62
    Google Scholar
  • 38 Conlan T, Garth Jr WPJ, Lemons J E. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee.  J Bone Joint Surg Am. 1993;  75(5) 682-693
    PubMedGoogle Scholar
  • 39 Courneya D L, Spritzer C E, Burk Jr D L, Strong J A. MR imaging of patellofemoral ligament avulsion: a newly recognized medial retinaculum injury [abstract].  Radiology. 1994;  193 A289
    PubMedGoogle Scholar
  • 40 Starok M, Lenchik L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation.  AJR Am J Roentgenol. 1997;  168(6) 1493-1499
    PubMedGoogle Scholar
  • 41 Davies A P, Costa M L, Shepstone L, Glasgow M M, Donell S, Donnell S T. The sulcus angle and malalignment of the extensor mechanism of the knee.  J Bone Joint Surg Br. 2000;  82(8) 1162-1166
    CrossrefPubMedGoogle Scholar
  • 42 Shellock F G, Mink J H, Fox J M. Patellofemoral joint: kinematic MR imaging to assess tracking abnormalities.  Radiology. 1988;  168(2) 551-553
    PubMedGoogle Scholar
  • 43 Shellock F G, Mink J H, Deutsch A D et al.. Evaluation of patellar tracking abnormalities using kinematic MR imaging. Clinical experience in 130 patient.  Radiology. 1989;  172 799-804
    PubMedGoogle Scholar
  • 44 Atkin D M, Fithian D C, Marangi K S, Stone M L, Dobson B E, Mendelsohn C. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury.  Am J Sports Med. 2000;  28(4) 472-479
    PubMedGoogle Scholar
  • 45 Spritzer C E, Courneya D L, Burk Jr D L, Garrett W E, Strong J A. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications.  AJR Am J Roentgenol. 1997;  168(1) 117-122
    PubMedGoogle Scholar
  • 46 Lance E, Deutsch A L, Mink J H. Prior lateral patellar dislocation: MR imaging findings.  Radiology. 1993;  189(3) 905-907
    PubMedGoogle Scholar
  • 47 Hughston J C, Walsh W, Puddu G. Diagnosis. In: Sledge CB Patellar Subluxation and Dislocation: Monographs in Clinical Orthopedics. Vol. 5. Philadelphia, PA; Saunders 1984: 13-84
    PubMedGoogle Scholar
  • 48 Jensen C M, Roosen J U. Acute traumatic dislocations of the patella.  J Trauma. 1985;  25(2) 160-162
    CrossrefPubMedGoogle Scholar
  • 49 Cash J D, Hughston J C. Treatment of acute patellar dislocation.  Am J Sports Med. 1988;  16(3) 244-249
    CrossrefPubMedGoogle Scholar
  • 50 Hawkins R J, Bell R H, Anisette G. Acute patellar dislocations. The natural history.  Am J Sports Med. 1986;  14(2) 117-120
    CrossrefPubMedGoogle Scholar
  • 51 Hammerle C P, Jacob R P. Chondral and osteochondral fractures after luxation of the patella and their treatment.  Arch Orthop Trauma Surg. 1980;  97(3) 207-211
    CrossrefPubMedGoogle Scholar
  • 52 Virolainen H, Visuri T, Kuusela T. Acute dislocation of the patella: MR findings.  Radiology. 1993;  189(1) 243-246
    PubMedGoogle Scholar
  • 53 Kirsch M D, Fitzgerald S W, Friedman H, Rogers L F. Transient lateral patellar dislocation: diagnosis with MR imaging.  AJR Am J Roentgenol. 1993;  161(1) 109-113
    CrossrefPubMedGoogle Scholar
  • 54 Quinn S F, Brown T R, Demlow T A. MR imaging of patellar retinacular ligament injuries.  J Magn Reson Imaging. 1993;  3(6) 843-847
    CrossrefPubMedGoogle Scholar
  • 55 Nakanishi K, Inoue M, Harada K et al.. Subluxation of the patella: evaluation of patellar articular cartilage with MR imaging.  Br J Radiol. 1992;  65(776) 662-667
    CrossrefPubMedGoogle Scholar
  • 56 Vainionpää S, Laasonen E, Pätiälä H, Rusanen M, Rokkannen P. Acute dislocation of the patella. Clinical, radiographic and operative findings in 64 consecutive cases.  Acta Orthop Scand. 1986;  57(4) 331-333
    PubMedGoogle Scholar
  • 57 Elias D A, White L M, Fithian D C. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella.  Radiology. 2002;  225(3) 736-743
    CrossrefPubMedGoogle Scholar
  • 58 Cofield R H, Bryan R S. Acute dislocation of the patella: results of conservative treatment.  J Trauma. 1977;  17(7) 526-531
    CrossrefPubMedGoogle Scholar
  • 59 Kelly D W, Carter V S, Jobe F W, Kerlan R K. Patellar and quadriceps tendon ruptures—jumper's knee.  Am J Sports Med. 1984;  12(5) 375-380
    CrossrefPubMedGoogle Scholar
  • 60 Kricun R, Kricun M E, Arangio G A, Salzman G S, Berman A T. Patellar tendon rupture with underlying systemic disease.  AJR Am J Roentgenol. 1980;  135(4) 803-807
    CrossrefPubMedGoogle Scholar
  • 61 McMaster P E. Tendon and muscle ruptures: clinical and experimental studies on the causes and location of subcutaneous ruptures.  J Bone Joint Surg Am. 1933;  15 705-721
    PubMedGoogle Scholar
  • 62 Burgess R C, Guise E R. Infrapatellar tendon ruptures.  Orthopedics. 1985;  8(3) 362-364
    PubMedGoogle Scholar
  • 63 Motamedi K, Seeger L L, Hame S L. Imaging of postoperative knee extensor mechanism.  Eur J Radiol. 2005;  54(2) 199-205
    CrossrefPubMedGoogle Scholar
  • 64 Hollinshead W H, Rosse C. Textbook of Anatomy. 4th ed. Philadelphia, PA; Harper & Row 1985: 434-435
    PubMedGoogle Scholar
  • 65 Khan K M, Bonar F, Desmond P M Victorian Institute of Sport Tendon Study Group et al. Patellar tendinosis (jumper's knee): findings at histopathologic examination, US, and MR imaging.  Radiology. 1996;  200(3) 821-827
    CrossrefPubMedGoogle Scholar
  • 66 Colosimo A J, Bassett III F H. Jumper's knee. Diagnosis and treatment.  Orthop Rev. 1990;  19(2) 139-149
    PubMedGoogle Scholar
  • 67 el-Khoury G Y, Wira R L, Berbaum K S, Pope Jr T L, Monu JUV. MR imaging of patellar tendinitis.  Radiology. 1992;  184(3) 849-854
    PubMedGoogle Scholar
  • 68 McLoughlin R F, Raber E L, Vellet A D, Wiley J P, Bray R C. Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification.  Radiology. 1995;  197(3) 843-848
    PubMedGoogle Scholar
  • 69 Boden B P, Pearsall A W, Garrett Jr W E, Feagin Jr J A. Patellofemoral instability: evaluation and management.  J Am Acad Orthop Surg. 1997;  5(1) 47-57
    PubMedGoogle Scholar
  • 70 Mink J H, Deutsch A L, Kerr R. Tendon injuries of the lower extremity: magnetic resonance assessment.  Top Magn Reson Imaging. 1991;  3(4) 23-38
    PubMedGoogle Scholar
  • 71 Davies S G, Baudouin C J, King J B, Perry J D. Ultrasound, computed tomography and magnetic resonance imaging in patellar tendinitis.  Clin Radiol. 1991;  43(1) 52-56
    CrossrefPubMedGoogle Scholar
  • 72 Kujala U M, Osterman K, Aalto T et al.. L'incongruenza patellofemorale e'spesso bilaterale.  J Sports Traumatol Rel Res. 1990;  12(1) 25-31
    PubMedGoogle Scholar
  • 73 Scranton Jr P E, Farrar E L. Mucoid degeneration of the patellar ligament in athletes.  J Bone Joint Surg Am. 1992;  74(3) 435-437
    PubMedGoogle Scholar
  • 74 Resnick D. Soft tissues. In: Resnick D Diagnosis in Bone and Joint Disorders. 4th ed. Philadelphia, PA; Saunders 2003: 1357-1374
    PubMedGoogle Scholar
  • 75 Jacobson J A, Lenchik L, Ruhoy M K, Schweitzer M E, Resnick D. MR imaging of the infrapatellar fat pad of Hoffa.  Radiographics. 1997;  17(3) 675-691
    PubMedGoogle Scholar
  • 76 Staeubli H U, Bollmann C, Kreutz R, Becker W, Rauschning W. Quantification of intact quadriceps tendon, quadriceps tendon insertion, and suprapatellar fat pad: MR arthrography, anatomy, and cryosections in the sagittal plane.  AJR Am J Roentgenol. 1999;  173(3) 691-698
    PubMedGoogle Scholar
  • 77 Schweitzer M E, Falk A, Pathria M, Brahme S, Hodler J, Resnick D. MR imaging of the knee: can changes in the intracapsular fat pads be used as a sign of synovial proliferation in the presence of an effusion?.  AJR Am J Roentgenol. 1993;  160(4) 823-826
    PubMedGoogle Scholar
  • 78 Hoffa A. Influence of adipose tissue with regard to the pathology of the knee joint.  JAMA. 1904;  43 795-796
    PubMedGoogle Scholar
  • 79 Williams P, Warwick R, Dyson M et al.. Gray's Anatomy. 37th ed. New York, NY; Churchill Livingstone 1989
    PubMedGoogle Scholar
  • 80 Roth C, Jacobson J, Jamadar D, Caoili E, Morag Y, Housner J. Quadriceps fat pad signal intensity and enlargement on MRI: prevalence and associated findings.  AJR Am J Roentgenol. 2004;  182(6) 1383-1387
    PubMedGoogle Scholar
  • 81 Hughston J C. Functional anatomy: fat pads. In: Hughston JC Knee Ligaments. St. Louis, MO; Mosby 1993: 28-29
    PubMedGoogle Scholar
  • 82 Metheny J A, Mayor M B. Hoffa disease: chronic impingement of the infrapatellar fat pad.  Am J Knee Surg. 1988;  1 134-139
    PubMedGoogle Scholar
  • 83 Chung C B, Skaf A, Roger B, Campos J, Stump X, Resnick D. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients.  Skeletal Radiol. 2001;  30(12) 694-697
    CrossrefPubMedGoogle Scholar
  • 84 Kim M G, Kim B H, Choi J A et al.. Intra-articular ganglion cysts of the knee: clinical and MR imaging features.  Eur Radiol. 2001;  11(5) 834-840
    CrossrefPubMedGoogle Scholar
  • 85 Saddik D, McNally E G, Richardson M. MRI of Hoffa's fat pad.  Skeletal Radiol. 2004;  33(8) 433-444
    PubMedGoogle Scholar
  • 86 Ogilvie-Harris D J, Giddens J. Hoffa's disease: arthroscopic resection of the infrapatellar fat pad.  Arthroscopy. 1994;  10(2) 184-187
    CrossrefPubMedGoogle Scholar
  • 87 Sanders T G, Morrison W B, Singleton B A, Miller M D, Cornum K G. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients.  J Comput Assist Tomogr. 2001;  25(6) 957-962
    CrossrefPubMedGoogle Scholar
  • 88 Smillie I S. Lesions of the infrapatellar fat pad and synovial fringes: Hoffa's disease. Acta Orthop Scand 1963;33:371–377 correlation in 14 patients.  J Comput Assist Tomogr. 2001;  25 957-962
    CrossrefPubMedGoogle Scholar
  • 89 Magi M, Branca A, Bucca C, Langerame V. Hoffa disease.  Ital J Orthop Traumatol. 1991;  17(2) 211-216
    PubMedGoogle Scholar
  • 90 Reicher M A. The spectrum of knee joint disorders. In: Mink JH, Reicher MA, Crues JV III, Deutsch AL MRI of the Knee. 2nd ed. New York, NY; Raven 1993: 333-399
    PubMedGoogle Scholar
  • 91 Shahriaree H. Arthroscopic technique and normal anatomy. In: Shahriaree H O'Connor's Textbook of Arthroscopic Surgery. 2nd ed. Philadelphia, PA; Lippincott 1992: 255-283
    PubMedGoogle Scholar

Josef KramerM.D. Ph.D. 

Inst. f. CT & MRI at Schillerpark, Rainerstrasse 6-8

4020 Linz, Austria

eMail: kramer@ctmri.at