Download PDF
Semin Musculoskelet Radiol 2022; 26(03): 230-241
DOI: 10.1055/s-0041-1741516
Review Article

Posttreatment Imaging of the Knee: Cruciate Ligaments and Menisci

Andreas Heuck 
1   Radiologische Klinik und Poliklinik, Ludwig-Maximilian-University Hospital, Munich, Germany
,
Klaus Woertler
2   Institut für Diagnostische und Interventionelle Radiologie, Technical University of Munich, Munich, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Cruciate ligament reconstruction and meniscal surgery are frequently performed for restoration of knee joint stability and function after cruciate ligament and meniscus injuries, and they contribute to the prevention of secondary osteoarthritis. In cruciate ligaments, the most common procedure is anterior cruciate ligament (ACL) reconstruction. Meniscal surgery most frequently consists of partial meniscectomy and suture repair, rarely of a meniscus transplant. In patients with symptoms following surgery, imaging reevaluation for a suspected intra-articular source of symptoms is indicated and mainly consists of radiography and magnetic resonance imaging. For proper imaging assessment of cruciate ligament grafts and the postoperative meniscus, it is crucial to understand the surgical techniques applied, to be familiar with normal posttreatment imaging findings, and to be aware of patterns and specific findings of recurrent lesions and typical complications. This article presents an updated review of the techniques and the imaging of cruciate ligament reconstruction and meniscus surgery, recurrent lesions, treatment failure, and potential complications.

Keywords

knee - ligaments - menisci - cruciate ligament reconstruction - meniscus repair - magnetic resonance imaging - computed tomography


Publication History

Article published online:
02 June 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 White LM, Kramer J, Recht MP. MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skeletal Radiol 2005; 34 (08) 431-452
    CrossrefPubMedGoogle Scholar
  • 2 Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 2009; 29 (07) 2115-2126
    CrossrefPubMedGoogle Scholar
  • 3 Meyers AB, Haims AH, Menn K, Moukaddam H. Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol 2010; 194 (02) 476-484
    CrossrefPubMedGoogle Scholar
  • 4 Grassi A, Bailey JR, Signorelli C. et al. Magnetic resonance imaging after anterior cruciate ligament reconstruction: a practical guide. World J Orthop 2016; 7 (10) 638-649
    CrossrefPubMedGoogle Scholar
  • 5 Kijowski R, Rosas H, Williams A, Liu F. MRI characteristics of torn and untorn post-operative menisci. Skeletal Radiol 2017; 46 (10) 1353-1360
    CrossrefPubMedGoogle Scholar
  • 6 Meredick RB, Vance KJ, Appleby D, Lubowitz JH. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 2008; 36 (07) 1414-1421
    CrossrefPubMedGoogle Scholar
  • 7 Yang J, Fu S, Song Y. A prospective randomized controlled trial to evaluate clinico-radiological outcome of arthroscopic single bundle versus double bundle anterior cruciate ligament reconstruction. Int J Clin Exp Med 2017; 10: 1087-1093
    PubMedGoogle Scholar
  • 8 Fineberg MS, Zarins B, Sherman OH. Practical considerations in anterior cruciate ligament replacement surgery. Arthroscopy 2000; 16 (07) 715-724
    CrossrefPubMedGoogle Scholar
  • 9 Marrale J, Morrissey MC, Haddad FS. A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2007; 15 (06) 690-704
    CrossrefPubMedGoogle Scholar
  • 10 Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am 2010; 41 (02) 249-262
    CrossrefPubMedGoogle Scholar
  • 11 Srinivasan R, Wan J, Allen CR, Steinbach LS. Knee imaging following anterior cruciate ligament reconstruction: the surgeon's and radiologist's perspectives. Semin Musculoskelet Radiol 2018; 22 (04) 386-397
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Bush-Joseph CA, Bach Jr BR. Migration of femoral interference screw after anterior cruciate ligament reconstruction. Am J Knee Surg 1998; 11 (01) 32-34
    PubMedGoogle Scholar
  • 13 Geeslin AG, Geeslin MG, LaPrade RF. Ligamentous reconstruction of the knee: what orthopaedic surgeons want radiologists to know. Semin Musculoskelet Radiol 2017; 21 (02) 75-88
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 1997; 10 (01) 14-21 ; discussion 21–22
    PubMedGoogle Scholar
  • 15 Morgan JA, Dahm D, Levy B, Stuart MJ. MARS Study Group. Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg 2012; 25 (05) 361-368
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Parkar AP, Adriaensen ME, Fischer-Bredenbeck C. et al. Measurements of tunnel placements after anterior cruciate ligament reconstruction—a comparison between CT, radiographs and MRI. Knee 2015; 22 (06) 574-579
    CrossrefPubMedGoogle Scholar
  • 17 Dhawan A, Gallo RA, Lynch SA. Anatomic tunnel placement in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 2016; 24 (07) 443-454
    CrossrefPubMedGoogle Scholar
  • 18 Sanders TG. MR imaging of postoperative ligaments of the knee. Semin Musculoskelet Radiol 2002; 6 (01) 19-33
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Collins MS, Unruh KP, Bond JR, Mandrekar JN. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption. Skeletal Radiol 2008; 37 (03) 233-243
    CrossrefPubMedGoogle Scholar
  • 20 Marchant Jr MH, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18 (08) 1059-1064
    CrossrefPubMedGoogle Scholar
  • 21 Weber AE, Delos D, Oltean HN. et al. Tibial and femoral tunnel changes after ACL reconstruction: a prospective 2-year longitudinal MRI study. Am J Sports Med 2015; 43 (05) 1147-1156
    CrossrefPubMedGoogle Scholar
  • 22 Rizer M, Foremny GB, Rush III A. et al. Anterior cruciate ligament reconstruction tunnel size: causes of tunnel enlargement and implications for single versus two-stage revision reconstruction. Skeletal Radiol 2017; 46 (02) 161-169
    CrossrefPubMedGoogle Scholar
  • 23 Saupe N, White LM, Chiavaras MM. et al. Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up–correlation with functional and clinical evaluation. Radiology 2008; 249 (02) 581-590
    CrossrefPubMedGoogle Scholar
  • 24 Stevenson III WW, Johnson DL. “Vertical grafts”: a common reason for functional failure after ACL reconstruction. Orthopedics 2007; 30 (03) 206-209
    CrossrefPubMedGoogle Scholar
  • 25 DeFrate LE. Effects of ACL graft placement on in vivo knee function and cartilage thickness distributions. J Orthop Res 2017; 35 (06) 1160-1170
    CrossrefPubMedGoogle Scholar
  • 26 Fauno P, Kaalund S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 2005; 21 (11) 1337-1341
    CrossrefPubMedGoogle Scholar
  • 27 Ghazikhanian V, Beltran J, Nikac V, Feldman M, Bencardino JT. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol 2012; 41 (11) 1375-1379
    CrossrefPubMedGoogle Scholar
  • 28 Konan S, Haddad FS. Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature. J Orthop Traumatol 2010; 11 (01) 51-55
    CrossrefPubMedGoogle Scholar
  • 29 Pelfort X, Monllau JC, Puig L, Cáceres E. Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature. Knee Surg Sports Traumatol Arthrosc 2006; 14 (06) 586-589
    CrossrefPubMedGoogle Scholar
  • 30 Bradley DM, Bergman AG, Dillingham MF. MR imaging of cyclops lesions. AJR Am J Roentgenol 2000; 174 (03) 719-726
    CrossrefPubMedGoogle Scholar
  • 31 Papakonstantinou O, Chung CB, Chanchairujira K, Resnick DL. Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol 2003; 13 (05) 1106-1117
    CrossrefPubMedGoogle Scholar
  • 32 Owesen C, Sandven-Thrane S, Lind M, Forssblad M, Granan L-P, Årøen A. Epidemiology of surgically treated posterior cruciate ligament injuries in Scandinavia. Knee Surg Sports Traumatol Arthrosc 2017; 25 (08) 2384-2391
    CrossrefPubMedGoogle Scholar
  • 33 Pache S, Aman ZS, Kennedy M. et al. Posterior cruciate ligament: current concepts review. Arch Bone Jt Surg 2018; 6 (01) 8-18
    PubMedGoogle Scholar
  • 34 Alcalá-Galiano A, Baeva M, Ismael M, Argüeso MJ. Imaging of posterior cruciate ligament (PCL) reconstruction: normal postsurgical appearance and complications. Skeletal Radiol 2014; 43 (12) 1659-1668
    CrossrefPubMedGoogle Scholar
  • 35 Sherman PM, Sanders TG, Morrison WB, Schweitzer ME, Leis HT, Nusser CA. MR imaging of the posterior cruciate ligament graft: initial experience in 15 patients with clinical correlation. Radiology 2001; 221 (01) 191-198
    CrossrefPubMedGoogle Scholar
  • 36 Maak TG, Fabricant PD, Wickiewicz TL. Indications for meniscus repair. Clin Sports Med 2012; 31 (01) 1-14
    CrossrefPubMedGoogle Scholar
  • 37 Hutchinson ID, Moran CJ, Potter HG, Warren RF, Rodeo SA. Restoration of the meniscus: form and function. Am J Sports Med 2014; 42 (04) 987-998
    CrossrefPubMedGoogle Scholar
  • 38 Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 2014; 42 (12) 3016-3030
    CrossrefPubMedGoogle Scholar
  • 39 LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Am J Sports Med 2017; 45 (04) 884-891
    CrossrefPubMedGoogle Scholar
  • 40 Elattar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty-six years of meniscal allograft transplantation: is it still experimental? A meta-analysis of 44 trials. Knee Surg Sports Traumatol Arthrosc 2011; 19 (02) 147-157
    CrossrefPubMedGoogle Scholar
  • 41 Vundelinckx B, Vanlauwe J, Bellemans J. Long- term subjective, clinical, and radiographic outcome evaluation of meniscal allograft transplantation in the knee. Am J Sports Med 2014; 42 (07) 1592-1599
    CrossrefPubMedGoogle Scholar
  • 42 Farley TE, Howell SM, Love KF, Wolfe RD, Neumann CH. Meniscal tears: MR and arthrographic findings after arthroscopic repair. Radiology 1991; 180 (02) 517-522
    CrossrefPubMedGoogle Scholar
  • 43 De Smet AA. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. Semin Musculoskelet Radiol 2005; 9 (02) 116-124
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Skeletal Radiol 2014; 43 (08) 1057-1064
    CrossrefPubMedGoogle Scholar
  • 45 Baker JC, Friedman MV, Rubin DA. Imaging the postoperative knee meniscus: an evidence-based review. AJR Am J Roentgenol 2018; 211 (03) 519-527
    CrossrefPubMedGoogle Scholar
  • 46 White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Radiology 2002; 222 (02) 421-429
    CrossrefPubMedGoogle Scholar
  • 47 Mutschler C, Vande Berg BC, Lecouvet FE. et al. Postoperative meniscus: assessment at dual-detector row spiral CT arthrography of the knee. Radiology 2003; 228 (03) 635-641
    CrossrefPubMedGoogle Scholar
  • 48 Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Am J Sports Med 2017; 45 (01) 42-49
    CrossrefPubMedGoogle Scholar