MRI is an excellent diagnostic tool in the imaging of sports-related musculoskeletal pathology; however, standard slice thickness acquisitions can lack the spatial resolution to accurately define and characterise osseous abnormalities. Standard MRI sequences may be supplemented with CT to reduce diagnostic uncertainty. We provide a clinical perspective, in the form of pictorial review, on the potential applications of 3D MRI sequences, specifically using volumetric interpolated breath-hold examination in the characterisation of various musculoskeletal osseous pathologies. The potential to negate the requirement for CT in a young radiation sensitive cohort is a clinically significant concept and suggests the requirement for further studies comparing the performance of volumetric MRI to CT.

CTA regularly overestimates thrombus length as the distal end of the thrombus is not delineated. This can be overcome through the use of a CECT acquisition which can reliably be used to estimate thrombus length.

Intra-articular entrapment of the medial collateral ligament (MCL) is a rare but recognised complication of traumatic injury to the posteromedial corner (PMC) of the knee. Considering the MCL is the most commonly injured ligament of the knee this complication is extremely rare with only a handful of cases describing MCL entrapment following distal avulsion of the MCL. We present the first known case of MCL entrapment following proximal avulsion of the MCL and posterior oblique ligament (POL) with the mid-substance of the MCL becoming entrapped in the joint, lying on the superior surface of the medial meniscus and extending up into the intercondylar notch. In addition, the medial patellar retinaculum was also entrapped in the medial aspect of the medial patellofemoral joint. MCL entrapment is best treated with expeditious surgical intervention and it is therefore crucial that the MRI findings are not overlooked. Details of the clinical assessment, MRI and operative findings are presented with a literature review of MCL entrapment.

Purpose To establish the magnetic resonance imaging (MRI) and operative incidence of ramp lesions in a consecutive group of patients who had undergone anterior cruciate ligament reconstruction (ACLR) and to propose a graded radiologic classification that seeks to define key preoperative features that most strongly correlate with arthroscopically confirmed ramp lesions. Methods After retrospective review, all consecutive patients who underwent ACLR with preoperative MRI over a 16-month period were included in the study. Diagnostic arthroscopy with direct visualization of the posteromedial compartment was used to establish the true incidence of ramp lesions. Three radiologists, blinded to the surgical findings, independently analyzed the MRI scans of all patients and classified the signal intensity at the posterior meniscocapsular junction using 4 criteria (type 1, diffuse increased signal equal to adjacent femoral cartilage; type 2, diffuse increased signal greater than cartilage; type 3, diffuse increased signal plus full-height linear fluid-signal cleft; and type 4, full-height fluid-signal meniscocapsular separation). Interobserver reliability, in addition to sensitivity, specificity, and positive and negative predictive values, was calculated. Results Of the 93 patients included (mean age, 26.7 years), 11 (11.8%) were confirmed to have ramp lesions on arthroscopy. Inter-rater reliability for the MRI diagnosis of the positive ramp lesions was good, at 0.75. Type 3 criteria were the most accurate, producing average sensitivity and specificity values of 85% and 82%, respectively. Conclusions Ramp lesions are not infrequently encountered in ACLR and, if not recognized at the time of surgery, may contribute to inferior outcomes. MRI is an effective method of preoperative assessment, and the presence of type 3 changes should be used as criteria for radiologically definitive ramp lesion diagnosis. Clinical Relevance This study highlights the incidence of meniscal ramp lesions encountered in ACLR surgery and the effectiveness of MRI as a preoperative imaging modality.