3-T MR imaging of partial ACL tears: a cadaver study

Abstract

Magnetic resonance imaging (MRI) is the most commonly used diagnostic imaging procedure for suspected injuries to the anterior cruciate ligament (ACL). However, MRI has less utility for the evaluation of partial ACL tears. The goal of this study was to evaluate the possibility of distinguishing partial ACL tears applying the double bundle concept by dividing the ACL anatomy in the anteromedial (AM) and posterolateral bundle (PL). Six human cadaver knees were used in this laboratory study. The protocol consisted of sagittal, oblique coronal, and oblique sagittal proton-density-weighted fast spin echo sequences. After MRI the AM and the PL bundle were severed to mimic different partial ACL rupture patterns. MRI scanning of each knee was repeated, to record the quantitative parameters tilt and ACL angles and discontinuity as a nonquantitative parameter. Three orthopaedic surgeons and two radiologists were enlisted as blinded observers to evaluate the images. The transection patterns could be differentiated by evaluating discontinuity both in the paracoronal and in the sagittal plane. Evaluating the transection patterns, the AM bundle reached a better result in both planes compared to the PL bundle and the paracoronal plane had a better result in assessing the transection patterns compared to the sagittal plane for the PL bundle. Partial ACL transections could predictably be recognized on oblique sagittal and oblique coronal planes utilizing 3-T MRI technology. This concept allows a more precise description of ACL rupture patterns and might lead to a more distinctive approach for reconstructive surgery. The presurgical planning could be improved by applying a treatment algorithm based on a description of each bundle as intact or ruptured, leading to a reconstruction of the torn and a preservation of the intact bundle.

How Useful Is MRI in Diagnosing Isolated Bundle ACL Injuries?

“…We found that diagnosis of PL bundle injuries indeed is more difficult, especially within 6 weeks of injury. Nevertheless, a previous study suggested that oblique coronal images can improve the ability of MRI to detect PL bundle injuries [25]. In that study, diagnostic accuracy of MRI to detect PL bundle injuries was between 67% and 80% with use of oblique coronal images [25].…”

MRI depiction and 3D visualization of three anterior cruciate ligament bundles

“…Although the previous studies have examined on this matter, it is still controversial regarding which plane is better depicted (Steckel et al, 2007;Kwon et al, 2009;Kaya et al, 2010;Adriaensen et al, 2012;Mackay et al, 2014). Adriaensen et al (2012) studied 50 knees in the standard planes using 3T-MRI and reported that the double-bundle ACL was identifiable in 47 knees (94%).…”

Regional fibrocartilage variations in human anterior cruciate ligament tibial insertion: a histological three-dimensional reconstruction

“…It is widely accepted that the ACL is composed of two functional bundles, the AM and the PL bundles (8)(9)(10)(11). They can be distinguished by the various tension patterns during knee range of motion and also with MRI along oblique sagittal and oblique coronal planes (20,21). However, conflicting evidence about the anatomic bundle division remains.…”