A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities

Izadpanah, Kaywan; Winterer, Jan Thorsten; Vicari, Marco; Jaeger, Martin; Maier, Dirk; Eisebraun, Leonie; Will, Jutta Ute; Kotter, Elmar; Langer, Mathias; Südkamp, Norbert P.; Hennig, Jürgen; Weigel, Matthias

doi:10.1002/jmri.23853

Cited by 25 publications

(17 citation statements)

References 13 publications

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“…In this context, preoperative MRI could prove of value for assessment ACLC tear patterns and identification of patients benefiting from mini-open surgery due to otherwise limited healing potential. Current ACJ-specific MRI techniques allow detailed assessment of ligamentous structures including the articular disc [11, 21, 29]. In our own series, we were able to distinguish distinct ACLC tear types and to diagnose articular disc dislocations in selective cases by means of ACJ-specific MRI (Fig.…”

Section: Discussionmentioning

confidence: 79%

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Maier

Jaeger

Reising

et al. 2016

BMC Musculoskelet Disord

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BackgroundHorizontal instability impairs clinical outcome following acute acromioclavicular joint (ACJ) reconstruction and may be caused by insufficient healing of the superior acromioclavicular ligament complex (ACLC). However, characteristics of acute ACLC injuries are poorly understood so far. Purposes of this study were to identify different ACLC tear types, assess type-specific prevalence and determine influencing cofactors.MethodsThis prospective, cross-sectional study comprised 65 patients with acute-traumatic Rockwood-5 (n = 57) and Rockwood-4 (n = 8) injuries treated operatively by means of mini-open ACJ reduction and hook plate stabilization. Mean age at surgery was 38.2 years (range, 19–57 years). Standardized pre- and intraoperative evaluation included assessment of ACLC tear patterns and cofactors related to the articular disc, the deltoid-trapezoidal (DT) fascia and bony ACJ morphology. Articular disc size was quantified as 0 = absent, 1 = remnant, 2 = meniscoid and 3 = complete.ResultsAll patients showed complete ruptures of the superior ACLC, which could be assigned to four different tear patterns. Clavicular-sided (AC-1) tears were observed in 46/65 (70.8 %), oblique (AC-2) tears in 12/65 (18.5 %), midportion (AC-3) tears in 3/65 (4.6 %) and acromial-sided (AC-4) tears in 4/65 (6.1 %) of cases. Articular disc size manifestation was significantly (P < .001) more pronounced in patients with AC-1 tears (1.89 ± 0.57) compared to patients with AC-2 tears (0.67 ± 0.89). Other cofactors did not influence ACLC tear patterns. ACLC dislocation with incarceration caused mechanical impediment to anatomical ACJ reduction in 14/65 (21.5 %) of cases including all Rockwood-4 dislocations. Avulsion “in continuity” was a consistent mode of failure of the DT fascia. Type-specific operative strategies enabled anatomical ACLC repair of all observed tear types.ConclusionsAcute ACLC injuries follow distinct tear patterns. There exist clavicular-sided (AC-1), oblique (AC-2), midportion (AC-3) and acromial-sided (AC-4) tears. Articular disc size was a determinant factor of ACLC tear morphology. Mini-open surgery was required in Rockwood-4 and a relevant proportion of Rockwood-5 dislocations to achieve both anatomical ACLC and ACJ reduction. Type-specific operative repair of acute ACLC tears might promote biological healing and lower rates of horizontal ACJ instability following acute ACJ reconstruction.

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Section: Discussionmentioning

confidence: 79%

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Maier

Jaeger

Reising

et al. 2016

BMC Musculoskelet Disord

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“…MRA with axial traction has been evaluated with success in the shoulder, [11][12][13] hip, [14][15][16][17][18][19][20][21] knee, 22 wrist, [23][24][25][26][27][28][29][30] ankle 31,32 and metatarsophalangeal 33 and metacarpophalangeal joints. 34 To the best of our knowledge, there is no study comparing MRA of the elbow with and without traction.…”

Section: Introductionmentioning

confidence: 99%

Elbow MR arthrography with traction

Lee

Griffith

Yuen

et al. 2016

BJR

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“…In addition, lack of post-operative data, in our cohort of diseased subjects, may bias the CT differentiation of these structures from post-traumatic scars. However, this is still a hot discussion topic for the MR that may necessitate dynamic evaluation [22].…”

Section: Discussionmentioning

confidence: 99%

The Normal Acromioclavicular Joint: An In Vivo Multidetector CT (MDCT) Morphometric and Biometric Cross Sectional Feasibility Study

MR¹,

AA²,

HA³

et al. 2017

OMICS J Radiol

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A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities

Abstract: Stress MRI facilitates simultaneous acquisition of morphologic and functional information of the ACJ stabilizers. In acute ACJ injuries it helps to distinguish between partial and complete ligament tears. In chronic ACJ injuries it provides functional information of the ligament regrinds.

Cited by 25 publications

References 13 publications

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study

Elbow MR arthrography with traction

The Normal Acromioclavicular Joint: An In Vivo Multidetector CT (MDCT) Morphometric and Biometric Cross Sectional Feasibility Study

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