Dynamic ultrasonography in the diagnosis of acute anterior cruciate ligament injury – a case report

Abstract

In the reported case of acute grade 3 anterior cruciate ligament injury, clinical examination and magnetic resonance imaging findings were in conflict, leading to confusion. Ultimately, dynamic ultrasound imaging proved to be the decisive test. The article describes the steps taken to reach the diagnosis. In addition, possible future diagnostic improvements are discussed. Dynamic ultrasound imaging, performed as part of the physical examination, is a valuable supplement to medical documentation. It provides appreciable diagnostic performance for the detection of anterior cruciate ligament insufficiency. Physical examination combined with magnetic resonance imaging, even though they represent the current diagnostic standard, have their limitations.

Prone Lachman with Ultrasound: A Literature Review and Description of the Technique

“…The ability to perform an immediate comparison with the uninjured, contralateral extremity is another advantage of MSKUS. Tibial translation can vary between individuals; however, the contralateral extremity can serve as an internal control and be especially useful when other objective findings are equivocal (10,(14)(15)(16)(17). Furthermore, quantifying tibial translation eliminates the subjectivity of traditional tests like the Lachman that can often make diagnosis challenging (15).…”

“…Dynamic ultrasonography overcomes the limitations of needing to directly visualize the entirety of the ACL by indirectly measuring its function. Previous literature has described several dynamic ultrasound variations for assessing ACL integrity by measuring tibial translation relative to the femur (10,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). The primary differences among these techniques are patient positioning (prone or supine), transducer placement (anterior or posterior), and force application method (manual, gravity-induced, or device-generated).…”

“…In contrast to MRI, musculoskeletal ultrasound (MSKUS) is more cost-effective, portable, and offers the ability to image structures dynamically. As the use of MSKUS has become more prevalent, an increasing number of studies have documented the efficacy of using this modality to diagnose ACL tears (10–12,14–36). However, tremendous heterogeneity exists between approaches, and optimal technique has not been clearly described in the literature.…”