Dynamic Ultrasound Can Accurately Quantify Severity of Medial Knee Injury: A Cadaveric Study

Bhimani, Rohan; Lubberts, Bart; DiGiovanni, Christopher W.; Tanaka, Miho J.

doi:10.1016/j.asmr.2022.07.003

Cited by 4 publications

(4 citation statements)

References 27 publications

(47 reference statements)

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“…Literature does exist that demonstrates greater increased medial joint gap width during the valgus stress test in patients with injured MCL. This increased widening of the medial knee joint gap has been found in studies using x‐ray and ultrasound imaging techniques 5,14 . The results of the cadaver and finite element studies suggest that injury of the dMCL or POL structures should result in greater widening of the medial joint gap during the ANTMED rotational stress test 7,15–17 .…”

Section: Introductionmentioning

confidence: 71%

“…This increased widening of the medial knee joint gap has been found in studies using x-ray and ultrasound imaging techniques. 5,14 The results of the cadaver and finite element studies suggest that injury of the dMCL or POL structures should result in greater widening of the medial joint gap during the ANTMED rotational stress test. 7,[15][16][17] Improved understanding of the clinical tests for the assessment of knee ANTMED rotational stability will lead to earlier recognition of injury to the dMCL and POL and will likely lead to improved outcomes for patients with ANTMED rotational knee instability.…”

Section: Introductionmentioning

confidence: 97%

“…The components of the dMCL insert into the medial meniscus and assist in holding the medial meniscus in place during tibial anterior translation and internal or external rotation. 5,6 Disruption of the dMCL decreases the anterior medial rotatory stability of the knee. 7 The clinical evaluation of the knee includes the assessment of knee frontal and sagittal plane stability.…”

Section: Introductionmentioning

confidence: 99%

“…The MCL has two major anatomical divisions, the superficial (sMCL) and deep (dMCL) portions. The components of the dMCL insert into the medial meniscus and assist in holding the medial meniscus in place during tibial anterior translation and internal or external rotation 5,6 . Disruption of the dMCL decreases the anterior medial rotatory stability of the knee 7 …”

Section: Introductionmentioning

confidence: 99%

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The medial knee gap measured on ultrasound images is wider during a valgus stress test compared to the anterior medial knee rotation test

Timmons,

Darnell,

Jude

et al. 2024

Sonography

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ObjectivesPatients with injuries to the deep fibers of the medial collateral ligament (dMCL) have a worse prognosis than patients with injuries to the superficial fibers (sMCL). The anterior medial (ANTMED) rotation test has been developed to differentiate between injuries to the dMCL and sMCL. The current study tested the hypothesis that the width of the medial knee gap would be greater during the valgus stress test than the ANTMED rotation test.MethodsFifty‐three participants were included in the study. Participants did not have a history of knee injury. Ultrasound images of the participants' medial knees were collected during the valgus stress test and the ANTMED rotation test. Repeated measures ANOVA was used to test differences in the medial knee gap between the tests, stress condition, and side.ResultsNo difference between the tests in the medial knee joint gap width in the no‐stress condition. The increase in the joint gap width was greater during the valgus stress test than the ANTMED rotation test. The medial knee gap increased during both the valgus stress (4.0 ± 0.12 mm) and the ANTMED rotation test (2.9 ± 0.12 mm).ConclusionsA greater increase in the medial knee gap was seen during the valgus stress test compared to the ANTMED rotation test. Knee external rotation increases the tension within the dMCL. Increased tension in the dMCL could explain the test differences in the increase in the joint gap found in the current study. The ANTMED rotation test may prove useful to identify injury to the dMCL.

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Section: Introductionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The medial knee gap measured on ultrasound images is wider during a valgus stress test compared to the anterior medial knee rotation test

Timmons,

Darnell,

Jude

et al. 2024

Sonography

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Ultrasound‐based bone tracking using cross‐correlation enables dynamic measurements of knee kinematics during clinical assessments

Blomquist,

Roth

2024

J. exp. orthop.

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PurposeMeasuring joint kinematics in the clinic is important for diagnosing injuries, tracking healing and guiding treatments; however, current methods are limited by accuracy and/or feasibility of widespread clinical adoption. Therefore, the purpose of this study was to develop and validate an ultrasound (US)‐based method for measuring knee kinematics during clinical assessments.MethodsWe mimicked four clinical laxity assessments (i.e., anterior, posterior, varus, valgus) on five human cadaver knees using our robotic testing system. We simultaneously collected B‐mode cine loops with an US transducer. We computed the errors in kinematics between those measured using our bone‐tracking algorithm, which cross‐correlated regions of interest across frames of the cine loops, and those measured using optical motion capture with bone pins. Additionally, we conducted studies to determine the effects of loading rate and transducer placement on kinematics measured using our US‐based bone tracking.ResultsPooling the trials at experimental speeds and those downsampled to replicate clinical laxity assessments, the maximum root‐mean‐square errors of knee kinematics using our bone‐tracking algorithm were 2.2 mm and 1.3° for the anterior‐posterior and varus‐valgus laxity assessments, respectively. Repeated laxity assessments proved to have good‐to‐excellent repeatability (intraclass correlation coefficients [ICCs] of 0.81–0.99), but ICCs from repositioning the transducer varied more widely, ranging from poor‐to‐good reproducibility (0.19–0.89).ConclusionOur results demonstrate that US is capable of tracking knee kinematics during dynamic movement. Because US is a safe and commonly used imaging modality, when paired with our bone‐tracking algorithm, US has the potential to assess dynamic knee kinematics across a wide variety of applications in the clinic.Level of EvidenceNot applicable.

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Current Clinical Approaches to Acute Medial Collateral Ligament Injuries

Brown

Rho

2023

Curr Phys Med Rehabil Rep

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Dynamic Ultrasound Can Accurately Quantify Severity of Medial Knee Injury: A Cadaveric Study

Cited by 4 publications

References 27 publications

The medial knee gap measured on ultrasound images is wider during a valgus stress test compared to the anterior medial knee rotation test

The medial knee gap measured on ultrasound images is wider during a valgus stress test compared to the anterior medial knee rotation test

Ultrasound‐based bone tracking using cross‐correlation enables dynamic measurements of knee kinematics during clinical assessments

Current Clinical Approaches to Acute Medial Collateral Ligament Injuries

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