Ultrasound-based examination of the medial ligament complex shows gender- and age-related differences in laxity

Abstract

Purpose Ultrasound (US) examination of the medial joint space of the knee has played a subordinate diagnostic role up till now. The purpose of the present study was to describe mean values of medial joint width and to investigate the impact of gender, age, and body mass index (BMI) on medial joint laxity in healthy knees using modern, dynamic US in a standardized fashion in unloaded and standardized loaded conditions. Methods A total of 65 subjects with 79 healthy knees were enrolled in this study. All volunteers underwent clinical examination of the knee. The medial knee joint width was determined using US in a supine position at 0° and 30° of knee flexion in unloaded and standardized loaded (= 15 Dekanewton, daN) conditions using a specific device. Mean values were described and correlations between medial knee joint width and gender, age, and BMI were assessed. Results Thirty-two females and 33 males were enrolled in this study. The mean medial joint width in 0° unloaded was 5.7 ± 1.2 mm and 7.4 ± 1.4 mm loaded. In 30° of knee flexion, the mean medial joint width was 6.1 ± 1.1 mm unloaded and 7.8 ± 1.2 mm loaded. The average change between unloaded and loaded conditions in 0° was 1.7 ± 1.0 mm and in 30° 1.7 ± 0.9 mm. A significant difference between genders was evident for medial joint width in 0° and 30° of flexion in unloaded and loaded conditions (p < 0.05). With rising age, a significant increased change of medial joint space width between unloaded and loaded conditions could be demonstrated in 0° (p = 0.032). No significant correlation between BMI and medial joint width in US could be found. Conclusion Mean values of medial joint width in unloaded and standardized loaded conditions using a fixation device could be demonstrated. Based on the results of this study, medial knee joint width in US is gender- and age-related in healthy knees. These present data may be useful for evaluating patients with acute or chronic pathologies to the medial side of the knee. Level of evidence III.

Imaging of the medial collateral ligament of the knee: a systematic review

“…Despite this variability, the trend of increasing medial joint space opening remains highly correlated to the grade of MCL lesion ultimately diagnosed. Furthermore, concomitant lesions of other stabilizing knee ligaments such as the anterior cruciate ligament magnifies the amount of medial joint space opening and clinical instability present (Table 4) [26,30,37,[42][43][44]52].…”

“…Overall, patients with an isolated MCL lesion had a smaller maximal medial gapping of 18 mm compared to patients with a combined injury of the MCL and one or both cruciate ligaments that allowed [30] dynamic MRI Clinical examination with valgus stress Gap width measurement: distance between medial tibial margin and the cortex of the medial femoral condyles Grade I rupture: 2.3 mm Grade II rupture: 2.9 mm (1.9-4.9 mm) a medial gapping as great as 29 mm [26,37]. Comparative analyses in healthy knees under valgus stress showed that a medial gapping of 3-11 mm can occur, even in the absence of medial joint pathology [44].…”

Comprehensive Assessment of Medial Knee Joint Instability by Valgus Stress MRI

“…Fifth, our method of image post-processing relies on time-consuming manual segmentations and, thus, is not (yet) ready for clinical implementation that would require automated segmentations and analyses for expedited workflows. Sixth, because of limited sample size we did not consider (statistically) the body donors' sex which may be a confounder as women tend to have lower medial joint space widths [16,43] and more severe valguslaxity [50][51][52]. Seventh, direct clinical translation of our approach is not readily possible.…”

“…Stress sonography has been under decade-long clinical investigation [15]. Despite its operator-dependence and reliance on high-resolution equipment, stress sonography is a promising and useful diagnostic tool if used properly and adopted by more joint surgeons and radiologists [16,17].…”

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

“…The medial tibiofemoral distance was defined by measuring the distance between the articular margins of the medial femoral condyle and the medial tibial plateau (Fig 3). 19…”