Ultrasound diagnosis of pathology of the anterior and posterior cruciate ligaments of the knee joint

Abstract

We established a method of diagnosing pathologic conditions of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) by using ultrasound. Normal ACL and PCL were delineated as hyperechoic images on the screen in sagittal and transverse sections. On the other hand, no image of the ligament could be seen when the ligament was ruptured. We examined nine ACL and five PCL injuries by our method. This is a safe and an effective method of determining the rupture of ACL and PCL.

Elastographic imaging of strain distribution in the anterior cruciate ligament and at the ligament–bone insertions

“…Several groups have implemented traditional B-mode diagnostic ultrasound imaging for in vivo evalutation of ligamentous tissues. 46,[54][55][56][57][58][59][60][61] Suzuki et al 60 applied ultrasound imaging as a noninvasive tool for diagnosing injuries to the ACL, and Scherer et al 58 used ultrasound to monitor postsurgery recovery of patients who had undergone ACL reconstruction. Recently, Revell et al 62 utilized a block-matching technique to determine strain fields from dynamic sequences of ultrasound images of digital flexor and patellar tendons.…”

Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Validation

“…Second, the success of the injection is predicated upon a complete understanding of US machine controls and use of meticulous scanning techniques. Optimizing the LAX view of the ACL requires the following: (1) adjusting the scanning depth to 4‐5 cm for most knees; (2) adjusting the scanning frequency to facilitate optimal resolution imaging at depth; (3) using the tibia as a reliable bony acoustic landmark; (4) detecting the tibial insertion of the ACL 1‐1.4 cm posterior (ie, deep) to the anterior tibia; (5) placing the tibia in slight internal rotation to increase ACL tension and conspicuity; and (6) performing appropriate amounts of transducer translation, rotation, heel‐toe, and tilting to optimize co‐linearity with the ACL [39‐41]. Optimal transducer positioning requires an in‐depth understanding of the orientation of the ACL relative to the tibia and femur.…”

“…Limb positioning was varied to account for potential personal preferences and patient factors, and the position order was randomized. Once positioned, the ACL was localized by the senior author using a modification of the techniques of Chen et al and Suzuki et al [39,40]. The transducer was initially placed in a midcoronal plane over the medial collateral ligament.…”

“…At this point, the operator translated the transducer slightly cephalad along the superficial convex anterior border of the knee. This maneuver created a “heel‐toe” effect to increase the conspicuity of the ACL, and also created working space between the tibial plateau and the caudad end of the transducer for needle entry (Figures 3a‐c) [40,41]. Finally, the image of the ACL could be further optimized by tilting the transducer in a slight medial to lateral direction to direct the beam toward the lateral aspect of intercondylar region.…”

“…In 2013, Chen et al used a modification of a previously described technique by Suzuki et al to document the ability to directly image the mid‐ and distal ACL in 33 asymptomatic volunteers. ACLs were evaluated by placing a 7‐ to 9‐MHz linear transducer parallel to the ACL with the knee flexed to 90° [39,40]. The mid‐ and distal portions of the ACL were visualized in all 33 volunteers, whereas the proximal ACL origin was not consistently identified [39].…”