Semin Musculoskelet Radiol 2016; 20(01): 074-090
DOI: 10.1055/s-0036-1579676
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Concepts on MRI Evaluation of Postoperative Knee Ligaments

Ioannis Tsifountoudis
1   Department of Radiology, 424 General Military Hospital, Thessaloniki, Greece
,
Apostolos H. Karantanas
2   Department of Radiology, Medical School-University of Crete, Greece
3   Department of Medical Imaging, Heraklion University Hospital, Greece
› Author Affiliations
Further Information

Publication History

Publication Date:
14 April 2016 (online)

Abstract

The growing number of patients undergoing arthroscopy or surgery of the knee for ligamentous injuries has led to a greater need for postoperative imaging because of poor outcome, recurrent symptoms, or a new injury. MRI is the most important imaging method when evaluating the postoperative knee. Radiologists should be familiar with the particular reconstruction technique applied to each examinee, know the spectrum of normal postoperative findings, recognize those findings that may be related to symptoms of failed reconstruction, as well as those lesions that are irrelevant to the previous surgery yet responsible for the new clinical symptoms. In view of the continually evolving surgical techniques, this review presents the current concepts of MRI evaluation of the postoperative knee ligaments based on recent literature reports.

 
  • References

  • 1 Mall NA, Chalmers PN, Moric M , et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
  • 2 Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Radiographics 2002; 22 (4) 765-774
  • 3 Papakonstantinou O, Chung CB, Chanchairujira K, Resnick DL. Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol 2003; 13 (5) 1106-1117
  • 4 White LM, Kramer J, Recht MP. MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skeletal Radiol 2005; 34 (8) 431-452
  • 5 Collins MS, Unruh KP, Bond JR, Mandrekar JN. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption. Skeletal Radiol 2008; 37 (3) 233-243
  • 6 Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 2009; 29 (7) 2115-2126
  • 7 White LM, Buckwalter KA. Technical considerations: CT and MR imaging in the postoperative orthopedic patient. Semin Musculoskelet Radiol 2002; 6 (1) 5-17
  • 8 McCauley TR. MR imaging evaluation of the postoperative knee. Radiology 2005; 234 (1) 53-61
  • 9 Siebold R, Fu FH. Assessment and augmentation of symptomatic anteromedial or posterolateral bundle tears of the anterior cruciate ligament. Arthroscopy 2008; 24 (11) 1289-1298
  • 10 Lipke JM, Janecki CJ, Nelson CL , et al. The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees. J Bone Joint Surg Am 1981; 63 (6) 954-960
  • 11 Dienst M, Burks RT, Greis PE. Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am 2002; 33 (4) 605-620 , v
  • 12 Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med 2012; 40 (1) 222-231
  • 13 Bowman KF, Sekiya JK. Anatomy and biomechanics of the posterior cruciate ligament and other ligaments of the knee. Oper Tech Sports Med 2009; 17 (3) 126-134
  • 14 Barba D, Barker L, Chhabra A. Anatomy and biomechanics of the posterior cruciate ligament and posterolateral corner. Oper Tech Sports Med . DOI: 10.1053/j.otsm.2015.06.007
  • 15 Harner CD, Giffin JR, Vogrin TM, Woo SLY. Anatomy and biomechanics of the posterior cruciate ligament and posterolateral corner. Oper Tech Sports Med 2001; 9 (2) 39-46
  • 16 Steensen RN, Dopirak RM, McDonald III WG. The anatomy and isometry of the medial patellofemoral ligament: implications for reconstruction. Am J Sports Med 2004; 32 (6) 1509-1513
  • 17 Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP. Anatomy and biomechanics of the medial patellofemoral ligament. Knee 2003; 10 (3) 215-220 [Erratum in Knee 2004;11(1):73]
  • 18 Kang HJ, Wang F, Chen BC, Su YL, Zhang ZC, Yan CB. Functional bundles of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1511-1516
  • 19 Thaunat M, Erasmus PJ. Management of overtight medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009; 17 (5) 480-483
  • 20 Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013; 223 (4) 321-328
  • 21 Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA. The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 2014; 96-B (3) 325-331
  • 22 Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J. A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy 2015; 31 (3) 583-591
  • 23 Klontzas ME, Maris TG, Zibis AH, Karantanas AH. Normal MRI anatomy of the anterolateral knee ligament with a T2/T1 3-D sequence: a feasibility study. Can Assoc Radiol J 2016; 67 (1) 52-59
  • 24 Claes S, Bartholomeeusen S, Bellemans J. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 2014; 80 (1) 45-49
  • 25 Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 2012; 22 (2) 116-121
  • 26 Kulczycka P, Larbi A, Malghem J, Thienpont E, Vande Berg B, Lecouvet F. Imaging ACL reconstructions and their complications. Diagn Interv Imaging 2015; 96 (1) 11-19
  • 27 Marrale J, Morrissey MC, Haddad FS. A literature review of autograft and allograft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2007; 15 (6) 690-704
  • 28 Sanders TG, Tall MA, Mulloy JP, Leis HT. Fluid collections in the osseous tunnel during the first year after anterior cruciate ligament repair using an autologous hamstring graft: natural history and clinical correlation. J Comput Assist Tomogr 2002; 26 (4) 617-621
  • 29 Rispoli DM, Sanders TG, Miller MD, Morrison WB. Magnetic resonance imaging at different time periods following hamstring harvest for anterior cruciate ligament reconstruction. Arthroscopy 2001; 17 (1) 2-8
  • 30 Gohil S, Annear PO, Breidahl W. Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation. A randomised prospective study with a one-year follow-up. J Bone Joint Surg Br 2007; 89 (9) 1165-1171
  • 31 Naraghi A, White LM. MR imaging of cruciate ligaments. Magn Reson Imaging Clin N Am 2014; 22 (4) 557-580
  • 32 Ochi M, Adachi N, Deie M, Kanaya A. Anterior cruciate ligament augmentation procedure with a 1-incision technique: anteromedial bundle or posterolateral bundle reconstruction. Arthroscopy 2006; 22 (4) 463.e1-463.e5
  • 33 Järvelä T, Moisala AS, Sihvonen R, Järvelä S, Kannus P, Järvinen M. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 2008; 36 (2) 290-297
  • 34 Muneta T, Koga H, Mochizuki T , et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 2007; 23 (6) 618-628
  • 35 Suomalainen P, Moisala AS, Paakkala A, Kannus P, Järvelä T. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 2011; 39 (8) 1615-1622
  • 36 Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive operations. Am J Sports Med 2005; 33 (5) 646-654
  • 37 Rochecongar G, Plaweski S, Azar M , et al; French Society for Arthroscopy (Société française d'arthroscopie, SFA). Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review. Orthop Traumatol Surg Res 2014; 100 (8, Suppl): S371-S378
  • 38 Weimann A, Schatka I, Herbort M , et al. Reconstruction of the posterior oblique ligament and the posterior cruciate ligament in knees with posteromedial instability. Arthroscopy 2012; 28 (9) 1283-1289
  • 39 Kang H, Cao J, Yu D, Zheng Z, Wang F. Comparison of 2 different techniques for anatomic reconstruction of the medial patellofemoral ligament: a prospective randomized study. Am J Sports Med 2013; 41 (5) 1013-1021
  • 40 Kader DF, Rajeev A. A review of functional anatomy and surgical reconstruction of medial patellofemoral ligament. J Arthrosc Joint Surg 2014; 1 (1) 5-10
  • 41 Wang CH, Ma LF, Zhou JW , et al. Double-bundle anatomical versus single-bundle isometric medial patellofemoral ligament reconstruction for patellar dislocation. Int Orthop 2013; 37 (4) 617-624
  • 42 Saupe N, White LM, Chiavaras MM , et al. Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up—correlation with functional and clinical evaluation. Radiology 2008; 249 (2) 581-590
  • 43 Naraghi AM, Gupta S, Jacks LM, Essue J, Marks P, White LM. Anterior cruciate ligament reconstruction: MR imaging signs of anterior knee laxity in the presence of an intact graft. Radiology 2012; 263 (3) 802-810
  • 44 Vogl TJ, Schmitt J, Lubrich J , et al. Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen. Eur Radiol 2001; 11 (8) 1450-1456
  • 45 Ilaslan H, Sundaram M, Miniaci A. Imaging evaluation of the postoperative knee ligaments. Eur J Radiol 2005; 54 (2) 178-188
  • 46 Sanders TG. Imaging of the postoperative knee. Semin Musculoskelet Radiol 2011; 15 (4) 383-407
  • 47 Ma Y, Murawski CD, Rahnemai-Azar AA, Maldjian C, Lynch AD, Fu FH. Graft maturity of the reconstructed anterior cruciate ligament 6 months postoperatively: a magnetic resonance imaging evaluation of quadriceps tendon with bone block and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 2015; 23 (3) 661-668
  • 48 Ntoulia A, Papadopoulou F, Zampeli F, Ristanis S, Argyropoulou M, Georgoulis A. Evaluation with contrast-enhanced magnetic resonance imaging of the anterior cruciate ligament graft during its healing process: a two-year prospective study. Skeletal Radiol 2013; 42 (4) 541-552
  • 49 Zaffagnini S, De Pasquale V, Marchesini Reggiani L , et al. Neoligamentization process of BTPB used for ACL graft: histological evaluation from 6 months to 10 years. Knee 2007; 14 (2) 87-93
  • 50 Kiekara T, Järvelä T, Huhtala H, Paakkala A. MRI of double-bundle ACL reconstruction: evaluation of graft findings. Skeletal Radiol 2012; 41 (7) 835-842
  • 51 Lin YC, Mhuircheartaigh JN, Cheung YC , et al. Pain following double-bundle anterior cruciate ligament reconstruction: correlation with morphological graft findings and dynamic contrast-enhanced MRI. Clin Radiol 2014; 69 (11) 1142-1148
  • 52 Miyawaki M, Hensler D, Illingworth KD, Irrgang JJ, Fu FH. Signal intensity on magnetic resonance imaging after allograft double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22 (5) 1002-1008
  • 53 Tsifountoudis I, Bisbinas I, Kalaitzoglou I , et al. The natural history of donor hamstrings unit after anterior cruciate ligament reconstruction: a prospective MRI scan assessment. Knee Surg Sports Traumatol Arthrosc 2015; ; August 4 ( Epub ahead of print)
  • 54 Roberts CC, Towers JD, Spangehl MJ, Carrino JA, Morrison WB. Advanced MR imaging of the cruciate ligaments. Radiol Clin North Am 2007; 45 (6) 1003-1016 , vi–vii
  • 55 Farshad-Amacker NA, Potter HG. MRI of knee ligament injury and reconstruction. J Magn Reson Imaging 2013; 38 (4) 757-773
  • 56 Weber AE, Delos D, Oltean HN , et al. Tibial and femoral tunnel changes after ACL reconstruction: a prospective 2-year longitudinal MRI study. Am J Sports Med 2015; 43 (5) 1147-1156
  • 57 Ghazikhanian V, Beltran J, Nikac V, Feldman M, Bencardino JT. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol 2012; 41 (11) 1375-1379
  • 58 Fules PJ, Madhav RT, Goddard RK, Newman-Sanders A, Mowbray MA. Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL replacement. Knee 2003; 10 (1) 87-91
  • 59 Hantes ME, Liantsis AK, Basdekis GK, Karantanas AH, Christel P, Malizos KN. Evaluation of the bone bridge between the bone tunnels after anatomic double-bundle anterior cruciate ligament reconstruction: a multidetector computed tomography study. Am J Sports Med 2010; 38 (8) 1618-1625
  • 60 Nebelung S, Deitmer G, Gebing R, Reichwein F, Nebelung W. High incidence of tunnel widening after anterior cruciate ligament reconstruction with transtibial femoral tunnel placement. Arch Orthop Trauma Surg 2012; 132 (11) 1653-1663
  • 61 Casagranda BU, Maxwell NJ, Kavanagh EC, Towers JD, Shen W, Fu FH. Normal appearance and complications of double-bundle and selective-bundle anterior cruciate ligament reconstructions using optimal MRI techniques. AJR Am J Roentgenol 2009; 192 (5) 1407-1415 [Erratum in AJR Am J Roentgenol 2009;192(6):1454]
  • 62 Hakozaki A, Niki Y, Enomoto H, Toyama Y, Suda Y. Clinical significance of T2*-weighted gradient-echo MRI to monitor graft maturation over one year after anatomic double-bundle anterior cruciate ligament reconstruction: a comparative study with proton density-weighted MRI. Knee 2015; 22 (1) 4-10
  • 63 Rahmer J, Börnert P, Dries SP. Assessment of anterior cruciate ligament reconstruction using 3D ultrashort echo-time MR imaging. J Magn Reson Imaging 2009; 29 (2) 443-448
  • 64 Biercevicz AM, Akelman MR, Fadale PD , et al. MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction. Am J Sports Med 2015; 43 (3) 693-699
  • 65 Alcalá-Galiano A, Baeva M, Ismael M, Argüeso MJ. Imaging of posterior cruciate ligament (PCL) reconstruction: normal postsurgical appearance and complications. Skeletal Radiol 2014; 43 (12) 1659-1668
  • 66 Sherman PM, Sanders TG, Morrison WB, Schweitzer ME, Leis HT, Nusser CA. MR imaging of the posterior cruciate ligament graft: initial experience in 15 patients with clinical correlation. Radiology 2001; 221 (1) 191-198
  • 67 Torabi M, Wo S, Vyas D, Costello J. MRI evaluation and complications of medial patellofemoral ligament reconstruction. Clin Imaging 2015; 39 (1) 116-127
  • 68 Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2002; 84-A (9) 1560-1572
  • 69 Pelfort X, Monllau JC, Puig L, Cáceres E. Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature. Knee Surg Sports Traumatol Arthrosc 2006; 14 (6) 586-589
  • 70 Kartus J, Lindahl S, Köhler K, Sernert N, Eriksson BI, Karlsson J. Serial magnetic resonance imaging of the donor site after harvesting the central third of the patellar tendon. A prospective study of 37 patients after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1999; 7 (1) 20-24
  • 71 Allum R. Complications of arthroscopy of the knee. J Bone Joint Surg Br 2002; 84 (7) 937-945
  • 72 Waltz RA, Solomon DJ, Provencher MT. A radiographic assessment of failed anterior cruciate ligament reconstruction: can magnetic resonance imaging predict graft integrity?. Am J Sports Med 2014; 42 (7) 1652-1660
  • 73 Horton LK, Jacobson JA, Lin J, Hayes CW. MR imaging of anterior cruciate ligament reconstruction graft. AJR Am J Roentgenol 2000; 175 (4) 1091-1097
  • 74 Jackson DW, Schaefer RK. Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 1990; 6 (3) 171-178
  • 75 Bradley DM, Bergman AG, Dillingham MF. MR imaging of cyclops lesions. AJR Am J Roentgenol 2000; 174 (3) 719-726
  • 76 Muellner T, Kdolsky R, Grossschmidt K, Schabus R, Kwasny O, Plenk Jr H. Cyclops and cyclopoid formation after anterior cruciate ligament reconstruction: clinical and histomorphological differences. Knee Surg Sports Traumatol Arthrosc 1999; 7 (5) 284-289
  • 77 Sonnery-Cottet B, Lavoie F, Ogassawara R , et al. Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2010; 26 (11) 1483-1488
  • 78 Cha J, Choi SH, Kwon JW, Lee SH, Ahn JH. Analysis of cyclops lesions after different anterior cruciate ligament reconstructions: a comparison of the single-bundle and remnant bundle preservation techniques. Skeletal Radiol 2012; 41 (8) 997-1002
  • 79 Gohil S, Falconer TM, Breidahl W, Annear PO. Serial MRI and clinical assessment of cyclops lesions. Knee Surg Sports Traumatol Arthrosc 2014; 22 (5) 1090-1096
  • 80 Simpfendorfer C, Miniaci A, Subhas N, Winalski CS, Ilaslan H. Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI. Skeletal Radiol 2015; 44 (8) 1169-1173
  • 81 Wang J, Ao Y. Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy 2009; 25 (6) 626-631
  • 82 Iriuchishima T, Shirakura K, Fu FH. Graft impingement in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (3) 664-670
  • 83 Bedi A, Maak T, Musahl V , et al. Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important?. Am J Sports Med 2011; 39 (2) 366-373
  • 84 Fujimoto E, Sumen Y, Deie M, Yasumoto M, Kobayashi K, Ochi M. Anterior cruciate ligament graft impingement against the posterior cruciate ligament: diagnosis using MRI plus three-dimensional reconstruction software. Magn Reson Imaging 2004; 22 (8) 1125-1129
  • 85 Maak TG, Bedi A, Raphael BS , et al. Effect of femoral socket position on graft impingement after anterior cruciate ligament reconstruction. Am J Sports Med 2011; 39 (5) 1018-1023
  • 86 Astur DC, Santos CV, Aleluia V , et al. Characterization of cruciate ligament impingement: the influence of femoral or tibial tunnel positioning at different degrees of knee flexion. Arthroscopy 2013; 29 (5) 913-919
  • 87 Gonzalez-Lomas G, Cassilly RT, Remotti F, Levine WN. Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction?. Clin Orthop Relat Res 2011; 469 (4) 1082-1088
  • 88 Sprowson AP, Aldridge SE, Noakes J, Read JW, Wood DG. Bio-interference screw cyst formation in anterior cruciate ligament reconstruction—10-year follow up. Knee 2012; 19 (5) 644-647
  • 89 Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR. Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation. AJR Am J Roentgenol 2004; 182 (5) 1283-1287
  • 90 Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD. Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction. Arthroscopy 2005; 21 (11) 1323-1329
  • 91 Haughom B, Schairer W, Souza RB, Carpenter D, Ma CB, Li X. Abnormal tibiofemoral kinematics following ACL reconstruction are associated with early cartilage matrix degeneration measured by MRI T1rho. Knee 2012; 19 (4) 482-487
  • 92 Theologis AA, Haughom B, Liang F , et al. Comparison of T1rho relaxation times between ACL-reconstructed knees and contralateral uninjured knees. Knee Surg Sports Traumatol Arthrosc 2014; 22 (2) 298-307
  • 93 Culvenor AG, Collins NJ, Guermazi A , et al. Early knee osteoarthritis is evident one year following anterior cruciate ligament reconstruction: a magnetic resonance imaging evaluation. Arthritis Rheum (Munch) 2015; 67 (4) 946-955
  • 94 Murray JR, Lindh AM, Hogan NA , et al. Does anterior cruciate ligament reconstruction lead to degenerative disease?: Thirteen-year results after bone-patellar tendon-bone autograft. Am J Sports Med 2012; 40 (2) 404-413
  • 95 Hirose J, Nishioka H, Okamoto N , et al. Articular cartilage lesions increase early cartilage degeneration in knees treated by anterior cruciate ligament reconstruction: T1ρ mapping evaluation and 1-year follow-up. Am J Sports Med 2013; 41 (10) 2353-2361
  • 96 Ahn JH, Lee YS, Chang MJ. Post-tibial cyst formation over 2 years after posterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2008; 16 (11) 996-998