Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2022

13.06.2021 | KNEE

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

verfasst von: Satoshi Takeuchi, Benjamin B. Rothrauff, Ryo Kanto, Kentaro Onishi, Freddie H. Fu

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Ultrasound with superb microvascular imaging (SMI) is a novel microvascular imaging technology which may be useful to assess the vascularity of the torn anterior cruciate ligament (ACL) as a potential measure of healing potential following surgery. This study aimed to quantify the vascularity of the torn and intact ACL using ultrasound with SMI.

Methods

23 patients (mean age ± standard deviation, 27.1 ± 12.8 years), who were diagnosed with an ACL tear with an intact contralateral ACL were enrolled (ACL injury group). Ten healthy volunteers (36.1 ± 4.9 years) who had intact ACLs in both knees were also recruited (ACL healthy controls). The vascularity of the ACL was assessed using SMI within 15 mm from the tibial insertion in both knees. The amount of the vascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0–3) and a quantified ratio of vascularized area with respect to total area of the region of interest (vascularity ratio).

Results

In the ACL injury group, a significantly higher vascularity grade and ratio were observed in the torn ACL (vascularity grade 0–3: 1, 8, 7, and 7 patients, respectively; vascularity ratio: 1.3 ± 1.4%) than the contralateral intact ACL (vascularity grade 0–3: 21, 1, 1, and 0 patients, respectively; vascularity ratio: 0.1 ± 0.5%) (P < 0.001), whereas no significant difference was observed between both ACLs in the ACL healthy control group.

Conclusions

SMI was useful to assess the increased vascularity in torn ACL, which may reflect the potential for, or state of, ACL maturation following reconstruction or repair.

Level of evidence

Level III.
Literatur
1.
Zurück zum Zitat Dunlap J, McCarthy JA, Joyce ME, Ogata K, Shively RA (1989) Quantification of the perfusion of the anterior cruciate ligament and the effects of stress and injury to supporting structures. Am J Sports Med 17:808–810CrossRef Dunlap J, McCarthy JA, Joyce ME, Ogata K, Shively RA (1989) Quantification of the perfusion of the anterior cruciate ligament and the effects of stress and injury to supporting structures. Am J Sports Med 17:808–810CrossRef
2.
Zurück zum Zitat Scapinelli R (1997) Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat 10:151–162CrossRef Scapinelli R (1997) Vascular anatomy of the human cruciate ligaments and surrounding structures. Clin Anat 10:151–162CrossRef
3.
Zurück zum Zitat Toy BJ, Yeasting RA, Morse DE, McCann P (1995) Arterial supply to the human anterior cruciate ligament. J Athl Train 30:149–152PubMedPubMedCentral Toy BJ, Yeasting RA, Morse DE, McCann P (1995) Arterial supply to the human anterior cruciate ligament. J Athl Train 30:149–152PubMedPubMedCentral
4.
Zurück zum Zitat Matsumoto T, Ingham SM, Mifune Y, Osawa A, Logar A, Usas A et al (2012) Isolation and characterization of human anterior cruciate ligament-derived vascular stem cells. Stem Cells Dev 21:859–872CrossRef Matsumoto T, Ingham SM, Mifune Y, Osawa A, Logar A, Usas A et al (2012) Isolation and characterization of human anterior cruciate ligament-derived vascular stem cells. Stem Cells Dev 21:859–872CrossRef
5.
Zurück zum Zitat Zhang S, Matsumoto T, Uefuji A, Matsushita T, Takayama K, Araki D et al (2015) Anterior cruciate ligament remnant tissue harvested within 3-months after injury predicts higher healing potential. BMC Musculoskelet Disord 16:390CrossRef Zhang S, Matsumoto T, Uefuji A, Matsushita T, Takayama K, Araki D et al (2015) Anterior cruciate ligament remnant tissue harvested within 3-months after injury predicts higher healing potential. BMC Musculoskelet Disord 16:390CrossRef
6.
Zurück zum Zitat Takayama K, Kawakami Y, Mifune Y, Matsumoto T, Tang Y, Cummins JH et al (2015) The effect of blocking angiogenesis on anterior cruciate ligament healing following stem cell transplantation. Biomaterials 60:9–19CrossRef Takayama K, Kawakami Y, Mifune Y, Matsumoto T, Tang Y, Cummins JH et al (2015) The effect of blocking angiogenesis on anterior cruciate ligament healing following stem cell transplantation. Biomaterials 60:9–19CrossRef
7.
Zurück zum Zitat Covey DC, Sandoval KE, Riffenburgh RH (2018) Contrast-enhanced MRI evaluation of bone-patellar tendon-bone and hamstring ACL autograft healing in humans: a prospective randomized study. Orthop J Sports Med 6:2325967118800298PubMedPubMedCentral Covey DC, Sandoval KE, Riffenburgh RH (2018) Contrast-enhanced MRI evaluation of bone-patellar tendon-bone and hamstring ACL autograft healing in humans: a prospective randomized study. Orthop J Sports Med 6:2325967118800298PubMedPubMedCentral
8.
Zurück zum Zitat Garika SS, Sharma A, Razik A, Sharma A, Pandey RM, Gamanagatti S et al (2019) Comparison of F18-fluorodeoxyglucose positron emission tomography/computed tomography and dynamic contrast-enhanced magnetic resonance imaging as markers of graft viability in anterior cruciate ligament reconstruction. Am J Sports Med 47:88–95CrossRef Garika SS, Sharma A, Razik A, Sharma A, Pandey RM, Gamanagatti S et al (2019) Comparison of F18-fluorodeoxyglucose positron emission tomography/computed tomography and dynamic contrast-enhanced magnetic resonance imaging as markers of graft viability in anterior cruciate ligament reconstruction. Am J Sports Med 47:88–95CrossRef
9.
Zurück zum Zitat Muramatsu K, Hachiya Y, Izawa H (2008) Serial evaluation of human anterior cruciate ligament grafts by contrast-enhanced magnetic resonance imaging: comparison of allografts and autografts. Arthroscopy 24:1038–1044CrossRef Muramatsu K, Hachiya Y, Izawa H (2008) Serial evaluation of human anterior cruciate ligament grafts by contrast-enhanced magnetic resonance imaging: comparison of allografts and autografts. Arthroscopy 24:1038–1044CrossRef
10.
Zurück zum Zitat Ntoulia A, Papadopoulou F, Ristanis S, Argyropoulou M, Georgoulis AD (2011) Revascularization process of the bone–patellar tendon–bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction. Am J Sports Med 39:1478–1486CrossRef Ntoulia A, Papadopoulou F, Ristanis S, Argyropoulou M, Georgoulis AD (2011) Revascularization process of the bone–patellar tendon–bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction. Am J Sports Med 39:1478–1486CrossRef
11.
Zurück zum Zitat Ntoulia A, Papadopoulou F, Zampeli F, Ristanis S, Argyropoulou M, Georgoulis A (2013) Evaluation with contrast-enhanced magnetic resonance imaging of the anterior cruciate ligament graft during its healing process: a two-year prospective study. Skeletal Radiol 42:541–552CrossRef Ntoulia A, Papadopoulou F, Zampeli F, Ristanis S, Argyropoulou M, Georgoulis A (2013) Evaluation with contrast-enhanced magnetic resonance imaging of the anterior cruciate ligament graft during its healing process: a two-year prospective study. Skeletal Radiol 42:541–552CrossRef
12.
Zurück zum Zitat Chiou HJ, Chou YH, Wu JJ, Hsu CC, Huang DY, Chang CY (2002) Evaluation of calcific tendonitis of the rotator cuff: role of color Doppler ultrasonography. J Ultrasound Med 21:289–295CrossRef Chiou HJ, Chou YH, Wu JJ, Hsu CC, Huang DY, Chang CY (2002) Evaluation of calcific tendonitis of the rotator cuff: role of color Doppler ultrasonography. J Ultrasound Med 21:289–295CrossRef
13.
Zurück zum Zitat Oh MJ, Park KT, Youn KM, Joo JC, Park SJ (2018) Color Doppler sonography accompanied by dynamic scanning for the diagnosis of ankle and foot fractures. J Ultrasound Med 37:1555–1564CrossRef Oh MJ, Park KT, Youn KM, Joo JC, Park SJ (2018) Color Doppler sonography accompanied by dynamic scanning for the diagnosis of ankle and foot fractures. J Ultrasound Med 37:1555–1564CrossRef
14.
Zurück zum Zitat Lee GY, Kim S, Choi ST, Song JS (2019) The superb microvascular imaging is more sensitive than conventional power Doppler imaging in detection of active synovitis in patients with rheumatoid arthritis. Clin Rheumatol 38:2613–2620CrossRef Lee GY, Kim S, Choi ST, Song JS (2019) The superb microvascular imaging is more sensitive than conventional power Doppler imaging in detection of active synovitis in patients with rheumatoid arthritis. Clin Rheumatol 38:2613–2620CrossRef
15.
Zurück zum Zitat Lim AKP, Satchithananda K, Dick EA, Abraham S, Cosgrove DO (2018) Microflow imaging: new Doppler technology to detect low-grade inflammation in patients with arthritis. Eur Radiol 28:1046–1053CrossRef Lim AKP, Satchithananda K, Dick EA, Abraham S, Cosgrove DO (2018) Microflow imaging: new Doppler technology to detect low-grade inflammation in patients with arthritis. Eur Radiol 28:1046–1053CrossRef
16.
Zurück zum Zitat Orlandi D, Gitto S, Perugin Bernardi S, Corazza A, De Flaviis L, Silvestri E et al (2017) Advanced power Doppler technique increases synovial vascularity detection in patients with Rheumatoid Arthritis. Ultrasound Med Biol 43:1880–1887CrossRef Orlandi D, Gitto S, Perugin Bernardi S, Corazza A, De Flaviis L, Silvestri E et al (2017) Advanced power Doppler technique increases synovial vascularity detection in patients with Rheumatoid Arthritis. Ultrasound Med Biol 43:1880–1887CrossRef
17.
Zurück zum Zitat Chen J, Chen L, Wu L, Wang R, Liu JB, Hu B et al (2017) Value of superb microvascular imaging ultrasonography in the diagnosis of carpal tunnel syndrome: compared with color Doppler and power Doppler. Medicine (Baltimore) 96:e6862CrossRef Chen J, Chen L, Wu L, Wang R, Liu JB, Hu B et al (2017) Value of superb microvascular imaging ultrasonography in the diagnosis of carpal tunnel syndrome: compared with color Doppler and power Doppler. Medicine (Baltimore) 96:e6862CrossRef
18.
Zurück zum Zitat Karahan AY, Arslan S, Ordahan B, Bakdik S, Ekiz T (2018) Superb microvascular imaging of the median nerve in carpal tunnel syndrome: an electrodiagnostic and ultrasonographic study. J Ultrasound Med 37:2855–2861CrossRef Karahan AY, Arslan S, Ordahan B, Bakdik S, Ekiz T (2018) Superb microvascular imaging of the median nerve in carpal tunnel syndrome: an electrodiagnostic and ultrasonographic study. J Ultrasound Med 37:2855–2861CrossRef
19.
Zurück zum Zitat Arslan S, Karahan AY, Oncu F, Bakdik S, Durmaz MS, Tolu I (2018) Diagnostic performance of superb microvascular imaging and other sonographic modalities in the assessment of lateral epicondylosis. J Ultrasound Med 37:585–593CrossRef Arslan S, Karahan AY, Oncu F, Bakdik S, Durmaz MS, Tolu I (2018) Diagnostic performance of superb microvascular imaging and other sonographic modalities in the assessment of lateral epicondylosis. J Ultrasound Med 37:585–593CrossRef
20.
Zurück zum Zitat Fujimaki Y, Thorhauer E, Sasaki Y, Smolinski P, Tashman S, Fu FH (2016) Quantitative in situ analysis of the anterior cruciate ligament: length, midsubstance cross-sectional area, and insertion site areas. Am J Sports Med 44:118–125CrossRef Fujimaki Y, Thorhauer E, Sasaki Y, Smolinski P, Tashman S, Fu FH (2016) Quantitative in situ analysis of the anterior cruciate ligament: length, midsubstance cross-sectional area, and insertion site areas. Am J Sports Med 44:118–125CrossRef
21.
Zurück zum Zitat Breukers M, Haase D, Konijnenberg S, Klos TVS, Dinant GJ, Ottenheijm RPG (2019) Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients. BMJ Open Sport Exerc Med 5:e000605CrossRef Breukers M, Haase D, Konijnenberg S, Klos TVS, Dinant GJ, Ottenheijm RPG (2019) Diagnostic accuracy of dynamic ultrasound imaging in partial and complete anterior cruciate ligament tears: a retrospective study in 247 patients. BMJ Open Sport Exerc Med 5:e000605CrossRef
22.
Zurück zum Zitat Lee SH, Yun SJ (2019) Efficiency of knee ultrasound for diagnosing anterior cruciate ligament and posterior cruciate ligament injuries: a systematic review and meta-analysis. Skeletal Radiol 48:1599–1610CrossRef Lee SH, Yun SJ (2019) Efficiency of knee ultrasound for diagnosing anterior cruciate ligament and posterior cruciate ligament injuries: a systematic review and meta-analysis. Skeletal Radiol 48:1599–1610CrossRef
24.
Zurück zum Zitat Mautner K, Sussman WI, Nanos K, Blazuk J, Brigham C, Sarros E (2019) Validity of indirect ultrasound findings in acute anterior cruciate ligament ruptures. J Ultrasound Med 38:1685–1692CrossRef Mautner K, Sussman WI, Nanos K, Blazuk J, Brigham C, Sarros E (2019) Validity of indirect ultrasound findings in acute anterior cruciate ligament ruptures. J Ultrasound Med 38:1685–1692CrossRef
25.
Zurück zum Zitat Smith J, Hackel JG, Khan U, Pawlina W, Sellon JL (2015) Sonographically guided anterior cruciate ligament injection: technique and validation. PM & R 7:736–745CrossRef Smith J, Hackel JG, Khan U, Pawlina W, Sellon JL (2015) Sonographically guided anterior cruciate ligament injection: technique and validation. PM & R 7:736–745CrossRef
26.
Zurück zum Zitat You CK, Chou CL, Wu WT, Hsu YC (2019) Nonoperative choice of anterior cruciate ligament partial tear: ultrasound-guided platelet-rich plasma injection. J Med Ultrasound 27:148–150CrossRef You CK, Chou CL, Wu WT, Hsu YC (2019) Nonoperative choice of anterior cruciate ligament partial tear: ultrasound-guided platelet-rich plasma injection. J Med Ultrasound 27:148–150CrossRef
27.
Zurück zum Zitat Gao J, Mennitt K, Belfi L, Zheng YY, Chen Z, Rubin JM (2013) Green tagging in displaying color Doppler aliasing: a comparison to standard color mapping in renal artery stenosis. Ultrasound Med Biol 39:1976–1982CrossRef Gao J, Mennitt K, Belfi L, Zheng YY, Chen Z, Rubin JM (2013) Green tagging in displaying color Doppler aliasing: a comparison to standard color mapping in renal artery stenosis. Ultrasound Med Biol 39:1976–1982CrossRef
28.
Zurück zum Zitat Gao J, Thai A, Erpelding T (2019) Comparison of superb microvascular imaging to conventional color Doppler ultrasonography in depicting renal cortical microvasculature. Clin Imaging 58:90–95CrossRef Gao J, Thai A, Erpelding T (2019) Comparison of superb microvascular imaging to conventional color Doppler ultrasonography in depicting renal cortical microvasculature. Clin Imaging 58:90–95CrossRef
29.
Zurück zum Zitat Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRef Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRef
30.
Zurück zum Zitat Hosseini A, Li JS, Gill TJT, Li G (2014) Meniscus injuries alter the kinematics of knees with anterior cruciate ligament deficiency. Orthop J Sports Med 2:2325967114547346PubMedPubMedCentral Hosseini A, Li JS, Gill TJT, Li G (2014) Meniscus injuries alter the kinematics of knees with anterior cruciate ligament deficiency. Orthop J Sports Med 2:2325967114547346PubMedPubMedCentral
31.
Zurück zum Zitat Mouton C, Magosch A, Pape D, Hoffmann A, Nührenbörger C, Seil R (2020) Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury. Knee Surg Sports Traumatol Arthrosc 28:1023–1028CrossRef Mouton C, Magosch A, Pape D, Hoffmann A, Nührenbörger C, Seil R (2020) Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury. Knee Surg Sports Traumatol Arthrosc 28:1023–1028CrossRef
32.
Zurück zum Zitat Samuelsen BT, Aman ZS, Kennedy MI, Dornan GJ, Storaci HW, Brady AW et al (2020) Posterior medial meniscus root tears potentiate the effect of increased tibial slope on anterior cruciate ligament graft forces. Am J Sports Med 48:334–340CrossRef Samuelsen BT, Aman ZS, Kennedy MI, Dornan GJ, Storaci HW, Brady AW et al (2020) Posterior medial meniscus root tears potentiate the effect of increased tibial slope on anterior cruciate ligament graft forces. Am J Sports Med 48:334–340CrossRef
33.
Zurück zum Zitat Gitto S, Messina C, Chianca V, Tuscano B, Lazzara A, Corazza A et al (2020) Superb microvascular imaging (SMI) in the evaluation of musculoskeletal disorders: a systematic review. Radiol Med 125:481–490CrossRef Gitto S, Messina C, Chianca V, Tuscano B, Lazzara A, Corazza A et al (2020) Superb microvascular imaging (SMI) in the evaluation of musculoskeletal disorders: a systematic review. Radiol Med 125:481–490CrossRef
34.
Zurück zum Zitat van der List JP, Mintz DN, DiFelice GS (2017) The location of anterior cruciate ligament tears: a prevalence study using magnetic resonance imaging. Orthop J Sports Med 5:2325967117709966PubMedPubMedCentral van der List JP, Mintz DN, DiFelice GS (2017) The location of anterior cruciate ligament tears: a prevalence study using magnetic resonance imaging. Orthop J Sports Med 5:2325967117709966PubMedPubMedCentral
35.
Zurück zum Zitat DiFelice GS, van der List JP (2018) Clinical outcomes of arthroscopic primary repair of proximal anterior cruciate ligament tears are maintained at mid-term follow-up. Arthroscopy 34:1085–1093CrossRef DiFelice GS, van der List JP (2018) Clinical outcomes of arthroscopic primary repair of proximal anterior cruciate ligament tears are maintained at mid-term follow-up. Arthroscopy 34:1085–1093CrossRef
37.
Zurück zum Zitat Houck DA, Kraeutler MJ, Belk JW, Goode JA, Mulcahey MK, Bravman JT (2019) Primary arthroscopic repair of the anterior cruciate ligament: a systematic review of clinical outcomes. Arthroscopy 35:3318–3327CrossRef Houck DA, Kraeutler MJ, Belk JW, Goode JA, Mulcahey MK, Bravman JT (2019) Primary arthroscopic repair of the anterior cruciate ligament: a systematic review of clinical outcomes. Arthroscopy 35:3318–3327CrossRef
Metadaten
Titel
Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament
verfasst von
Satoshi Takeuchi
Benjamin B. Rothrauff
Ryo Kanto
Kentaro Onishi
Freddie H. Fu
Publikationsdatum
13.06.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 1/2022
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-021-06640-6

Weitere Artikel der Ausgabe 1/2022

Knee Surgery, Sports Traumatology, Arthroscopy 1/2022 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.