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24.09.2021 | Scientific Article

The accuracy of routine knee MR imaging in detection of acute neurovascular injury following multiligamentous knee injury

verfasst von: Angela Atinga, Dawn H. Pearce, Daniel B. Whelan, Ali Naraghi, Lawrence M. White

Erschienen in: Skeletal Radiology | Ausgabe 5/2022

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Abstract

Objective

To assess the accuracy of routine knee MRI in detecting acute popliteal artery and/or common peroneal nerve (CPN) dysfunction following multiligamentous knee injury (MLKI), with correlation of MRI findings to clinical outcome.

Materials and methods

Routine MRI knee examinations in 115 MLKI patients (54/115 with acute neurovascular injury, 61/115 without neurovascular injury) were retrospectively reviewed. Cases were classified by injury mechanism and ligamentous injuries sustained. MRI examinations were reviewed by two readers for vascular (arterial flow void, arterial calibre, intimal flap, perivascular hematoma) and CPN (intraneural T2-hyperintensity, calibre, discontinuity, perineural hematoma) injuries. Accuracy of routine knee MRI in the diagnosis of acute neurovascular injury and correlation of MRI findings to clinical outcome were evaluated.

Results

Patients included 86/115 males, mean age 33 years. The accuracy of MRI in diagnosis of acute CPN injury was 80.6%, 83.6% (readers 1 and 2): sensitivity (78%, 79.7%), specificity (80%, 86.7%), PPV (78%, 82.5%), and NPV (82.7%, 84.4%). Increased intraneural T2 signal showed a significant correlation to acute CPN dysfunction (p < 0.05). MRI was 75%, 69.8% (readers 1 and 2) accurate in detecting acute vascular injury: sensitivity (73.3%, 86.7%), specificity (75.2%, 67.3%), PPV (30.5%, 36.1%), and NPV (95%, 97.1%). No MRI features of vascular injury showed a statistical correlation with clinical outcome. Neurovascular complications were more common in ultra-low-energy injuries and KD-V3L pattern of ligament disruption.

Conclusion

Routine MRI is of limited accuracy in assessing vascular complication, but higher accuracy in assessing CPN injury following MLKI. Increased intraneural T2 signal on conventional knee MR imaging shows statistically significant association with clinically documented acute CPN dysfunction following MLKI.
Literatur
1.
Zurück zum Zitat Walker REA, McDougall D, Patel S, Grant JA, Longino PD, Mohtadi NG. Radiologic review of knee dislocation: from diagnosis to repair. AJR Am J Roentgenol. 2013;201(3):483–95.CrossRef Walker REA, McDougall D, Patel S, Grant JA, Longino PD, Mohtadi NG. Radiologic review of knee dislocation: from diagnosis to repair. AJR Am J Roentgenol. 2013;201(3):483–95.CrossRef
2.
Zurück zum Zitat Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol. 2008;37(7):653–61.CrossRef Bui KL, Ilaslan H, Parker RD, Sundaram M. Knee dislocations: a magnetic resonance imaging study correlated with clinical and operative findings. Skeletal Radiol. 2008;37(7):653–61.CrossRef
3.
Zurück zum Zitat Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop. 2012;470(3):774–8.CrossRef Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop. 2012;470(3):774–8.CrossRef
4.
Zurück zum Zitat Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop. 2014;472(9):2621–9.CrossRef Medina O, Arom GA, Yeranosian MG, Petrigliano FA, McAllister DR. Vascular and nerve injury after knee dislocation: a systematic review. Clin Orthop. 2014;472(9):2621–9.CrossRef
5.
Zurück zum Zitat Naziri Q, Beyer GA, Shah NV, Solow M, Hayden AJ, Nadarajah V, et al. Knee dislocation with popliteal artery disruption: a nationwide analysis from 2005 to 2013. J Orthop. 2018;15(3):837–41.CrossRef Naziri Q, Beyer GA, Shah NV, Solow M, Hayden AJ, Nadarajah V, et al. Knee dislocation with popliteal artery disruption: a nationwide analysis from 2005 to 2013. J Orthop. 2018;15(3):837–41.CrossRef
6.
Zurück zum Zitat Tuite MJ, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, et al. ACR appropriateness criteria acute trauma to the knee. J Am Coll Radiol JACR. 2015;12(11):1164–72.CrossRef Tuite MJ, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, et al. ACR appropriateness criteria acute trauma to the knee. J Am Coll Radiol JACR. 2015;12(11):1164–72.CrossRef
7.
Zurück zum Zitat Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL. Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma. 2002;16(5):330.CrossRef Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL. Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma. 2002;16(5):330.CrossRef
8.
Zurück zum Zitat Stewart RJ, Landy DC, Khazai RS, Cohen JB, Ho SS, Dirschl DR. Association of injury energy level and neurovascular injury following knee dislocation. J Orthop Trauma. 2018;32(11):579–84.CrossRef Stewart RJ, Landy DC, Khazai RS, Cohen JB, Ho SS, Dirschl DR. Association of injury energy level and neurovascular injury following knee dislocation. J Orthop Trauma. 2018;32(11):579–84.CrossRef
9.
Zurück zum Zitat Mullenix PS, Steele SR, Andersen CA, Starnes BW, Salim A, Martin MJ. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg. 2006;44(1):94–100.CrossRef Mullenix PS, Steele SR, Andersen CA, Starnes BW, Salim A, Martin MJ. Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank. J Vasc Surg. 2006;44(1):94–100.CrossRef
10.
Zurück zum Zitat Peripheral nerve injuries. Medical Research Council Special Report Series No. 282. Edited by H. J. Seddon. 9½ × 6 in. Pp. 452 + xvi, with 276 illustrations. 1954. London: H.M.S.O. 55s. BJS Br J Surg. 1955;42(175):558–558. Peripheral nerve injuries. Medical Research Council Special Report Series No. 282. Edited by H. J. Seddon. 9½ × 6 in. Pp. 452 + xvi, with 276 illustrations. 1954. London: H.M.S.O. 55s. BJS Br J Surg. 1955;42(175):558–558.
12.
Zurück zum Zitat Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11(7):525–9.CrossRef Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11(7):525–9.CrossRef
13.
Zurück zum Zitat Kohler R, Vargas MI, Masterson K, Lovblad KO, Pereira VM, Becker M. CT and MR angiography features of traumatic vascular injuries of the neck. Am J Roentgenol. 2011;196(6):W800–9.CrossRef Kohler R, Vargas MI, Masterson K, Lovblad KO, Pereira VM, Becker M. CT and MR angiography features of traumatic vascular injuries of the neck. Am J Roentgenol. 2011;196(6):W800–9.CrossRef
14.
Zurück zum Zitat Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2009;17(9):1013–26.CrossRef Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2009;17(9):1013–26.CrossRef
15.
Zurück zum Zitat Cook S, Ridley TJ, McCarthy MA, Gao Y, Wolf BR, Amendola A, et al. Surgical treatment of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2015;23(10):2983–91.CrossRef Cook S, Ridley TJ, McCarthy MA, Gao Y, Wolf BR, Amendola A, et al. Surgical treatment of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2015;23(10):2983–91.CrossRef
16.
Zurück zum Zitat Azar FM, Brandt JC, Miller RH, Phillips BB. Ultra-low-velocity knee dislocations. Am J Sports Med. 2011;39(10):2170–4.CrossRef Azar FM, Brandt JC, Miller RH, Phillips BB. Ultra-low-velocity knee dislocations. Am J Sports Med. 2011;39(10):2170–4.CrossRef
17.
Zurück zum Zitat Georgiadis AG, Mohammad FH, Mizerik KT, Nypaver TJ, Shepard AD. Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese. J Vasc Surg. 2013;57(5):1196–203.CrossRef Georgiadis AG, Mohammad FH, Mizerik KT, Nypaver TJ, Shepard AD. Changing presentation of knee dislocation and vascular injury from high-energy trauma to low-energy falls in the morbidly obese. J Vasc Surg. 2013;57(5):1196–203.CrossRef
18.
Zurück zum Zitat Edwards GAD, Sarasin SM, Davies AP. Dislocation of the knee: an epidemic in waiting? J Emerg Med. 2013;44(1):68–71.CrossRef Edwards GAD, Sarasin SM, Davies AP. Dislocation of the knee: an epidemic in waiting? J Emerg Med. 2013;44(1):68–71.CrossRef
19.
Zurück zum Zitat Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. AJR Am J Roentgenol. 2009;192(1):101–6.CrossRef Peltola EK, Lindahl J, Hietaranta H, Koskinen SK. Knee dislocation in overweight patients. AJR Am J Roentgenol. 2009;192(1):101–6.CrossRef
20.
Zurück zum Zitat Mook WR, Ligh CA, Moorman CT, Leversedge FJ. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Surg. 2013;21(6):343–54.PubMed Mook WR, Ligh CA, Moorman CT, Leversedge FJ. Nerve injury complicating multiligament knee injury: current concepts and treatment algorithm. J Am Acad Orthop Surg. 2013;21(6):343–54.PubMed
21.
Zurück zum Zitat Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve. 2000;23(6):863–73.CrossRef Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve. 2000;23(6):863–73.CrossRef
22.
23.
Zurück zum Zitat Mallon S, Starcevic V, Rheinboldt M, Petraszko A. Sonographic evaluation of peripheral nerve pathology in the emergency setting. Emerg Radiol. 2018;25(5):521–31.CrossRef Mallon S, Starcevic V, Rheinboldt M, Petraszko A. Sonographic evaluation of peripheral nerve pathology in the emergency setting. Emerg Radiol. 2018;25(5):521–31.CrossRef
24.
Zurück zum Zitat Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR neurography in evaluation of peripheral nerve trauma and postsurgical assessment. Radiographics. 2019;39(2):427–46.CrossRef Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR neurography in evaluation of peripheral nerve trauma and postsurgical assessment. Radiographics. 2019;39(2):427–46.CrossRef
25.
Zurück zum Zitat Zuniga JR, Mistry C, Tikhonov I, Dessouky R, Chhabra A. Magnetic resonance neurography of traumatic and nontraumatic peripheral trigeminal neuropathies. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2018;76(4):725–36.CrossRef Zuniga JR, Mistry C, Tikhonov I, Dessouky R, Chhabra A. Magnetic resonance neurography of traumatic and nontraumatic peripheral trigeminal neuropathies. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2018;76(4):725–36.CrossRef
26.
Zurück zum Zitat Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M. The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve. 2002;25(3):314–31.CrossRef Grant GA, Britz GW, Goodkin R, Jarvik JG, Maravilla K, Kliot M. The utility of magnetic resonance imaging in evaluating peripheral nerve disorders. Muscle Nerve. 2002;25(3):314–31.CrossRef
27.
Zurück zum Zitat Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: logistic regression. Perspect Clin Res. 2017;8(3):148–51.PubMedPubMedCentral Ranganathan P, Pramesh CS, Aggarwal R. Common pitfalls in statistical analysis: logistic regression. Perspect Clin Res. 2017;8(3):148–51.PubMedPubMedCentral
28.
Zurück zum Zitat van Smeden M, Moons KG, de Groot JA, Collins GS, Altman DG, Eijkemans MJ, et al. Sample size for binary logistic prediction models: beyond events per variable criteria. Stat Methods Med Res. 2019;28(8):2455–74.CrossRef van Smeden M, Moons KG, de Groot JA, Collins GS, Altman DG, Eijkemans MJ, et al. Sample size for binary logistic prediction models: beyond events per variable criteria. Stat Methods Med Res. 2019;28(8):2455–74.CrossRef
29.
Zurück zum Zitat McCutchan JD, Gillham NR. Injury to the popliteal artery associated with dislocation of the knee: palpable distal pulses do not negate the requirement for arteriography. Injury. 1989;20(5):307–10.CrossRef McCutchan JD, Gillham NR. Injury to the popliteal artery associated with dislocation of the knee: palpable distal pulses do not negate the requirement for arteriography. Injury. 1989;20(5):307–10.CrossRef
30.
Zurück zum Zitat Tocci SL, Heard WMR, Fadale PD, Brody JM, Born C. Magnetic resonance angiography for the evaluation of vascular injury in knee dislocations. J Knee Surg. 2010;23(4):201–7.CrossRef Tocci SL, Heard WMR, Fadale PD, Brody JM, Born C. Magnetic resonance angiography for the evaluation of vascular injury in knee dislocations. J Knee Surg. 2010;23(4):201–7.CrossRef
Metadaten
Titel
The accuracy of routine knee MR imaging in detection of acute neurovascular injury following multiligamentous knee injury
verfasst von
Angela Atinga
Dawn H. Pearce
Daniel B. Whelan
Ali Naraghi
Lawrence M. White
Publikationsdatum
24.09.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Skeletal Radiology / Ausgabe 5/2022
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-021-03907-4

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