Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee

Abstract

OBJECTIVE: Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. METHODS: We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. RESULTS: We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). CONCLUSION: Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis. Level of Evidence II. Diagnostic Studies.

Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up

“…In addition to being difficult to treat, PLC injuries often also pass unnoticed [21] because of their difficult diagnosis [2,4]. In the United States, approximately 200,000 ACL reconstructions are performed annually, which implies a significant number of PLC reconstructions when we consider that 11 % of injuries are associated with these structures [11,19].…”

Functional Movement Analysis in the Differential Diagnosis of a Patient with a Posterolateral Corner Knee Injury

“…In this and other clinicians' experiences, a varus force at the knee can commonly be seen during the loading response to mid-stance phases of gait. 3 The patient may then fully contract the quadriceps to lock out the knee in hyperextension in order to create additional stability through the passive intact posterior knee structures and compression of the tibiofemoral joint. 30 As seen with the patient presented in this case study, it is also possible that they will overcorrect a varus thrust using a compensatory valgus thrust during the phases of loading response to mid-stance.…”

“…Magnetic Resonance Imaging (MRI) is considered the gold standard for diagnosing ligamentous injuries in the knee, with an accuracy of 95% for identifying major injury to the PLC structures. 3 While MRI can be extremely helpful in diagnosing acute PLC injuries, they have been found to be less accurate in diagnosing chronic tears, and are costly. 4 Therefore, a thorough history and physical examination should always precede MRI and guide the interpretation of diagnostic imaging results.…”

Uso do fixador externo articulado no tratamento cirúrgico da instabilidade multiligamentar crônica do joelho

“…Em 2014, Bonadio et al (62) advertem que a sensibilidade da RM em diagnosticar lesões do canto posterolateral não é alta, baseada em uma série de casos.…”

“…O terceiro motivo é a baixa sensibilidade da ressonância magnética para diagnosticar estas lesões (62) . Numa época em que esse exame, de tão sensível para o diagnóstico da lesão ligamentar mais frequente do joelho (LCA), das lesões meniscais e das lesões condrais, causa surpresa como em relação ao CPL, ele pouco ajuda, e, às vezes, atrapalha.…”