Avulsion Fractures of the Knee: Imaging Findings and Clinical Significance

Abstract

The knee is an intricate joint with numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to complex injuries after trauma. A variety of avulsion fractures of the knee can occur, including Segond and reverse Segond fractures; avulsions of the anterior and posterior cruciate ligaments; arcuate complex avulsion; iliotibial band avulsion; avulsions of the biceps femoris, semimembranosus, and quadriceps tendons; Sinding-Larsen-Johansson syndrome; and Osgood-Schlatter disease. These fractures often have a subtle appearance at conventional radiography, which is typically the first imaging modality performed in these cases. Advanced imaging modalities, particularly magnetic resonance imaging, are helpful and can provide valuable additional information for adequately defining the extent of damage. The onus is on the radiologist to identify the pattern of injury and to understand the substantial underlying damage that it frequently represents. Conveying this information to the referring clinician is crucial and represents the first step toward additional evaluation and probable orthopedic referral. By recognizing the significance of these injuries at initial presentation, radiologists can facilitate appropriate patient work-up and prevent the chronic morbidity associated with delayed treatment.

Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease

“…5,6 Recent MRI and ultrasound reports are also consistent with a description of OSD as "a tendinopathy/ apophysosis of the patellar tendon/tibial tubercle." [7][8][9][10][11][12] Safety and level A-C evidence of efficacy (per US Preventive Services Task Force criteria) of injection of 10% to 25% dextrose in areas of damaged ligament, tendon, and cartilage in adults has been demonstrated in randomized controlled trials in Achilles tendinosis, 13 finger osteoarthritis, 14 knee osteoarthritis, 15 lateral epicondylosis, 16 sacroiliac joint pain, 17 and in case series collections of patients with Achilles degeneration, 18,19 anterior cruciate ligament laxity, 20 coccygodynia, 21 hip adductor and abdominal tendinosis, 22 and plantar fasciosis. 23 There are no previous reports of application of dextrose injection in a strictly pediatric population, nor are there reports of injection about an apophysis where, as described, the source of pain and pathomechanism are not yet clear.…”

The Role of Magnetic Resonance Musculoskeletal Imaging in Evaluation of Sports Injuries of the Knee Joint

“…Christopher et al , 2008 (12) stated that the knee is the largest joint in the body and is a relatively unstable and intricate joint with numerous tendinous, ligamentous, and meniscal attachments, which makes it particularly vulnerable to complex injuries after trauma. Moreover, according to Lim et al, 2008 (3), relatively few injuries involve isolated structures, with complex injuries affecting multiple structures being much more common.…”

Posterolateral and Posteromedial Corner Injuries of the Knee

“…13,80 In their evaluation of avulsion fractures of the lateral femoral condyle in children, Sferopoulos and colleagues 81 reported 2 cases of avulsive fracture of the Gerdy's tubercle. Both of these were sport-related injuries from a direct blow to the medial aspect of the knee while playing football.…”