How Useful Is MRI in Diagnosing Isolated Bundle ACL Injuries?

Abstract

Background Selective bundle anterior cruciate ligament (ACL) reconstruction and/or remnant ACL preservation may be reasonable options for some patients. However, the frequency of isolated anteromedial (AM) or posterolateral (PL) bundle injuries in patients undergoing ACL reconstruction is unknown, and the value of MRI for prediction of this injury pattern is likewise unknown. Questions/purposes We sought to determine (1) the proportion of knees with an intact AM or PL bundle in patients undergoing ACL reconstruction; (2) whether MRI predicted the bundle conditions seen at the time of surgery; and (3) whether the accuracy of the MRI prediction was affected by the timing of MRI after injury. Methods During primary ACL reconstructions of 156 knees, conditions of AM and PL bundles were separately examined and classified into three categories: (1) completely torn; (2) attenuated; and (3) intact. Then, the bundles were assessed by blinded observers on MRI and classified into the corresponding three categories for 77 patients who had an MRI at our institution using a standard protocol. Diagnostic accuracy of MRI was computed, and the early MRI group (B 6 weeks from injury to MRI acquisition) was compared with the late MRI group ([6 weeks). Results Only 11 (7%) of the 156 knees we treated had an intact AM (one knee) or PL bundle (10 knees). Another 55 knees (35%) had a structurally continuous but attenuated AM or PL bundle. The overall diagnostic accuracy of MRI was 83%; accuracy was better for the AM bundle than the PL bundle (91% versus 78%; p = 0.026). MR prediction was less accurate in the early MRI group, particularly for PL bundle injury.

Combining ACL Oblique Coronal MRI with the Routine Knee MRI Protocol in the Diagnosis of ACL Bundle Lesions. Can It Add A Value?

“…A study done by Lawrence et al, [12] showed that MRI accurately diagnosed only one of nine partial ACL tears confirmed by arthroscopy [12] . However in another study done by Chang et al, [13] showed overall diagnostic accuracy of MRI in partial tears of 83% [13] .…”

Femoral attachment of anterior cruciate ligament remnant tissue influences the stability of the anterior cruciate ligament-injured knee in patients over 40 years old

“…MRI is highly sensitive and specific for the diagnosis of ACL injuries, 25 its usefulness with respect to the remnant tissue is controversial. Although a previous report suggests that diagnostic preoperative MRI provides limited information about the remnant tissue, 26 other researchers describe MRI as an important tool for predicting patterns of ACL remnant tissues 10 or bundle injuries with satisfactory precision. 26 In this study, MRI findings and videos of arthroscopic assessments were used to evaluate the remnant tissue volume, continuity, and tension.…”

MRI evaluation of the ACL remnant tissue in ACL-deficient knee

“…29,30 However, despite recent interest in ACL reconstruction with remnant tissue preservation, 18,20 there is limited information about the diagnostic values of preoperative MRI for the remnant tissue. 31 Normal ACL appears as a band comprising low signal lines, 32 while injured ACL gives a high signal in the MRI, which indicates fluid and hemorrhage confined to the intact synovial sheath. 33,34 Additionally, there is a report that MRI is also considered to be an important tool for predicting the pattern of ACL remnant tissue or bundle injury pattern with satisfactory precision.…”