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Knee Extension and Flexion: MR Delineation of Normal and Torn Anterior Cruciate Ligaments

Niitsu, Mamoru; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji

Journal of Computer Assisted Tomography: March-April 1996 - Volume 20 - Issue 2 - p 322-327
Musculoskeletal Imaging

Objective Our goal was to assess the effect of joint position of semiflexed and extended knees in MR delineation of the anterior cruciate ligament (ACL).

Methods With a mobile knee brace and a flexible surface coil, the knee joint was either fully extended or bent to a semiflexed position (average 45° of flexion) within the magnet bore. Sets of oblique sagittal MR images were obtained for both extended and flexed knee positions. Thirty-two knees with intact ACLs and 43 knees with arthroscopically proven ACL tears were evaluated. Two observers compared paired MR images of both extended and flexed positions and rated them by a relative three point scale. Anatomic correlation in MR images was obtained by a cadaveric knee with incremental flexion.

Results The MR images of flexed knees were more useful than of extended knees in 53% of the case reviews of femoral attachments and 36% of reviews of midportions of normal ACLs. Compared with knee extensions, the MR images for knee flexion provided better clarity in 48% of reviews of disrupted sites and 52% of residual bundles of torn ACLs. Normal ACL appeared taut in the knee extension and lax in semiflexion.

Conclusion Compared with MR images of knees in extension, MR images of knees in flexion more clearly delineate the femoral side of the ligament with wider space under the intercondylar roof and with decreased volume-averaging artifacts, providing superior visualization of normal and torn ACLs.

From the Departments of Radiology (M. Niitsu, I. Anno and Y. Itai) and Orthopedic Surgery (K. Ikeda and T. Fukubayashi) Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki 305, Japan.

Address correspondence and reprint requests to Dr. M. Niitsu.

© Lippincott-Raven Publishers