MRI Evaluation of Internal Derangements of the Knee Joint In a Tertiary Care Hospital of Deccan India

Dr Japnit Singh, Dr Ashutosh Chitnis, Dr Kanchan Bhardwaj

Abstract: Background: Internal derangement of the knee joint (IDK) involves destruction of ligaments/cartilages causing significant morbidity in the young, active individuals. An accurate assessment of the type/extent of injuries is important. Most widely used diagnostic modalities are arthroscopy and magnetic resonance imaging (MRI). MRI is reliable, safe and offers advantages over diagnostic arthroscopy, a standard reference for the diagnosis of IDK. Objectives: To evaluate the types & incidences of injuries in the knee on MRI and to compare with arthroscopy in selected cases. Study: Prospective, cross sectional & open label study. Materials & Methods: Patients suspected of an IDK by the orthopedician, were referred for a knee MRI, to the Department, of Radiodiagnois, who came consecutively during 2014-2016, were included in the study. These patients were examined clinically and underwent a knee MRI, a few selected cases also were taken up for diagnostic arthroscopy. Results: 111 patients were evaluated, anterior cruciate ligament tear was seen in76 patient (68 %), with complete tears more common seen in 40 patients (52.6 %). Posterior cruciate ligament tears were the least common type of injury, seen in4 patients (3.6 %). Medial meniscus (MM) tears, seen in33 patients (29.7 %), were more common, as compared to lateral meniscus (LM) tears, seen in 20 patients (18.1 %). Grade 3 type of tears was more common in both, MM seen in29 patients (87.8 %) and the LM injuries, seen in 12 patients (60 %). Medial collateral ligament (MCL) injuries seen in11 patients (9.9 %) outnumbered the lateral collateral ligament injuries, seen in 3patients (2.7 %). Grade 3 type of tears was common in MCL tears, seen in 5 patients (45.5 %). Osseous/osteochodral lesions were seen in 52 patients (46.8s %). Most of these were bony contusions involving the femoral-tibial condyles. Arthroscopy was done in 25 patients (22.5 %) and the findings correlated in 22 patients (88 %), which was statistically significant with a 95 % CI 70.04-95.83 %. Conclusion: MRI is an excellent, non-invasive imaging modality with multi-planar capabilities used to detect, localize and characterize IDK and correlates well with arthroscopy thus avoiding unnecessary invasive arthroscopy for diagnostic purpose.

Keywords: Anterior cruciate liagment, Posterior cruciate ligament, Medial collateral ligament, Lateral collateral ligament, Lateral meniscus, Medial meniscus, Arthroscopy, internal derangements of the knee