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Best Practice Case Studies
Knee Dislocation
Knee Dislocation
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Video Transcription
This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 25-year-old running back presented with right knee pain after hyperextending his knee, concern for knee dislocation. The patient in this case presented with this knee MRI. In here, we can see that there is complete rupture of the anterior cruciate ligament and also reported posterior cruciate ligament. Additionally, here on our coronal T2 FATSAT imaging, we can see that there is high-grade tearing of the lateral collar ligament complex at the fibular attachment with retraction of the torn fibers. Additionally, we can see this sprain of the medial collar ligament. This is in a different patient with a knee radiograph. Knee radiograph could be obtained as the initial imaging modality of choice for evaluation of patients with knee injury to exclude any bony abnormality. Here in this patient, we can see that there is large suprapatellar effusion and also, we can see this impaction deformity of the lateral femoral condyle. The patient did undergo MRI. Here in the same patient, we can see the complete rupture of the anterior cruciate ligament and the posterior cruciate ligament. A multi-ligamentous injury is defined as grossly unstable knee with disruption with at least two of the four major ligamentous structures. A two-ligament knee dislocation usually requires complete tears of both the anterior and posterior cruciate ligament. Additionally, here on our coronal T2 FATSAT imaging, we can see a bone contusion in the lateral femoral condyle and also, an MCL sprain injury as seen here. In cases of knee dislocation, we do review all the knee structures, paying special attention to specific structures that could be injured. For the meniscus, we evaluate the tear of the meniscus, if there is any flap of the meniscus, the location of the meniscus, and either medial or lateral meniscus involvement. For the ligaments, we also evaluate where the tear is, if there's any retraction. And for the bones, we do evaluate for any type of avulsion fracture, including fragment dimension, any bone contusion, or any osteochondral injuries. For any vascular injury, we want to evaluate the popliteal artery and look for perivascular hematoma or signs of thrombosis, pseudoaneurysm, or dissection. And here, for the nerves right here, we evaluate for any abnormal signal, morphology of the tibial and the common peroneal nerve. And we do describe the extent of soft tissue abnormality. For a more detailed knee MRI anatomy review, an excellent lecture by Dr. Christopher Beaulieu on YouTube is available.
Video Summary
Barry Belosis, a musculoskeletal radiology fellow at Stanford, discusses the case of a 25-year-old running back with right knee pain after hyperextension, suspected of knee dislocation. MRI reveals complete ruptures of the anterior and posterior cruciate ligaments, high-grade tearing of the lateral collateral ligament complex, and an MCL sprain. Radiographs show suprapatellar effusion and impaction deformity of the lateral femoral condyle. In multi-ligamentous knee injury assessment, it's crucial to evaluate meniscal tears, ligament retraction, bone fractures, vascular injuries, and nerve signals. A detailed knee MRI anatomy lecture by Dr. Christopher Beaulieu is recommended.
Meta Tag
Edition
2nd Edition
Related Case
2nd Edition, CASE 28
Topic
Knee
Keywords
2nd Edition, CASE 28
2nd Edition
Knee
musculoskeletal radiology
knee dislocation
multi-ligamentous injury
MRI assessment
Stanford
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