MRI-Arthroscopy Correlations : A Case-Based Atlas of the Knee, Shoulder, Elbow, Hip and Ankle

Integrating MRI findings associated with the spectrum of problems seen in the most commonly treated joints in sports medicine with the diagnostic findings seen during arthroscopy of the same joint in the same patient, this unique text correlates this pathology and applies these findings to the clinic, the radiology reading room and the operating suite. Representing a microcosm of daily patient care, this atlas of interactive correlation is an exceedingly effective tool for education and continued learning, an impetus for interdisciplinary research collaboration, and a critical part of an approach to optimum patient care. Furthermore, this case-based correlation between MRI imaging and arthroscopic findings and treatment has been a well-received and effective method for teaching and discussion at meetings and instructional courses. The second edition of this popular case atlas is organized into five sections highlighting the major joints in which MRI and arthroscopy are most commonly used in sports medicine: knee, shoulder, elbow, hip, and a brand new section on the ankle. Chapters have been reformatted to a consistent presentation, beginning with an overview of the specific disease entity and followed by selected cases chosen by the chapter authors that best illustrate common or noteworthy disease entities or pathology, with an emphasis on the parallel MRI imaging and arthroscopic findings. Throughout the text, updated arthroscopy images reflect current surgical techniques, many of which have changed significantly since the original edition was published. Authors and section editors, many new to this edition, are nationally recognized experts, teachers and pioneers in their respective areas of sports medicine and have covered the gamut of topics in each of their sections. Taken together, this will be an invaluable resource for sports medicine specialists, orthopedic surgeons and musculoskeletal radiologists alike, promoting increasingly accurate diagnoses of pathology and advanced treatment options to aid in the optimization of patient care and recovery. Preface Contents Contributors 1: MR Imaging for the Orthopedic Surgeon 1.1 Introduction 1.2 What Is MRI and How Does It Work? 1.3 Why Does the Image Look the Way It Does? 1.3.1 T1 and T2 1.3.2 Pulse Sequences 1.3.3 Gadolinium Contrast Agents 1.3.4 Intravenous 1.3.5 Intra-articular (MR Arthrography) 1.3.6 Fat Saturation 1.4 What Should Normal Musculoskeletal Tissues Look Like on MRI? (Table 1.1) 1.4.1 Fluid 1.4.2 Fibrocartilage 1.4.3 Hyaline Cartilage 1.4.4 Tendons/Ligaments 1.4.5 Muscle 1.4.6 Bone/Marrow 1.4.6.1 Normal Marrow 1.5 What Do Common Types of Musculoskeletal Pathology Look Like on MRI? 1.5.1 Fibrocartilage 1.5.2 Hyaline Cartilage 1.5.3 Ligaments and Tendons 1.5.4 Muscle 1.5.4.1 Injury 1.5.4.2 Atrophy 1.6 Bone Injury 1.7 Infection 1.8 Tumor 1.8.1 Bone 1.8.2 Soft Tissue 1.9 When Is MRI Most Useful and When Should a Different Modality Be Chosen? 1.10 What Is on the Horizon for MR Imaging? 1.10.1 Ultra-High Field (UHF) MRI References Part I: The Knee 2: Diagnostic Knee Arthroscopy and Arthroscopic Anatomy 2.1 Overview and Brief History 2.2 Anesthesia 2.3 Indications 2.4 Setup and Positioning 2.4.1 Equipment 2.5 Pertinent Anatomy 2.6 Anterolateral Portal 2.7 Anteromedial Portal 2.8 Superomedial/Superolateral Portal 2.9 Accessory Anteromedial Portal 2.10 Accessory Anterolateral Portal 2.11 Posteromedial Portal 2.12 Posterolateral Portal 2.13 Transpatellar Portal 2.14 Proximal Superomedial Portal 2.15 Other Portals 2.15.1 Transseptal Portal 2.16 Steps in Diagnostic Knee Arthroscopy 2.17 Summary References 3: Meniscus Tear MRI Correlation 3.1 Introduction 3.2 Case: Bucket-Handle Tear (Vertical) 3.3 Case: Horizontal 3.4 Case: Complex 3.5 Case: Radial Tear 3.6 Case: Root Tear 3.7 Case: Ramp 3.8 Case: Discoid References 4: Chondral Lesions 4.1 Introduction 4.2 Case 1: Grade II and IV Femoral Condyle Lesion Treated with Microfracture 4.2.1 History/Exam 4.2.2 Imaging 4.2.3 Arthroscopy 4.3 Case 2: Grade IV Femoral Condyle Lesion Treated with Osteochondral Autograft Transplantation (OATS)/Mosaicplasty 4.3.1 History/Exam 4.3.2 Imaging 4.3.3 Arthroscopy 4.3.4 Discussion for Microfracture and OATS/Mosaicplasty 4.4 Case 3: Nontraditional, Unstable Osteochondritis Dissecans (OCD) of the Knee Treated with Arthroscopic Fixation 4.4.1 History/Exam 4.4.2 Imaging 4.4.3 Arthroscopy 4.5 Case 4: Traditional, Unstable Osteochondritis Dissecans (OCD) of the Knee Treated with Open Fixation 4.5.1 History/Exam 4.5.2 Imaging 4.5.3 Arthroscopy 4.5.4 Discussion for Osteochondritis Dissecans (OCD) 4.6 Case 5: Grade II–III Femoral Condyle Lesion After Failed Chondroplasty Treated with Osteochondral Allograft 4.6.1 History/Exam 4.6.2 Imaging 4.6.3 Arthroscopy 4.6.4 Discussion 4.7 Case 6: Grade IV Femoral Condyle Lesion with Deficient Bone Treated with Osteochondral Allograft 4.7.1 History/Physical 4.7.2 Imaging 4.7.3 Arthroscopy 4.7.4 Discussion 4.8 Case 7: Grade IV Medial Femoral Condylar Defect Treated with Matrix Autologous Chondrocyte Implantation® 4.8.1 History/Exam 4.8.2 Imaging 4.8.3 Arthroscopy 4.8.4 Discussion 4.9 Conclusions References 5: Anterior Cruciate Ligament Injury and Reconstruction 5.1 Introduction 5.2 Case 1: ACL Rupture 5.2.1 History/Exam 5.2.2 Imaging 5.2.3 Arthroscopy 5.2.4 Discussion 5.3 Case 2: ACL Reconstruction with Patellar Tendon Autograft 5.3.1 History/Exam 5.3.2 Imaging 5.3.3 Arthroscopy 5.3.4 Discussion 5.4 Case 3: ACL Reconstruction with Quadriceps Tendon Autograft 5.4.1 History/Exam 5.4.2 Imaging 5.4.3 Arthroscopy 5.4.4 Discussion 5.5 Case 4: Bony ACL Avulsion 5.5.1 History/Exam 5.5.2 Imaging 5.5.3 Arthroscopy 5.5.4 Discussion 5.6 Conclusions References 6: Posterior Cruciate Ligament 6.1 Anatomy and Biomechanics 6.2 Injury Mechanism 6.3 History and Physical Examination 6.4 Imaging Studies 6.5 Arthroscopic Evaluation of the Posterior Cruciate Ligament 6.6 Case 1 6.6.1 History/Physical Exam 6.6.2 Imaging Studies 6.6.3 Treatment Decision 6.6.4 Discussion and Surgical Reconstruction 6.7 Case 2 6.7.1 History/Physical Exam 6.7.2 Left Knee Imaging Studies 6.7.3 Treatment Decision 6.7.4 Discussion and Surgical Reconstruction 6.8 Case 3 6.8.1 History/Physical Exam 6.8.2 Imaging Studies 6.8.3 Treatment Decision 6.8.4 Discussion and Surgical Reconstruction References 7: Medial Collateral Ligament Injuries of the Knee 7.1 Anatomy and Biomechanics 7.1.1 Anatomy 7.1.2 Biomechanics 7.2 Mechanism of Injury and Diagnosis with Physical Exam 7.3 Imaging 7.4 Treatment 7.4.1 Prevention 7.4.2 Nonoperative Treatment 7.4.3 Surgical Indications 7.4.4 Surgical Techniques 7.5 Cases 7.5.1 Case 1 7.5.2 Case 2 7.5.3 Case 3 7.5.4 Case 4 References 8: The Posterolateral Corner of the Knee 8.1 Introduction 8.2 Case 1: ACL Tear, Grade III FCL Tear, Complete Avulsion of Biceps Femoris Off the Fibular Head and Styloid, and Partial PLT Tear 8.2.1 History/Exam 8.2.2 Imaging 8.2.3 Arthroscopy 8.2.4 Discussion 8.3 Case 2: Grade III PCL Tear, Grade III Complete Posterolateral Corner Injury, Mild Entrapment of the Common Peroneal Nerve, and Medial Meniscus Cyst 8.3.1 History/Exam 8.3.2 Imaging 8.3.3 Arthroscopy 8.3.4 Discussion 8.4 Case 3: PLC Reconstruction Revision, ACL Tear, Chronic PCL Tear, Biceps Femoris Avulsion with Concurrent Displaced Fibular Head Fracture, Stable Impaction Fracture of the MFC, and Severe Entrapment of the Common Peroneal Nerve 8.4.1 History/Exam 8.4.2 Imaging 8.4.3 Arthroscopy 8.4.4 Discussion References 9: Patellofemoral Disorders 9.1 Introduction 9.2 Case 1 9.2.1 History/Exam 9.2.2 Imaging 9.2.3 Surgery 9.2.4 Discussion 9.3 Case 2 9.3.1 History/Exam 9.3.2 Imaging 9.3.3 Surgery 9.3.4 Discussion 9.4 Case 3 9.4.1 History/Exam 9.4.2 Imaging 9.4.3 Surgery 9.4.4 Discussion 9.5 Conclusion References 10: Synovial Pathology in the Knee 10.1 Introduction 10.2 Pigmented Villonodular Synovitis (PVNS) 10.2.1 Background 10.2.2 Clinical Presentation 10.2.3 Histopathology 10.2.4 Imaging 10.2.5 Treatment 10.2.5.1 Localized PVNS 10.2.5.2 Diffuse PVNS 10.3 Synovial Chondromatosis 10.3.1 Background 10.3.2 Clinical Presentation 10.3.3 Histopathology 10.3.4 Imaging 10.3.5 Treatment 10.4 Lipoma Aborescens (Synovial Lipomatosis) 10.4.1 Introduction 10.4.2 Clinical Presentation 10.4.3 Histopathology 10.4.4 Imaging 10.4.5 Treatment 10.5 Hemorrhagic Synovitis 10.5.1 Background 10.5.2 Presentation 10.5.3 Imaging 10.5.4 Arthroscopic Findings 10.5.5 Treatment 10.6 Conclusion References Part II: The Shoulder 11: Diagnostic Shoulder Arthroscopy and Arthroscopic Anatomy 11.1 Overview and Brief History 11.2 Anesthesia 11.3 Setup and Positioning 11.3.1 Lateral Decubitus 11.3.1.1 Considerations 11.3.2 The Beach Chair 11.3.2.1 Considerations 11.4 Examination Under Anesthesia 11.5 Pertinent Shoulder Anatomy and Portal Locations 11.5.1 Primary Portals 11.5.2 Secondary Portals 11.6 Diagnostic Shoulder Arthroscopy 11.6.1 Viewing from the Posterior Portal [10] 11.6.2 Viewing from the Anterior Portal [5] 11.7 Subacromial Space 11.8 Subdeltoid Space 11.9 Summary References 12: MRI-Arthroscopy Correlations in Anterior Shoulder Instability 12.1 Introduction 12.2 Clinical Examination of Patients with Anterior Shoulder Instability 12.3 MRI in Anterior Shoulder Instability 12.4 Normal Anatomic Variants 12.5 Case 1: Soft Tissue Bankart Lesion 12.5.1 Discussion 12.6 Case 2: ALPSA Lesion with Sublabral Foramen 12.6.1 Discussion 12.7 Cases 3 and 4: Bony Bankart Lesions 12.7.1 Discussion 12.8 Case 5: Humeral Avulsion of the Glenohumeral Ligament (HAGL) 12.8.1 Discussion 12.9 Case 6: Rotator Cuff Tear with Anterior Instability 12.9.1 Discussion 12.10 Conclusions References 13: Posterior Shoulder Instability and Labral Pathology 13.1 Introduction 13.2 Clinical Presentation 13.3 Imaging Technique 13.4 Imaging 13.5 Treatment 13.6 Outcomes 13.7 Case 1: Posterior Labral Tear 13.7.1 History/Exam 13.7.2 Imaging 13.7.3 Arthroscopy 13.7.4 Discussion 13.8 Case 2: Reverse Bony Bankart 13.8.1 History/Exam 13.8.2 Imaging 13.8.3 Arthroscopy 13.8.4 Discussion 13.9 Case 3: Posterior Labral Tear with Humeral Avulsion of the Glenohumeral Ligaments (HAGL) 13.9.1 History/Exam 13.9.2 Imaging 13.9.3 Arthroscopy 13.9.4 Discussion 13.10 Case 4: Posterior Dislocation Recurrence 13.10.1 History/Exam 13.10.2 Imaging 13.10.3 Arthroscopy 13.10.4 Discussion 13.11 Summary References 14: Rotator Cuff Disease 14.1 Introduction 14.2 Case 1: Group I – Partial-Thickness Undersurface Subscapularis Rotator Cuff Tear 14.2.1 History and Exam 14.2.2 Imaging 14.2.3 Arthroscopy 14.2.4 Discussion 14.3 Case 2: Group II – Chronic Full-Thickness Rotator Cuff Tear in a Young (