OBJECTIVE: To evaluate the MR findings of normal and abnormal collateral ligament and the meaning of medical jurisprudence appraisal. METHODS: The MR findings of 12 normal and 13 surgically confirmed injured collateral ligaments were retrospectively reviewed and compared. RESULTS: The normal tibial and fibular collateral ligaments were hypointense string on both T1 and T2 coronal MR images, with average length of 6.8 cm for tibial collateral ligament and 5.7 cm for fibular collateral ligament.13 collateral ligaments were injured, including 6 tibial and 3 fibular collateral ligaments. Two cases(4 ligaments) had both tibial and fibularcollateral ligaments injuries. The injury of collateral ligament was classified as: Grade I(5 ligaments), Grade II(5 ligaments), and Grade III(3 ligaments). The complications of anterior cruciate ligament sprains(3 cases), posterior cruciate ligament sprains(4 cases), meniscal tear(2 cases) were found in 7 patients(63.6%). CONCLUSION Coronal MR imaging can clearly demonstrate the structure of the knee collateral ligaments, accurately diagnose and classify the ligament injury, and correctly detect the complications, MRI is very valuable for medical jurisprudence appraisal.
Adult ; Collateral Ligaments/pathology* ; Female ; Forensic Medicine ; Humans ; Knee Injuries/diagnosis* ; Knee Joint ; Magnetic Resonance Imaging ; Male ; Medial Collateral Ligament, Knee/pathology* ; Middle Aged ; Retrospective Studies

This study sought to detect the pathological changes of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) under injury stretch. Bone-ACL-Bone (B-ACL-B) and B-MCL-B complexes were isolated from 20 male Wister rats, and were immersed in phosphate buffered saline. The complexes were stretched with 10% or 20% strain for 10 min or 30 min. After being stretched, the specimens were fixed in 10% buffered formalin, then mounted in paraffin. Sections were stained with Alcian blue-PAS and HE. The following results were found: In the control group, the matrix in ACL contained much more GAGs, as compared with that in MCL. When stretched with 10%, most of the fibroblasts in ACL were elongated like spindles in shape, and some pyknotic nuclei were found increased with stretching time. With 20% strain, ACL showed disruption in parts of collagen fibrils and lysis. But MCL was often torn at its tibia end. The injury can be detected in pathological slices under microscope, even this injury can not be found with naked eye. This injury first starts with the disturbance of the nucleus in the ligament, but following further stretching, it will extend to the rupture of collagen fibrils, and the serious injury of the fibroblasts is especially bad to the repair of the ligament.
Animals ; Anterior Cruciate Ligament ; pathology ; Anterior Cruciate Ligament Injuries ; Male ; Medial Collateral Ligament, Knee ; injuries ; pathology ; Rats ; Rats, Wistar ; Stress, Mechanical

OBJECTIVETo study the application of stress X-ray of knee joint for the diagnosis ot medial collateral ligament injury.

METHODSFrom January 2008 to June 2011, 46 patients with medial collateral ligament injury were reviewed. Among the patients, 32 patients were male and 14 patients were female, ranging in age from 28 to 72 years, with an average of (49.46 +/- 22.54) years. Left knee joint injuries occurred in 22 patients, and 24 patients had injuries in right knee joint. Thirty-one patients were treated with surgical method, and 15 patients were treated with conservative method including 1 patient finally received operation after 3 months treatment with conservative method without effect. The injury side and normal side were observed by X-ray under stress and non-stress, as well as MRI. Operation was used to treat patients with medial gap markedly widen and the deep layer of medial collateral ligament injury in MRI. A line (line A) was drawn from medial condyle to lateral condyle of tibia platform. The line A was translated to the inner margin of condylus medialis femoris, which was line B. The perpendicular distance was measured, which was line C. The ration of space difference (R) was calculated by (space at stress force of injured side-space at non-stress force of injured side)/(space at stress force of normal side-space at non-stress force of normal side). The relationship between R and ligament injury type were investigated.

RESULTSThere were 17 patients with injuries of superficial lamella, 21 patients with injuries of deep lamella. Eight patients had associated injuries of articular capsule and posterior cruciate ligament. When R value was between 1.51 to 5.24, the injury of superficial ligament was found in 15 patients, actual injuries were found in 17 patients. When R value between 5.28 and 13.85, the injuries of bathypelagic ligament were found in 19 patients, actual injuries were found in 21 patients. When R value was between 15.61 and 26.25, the associated injuries of articular capsule and posterior cruciate ligament were found in 7 patients, actual injuries were found in 8 patients.

CONCLUSIONUsing the specific value as the standard of measurement can provide the quantizatily fractionation of the medial collateral ligament injury.

Adult ; Aged ; Female ; Humans ; Knee Joint ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; methods ; Male ; Medial Collateral Ligament, Knee ; injuries ; Middle Aged ; Radiography

OBJECTIVETo evaluate the values of spiral CT arthrography with multiplanar reconstruction and virtual arthroscopy technique in diagnosis of internal derangements of the knee.

METHODSTen bovine knees were used for experiment. The menisci, anterior and posterior cruciate ligaments and cartilage of these 10 bovine knees were injured with a hook. Each of the joints was injected with 100 ml air, then soon scanned with a PQ6000 spiral computed tomography scanner. The data obtained was input into the work station, and multiplanar reconstruction technique was used to illustrate lesions in the knees. The results of CT diagnosis were compared to those found by gross inspection of the specimens. Clinically, 10 knees of 9 patients diagnosed as internal derangement were evaluated with the same method after 50-70 ml air was injected into each of the joints. Nine months later, the data of 2 patients were used for CT endoscopy reconstruction. The results were compared with intraoperative findings.

RESULTSExperimentally, the sensitivity and specificity were 88.9% and 93.9% by detection of meniscal abnormalities, 85.7% and 100% by detection of cruciate ligament lesions, and 72.7% and 100% by detection of cartilage damage, respectively. Clinically, the sensitivity and specificity were 90.0% and 95.0% by detection of meniscal lesion. As to ligament, the figures were 85.7% and 100% respectively. Images of virtual arthroscopy simulated the images of real arthroscopy.

CONCLUSIONSSpiral CT arthrography of multiplanar reconstruction technique offers fine images of internal structures of the knee, with clear border and internal structure. It is an accurate method for detecting meniscal, cruciate and collateral ligament and cartilaginous lesions that cause internal derangement of the knee. Virtual arthroscopy technique is a hopeful method for detecting reasons of derangement of the knee.

Animals ; Anterior Cruciate Ligament ; pathology ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Cattle ; Female ; Humans ; Knee Injuries ; diagnostic imaging ; pathology ; surgery ; Male ; Medial Collateral Ligament, Knee ; injuries ; pathology ; Menisci, Tibial ; pathology ; Reconstructive Surgical Procedures ; Tibial Meniscus Injuries ; Tomography, Spiral Computed