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Imaging of Knee Injuries with Special Focus on Tibial Plateau Fractures

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Imaging of Knee Injuries with Special Focus on Tibial Plateau Fractures Department of Diagnostic Radiology Helsinki University Central Hospital University of Helsinki, Finland IMAGING OF KNEE INJURIES WITH SPECIAL FOCUS ON TIBIAL PLATEAU FRACTURES Antti Mustonen Academic Dissertation To be presented with the permission of the Faculty of Medicine of the University of Helsinki, for public discussion in Auditorium I, Töölö Hospital On 6 June 2009 at 12 noon Helsinki 2009 Supervised by Docent Seppo Koskinen Helsinki Medical Imaging Center, Töölö Hospital Helsinki University Central Hospital Department of Diagnostic Radiology, University of Helsinki Helsinki, Finland Docent Martti Kiuru Terveystalo Healthcare Ltd. Helsinki, Finland Reviewed by Professor Osmo Tervonen Department of Diagnostic Radiology, Oulu University Hospital Oulu, Finland Docent Arsi Harilainen Orton Orthopaedic Hospital Helsinki, Finland To be discussed with Docent Kimmo Mattila Medical Imaging Centre of Southwest Finland Turku University Hospital and Department of Diagnostic Radiology University of Turku Turku, Finland ISBN 978–952–92–5567–2 (paperback) ISBN 978–952–10–5575–1 (PDF) Helsinki University Print Helsinki 2009 TABLE OF CONTENTS ORIGINAL PUBLICATIONS.............................................................................................................6 ABBREVIATIONS..............................................................................................................................7 ABSTRACT.........................................................................................................................................8 REVIEW OF THE LITERATURE....................................................................................................11 Pertinent knee anatomy and biomechanics ........................................................................................11 Bony structures...........................................................................................................................11 Articular cartilage.......................................................................................................................12 Soft tissue structures...................................................................................................................13 Posterolateral corner...................................................................................................................16 Knee injury.........................................................................................................................................16 Tibial plateau fractures...............................................................................................................17 Femur, patella and fibula fractures.............................................................................................17 Meniscal injury...........................................................................................................................18 Ligament injuries........................................................................................................................18 Posterolateral corner...................................................................................................................19 Imaging of knee injury .......................................................................................................................19 Radiography ...............................................................................................................................19 Computed tomography...............................................................................................................21 Multi-detector computed tomography (MDCT) ........................................................................22 Magnetic resonance imaging (MRI) ..........................................................................................24 Arthrography ..............................................................................................................................27 Ultrasonography.........................................................................................................................28 Treatment options...............................................................................................................................28 Femur .........................................................................................................................................28 Tibial plateau..............................................................................................................................28 Patella.........................................................................................................................................29 Menisci.......................................................................................................................................29 Cruciate ligaments......................................................................................................................30 Collateral ligaments....................................................................................................................31 Posterolateral corner...................................................................................................................31 AIMS OF THE STUDY.....................................................................................................................32 PATIENTS AND METHODS...........................................................................................................33 Study I Knee fractures in radiography and MDCT...............................................................33 Study II Cruciate ligaments in MDCT ..................................................................................34 Study III Meniscal injury in MRI..........................................................................................35 Study IV Meniscal repair in MRI..........................................................................................37 Study V Postoperative tibial plateau fractures in MDCT .....................................................38 STATISTICAL ANALYSIS..............................................................................................................40 IMAGING METHODS......................................................................................................................41 RESULTS...........................................................................................................................................43 Study I Knee fractures in radiography and MDCT...............................................................43 Study II Cruciate ligaments in MDCT ..................................................................................45 Study III Meniscal injury in MRI..........................................................................................45 Study IV Meniscal repair in MRI..........................................................................................46 Study V Postoperative tibial plateau fractures in MDCT .....................................................47 DISCUSSION ....................................................................................................................................49 Study I Knee fractures in radiography and MDCT...............................................................51 Study II Cruciate ligaments in MDCT ..................................................................................52 Study III Meniscal injury in MRI..........................................................................................54 Study IV Meniscal repair in MRI..........................................................................................55 Study V Postoperative tibial plateau fractures in MDCT .....................................................56 Future aspect of the knee trauma imaging .................................................................................57 CONCLUSIONS................................................................................................................................59 ACKNOWLEDGEMENTS ...............................................................................................................60 APPENDIX ........................................................................................................................................62 REFERENCES...................................................................................................................................67 ORIGINAL PUBLICATIONS This thesis is based on the following publications which are referred to in the text by Roman numerals I – V. I Antti O. Mustonen, Seppo K. Koskinen, Martti J. Kiuru: Acute knee trauma: Analysis of multidetector computed tomography findings and comparison to conventional radiography. Acta Radiol 46:866–874, 2005 II Antti O. Mustonen, Mika P. Koivikko, Ville V. Haapamäki, Martti J. Kiuru, Antti E. Lamminen, Seppo K. Koskinen. MDCT in acute knee injuries – assessment of cruciate ligaments with MRI correlation. Acta Radiol 48:104–11, 2007 III Antti O. Mustonen, Mika P. Koivikko, Jan Lindahl, Seppo K. Koskinen: MRI of acute meniscal injury associated with tibial plateau fractures: Prevalence, type, and location. AJR Am J Roentgenol 191:1002–1009, 2008 IV Antti O. Mustonen, Laura Tielinen, Jan Lindahl, Eero Hirvensalo, Martti J. Kiuru, Seppo K. Koskinen: MRI of menisci repaired with bioabsorbable arrows. Skeletal Radiol 35:515–521, 2006
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