Chronic sport injuries of the knee

Transcription

1 Chronic sport injuries of the knee 5th Musculoskeletal MRI meeting 2018: Knee MRI Gustav Andreisek, MD, MBA Saturday, May 5th, 2018; 14:00-16:00 Professor of Radiology, University of Zurich and Head of Radiology Spital Thurgau, Cantonal Hospital Münsterlingen, Switzerland

2 Declaration of Financial Interests or Relationships Gustav Andreisek was co-worker of a study which resulted in US patent (USPTO Number 12/947,256); received grants from Swiss National Science Foundation (SNCF), Holcim, and Siemens; is currently Co-PI or Sub-PI in several third party funded clinical trials at the University of Zurich (Sponsors include: Millennium Pharmaceuticals, Eli Lilly, GlaxoSmithKline, Cytheris SA, Roche, BioChemics, Novartis, Bristol-Meyers Squibb, TopoTarget, and Merck Sharp & Dohme) and where money is paid to the department Gustav Andreisek works for. The department also receives grants from Bayer and Guerbet and has ongoing research collaborations with Siemens. Gustav Andreisek has given workshops and talks at a congress which was sponsored by Mepha Pharma AG, Switzerland, and received a speaker fee. He also gives talks at Lunch symposia and CME courses, which are organized and sponsored by Guerbet, and receives speakers fees. Gustav Andreisek served as a consultant for Otsuka Pharmaceutical Europe Ltd at a one-day meeting in London, and received a consultant fee and reimbursement of travel costs. Gustav Andreisek was invited by GE, Philips and Siemens for official company receptions at international radiological congresses (RSNA).

3 Learning Objectives After this talk you will be able To know common chronic sport injuries To recognize and report them

4 Learning Material Review Article, Book, and Online Video

5 Content Tendinopathies & Avulsion fractures Morbus Osgood-Schlatter Morbus Sinding-Larsen-Johansson Jumpers Knee Hamstrings Pes anserinus Entrapment-, Friction-, and Impingement Syndroms Iliotibial band Patella Plica Fat pads Infrapatellar (Hoffa) Suprapatellar

6 Our Knee MR Imaging Protocol Standard Protocol (Skyra 3T, transmit-receive coil) Sagittal T2 weighted fat sat, 4238 / 78 ms, 384x384, 3mm Sagittal intermediate weighted, 3000 / 29 ms, 448x403, 3mm Coronal intermediate weighted, 2270 / 25 ms, 384x346, 3mm Axial T2 weighted fat sat, 5200 / 41 ms, 448x358, 2.5 mm Additional Sequences Gadolinum enhanced T1 fat sat Direct MR arthrography After meniscus repair

7 Causes for Knee MRI mostly acute injuries > 40% sport injuries* 15% Soccer 12% Ski 7% Running Bild: Getty

8 a typical week in Münsterlingen

9 Content Tendinopathies & Avulsion fractures Morbus Osgood-Schlatter Morbus Sinding-Larsen-Johansson Jumpers Knee Hamstrings Pes anserinus Entrapment-, Friction-, and Impingement Syndroms Iliotibial band Patella Plica Fat pads Infrapatellar (Hoffa) Suprapatellar

10 Morbus Osgood-Schlatter Facts Overuse / traction Microavulsion, Osteonecrosis ys old, m > f Basketball, Volleyball MRI Findings Bone marrow edema Bursitis, soft tissue reaction Fragmentation of apophysis Bild: betterbraces.com

11 12 ys old boy (acute)

12 Morbus Sinding-Larsen-Johansson Facts Overuse / traction Microavulsion, Osteonecrosis Teenager, m > f Running, Basketball, Volleyball MRI Findings Bone marrow edema Tendinitis, calcifications Bild: wiki Edema of Hoffa DD sleeve avulsion

13 15ys old boy

14 Jumpers Knee Facts Overuse / extension Tendon degeneration Jumping, Basketball MRI Findings Tendon abnormalities Increased T1 and T2 >7mm patellar tendon Bild: knieweh.at Soft tissue edema (Hoffa)

15 23ys old femal medical student Pe rso na lu se on ly Mit freundl. Genehmigung von PD Dr. Claudia Schueller-Weidekamm,Wien)

16 Hamstrings Facts Acute trauma Acute-on-chronic Soccer, Water-ski MRI Findings Partial or complete rupture from the origin Increased T2 muscle signal may maintain Peetron classification (normal, T2 signal, fiber disruption of less than 50% of the muscle, >50%)

17 How one can train them Quelle: Google

18 and so it would look like Quelle: Google

19 Why does he show this in a knee talk? Most cranial slide of a knee MRI

20 Various degree of severity Quelle: own images&radsource.us

21 Pes anserinus Facts Mostly M. sartorius Chronic stress Repetitive strains Jogging / MCL tear MRI Findings Tendinitis /Tendinopathy Inflammation, degeneration, partial rupture Quelle: physioworks.com Bursitis

22 30ys old male Pe rso na lu se on ly

23 Content Tendinopathies & Avulsion fractures Morbus Osgood-Schlatter Morbus Sinding-Larsen-Johansson Jumpers Knee Hamstrings Pes anserinus Entrapment-, Friction-, and Impingement Syndroms Iliotibial band Patella Plica Fat pads Infrapatellar (Hoffa) Suprapatellar

24 Iliotibial Band Friction Syndrom («Runners Knee») Facts Runners, cyclists, soccer and hockey players Most common lateral-side chronic injury Quelle: med-info.nl

25 Insertion

26 23ys old female skier Pe rso na lu MRI Findings Soft tissue edema (fat) May involve M. biceps femoris se on ly ITB thickening in chronic stages +/- fuid collection

27 Patellar Pain Syndrome (PFPS) Facts Quelle: Syn: patellar overload syndrome Runners, cyclists, basketball players and other sports participants Often caused by a change in training regime that includes dramatic increases in training time, distance or intensity, it can be compounded by worn or the wrong type of footwear braceability.com Discomfort while sitting with bent knees or descending stairs and generalised knee pain

28 MRI Findings To differentate possible other causes Excessive lateral pressure syndrome (ELPS) due to abnormal lateral tilt of the patella Chondromalacia patellae which refers to softening and degeneration of the articular hyaline cartilage of the patella Patellofemoral maltracking

29 Patellofemoral chondromalacia

30 Plica Facts Repetitive trauma of plica Chronic inflammation / synovits, joint effusion Cartilage damage «kissing lesions» Plica mediopatellaris > infrapatellaris > suprapatellaris MRI Findings Normal low signal on T1 and T2 Increased T1 and T2, thickening of plica Magnetic resonance spin-labeling perfusion imaging of synovitis in inflammatory arthritis at 3.0 T. Boss A, Martirosian P, Fritz J, Kötter I, Henes JC, Claussen CD, Schick F, Horger M. MAGMA Jun;22(3): doi: /s y. Chronic inflammation / synovits, joint effusion Synovial perfusion maps (4D Angio)

31 Plica mediopatellaris

32 Content Tendinopathies & Avulsion fractures Morbus Osgood-Schlatter Morbus Sinding-Larsen-Johansson Jumpers Knee Hamstrings Pes anserinus Entrapment-, Friction-, and Impingement Syndroms Iliotibial band Patella Plica Fat pads Infrapatellar (Hoffa) Suprapatellar

33 Infrapatellar (Hoffitis) Facts Syn: infrapatellar impingement syndrome Mechanic impingement Inflammation, fibrosis, calcification MRI Findings Acute: Increased signal on T2 fat sat, contrast enhancement and hypertrophy Chronic: Fibrosis, hemorrage and calcifications

34 Hoffa - infrapatellar impingement syndrome Quelle: ultimate-radiology.blogspot.ch

35 43ys old male and 25 ys old female patellar tendon lateral femoral condyle friction syndrome PT-LFCFS «patellofemoral friction syndrome,»

36 Sagittal View

37 Learning Objectives After this talk you are now able To know common chronic sport injuries To recognize and report them Tendinopathies & Avulsion fractures Morbus Osgood-Schlatter Morbus Sinding-Larsen-Johansson Jumpers Knee Hamstrings Pes anserinus Entrapment-, Friction-, and Impingement Syndroms Iliotibial band Patella Plica Fat pads Infrapatellar (Hoffa) Suprapatellar

38 See you in 5 days in Lausanne