Unlocking the locked Knee Poster No.: P-0027 Congress: ESSR 2013 Type: Scientific Exhibit Authors: J. P. SINGH, S. Srivastava, S. S. BAIJAL ; Gurgaon, Delhi 1 1 2 1 2 NCR/IN, LUCKNOW, UTTAR PRADESH/IN Keywords: Musculoskeletal joint, MR, CT, Education, Education and training DOI: 10.1594/essr2013/P-0027 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.essr.org Page 1 of 18
Purpose Locking of knee is a common orthopaedic presentation, requiring arthroscopy and is described as patient's inability to either bend or straighten their knee. In recent years, magnetic resonance imaging (MRI) has been shown to be accurate for diagnosing the causes of knee locking, and has become the pre-surgical investigation of choice. However the causes are variable and their identification is crucial. Methods and Materials A MEDLINE and PubMed search was performed for journals before Nov 2012 with MeSH major terms 'Knee', 'Locking' and 'Causes' within the last 10 years. Non-English speaking and non- human literature was excluded. Results 82 articles were reviewed and of these 32 were found to be relevant. The various causes of knee locking were meniscal pathology, collateral ligament pathology, PVNS, bucket handle tear of medio-patellar plica, gouty tophi, foreign body, superior dislocation of patella, sarcoid arthritis, tibio-femoral joint instability, giant cell tumor of tendon sheath, osteochondral fracture of patella, lipoma and intra-articular tumors. A few of these examples have been shown in this pictorial review. Images for this section: Page 2 of 18
Fig. 1: Sagittal T2* sequence showing TORN ACL (blue arrow). The intact portion of ACL is entrapped between tibia and femur resulting in locking. Page 3 of 18
Fig. 2: Sagittal Gradient sequence showing MUCOID degeneration of ACL with positive celery stick sign. The swollen portion of ACL (blue arrow) resulted in locking in flexion. Page 4 of 18
Fig. 3: Sagittal PDFS image show BUCKET HANDLE TEAR with torn MENISCAL fragment in intercondylar notch which resulted in locking in extension. Page 5 of 18
Fig. 4: Coronal PDFS image show BUCKET HANDLE TEAR with torn MENISCAL fragment in intercondylar notch which resulted in locking in extension. Page 6 of 18
Fig. 5: Sagittal T1W image shows entrapped FAT LOCULE in postero-medial recess behind the meniscus, which was the cause of locking in extension. Page 7 of 18
Fig. 14: Coronal PD image shows SYNOVIAL OSTEOCHONDROMATOSIS which as the cause of intermittent locking. Page 8 of 18
Fig. 13: Sagittal Gradient image shows DISCOID MENISCUS as cause of locking with linear intra-substance high signal secondary to tear. Page 9 of 18
Fig. 12: Coronal PDFS image shows grade III TEAR OF MCL towards femoral attachment site. The mechanism of locking is unclear but may be due to spasm associated with the collateral ligament tear. Page 10 of 18
Fig. 11: Sagittal gradient image shows TORN PCL. PCL tear in combination with MCL tear has been described in locking. Page 11 of 18
Fig. 10: Sagittal Gradient image shows nodular area of reduced signal intensity (hemosiderin within PVNS) in anterior joint recess. This was seen as thickened nodular tissue at arthroscopy and was the cause of locking. Page 12 of 18
Fig. 9: Lateral radiograph shows DISLOCATED PATELLA (blue arrow). Page 13 of 18
Fig. 8: Coronal PDFS image shows LOOSE BODY in posterior intercondylar region which caused intermittent locking. Page 14 of 18
Fig. 7: Coronal PD image shows FOLDED MENISCAL FRAGMENT in posterior intercondylar notch as the cause of locking. Page 15 of 18
Fig. 6: Sagittal PDFS image shows FLIPPED MENISCAL FRAGMENT as the cause of locking. Page 16 of 18
Fig. 15: Reconstructed axial oblique image from 3D PD space sequence shows splitting of medial plica suggestive of BUCKET HANDLE TEAR OF MEDIAL PLICA as the cause of locking. Page 17 of 18
Conclusion The identification and differentiation of the causes of knee locking facilitates accurate pre-operative evaluation, necessary to plan patient management and potential surgical approach. References 1. 2. 3. 4. 5. 6. Elliott JM, Tirman PFJ, Grainger AJ, Brown DH, Campbell RSD, Genant HK. MR appearances of the locked knee. Br J Radiol 2000;73:1120-6. Suqanuma J, Ohkoshi T. Association of internal rotation of theknee jointwith recurrent subluxation of the lateral meniscus. Arthroscopy. 2011 Aug; 27(8):1071-8. Yotsumoto T, Iwasa J, Uchio Y. Localized pigmented villonodular synovitis in theknee associated withlocking symptoms. Knee. 2008 Jan;15(1):68-70. Swenning TA, Prohaska DJ. Isolated posterior cruciate ligament rupture presenting as a lockedknee. Arthroscopy. 2004 Apr;20(4):429-31. Tudisco C, Farsetti P, Febo A. Solitary intra-articular lipomalocking theknee in a young boy. J Pediatr Orthop B. 2008 May;17(3):131-3. He R, Yang L, Guo L. Painful locking of the knee due to bucket handle tear of mediopatellar plica. Chin J Traumatol. 2011 Apr 1;14(2):117-9. Personal Information Page 18 of 18