Imaging of Knee Injuries with Special Focus on Tibial Plateau Fractures

........................................................................................................................................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