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Knee Joint Diseases, Magnetic Resonance Imaging, Menisci, Cruciate Ligaments, Internal Derangement
Background: Knee joint pathologies/injuries are one of the most common musculoskeletal complaints in adults worldwide. The aetiologies of knee joint disorders are diverse. Magnetic resonance imaging (MRI) is a sophisticated method of detecting and characterizing knee pathologies. This study was conducted to document the clinical presentation and MRI patterns of knee joint abnormalities in a group of adults in Lagos, Nigeria, and to juxtapose it with reports from other climes.
Methodolody: A retrospective hospital-based analysis of the knee MRI of 158 adult Nigerians was conducted in a single health facility. The clinical history and knee MRI findings were extracted, analyzed, and documented. Statistical significance was established at P≤0.05.
Results: There were 158 participants comprising 92 males (58.2%) and 66 females (41.8%) between the ages of 18 and 79. The mean age of the males was 44.75 ± 14.41 years, while that of the females was 47.76 ± 13.72 years (P = 0.19). A history of previous trauma was elicited in 135 (85.4%) participants. Eighty-two right knees (51.9%) and 76 left knees (48.1%) were examined. The dominant joint pathologies detected include effusion (77.2%), medial meniscopathy (48.1%), tibial abnormalities (46.2%), femoral abnormalities (46.2%), patella abnormalities (46.2%), anterior cruciate ligament disorders (37.3%), lateral meniscopathy (27.2%), medial collateral ligament disorders (22.2%), and popliteal (Baker’s) cysts (15.8%). ACL abnormalities were significantly more prevalent in male subjects. Knees with ruptured ACL had significantly more joint effusion and injuries to the medial meniscus, lateral meniscus, posterior cruciate ligament (PCL), medial retinacular ligament (MRL), femur, tibia, and fibula. There was no significant difference in the frequency of abnormalities between the right and left knees.
Conclusion: Joint effusion, medial meniscopathy, osseous abnormalities (tibia, femur, patella), ACL abnormalities, lateral meniscopathy, and MCL abnormalities, in decreasing order, were the most frequent pathologies in the knee joints evaluated.
2. Gimber LH, Hardy JC, Melville DM, Scalcione LR, Rowan A, Taljanovic MS. Normal Magnetic Resonance Imaging Anatomy of the Capsular Ligamentous Supporting Structures of the Knee. Can AssocRadiol J 2016;67:356–67.
3. Kean DM, Worthington BS, Preston BJ, Roebuck EJ, McKim-Thomas H, Hawkes RC, et al. Nuclear magnetic resonance imaging of the knee: examples of normal anatomy and pathology. Br J Radiol 1983;56:355–64.
4. Sharma D, Sharma A, Talwar N, Mittal P, Garg S, Airon D. Role of MRI evaluation in knee injuries. J Evol Med Dent Sci 2020;9:1435–41.
5. Vaidya SV, Aneesh M, Mahajan SM, Dhongade HS.Radiological Assessment of Meniscal Injuries of the Knee on Magnetic Resonance Imaging. Int J Curr Res Rev 2020;12:98–102.
6. Chien A, Weaver JS, Kinne E, Omar I. Magnetic resonance imaging of the knee. Pol J Radiol 2020;85(1):509–31.
7. Ahirwar LP, Ahirwar C. Can MRI replace diagnostic arthroscopy in evaluation of internal derangement of knee joint – a prospective study. J Evol Med Dent Sci 2013;2:7621–31.
8. Arumugam V, Ganesan GR, Natarajan P. MRI Evaluation of Acute Internal Derangement of Knee. Open J Radiol 2015;05:66–71.
9. Griffith JF. Five Overlooked Injuries on Knee MRI. Am J Roentgenol 2021;217(5):1165–74.
10. Maurer EJ, Kaplan PA, Dussault RG, Diduch DR, Schuett A, McCue FC, et al. Acutely injured knee: effect of MR imaging on diagnostic and therapeutic decisions. Radiology 1997;204(3):799–805.
11. Phelan N, Rowland P, Galvin R, O’Byrne JM. A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2016;24(5):1525–39.
12. Wang W, Li Z, Peng HM, Bian YY, Li Y, Qian WW, et al. Accuracy of MRI Diagnosis of Meniscal Tears of the Knee: A Meta-Analysis and Systematic Review. J Knee Surg 2021;34(2):121–9.
13. Challen J, Tang Y, Hazratwala K, Stuckey S. Accuracy of MRI diagnosis of internal derangement of the knee in a non-specialized tertiary level referral teaching hospital. AustralasRadiol2007;51:426–31.
14. Fisher T, Glasgow M. Internal Derangement of the Knee [Internet]. 2008 [cited 2022 Jun 4];Available from: https://tinyurl.com/4ekdxw6t
15. Ogunbode AM, Alonge TO, Adebusoye LA. Magnitude of knee osteoarthritis and associated risk factors among adult patients presenting in a family practice clinic in Nigeria. J Med Trop 2013;15(2):144–50.
16. Omoke NI, Ekumankama FO. Incidence and Pattern of Extremity Fractures seen in Accident and Emergency Department of a Nigerian Teaching Hospital. Niger J Surg 2020;26:28–34.
17. Babalola OM, Salawu ON, Ahmed BA, Ibraheem GH, Olawepo A, Agaja SB. Epidemiology of traumatic fractures in a tertiary health center in Nigeria. J OrthopTraumatolRehabil 2018;10:87–9.
18. Babalola OM, Salawu ON, Ahmed BA, Ibraheem GH, Kolade OA, Olawepo A, et al. Magnetic resonance imaging request pattern in a poor resource environment as a prerequisite for future planning. J OrthopTraumatolRehabil
19. Idowu B, Okedere T. Diagnostic radiology in Nigeria: A country report. J Glob Radiol 2020;6(1):1072.
20. Idowu BM, Afolabi BI, Onigbinde SO, Ogholoh OD, Nwafor NN. Magnetic Resonance Imaging of Ankle Disorders in Adult Nigerians in Lagos. J West AfrCollSurg 2022;12(2):81–7.
21. Idowu BM. Postgraduate radiology education in Nigeria: Looking backward and forward. SA J Radiol 2018;22(1):1362.
22. Erondu OF, Aniebo N. A Spectrum of MRI Findings in the Knee Joint: A Retrospective Study of Selected Population in South-South Nigeria. J Med BiolSci Res 2021;7:5–9.
23. Babalola OR, Itakpe SE, Afolayan TH, Olusola-Bello MA, Egbekun EI. Predictive Value of Clinical and Magnetic Resonance Image Findings in the Diagnosis of Meniscal and Anterior Cruciate Ligament Injuries. West Afr J Med 2021;38(1):15–8.
24. Erim AE, Udoh BE, Agweye P, Ukweh O, Ugwu AC. Magnetic Resonance Image Characterization of Knee Meniscus Signal Intensity using Crue’s Approach: Results from a Multi-centre Evidence. AdvBiosciClin Med 2021;9(3):15–20.
25. KelechiOkwara, Michael Sunday Okpaleke, Uchenna Eusebius Dike, Anthony Ugwu, Joe Umunnah, IsiaqJamiu. Magnetic resonance imaging assessment of the cruciate ligament thickness among apparently healthy Nigerians. Int J Sci Res Arch 2021;3(2):19–26.
26. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013;35(2):121–6.
27. Gizaw E. Cross Sectional Study of the patterns of knee joint abnormalities detected by knee MRI in patients evaluated at TikurAnbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia From April–September 2017. [Internet]. 2017 [cited 2022 Jun 9];Available from: http://etd.aau.edu.et/handle/123456789/13077
28. Mangukiya MG, Desai E, Shastri M. Magnetic Resonance Imaging Evaluation of Cruciate Ligament Injuries and Associated Knee Joint Injuries. Int J Sci Res 2018;7:502–5.
29. Thapa M, Thapa S, Chhetri PK. The Role of Magnetic Resonance Imaging in Traumatic Knee Injury. Nepal J Med Sci 2020;5:53–61.
30. Sagar S, Malhotra S, Swarup A, Kaushik R. Evaluation of MRI Findings in Chronic Painful Knee Joint. J Evid Based Med Healthc 2019;6:2818–23.
31. Bhandari L, Mangal R. An analytical study on prevalence of knee joint abnormalities assessed by MRI - A hospital based study. Int Arch Biomed Clin Res 2019;5:61–3.
32. Ginalski JM, Landry M, Meuli RA. Normal range of intraarticular fluid in the knee of healthy volunteers: easy evaluation with MRI. EurRadiol 1993;3(2):135–7.
33. Torry MR, Decker MJ, Viola RW, O’Connor DD, Steadman JR. Intra-articular knee joint effusion induces quadriceps avoidance gait patterns. ClinBiomech 2000;15:147–59.
34. Wang Y, Teichtahl AJ, Pelletier JP, Abram F, Wluka AE, Hussain SM, et al. Knee effusion volume assessed by magnetic resonance imaging and progression of knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology 2019;58(2):246–53.
35. Jaremko JL, McDougall D, Smith B, Lambert RG, Maksymowych WP. Clinical significance of a knee effusion detected on MRI by moaks or kimriss in a patient with knee OA. Osteoarthritis Cartilage 2015;23:A243–4.
36. Radhakrishnan A, Gurubharath I. A study on MRI of internal derangements of knee.Int Arch Integr Med 2019;6:32–5.
37. Ningappa R, Jayasudha S. MRI Findings of Internal Derangement of Knee in Trauma. J Evid Based Med Healthc 2015;2:1188–97.
38. Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol2020;49:1099–107.
39. Evans J, Nielson J l. Anterior Cruciate Ligament Knee Injuries [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Oct 25]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499848/
40. Palmer B. Mariano Rivera injury: Why do so many athletes tear their ACLs? [Internet]. 2012 [cited 2022 Oct 25]; Available from: https://slate.com/culture/2012/05/mariano-rivera-injury-why-do-so-many-athletes-tear-theiracls.html
41. Nandy D, Sinha N. Magnetic resonance imaging evaluation of painful knee joint: an experience from a rural medical college of West Bengal, India. Int J Res Med Sci 2019;7:3352–6.
42. Miller TT, Staron RB, Koenigsberg T, Levin TL, Feldman F. MR imaging of Baker cysts: association with internal derangement, effusion, and degenerative arthropathy. Radiology1996;201:247–50.
43. Sansone V, de Ponti A, Paluello GM, delMaschio A. Popliteal cysts and associated disorders of the knee. Critical review with MR imaging.IntOrthop 1995;19:275–9.