Original Research
Magnetic
Resonance Imaging of Internal Derangements
and
Other Knee Pathologies in Adult Nigerians
Bukunmi Michael Idowu1<=
/sup>,
Babalola Ishmael Afolabi2, Stephen Olaoluwa Onigbinde3, Oghenetejiri Denise Ogholoh4, Nkem Nnenna =
Nwafor5,
*Tolulope Adebayo Okedere6
1Department
of Radiology, Union Diagnostics and Clinical Services Plc, Yaba,
Lagos State, Nigeria
2Dep=
artment
of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-If=
e,
Osun State, Nigeria3School of Medicine, St George’s University,
Grenada4Department of Radiology, Delta State University Teaching
Hospital, Oghara, Delta State, Nigeria5Department
of Radiology, Faculty of Clinical Sciences,
College of Health Sciences, University=
of Uyo, Akwa Ibom State, Nigeria.6Department of Radiology,
Clinix HealthCare, 6 Ago Palace Way, Festac Town, Lagos state, Nigeria
: 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.
: A retrospective hospital-bas=
ed 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.
: There were 158 participants
comprising 92 males (58.2%) and 66 females (41.8%) between the ages of 18 a=
nd
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 =3D 0.19). A history of previous trauma was elicited in 135 (85.4%) participa=
nts.
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%), f=
emoral
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 sACL
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 differen=
ce
in the frequency of abnormalities between the right and left knees.
: Joint effusion, medial menisc=
opathy,
osseous abnormalities (tibia, femur, patella), ACL abnormalities, lateral <=
span
class=3DSpellE>meniscopathy, and MCL abnormalities, in decreasing or=
der,
were the most frequent pathologies in the knee joints evaluated.
: Knee Joint Diseases, Magnetic Resonance Imaging, Menisci, Cruc=
iate
Ligaments,
Internal Derangement
=
=
*Correspondence:
How
to cite this article
The knee, the
largest and most complex joint in the body, is a synovial hinge joint that
comprises the patellofemoral, medial, and later=
al
femorotibial compartments, stabilized by a delicate array of muscular,
tendinous, ligamentous, cartilaginous, and capsular structures. Its numerous
bursae facilitate easy mobility of the joint’s stabilizing structures.=
[1,2]=
[3–5] In contrast, modern MRI
scanners demonstrate the vast majority of the osseous and non-osseous
components of the knee joint in exquisite detail.=
[1,2,6]MRI is now the non-invasive imaging
method of choice for virtually all clinical indications involving the knee.=
[7]
Although arthroscopy is the gold stan=
dard
for intra-articular knee pathologies, its cost, invasiveness, and operator =
dependence
have now made it a more therapeutic surgical procedure than a diagnostic to=
ol.[7,8]=
Furthermo=
re,
partial tears and intrasubstance tears of the anterior cruciate ligament (A=
CL)
are difficult to evaluate on arthroscopy. Similarly, via the conventional
anteromedial arthroscopy portal, ramp lesions at the posterior third of the
medial meniscus are often inaccessible.=
[9]=
=
Reduced
arthroscopic operations, improved diagnostic certainty, and simplified mana=
gement
choices are benefits of using MRI to diagnose and treat knee pathologies.=
[10]=
[11,12]Even
where there is no subspecialist musculoskeletal radiologist, interpretation=
of
knee MRI by general radiologists shows acceptable accuracy rates. ADDIN ZOTERO_ITEM CSL_CITATION
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;itemData":{"id":16097,"type":"article-journa=
l","container-title":"Australasian
Radiology","DOI":"10.1111/j.1440-1673.2007.01865.x"=
;,"ISSN":"0004-8461,
1440-1673","journalAbbreviation":"Australas
Radiol","language":"en","page":"426=
-431","source":"DOI.org
(Crossref)","title":"Accuracy of MRI diagnosis of inter=
nal
derangement of the knee in a non-specialized tertiary level referral teachi=
ng
hospital","volume":"51","author":[{"=
;family":"Challen","given":"J"},{"f=
amily":"Tang","given":"Ym"},{"famil=
y":"Hazratwala","given":"K"},{"fami=
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[13]
“Internal derangement of the knee (IDK) is an inclusive term used to
indicate (alone or in combination) certain disorders of the joint, including
(alone or in combination) torn meniscus, loose bodies in the knee, and dama=
ged
collateral or cruciate ligaments. The term does not signify chronic disorde=
rs
such as chondromalacia patellae, congenital discoid meniscus, meniscal cyst=
s,
or degenerative processes such as knee osteoarthritis.”=
[14]
Previous studies in the local population showed the k=
nee to
be a common site of osteoarthritis.=
[15]Furthermore, tibia (most
commonly fractured bone), femur, and patella fractures constituted 25.0 -
32.6%, 19.2 - 19.6%, and 1.6% of all post-traumatic extremity fractures in
other local studies.=
[16,17]
A recent analysis of MRI requests showed a low nu=
mber
of knee MRI orders (1% of all MRI studies over a two-year duration)<=
!--[if supportFields]>
ADDIN ZOTERO_ITEM CSL_CITATION
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l","abstract":"<br><b>Introduction:</b&g=
t;
Magnetic Resonance Imaging (MRI) is a non invasive imaging technique used f=
or
diagnosis of pathology in parts of the body, it is particularly useful in
demonstrating soft tissue such as brain, spinal cord, nerve root,
intervertebral disc, muscles etc. contrast can be used to enhance the MRI
image. The aim of this study is to know the indications and pattern of MRI
request in this environment. <b>Methods:</b> A two year
retrospective study was carried out in a private diagnostic centre in the N=
orth
– Central Nigeria from September 2014 – August 2016. A record of biodata, b=
ody
regions and indications requested were analyzed with SPSS version 17.
<b>Results:</b> total of 837 MRI were requested during the study
period, there was a male preponderance with male to female ratio of 1.6: 1,=
the
commonest age group was those greater than 60 years. MRI request was found =
to
be highest in the spine region of the body, the commonest indication for MRI
request was low back pain from disc prolapsed, this made MRI of the lumbar
spine the most frequently requested MRI in the body.
<b>Conclusion:</b> Soft tissue pathologies of the spine, brain,
muscles and nerves are clearly demonstrated by MRI, this make it an
indispensable equipment which should be available in all tertiary health
centres in the country for early detection and treatment of different
pathologies. There is also need for inclusion of MRI charges in national he=
alth
insurance scheme because of the frequent indications for the
procedure.<br>","container-title":"Journal of
Orthopedics, Traumatology and Rehabilitation","DOI":"10=
.4103/jotr.jotr_19_17","ISSN":"0975-7341","is=
sue":"2","language":"en","note"=
;:"Company:
Medknow Publications and Media Pvt. Ltd.\nDistributor: Medknow Publications=
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Media Pvt. Ltd.\nInstitution: Medknow Publications and Media Pvt. Ltd.\nLab=
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Medknow Publications and Media Pvt. Ltd.\npublisher: Medknow
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resonance imaging request pattern in a poor resource environment as a
prerequisite for future planning","volume":"9",&qu=
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:"O.
M."},{"family":"Salawu","given":"O.
N."},{"family":"Ahmed","given":"B.
A."},{"family":"Ibraheem","given":"=
G.
H."},{"family":"Kolade","given":"O.
A."},{"family":"Olawepo","given":"A=
."},{"family":"Agaja","given":"S.
B."}],"issued":{"date-parts":[["2017",1,=
7]]}}}],"schema":"https://github.com/citation-style-language=
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[18], even though MRI scanners are now mo=
re
available than before.[19,20]MRI use in Nigeria is still hampered by
non-availability (due to high procurement, installation, and maintenance co=
sts),
frequent breakdowns, low-field strength machines, and unaffordability.
Consequently, there is a paucity of data on the MRI pattern of knee disorde=
rs
in Nigerians. ADDIN ZOTERO_ITEM CSL_CITATION
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quot;article-journal","abstract":"The
knee is a very important joint and injuries affecting it may cause signific=
ant
disability and discomfort to the patient. Despite a variety of methods
available to assess injuries of the knee joint, Magnetic Resonance Imaging
(MRI) continues to play a major role.
This study evaluated the spectrum of MRI findings in a relatively low
resource environment, with limited access to MRI modality. The outcome shou=
ld
justify further investment in MRI services in this locality. The study invo=
lves
retrospective analysis of MRI reports of 198 clinically symptomatic patients
referred for imaging in a Port-Harcourt. All examinations were performed us=
ing
GE BRIVO MR 235 machine with 0.35 Tesla field strength in a well-coupled
standard knee coil. All images were analyzed for normality or otherwise and
radiological reports generated by competent radiologists. The most common
findings are traumatic in origin, notably cruciate ligament tears (37.37%) =
and
meniscal tears (33.3%) as well as quadriceps tendon tears (3.03%). The medi=
al
meniscus and anterior cruciate ligaments were more frequently involved.
Furthermore, patients in the 3rd and 4th decade of life were more commonly
involved, with a male preponderance. The less common findings of Synovial
chondromatosis, cyst-like lesions, tumors and loose bodies, all buttress the
importance of routine MRI in atraumatic cases. The spectrum of MRI findings=
in
this study is a reflection of growing interest and confidence in MRI of the
diseased knee joint in our environment. The outcome would be a justification
for future investments in MRI. Keywords: Magnetic Resonance Imaging, knee
injuries, tibial meniscal tears, incidental
findings","container-title":"Journal of Medical and
Biological Science Research","DOI":"10.36630/jmbsr_2100=
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t;:"JMBSR","page":"5-9","source":&q=
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Knee
Joint: A Retrospective Study of Selected Population in South-South Nigeria&=
quot;,"title-short":"A
Spectrum of MRI Findings in the Knee Joint","volume":"7=
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Felix"},{"family":"Aniebo","given":"=
;Nonyelum"}],"issued":{"date-parts":[["2021&q=
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quot;BACKGROUND:
Anterior Cruciate Ligament (ACL) injuries may be accompanied by associated
injuries such as meniscal injuries. Clinical evaluation alone may at times =
miss
the diagnosis of ACL injury and one or more associated injuries. However, an
adjuvant diagnostic tool such as an MRI of the knee may be unaffordable to =
some
patients. The goal of this study was to compare the sensitivity, specificity
and predictive value of clinical and magnetic resonance image (MRI) finding=
s in
the diagnosis of anterior cruciate ligament and meniscal injuries.\nMETHODS:
This was a prospective study. The cases of ACL injury recruited had a magne=
tic
resonance imaging of the injured knee, and knee arthroscopy done. The clini=
cal,
magnetic resonance imaging and arthroscopic diagnostic findings were all no=
ted.
The sensitivity, specificity, positive predictive value and negative predic=
tive
values of clinical and MRI findings were compared, with arthroscopic findin=
gs
as gold standard.\nRESULTS: A total of seventy-seven patients were recruited
for the study. There were fifty-four males and twenty three females. The
results of the tests of the sensitivity, specificity, positive predictive v=
alue
and negative predictive value of clinical diagnosis and MRI when compared w=
ith
arthroscopy findings, in detecting meniscal and anterior cruciate ligament
injuries were as follows: For Clinical evaluation; Anterior Cruciate ligame=
nt:
81%, 80%, 86% and 76%; Medial Meniscus: 84%, 77%, 84% and 93%; and Lateral
Meniscus: 85%, 77%, 85% and 82% respectively. For MRI: Anterior Cruciate
Ligament (ACL): 87%, 89%, 93% and 78% ; Medial Meniscus: 87% 79%, 70% and 8=
2%;
and the Lateral Meniscus: 70%, 76% 73% and 72%.\nCONCLUSION: The specificit=
y,
sensitivity and predictive value of clinical and MRI findings were comparab=
le
in relation to the diagnosis of ACL and Medial Meniscus tears. However, the
values of these parameters were better with clinical examination than with =
MRI
in relation to the diagnosis of lateral meniscus tears.","contain=
er-title":"West
African Journal of
Medicine","ISSN":"0189-160X","issue":&qu=
ot;1","journalAbbreviation":"West
Afr J
Med","language":"eng","note":"PMID:=
33463701","page":"15-18","source":"=
;PubMed","title":"Predictive
Value of Clinical and Magnetic Resonance Image Findings in the Diagnosis of
Meniscal and Anterior Cruciate Ligament
Injuries","volume":"38","author":[{"=
;family":"Babalola","given":"O.
R."},{"family":"Itakpe","given":"S.
E."},{"family":"Afolayan","given":"=
T.
H."},{"family":"Olusola-Bello","given":&=
quot;M.
A."},{"family":"Egbekun","given":"E.
I."}],"issued":{"date-parts":[["2021",1]=
]}}},{"id":14954,"uris":["http://zotero.org/users/=
5658208/items/78PDSYN4"],"itemData":{"id":14954,&q=
uot;type":"article-journal","abstract":"This
study aimed to characterize knee meniscus signal-intensity using magnetic
resonance imaging. Our research included knee MR images of 138 subjects from
multi-centres in Nigeria, between September 2016 and December 2017. Knee im=
ages
were retrieved from patients' folder of MRI scanners and transfered to a DI=
COM
workstation (Onis 2.6) for image analysis. Knee meniscus was characterized =
into
0, 1, 2 & 3 grades using Crue’s grading approach. Our research revealed=
58%
incidence of meniscal lesion. Study yielded a significant relationship betw=
een
meniscal lesion and gender (p <.005) with a greater proportion of these
lesions in women than in men. Meniscal lesions showed significant associati=
on
with osteoarthritis (OA) (p < 0.05). Grade 3 lesions (actual tears) were
largely of horizontal configuration.","container-title":&quo=
t;Advances
in Bioscience and Clinical
Medicine","DOI":"10.7575/aiac.abcmed.v.9n.3p.15",&=
quot;ISSN":"2203-1413","issue":"3","=
;language":"en-US","license":"Copyright
(c) 2021 Akwa E. Erim, Benjamin E. Udoh, Pius Agweye, Ofonime Ukweh, Anthon=
y C.
Ugwu","note":"number:
3","page":"15-20","source":"www.jou=
rnals.aiac.org.au","title":"Magnetic
Resonance Image Characterization of Knee Meniscus Signal Intensity using Cr=
ue’s
Approach: Results from a Multi-centre
Evidence","title-short":"Magnetic Resonance Image Chara=
cterization
of Knee Meniscus Signal Intensity using Crue’s
Approach","volume":"9","author":[{"=
family":"Erim","given":"Akwa
E."},{"family":"Udoh","given":"Benj=
amin
E."},{"family":"Agweye","given":"Pi=
us"},{"family":"Ukweh","given":"Ofo=
nime"},{"family":"Ugwu","given":"An=
thony
C."}],"issued":{"date-parts":[["2021",7,=
31]]}}},{"id":16503,"uris":["http://zotero.org/use=
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quot;International
Journal of Science and Research Archive","DOI":"10.3057=
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ue":"2","journalAbbreviation":"Int.
J. Sci. Res. Arch.","page":"19-26","source&qu=
ot;:"DOI.org
(Crossref)","title":"Magnetic resonance imaging assessm=
ent
of the cruciate ligament thickness among apparently healthy
Nigerians","volume":"3","author":[{"=
;literal":"Kelechi
Okwara"},{"literal":"Michael Sunday
Okpaleke"},{"literal":"Uchenna Eusebius Dike"},{&q=
uot;literal":"Anthony
Ugwu"},{"literal":"Joe
Umunnah"},{"literal":"Isiaq
Jamiu"}],"issued":{"date-parts":[["2021"=
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=
[22–25]
The objective of this retrospective study was to <=
/span>investigate the frequency and range/array =
of
pathologies in adult Nigerians who underwent knee MRI at a single health
facility and compare/contrast
the results to those of other studies conducted in different regions of the
world.
Mate=
rials
and Methods
This w=
as a
retrospective descriptive study that included the records of 158 patients who had
undergone knee MRIs at the radiology department of our institution. =
The sample size was calculated using the Fischer formula:=
[26]
Where:
N =3D =
Sample
size
Z =3D Standard normal deviate =3D 1.96
(corresponding to 95% Confidence interval)
p =3D
Proportion of target population estimated to have knee pain (0.115)<=
!--[if supportFields]><=
/span>
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of Medicine in the
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SN":"2276-7096","issue":"2","journa=
lAbbreviation":"J
Med
Trop","language":"en","page":"144-1=
50","source":"DOI.org
(Crossref)","title":"Magnitude of knee osteoarthritis a=
nd
associated risk factors among adult patients presenting in a family practice
clinic in
Nigeria","volume":"15","author":[{"=
family":"Ogunbode","given":"Adetola
M"},{"family":"Alonge","given":"Tem=
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O"},{"family":"Adebusoye","given":"=
Lawrence
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=
[15]
q =3D =
1.0 – p =3D 1.0 – 0.115 =3D 0.885
d =3D =
Degree of accuracy desired, usually set at 0.05
Substituting these into the formula yield=
s
=
N =3D 156
The He=
alth
Research and Ethics Committee (UUTH/AD/S/96/VOL.XXI/440) approved the study protocol. Informed
consent was waived
because of the retrospective study design. The
study included all the knee MRI scans done over the study period.
Data on the patien=
ts'
demographics, imaging indications, and other relevant medical information w=
as
retrieved from their electronic medical records. All adult Nigerians having=
complete
clinical data, MRI images, and radiologists' reports of knee MRI scans betw=
een
December 2019 and December 2021 were included in the study. Participants
included any adult patient who reported knee symptoms (pain, swelling, limi=
ted
movement, etc.) regardless of whether they had a history of trauma. Individ=
uals
with inadequate clinical history, past knee surgery, inferior quality MRI
images, and incomplete/inconclusive studies were excluded. The MRI
images and reports were re-analyzed by one diagnostic radiologist with eight
years of experience.
The MRI scans were performed on=
a
1.5 Tesla General Electric Optima MR scanner (GE Healthcare, Chicago, Illin=
ois,
USA) in an extremity coil using a small field of view (14-16 cm,
including the suprapatellar bursa and patellar =
tendon
insertion on the tibial tubercle), 4 mm slice thickness, and 0.4 mm
interslice gap. The participant was scanned in =
the
supine position (feet first in the MRI scanner), with the knee under evalua=
tion
externally rotated by 15-20 degrees to aid the imaging of ACL in the sagitt=
al
plane. In addition, the knee was flexed 5-10 degrees to evaluate the
patellofemoral compartment.[4]
The sequences acquired (in axial,
sagittal, and coronal planes as appropriate) were T1-weighted (T1=
W), T2-weighted =
(T2W),
Short =
Tau
Inversion Recovery (STIR), Proton Density weighted Imaging (PDWI), and
Proton=
Density
weighted Fat Saturation (PDFS). Image interpretation and diag=
nostic
criteria adhered to the published glossary of terms, classifications, and
criteria.
The study data were entered int=
o an
Excel spreadsheet (Microsoft, Redmond, Washington, USA) =
and
analyzed with IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armon=
k,
N.Y., USA). Categorical variables were presented as absolute and relative
frequencies (%), while continuous variables were presented as mean values. =
Mean values were compared with the stud=
ent’s
t-test, while percentages were compared with the Chi-square test and likelihood ratio
test (for percentages <5). Statis=
tical
significance was P
There were 158 participants comprising 92 males
(58.2%) and 66 females (41.8%) aged 18 – 79. The mean age was 46.01 ± 14.16
years. Ninety-two subjects were ≤ 46 years old, while 66 were > 46
years old. There was no statistically significant difference between the me=
an
age of the male (44.75 ± 14.41 years; range =3D 18 – 79 years) and female (=
47.76
± 13.72 years; range =3D 24 – 75 years) participants (P =3D 0.19). The age subgroups were 18-20 years (5; 3.2%), 21-30
years (17; 10.8%), 31-40 years (34; 21.5%), 41-50 years (47; 29.7%), 51-60
years (23; 14.6%), 61-70 years (25; 15.8%), and 71-80 years (7; 4.4%).
An overwhelming majority (136; 86.1%)
presented with knee pain followed by knee pain and swelling in 20 subjects =
(12.7%).
Just two subjects (1.3%) complained of only knee swelling. History of previ=
ous
trauma was elicited in 135 (85.4%) participants (80 males and 55 females; 69
right and 66 left knees). There was no antecedent trauma in 23 (14.6%) subj=
ects
(12 males and 11 females; 13 right and 10 left knees). There were 82 right =
knee
(51.9%) and 76 left knee (48.1%) MRI studies.
All the
knee MRI scans done over the study period were abnormal. The major structur=
al
pathologies of the knees detected on MRI are summarized in Table 1.
Table 1. Frequency of major knee patholo=
gies
|
Knee patho=
logies
(All knees;
N=3D158) |
Frequency =
(n) |
Percentage=
(n/N x 100=
) |
|
|
|
|
|
Abnormal
medial meniscus |
76 |
48.1% |
|
Abnormal
lateral meniscus |
43 |
27.2% |
|
Abnormal
ACL |
59 |
37.3% |
|
Abnormal
PCL |
8 |
5.1% |
|
Abnormal
MCL |
35 |
22.2% |
|
Abnormal
LCL |
8 |
5.1% |
|
Abnormal
MRL |
4 |
2.5% |
|
Abnormal
patellar tendon |
14 |
8.9% |
|
Abnormal
popliteus tendon |
7 |
4.4% |
|
Abnormal
QT |
16 |
10.1% |
|
Abnormal
BFT |
1 |
0.6% |
|
Joint
effusion |
122 |
77.2% |
|
Abnormal
Synovium |
8 |
5.1% |
|
Abnormal
femoral cartilage |
17 |
10.8% |
|
Abnormal
tibial cartilage |
11 |
7.0% |
|
Abnormal
femur |
73 |
46.2% |
|
Abnormal
tibia |
73 |
46.2% |
|
Abnormal
patella |
68 |
43% |
|
Abnormal
fibula |
8 |
5.1% |
|
Baker’s
cyst |
25 |
15.8% |
**=
Knee
pathologies were not mutually exclusive, total percentages may exceed 100%<=
/i>
Menisci
The medial m=
enisci
of 82 knees (51.9%) were normal. It had tears only in 24 (15.2%), degenerat=
ive
changes only in 24 (15.2%), extrusion only in two (1.3%), meniscocapsular
separation in two (1.3%), and various combinations of degenerative changes,
tear, and extrusion in 24 (15.2%) knees.
The lateral
meniscus was normal in 115 knees (72.8%). It had degenerative changes only =
in
14 (8.9%), tears only in 20 (12.7%), various combinations of degenerative
changes, tears, and extrusion in 8 (5.1%), and extrusion only in one knee
(0.6%).
Ligaments
The ACL was =
normal
in 99 (62.7%) of the 158 participants. Partial tear (32; 20.3%), mucoid
degeneration (16; 10.1%), and complete rupture (13; 8.2%) were the identifi=
ed
ACL abnormalities.
The posterior cruciate ligament (PCL) was
normal in 150 (94.9%) of the 158 participants. Partial tear (7; 4.4%) and
mucoid degeneration (1; 0.6%) were the other identified abnormalities of the
PCL.
The medial collateral ligament (MCL) was normal in 123 subjects
(77.8%) and partially torn in 35 subjects (22.2%). The lateral collateral
ligament was normal in 150 subjects (94.9%) and partially torn in eight (5.=
1%)
subjects.
The medial retinacular ligament (MRL) was normal in 154 subjects
(97.5%) and partially torn in four (2.5%) subjects. The lateral retinacular
ligament was normal in all the knees.
Tendons
The patellar
tendon was normal in 144 subjects (91.1%), showed tendinosis in 11 (7.0%), =
and was
partially torn in three (1.9%) subjects. The popliteus tendon was normal in=
151
subjects (95.6%) and showed tendinosis in seven (4.4%) subjects. There were
twelve (7.6%), three (1.9%), and one (0.6%) cases of quadriceps tendinosis,
partial tear, and rupture, respectively. The biceps femoris tendon was abno=
rmal
(tendinosis) in only one (0.6%) subject.
Bones
The femoral
pathologies observed include osteophytes (53; 33.5%), contusion (18; 11.4%),
subchondral cysts (3; 1.9%), infarction (1; 0.6%), and enchondroma (1; 0.6%=
).
The tibial abnormalities sighted include osteophytes (48; 30.4%), contusion
(19; 12.0%), and subchondral cysts (5; 3.2%). The patellar pathologies dete=
cted
were chondromalacia (47; 29.7%), osteophytes (14; 8.9%), subluxation/disloc=
ation
(8; 5.1%), and patella alta (8; 5.1%). Fibula
osteophytes (4; 2.5%), contusion (3; 1.9%), and subchondral cysts (1; 0.6%)
were the fibular lesions identified.
Cartilage
Femoral arti=
cular
cartilage irregularity and full-thickness cartilage ulceration were seen in=
15
(9.5%) and two (1.3%) knees, respectively. Tibial articular cartilage
irregularity was present in 11 (7.0%) knees.
Synovium
Localized synovitis was seen in five knees
(3.2%), while there was one case each (0.6%) of generalized synovitis, chondromatosis, and synovial proliferation. Mild, mod=
erate,
and massive joint effusion occurred in 80 (50.6%), 37 (23.4%), and five (3.=
2%)
knees, respectively.
Other Findin=
gs
Other findings include Baker’s cyst (25; 15.8%), H=
offa
fat pad oedema/injury (20; 12.7%), soft tissue oedema (15; 9.5%), loose bod=
ies
(4; 2.5%), bursitis (3; 1.9%), osteochondroma (2; 1.3%), and fabella (1; 0.=
6%).
Only ACL abnormalities were significantly =
more
prevalent in the male subjects
Table 2. Proportion of abnormal knee
structures by sex
|
Pathology |
Male; N =3D 92 n
(%) |
Female; N =3D 66 n
(%) |
P val=
ue |
|
Medial
Meniscus |
44
(47.8%) |
32
(48.5%) |
0.07 |
|
Lateral
Meniscus |
25
(27.17%) |
18
(27.3%) |
0.80 |
|
ACL |
36
(39.1%) |
23
(34.8%) |
0.04 |
|
PCL |
6
(6.5%) |
2
(3.0%) |
0.62 |
|
MCL |
23
(25%) |
12
(18.2%) |
0.67 |
|
LCL |
5
(5.4%) |
3
(4.5%) |
0.70 |
|
MRL |
4
(4.3%) |
0 |
0.40 |
|
Patella
tendon |
11
(13.3%) |
3
(5.6%) |
0.19 |
|
Popliteus
tendon |
6
(6.1%) |
1
(1.4%) |
0.13 |
|
Quadriceps
tendon |
11
(12%) |
5
(7.6%) |
0.74 |
|
BFT |
1
(1.1%) |
0 |
0.40 |
|
Joint
Effusion |
74
(80.4%) |
48
(72.7%) |
0.51 |
|
Synovium |
5
(5.4%) |
3
(4.5%) |
0.34 |
|
Femoral
cartilage |
11
(12%) |
6
(9.1%) |
0.77 |
|
Tibial
cartilage |
7
(7.6%) |
4
(6.1%) |
0.71 |
|
Femur |
45
(48.9%) |
28
(42.4%) |
0.40 |
|
Tibia |
42
(45.7%) |
31
(47%) |
0.58 |
|
Patella
|
38
(41.3%) |
30
(45.5%) |
0.74 |
|
Fibula |
2
(2.2%) |
6
(9.1%) |
0.06 |
|
Baker’s
cyst |
9
(9.8%) |
13
(19.7%) |
0.07 |
Using the mean age (46.01 years) as cut-of=
f,
abnormal medial meniscus, femoral abnormalities, tibial abnormalities, joint
effusion, and Baker’s cyst were significantly more prevalent in the
participants > 46 years old than those ≤ 46 years old
|
Pathology |
≤
46 years; N =3D92 n
(%) |
> 46 years; N =3D 66 n
(%) |
P val=
ue |
|
Medial
Meniscus |
30
(32.6%) |
46
(69.7%) |
<0.0001 |
|
Lateral
Meniscus |
18
(19.6%) |
15
(22.7%) |
0.17 |
|
ACL |
36
(39.1%) |
23
(34.8%) |
0.16 |
|
PCL |
5
(5.4%) |
3
(4.5%) |
0.42 |
|
MCL |
17
(18.5%) |
18
(27.3%) |
0.31 |
|
LCL |
4
(4.3%) |
4
(6.5%) |
0.49 |
|
MRL |
2
(2.17%) |
2
(3%) |
0.53 |
|
Patella
tendon |
10
(10.9%) |
4
(6.5%) |
0.19 |
|
Popliteus
tendon |
5
(5.4%) |
2
(3%) |
0.47 |
|
Quadriceps
tendon |
9
(9.8%) |
7
(10.6%) |
0.69 |
|
Biceps
Femoris Tendon |
1
(1.1%) |
0 |
0.40 |
|
Joint
Effusion |
66
(71.7%) |
56
(84.8%) |
0.01 |
|
Synovium |
4
(4.3%) |
4
(6.5%) |
0.47 |
|
Femoral
cartilage |
10
(10.9%) |
7
(10.6%) |
0.45 |
|
Tibial
cartilage |
9
(9.8%) |
2
(3%) |
0.10 |
|
Femur |
31
(33.7%) |
42
(63.6%) |
<0.0001 |
|
Tibia |
28
(30.4%) |
45
(68.2%) |
<0.0001 |
|
Patella
|
39
(42.4%) |
29
(43.9%) |
0.77 |
|
Fibula |
2
(2.17%) |
6
(9.1%) |
0.06 |
|
Baker’s
cyst |
9
(9.8%) |
13
(19.7%) |
0.02 |
Knees with rupture of the ACL had
significantly more joint effusion, and injuries to the medial meniscus, lat=
eral
meniscus, PCL, MRL, femur, tibia, and fibula.
|
Pathology |
ACL rupture; N =3D 13 n
(%) |
No ACL rupture; N =3D 145 n
(%) |
P val=
ue |
|
Medial
Meniscus |
10 (77) |
66 (45.5) |
0.02 |
|
Lateral
Meniscus |
9 (69.2) |
35 (24.1) |
<0.0001 |
|
PCL |
2 (15.4) |
6 (4.1) |
0.01 |
|
MCL |
5 (38.5) |
30 (20.7) |
0.47 |
|
LCL |
1 (7.7) |
7 (4.8) |
0.80 |
|
MRL |
1 (7.7) |
3 (2.1) |
0.01 |
|
Patella
tendon |
0 |
14 (9.7) |
0.50 |
|
Popliteus
tendon |
1 (7.7) |
6 (4.1) |
0.55 |
|
Quadriceps
tendon |
1 (7.7) |
15 (10.3) |
0.95 |
|
BFT |
0 |
1 (0.7) |
0.76 |
|
Joint
Effusion |
12 (92.3) |
110 (76) |
<0.0001 |
|
Synovium |
1 (7.7) |
7 (4.8) |
0.02 |
|
Femoral
cartilage |
3 (23.1) |
14 (9.7) |
0.07 |
|
Tibial
cartilage |
2 (15.4) |
9 (6.2) |
0.21 |
|
Femur |
11 (84.6) |
62 (42.8) |
0.04 |
|
Tibia |
11 (84.6) |
62 (42.8) |
0.02 |
|
Patella
|
5 (38.5) |
63 (43.4) |
0.07 |
|
Fibula |
1 (7.7) |
7 (4.8) |
0.01 |
|
Baker’s
cyst |
2 (15.4) |
20 (13.8) |
0.31 |
Fifty-nine knees (37.3%) had various ACL
abnormalities [Partial tear (32; 20.3%), mucoid degeneration (16; 10.1%), a=
nd
complete rupture (13; 8.2%)]. PCL injury (7/59 =3D 11.9% vs 1/99 =3D 1%; P =3D 0.02) and joint effusion (4=
9/59 =3D
83.1% vs 73/99 =3D 73.7%; P =3D=
0.03)
were significantly more prevalent in the knees with abnormal ACL than those
with a normal ACL. There was no statistically significant difference in the
frequency of abnormalities between the right and left knees.
Figures 1 and 2 are representative
images of some pathologies encountered.
Figure 1.
Proton density fat-satu=
rated
(PDFS) sagittal MRI of the knee (A & B) showing ACL rupture as absent A=
CL.
Sagittal T1W images show celery stalk appearance of ACL mucoid degeneration=
(C)
and partial tear of the PCL (D). PDFS Coronal view shows a partial tear of =
the
lateral collateral ligament and severe contusion of the lateral femoral con=
dyle
(E). Axial PDFS (F) shows avulsion of the medial retinacular ligament.
Discussion
This retrosp=
ective
study analyzed the array of knee abnormalities in adult Nigerians detected =
on
MRI at a single health facility. The 41-50 yea=
rs
(29.7%) and 31-40 years (21.5%) age groups constituted the bulk of
participants. The vast majority (85.4%) of the study population had a histo=
ry
of trauma to the examined knee. Joint effusion, medial meniscal pathologies,
osseous abnormalities, ACL pathologies, lateral menisc=
opathy,
and medial collateral ligament injuries were the most common joint
abnormalities on MRI. A history of previous trauma was elicited in 135 (85.=
4%)
participants (80 males and 55 females; 69 right and 66 left knees). This ra=
te
is much higher than the 22.4% reported by Gizaw in Ethiopia.=
[27]
Joint effusion, the most
prevalent abnormality, was present in 77.2% of the examined knees. This
effusion prevalence is consistent with the 73.0 – 91.2% reported in previous
studies.=
[7,28–31] On MRI, significant patholog=
ical
knee effusion is diagnosed when the fluid thickness at the suprapatellar re=
cess
and or the posterior joint recess is ≥ 10 mm.=
[32] Rheumatological diseases,
infection, trauma, synovial diseases, vasculitides,
haemoglobinopathies, and neoplastic lesions are known causes of knee joint
effusion.=
[6] Knee effusion alters the joi=
nt’s
biomechanics (increased hamstring activity, decreased quadriceps activity, =
gait
cycle alterations).=
[33] In patients with established
knee osteoarthritis, effusion is associated with a substantial increase in =
pain
and disability, while effusion volume predicts disease progression.<=
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[34,35]
The menisci reinforce the knee joint's
stability, distribute the axial load, absorb stress and shock, and keep the
joint lubricated and nourished. The menisci transmit 50% of the load in the
medial compartment and 70% in the lateral compartment; removing the menisci
elevates contact stress by 100% in the medial compartment and by 200% to 30=
0%
in the lateral compartment.=
[6] Media=
l meniscopathy was seen in 48.1% of the knees, while la=
teral meniscopathy affected 27.2%. Previous authors also reported similarly
higher rates of medial meniscus (MM) than lateral meniscus (LM) injuries – =
Gizaw(MM =3D 20.8%, LM =3D 2.0%)=
=
[27], Thapaet al. (MM =
=3D 26.2%,
LM =3D 12.6%)=
[29], Arumugam et al. (M=
M =3D
32%, LM =3D 22%)=
[8], Radhakrishnan et al. (MM =3D =
36%,
LM =3D 22%)[36], Ningappa et
al. (MM =3D 47%, LM =3D 13%)[37], Ahirwar et
al. (MM =3D 49%, LM =3D 18%)[7], Vaidyaet al. (MM =3D 64%, LM =3D 31%)[5], Mangukiya et
al. (MM =3D 68%, LM =3D 40%)[28], and
Ligamentous derangement predominantly affe=
cted
the ACL (37.3%) and MCL (22.2%). The PCL, LCL, and LCL were abnormal in
relatively few knees. Previous studies also had the ACL as the most injured
ligament (32-90%).=
[5,7,8,28,29,36–38]
The ACL is the most frequently injured knee ligament because it is one of t=
he
two cruciate ligaments that stabilize the joint coupled with the absence of
muscular support for twisting and rotational movements around the knee.=
[39,40]
Baker’s cysts (popliteal cysts) were the m=
ost prevalent
non-specific finding at 15.8%, which lies within the range of 4%-33% report=
ed
by previous investigators.=
[5,22,30,38,41] Although often found incidentally, poplit=
eal
cysts have a well-known association with joint effusi=
on,
meniscal tear, and ACL tear. In a study of 3355 popliteal cysts, MRI detected an associated disorder in =
94% of
the cases.[42,43]
We surmise that the disparities in =
the
proportion of abnormal knee MRI findings among the various studies could be
explained, at least partly, by differences in rates of previous trauma, stu=
dy
designs (prospective vs. retrospective), MRI field strength, age of the stu=
dy
populations, physical activity levels of participants, and level of experti=
se
of the interpreting radiologist.
In conclusion, joint effusi=
on,
medial meniscopathy, osseous abnormalities (tib=
ia,
femur, patella), ACL abnormalities, lateral meniscopat=
hy,
and MCL abnormalities, in decreasing order, were the most frequent patholog=
ies
in the knee joints evaluated.
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