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Chronic sport injuries of the knee
5th Musculoskeletal MRI meeting 2018: Knee MRI
Saturday, May 5th, 2018; 14:00-16:00Gustav Andreisek, MD, MBA
Professor of Radiology, University of Zurich andHead of Radiology Spital Thurgau,Cantonal Hospital Münsterlingen,Switzerland
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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).
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Learning Objectives
After this talk you will be able
� To know common chronic sport injuries
� To recognize and report them
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Learning Material
Review Article, Book, and Online Video
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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
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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
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Causes for Knee MRI – mostly acute injuries
� > 40% sport injuries*
� 15% Soccer
� 12% Ski
� 7% Running
Bild: Getty
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… a typical week in Münsterlingen…
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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
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Morbus Osgood-Schlatter
Facts
� Overuse / traction
� Microavulsion, Osteonecrosis
� 10-15 ys old, m > f
� Basketball, Volleyball
MRI Findings
� Bone marrow edema
� Bursitis, soft tissue reaction
� Fragmentation of apophysis
Bild: betterbraces.com
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12 ys old boy (acute)
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Morbus Sinding-Larsen-Johansson
Facts
� Overuse / traction
� Microavulsion, Osteonecrosis
� Teenager, m > f
� Running, Basketball, Volleyball
MRI Findings
� Bone marrow edema
� Tendinitis, calcifications
� Edema of Hoffa
� DD sleeve avulsion
Bild: wiki
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15ys old boy
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Jumpers Knee
Bild: knieweh.at
Facts
� Overuse / extension
� Tendon degeneration
� Jumping, Basketball
MRI Findings
� Tendon abnormalities
� Increased T1 and T2
� >7mm patellar tendon
� Soft tissue edema (Hoffa)
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23ys old femal medical student
Mit freundl. Genehmigung von PD Dr. Claudia Schueller-Weidekamm,Wien)
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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 disruptionof less than 50% of the muscle, >50%)
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How one can train them …
Quelle: Google
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… and so it would look like
Quelle: Google
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Why does he show this in a knee talk?
Most cranial slide of a knee MRI
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Various degree of severity
Quelle: own images&radsource.us
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Pes anserinus
Quelle: physioworks.com
Facts
� Mostly M. sartorius
� Chronic stress
� Repetitive strains
� Jogging / MCL tear
MRI Findings
� Tendinitis /Tendinopathy
� Inflammation, degeneration, partial rupture
� Bursitis
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30ys old male
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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
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Iliotibial Band Friction Syndrom («Runners Knee»)
Quelle: med-info.nl
Facts
� Runners, cyclists, soccer and hockeyplayers
� Most common lateral-side chronic injury
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Insertion
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23ys old female skier
MRI Findings
� Soft tissue edema (fat)
� May involve M. biceps femoris
� ITB thickening in chronic stages +/- fuid collection
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Patellar Pain Syndrome (PFPS)
Facts
� 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
� Discomfort while sitting with bent knees or descending stairs and generalised knee pain
Quelle: braceability.com
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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
� …
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Patellofemoral chondromalacia
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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
� Chronic inflammation / synovits, joint effusion
� Synovial perfusion maps (4D Angio)
Magnetic resonance spin-labelingperfusion 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. 2009 Jun;22(3):175-80. doi: 10.1007/s10334-008-0162-y.
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Plica mediopatellaris
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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
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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
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Hoffa - infrapatellar impingement syndrome
Quelle: ultimate-radiology.blogspot.ch
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43ys old male and 25 ys old female
„patellar tendon lateral femoral condyle friction syndrome PT-LFCFS “«patellofemoral friction syndrome“,»
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Sagittal View
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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
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See you in 5 days in Lausanne
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