Ligament Injury

KEY FACTS

Terminology

• Ligament tear: Tear or avulsion of ligament fibers

Imaging

• Ligament tears have similar appearances irrespective of ligament location
• Acute stage

Diffuse or localized ligament swelling

Tear can be partial or full thickness

Ligament retraction or discontinuity if complete

± wavy, displaced ligament

Widening of ligament tear or joint space when ligament is stressed

Surrounding soft tissue edema and hemorrhage
• Chronic stage: 4 possible sequelae of ligament tear exist

Diffusely thickened continuous ligament

– Can remain for many years following injury

– Most common sequela of ligament tear

Diffusely thickened discontinuous ligament

Ligament is continuous but attenuated compared to normal ligament

– Ligament laxity with widening of joint space is demonstrated during stress maneuver

Absent ligament

– No ligament visible due to attrition or resorption of ligament fibers

Pathology

• Grade 1: Mild partial ligament tear
• Grade 2: Moderate-to-severe partial ligament tear
• Grade 3: Complete ligament tear or avulsion

Clinical Issues

• Most frequent musculoskeletal injury
• Usually does not require surgical intervention

Most partial and some complete ligament tears heal spontaneously
• Ligament tears can lead to joint instability or impingement

TERMINOLOGY

Synonyms

• Skiers or gamekeepers thumb: Injury of ulnar collateral ligament (UCL) of thumb
• Stener lesion: Proximal retraction of UCL, which then overlies adductor aponeurosis
• Ligament sprain or strain

Definitions

• Ligament: Fibrous band that connects 2 bones and helps stabilize intervening joint
• Ligament tear: Tear or avulsion of ligament fibers
• Avulsion: Some or all ligament fibers are torn away (avulsed) from their bony attachment

± attached avulsed fragment of bone (avulsion fracture)
• Ligament sprain or strain: Partial ligament tear

IMAGING

General Features

• Best diagnostic clue

Discontinuity of ligament fibers

Swollen ligament with history of trauma
• Location

Some ligaments are more susceptible to tear

– Ankle

Anterior talofibular ligament (ATFL)/calcaneofibular ligament (CFL)/anterior tibiofibular ligament (ATibFL): Anywhere along course of ligament

ATFL ligament tears before CFL; ATibFL tear is “high ankle sprain” and associated with deltoid ligament tear

Deltoid ligament: Particularly anterior deep fibers

– Knee

Medial collateral ligament (MCL): Anterior fibers at femoral attachment

Lateral collateral ligament (LCL): Anywhere along course of ligament, usually in association with posterolateral corner injury

– Thumb

UCL of metacarpophalangeal (MCP) joint: Particularly phalangeal attachment

– Elbow

Radial collateral ligament: Particularly at humeral attachment
• Morphology

Normal

– Normal fibrillar pattern and fibers preserved

– No edema, normal thickness and tautness

Partial tear

– Edema and swelling

– Loss of fibrillar pattern ± partial discontinuity

– ± laxity on stress testing

Complete tear

– Discontinuity or complete attenuation of fibers

– Avulsion of bony attachment

Radiographic Findings

• Soft tissue swelling ± joint effusion

± avulsion fracture at ligament insertional area

± diastasis of opposing bone margins
• Stress radiographs

Less frequently used nowadays

Mainly indicate complete ligament tear

Ultrasonographic Findings

• All ligament injuries have same appearance irrespective of where ligament is located
• Acute stage

Diffuse or localized ligament swelling

Ligament fiber discontinuity with hypoechoic gap at site of tear

– Tear can be partial or full thickness

– ± avulsion fracture at bony attachment

Ligament retraction if complete

– ± wavy, displaced ligament

– Widening of ligament tear or joint space when ligament is stressed

Surrounding soft tissue edema and hemorrhage

Surrounding soft tissue hyperemia on color Doppler

Variable size joint effusion
• Chronic stage: 4 possible sequelae of ligament tear exist

Diffusely thickened continuous ligament

– Most common sequela of ligament tear, which can remain unchanged for many years following injury

– Disorganized reparative tissue undergoing gradual remodeling

– Even completely torn ligaments can regain full continuity with healing

– ± ligament calcification

– Pellegrini Stieda: Calcification at proximal attachment of MCL

Due to periosteal elevation, proximal end of medial femoral condyle ± associated with adductor magnus tendon avulsion

Diffusely thickened discontinuous ligament

– Uncommon sequela

– Stener lesion: Yo-yo sign due to retracted stump of torn ligament lying superficial to adductor aponeurosis

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Tags: Diagnostic Ultrasound Musculoskeletal

Apr 9, 2020 | Posted by admin in MUSCULOSKELETAL IMAGING | Comments Off

KEY FACTS

Terminology

TERMINOLOGY

Synonyms

IMAGING

General Features

Radiology Key

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Ligament Injury

Ligament Injury

Imaging

Pathology

Clinical Issues

Definitions

Radiographic Findings

Ultrasonographic Findings

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Ligament Injury

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