PRE- AND POSTOPERATIVE COMPLEX RADIOLOGICAL DIAGNOSTICS OF KNEE TRAUMATIC INJURIES

Belysheva E.S., Serova N.S., Lychagin A.V., Belov S.A., Putilo D.V., Babkova A.A.

 

Injuries of musculoskeletal system occupy one of leading places in the morbidity and disability structure of the population and have a tendency to increase.

I.M. Sechenov First
Moscow State Medical University.
Moscow, Russia.

Purpose. To present a rare clinical case of knee meniscus damage on the background of the tibia fractured condyle with partial prolapse and entrapment of its flapped fragment into the tibia defect of the articular cartilage and the subchondral plate formed after the reposition of fragments in the load divisions of the lateral condyle.

Materials and methods. Patient D., 58 years, was addressed to the traumatological department of the University clinical hospital №1 of the I. M. Sechenov First MSMU with complaints of continuing pain in his left knee after surgery. The surgery was performed – osteosynthesis of the tibia external condyle with screws. Three months after the operation the metal was removed, but the patient continued feeling pain in his left knee. Considering this radiography and magnetic resonance imaging (MRI) of this joint were performed. After examination the surgery was performed again - arthroscopic autoplasty of the anterior cruciate ligament, resection of the lateral meniscus and ablation of chondronecrotic lesions. After repeated surgical interventions (osteosynthesis and plastic of anterior cruciate ligament), multislice computed tomography (MSCT) of the knee joint was performed to clarify the status of the bonе structures.

Results. According to the Х-ray the consolidated fractures of the lateral tibial condyle with the presence of a small bone defect in the load zone of the lateral condyle of the tibia was determined. After the MRI examination intra-articular fracture of the lateral condyle of the tibia, complex tear of the lateral meniscus of the knee joint ("handle watering can" type) were identified with a partial prolapse and entrapment of its flapped fragment into the tibia defect of the articular cartilage and the subchondral plate formed after the reposition of fragments in the load divisions of the lateral condyle and a full "chronic" rupture of the anterior cruciate ligament. The surgery was performed: arthroscopic autoplasty of the anterior cruciate ligament, resection of the lateral meniscus, which was confirmed by the data detected on MRI. After the repeated surgical interventions MSCT of the knee joint was perfored to clarify the state of bone structures. According to MSCT consolidated fracture in the lateral condyle of the tibia without displacement of the fragments was identified with rounded cavities with smooth clear contours, with the rim of osteosclerosis at the periphery in the upper sections of the lateral condyle of the tibia.

Conclusions. This clinical observation shows the importance of a comprehensive radiology diagnostics of knee traumatic injuries in pre - and post-operative stages. MRI and MSCT are the "gold standard" examinations of the knee joint injuries before surgical intervention, complementing each other, allowing to reliably determining damage to soft tissue and bone structures of the knee joint. Performance of MRI prior to arthroscopy allows optimizing the treatment planning.

Keywords: meniscal tear, intraarticular fractures, radiography, multislice computed tomography (MSCT), magnetic resonance imaging (MRI), arthroscopy.


 

Corresponding author: Putilo D.V., Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Serova N.S., Belysheva E.S., Babkova A.A., Al’bekova Zh.Je, Chibarov A.A., Prostomolotov A.V. Pre- and postoperative complex radiological diagnostics of knee traumatic injuries. REJR. 2016; 6 (2):120-130. DOI:10.21569/2222-7415-2016-6-2-120-130

Received: 26.04.2016            Accepted: 05.05.2016