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Traumatic Musculotendinous Injuries of the Knee: Diagnosis with MR Imaging¹

¹ From the Department of Radiology, Long Island Jewish Medical Center, New Hyde Park, NY (J.T.B., A.H., E.S.L.); the Department of Radiology, Hospital for Joint Diseases/Orthopaedic Institute, New York, NY (Z.S.R., R.R.B.); and the Department of Radiology, Maimonides Medical Center, Brooklyn, NY (J.B.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1999 RSNA scientific assembly. Received February 1, 2000; revision requested March 13 and received April 20; accepted April 26. Address correspondence to J.T.B., Department of Radiology, Massachusetts General Hospital, 15 Parkman St, WACC 515, Boston, MA 02114 (e-mail: bencardi@hotmail.com).

Magnetic resonance (MR) imaging is the imaging modality of choice for evaluation of acute traumatic musculotendinous injuries of the knee. Three discrete categories of acute injuries to the musculotendinous unit can be defined: muscle contusion, myotendinous strain, and tendon avulsion. Among the quadriceps muscles, the rectus femoris is the most susceptible to injury at the myotendinous junction due to its superficial location, predominance of type II fibers, eccentric muscle action, and extension across two joints. Among the muscles of the pes anserinus, the sartorius is the most susceptible to strain injury due to its superficial location and biarticular course. The classic fusiform configuration of the semimembranosus along with a propensity for eccentric actions also make it prone to strain injury. MR imaging findings associated with rupture of the iliotibial tract include discontinuity and edema, which are best noted on coronal images. The same mechanism of injury that tears the arcuate ligament from its fibular insertion can also result in avulsion injury of the biceps femoris. The gastrocnemius muscle is prone to strain injury due to its action across two joints and its superficial location. Injuries of the muscle belly and myotendinous junction of the popliteus are far more common than tendinous injuries.

Index Terms: Knee, anatomy, 45.92 • Knee, injuries, 45.485 • Muscles, injuries, 45.485 • Tendons, injuries, 45.485

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