Abstract
Magnetic resonance imaging (MRI) has revolutionised diagnostic imaging of the knee. It has evolved significantly since Kean described healthy and pathologic knee anatomy in 1983. This innovative technology allows superior soft-tissue detail with multiplanar imaging capability that provides accurate evaluation of intra and extra-articular structures of the knee not demonstrated with other imaging modalities. The development and advancements in MRI and the introduction of high-resolution coils have provided a noninvasive, nonoperator dependent, cost effective means to diagnose knee pathology. MRI is well tolerated by patients, widely accepted by evaluating physicians, and assists in distinguishing pathologic knee conditions that may have similar clinical signs and symptoms (i.e. meniscal tears, osteochondral lesions). This paper presents an overview of MRI of the knee and focuses on the MRI findings in a number of common pathologic conditions.
Similar content being viewed by others
References
Kean DM, Worthington BS, Preston BJ, et al. Nuclear magnetic resonance imaging of the knee: examples of normal anatomy and pathology. Br J Radiol 1983; 56 (666): 355–64
Shaw D. The fundamental principles of nuclear magnetic resonance. In: Wehrli FW, Shaw D, Kneeland WW, editors. Biomedical magnetic resonance imaging: principles, methodology, and applications. New York (NY): VCH Publishers, 1988: 1–46
Young SW. Magnetic resonance imaging basic principles. New York (NY): Raven Press, 1988
Fu FH, Harner CD, Vince KG. Knee surgery. Vol. 1. Baltimore (MD): Williams & Wilkins, 1994
Kanal E, Wehrli FW. Signal-to-noise ratio, resolution, and contrast. In: Wehrli FW, Shaw D, Kneeland BW, editors. Biomedical magnetic resonance imaging: principles, methodology, and applications. New York (NY): VCH Publishers, 1988: 47–114
Boeree NR, Watkinson AF, Ackroyd CE, et al. Magnetic resonance imaging of meniscal and cruciate injuries of the knee. J Bone Joint Surg Br 1991; 73 (3): 452–7
Crues JV, Mink J, Levy TL, et al. Meniscal tears of the knee: accuracy of MR imaging. Radiology 1987; 164 (2): 445–8
Fischer SP, Fox JM, Del Pizzo W, et al. Accuracy of diagnoses from magnetic resonance imaging of the knee: a multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991; 73 (1): 2–10
Heron CW, Calvert PT. Three-dimensional gradient-echo MR imaging of the knee: comparison with arthroscopy in 100 patients. Radiology 1992; 183 (3): 839–44
Jackson DW, Jennings LD, Maywood RM, et al. Magnetic resonance imaging of the knee. Am J Sports Med 1988; 16 (1): 29–38
Kelly MA, Flock TJ, Kimmel JA, et al.MR imaging of the knee: clarification of its role. Arthroscopy 1991; 7 (1): 78–85
Lee JK, Yao L, Phelps CT, et al. Anterior cruciate ligament tears: MR imaging compared with arthroscopy and clinical tests. Radiology 1988; 166 (3): 861–4
Mandelbaum BR, Finerman GA, Reicher MA, et al. Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries: anatomical and pathoanatomical correlations. Am J Sports Med 1986; 14 (5): 361–70
Mink JH, Levy T, Crues JV. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology 1988; 167 (3): 769–74
Polly DW, Callaghan JJ, Sikes RA, et al. The accuracy of selective magnetic resonance imaging compared with the findings of arthroscopy of the knee. J Bone Joint Surg Am 1988; 70 (2): 192–8
Quinn SF, Brown TF. Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy? Radiology 1991; 181 (3): 843–7
Raunest J, Oberle K, Loehnert J, et al. The clinical value of magnetic resonance imaging in the evaluation of meniscal disorders. J Bone Joint Surg Am 1991; 73 (1): 11–6
Reicher MA, Hartzman S, Duckwiler GR, et al. Meniscal injuries: detection using MR imaging. Radiology 1986; 159 (3): 753–7
Turner DA, Prodromos CC, Petasnick JP, et al. Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology 1985; 154 (3): 717–22
Mackenzie R, Dixon AK, Keene GS, et al. Magnetic resonance imaging of the knee: assessment of effectiveness. Clin Radiol 1996; 51 (4): 245–50
Maurer EJ, Kaplan PA, Dussault RG, et al. Acutely injured knee: effect of MR imaging on diagnostic and therapeutic decisions. Radiology 1997; 204 (3): 799–805
Munk B, Madsen F, Lundorf E, et al. Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus anterior cruciate ligament and cartilage lesions. Arthroscopy 1998; 14 (2): 171–5
Rangger C, Klestil T, Kathrein A, et al. Influence of magnetic resonance imaging on indications for arthroscopy of the knee. Clin Orthop 1996 (330): 133–42
Spiers AS, Meagher T, Ostlere SJ, et al. Can MRI of the knee affect arthroscopic practice? A prospective study of 58 patients. J Bone Joint Surg Br 1993; 75 (1): 49–52
Carslow HC. The approximation curves and the Gibbs phenomenon in Fourier’s series. In: Introduction to the theory of Fourier’s series and integrals. York: Dover, 1930: 289–311
Hollister MC. Dedicated extremity MR imaging of the knee: how low can you go? Magn Reson Imaging Clin N Am 2000; 8 (2): 225–41
Yu JS, Popp JE, Kaeding CC, et al. Correlation of MR imaging and pathologic findings in athletes undergoing surgery for chronic patellar tendinitis. AJR Am J Roentgenol 1995; 165 (1): 115–8
Kneeland JP. MR imaging of muscle and tendon injury. Eur J Radiol 1997; 25 (3): 198–208
Allen GM, Tauro PG, Ostlere SJ. Proximal patellar tendinosis and abnormalities of patellar tracking. Skeletal Radiol 1999; 28 (4): 220–3
El-Khoury GY, Wira RL, Berbaum KS, et al. MR imaging of patellar tendinitis. Radiology 1992; 184 (3): 849–54
Staeubli HU, Bollmann C, Kreutz R, et al. Quantification of intact quadriceps tendon, quadriceps tendon insertion, and suprapatellar fat pad: MR arthrography, anatomy, and cryosections in the sagittal plane. AJR Am J Roentgenol 1999; 173 (3): 691–8
Kelly DW, Carter VS, Jobe FW, et al. Patellar and quadriceps tendon ruptures —jumper’s knee. Am J Sports Med 1984; 12 (5): 375–80
Yu JS, Petersilge C, Sartoris DJ, et al. MR imaging of injuries of the extensor mechanism of the knee. Radiographics 1994; 14 (3): 541–51
Nobel CA. Iliotibial band friction syndrome in runners. Am J Sports Med 1980; 8: 232–4
Jones DC, James SL. Overuse injuries of the lower extremity: shin splints, iliotibial band friction syndrome, and exertional compartment syndromes. Clin Sports Med 1987; 6 (2): 273–90
Ekman EF, Pope T, Martin DF, et al. Magnetic resonance imaging of iliotibial band syndrome. Am J Sports Med 1994; 22 (6): 851–4
Nishimura G, Yamato M, Tamai K, et al. MR findings in iliotibial band syndrome. Skeletal Radiol 1997; 26 (9): 533–7
Berquist TM, Ehman RL. The knee. In: Berquist TM, editor. MRI of the musculoskeletal system. New York (NY): Raven Press, 1990: 285–409
Broom MJ, Fulkerson JP. The plica syndrome: a new perspective. Orthop Clin North Am 1986; 17 (2): 279–81
Jackson RW, Marshall DJ, Fujisawa Y. The pathologic medical shelf. Orthop Clin North Am 1982; 13 (2): 307–12
Patel D. Arthroscopy of the plicae - synovial folds and their significance. Am J Sports Med 1978; 6 (5): 217–25
Dooms GC, Fisher MR, Hricak H, et al. MR imaging of intramuscular hemorrhage. J Comput Assist Tomogr 1985; 9 (5): 908–13
Garrett WE. Muscle strain injuries: clinical and basic aspects. Med Sci Sports Exerc 1990; 22 (4): 436–43
Garrett WE. Muscle strain injuries. Am J Sports Med 1996; 24 (6 Suppl.): S2-S8
Ehman RL, Berquist TH. Magnetic resonance imaging of musculoskeletal trauma. Radiol Clin North Am 1986; 24 (2): 291–319
El-Khoury GY, Brandser EA, Kathol MH, et al. Imaging of muscle injuries. Skeletal Radiol 1996; 25 (1): 3–11
Levine WN, Bergfeld JA, Tessendorf W, et al. Intramuscular corticosteroid injection for hamstring injuries: a 13-year experience in the National Football League. Am J Sports Med 2000; 28 (3): 297–300
Gallimore GW, Harms SE. Knee injuries: high-resolution MR imaging. Radiology 1986; 160 (2): 457–61
Reicher MA, Hartzman S, Bassett LW, et al. MR imaging of the knee. Part I. Traumatic disorders. Radiology 1987; 162 (2): 547–51
Vahey TN, Broome DR, Kayes KJ, et al. Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging. Radiology 1991; 181 (1): 251–3
Grover JS, Bassett LW, Gross ML, et al. Posterior cruciate ligament: MR imaging. Radiology 1990; 174 (2): 527–30
Watanabe AT, Carter BC, Teitelbaum GP, et al. Normal variations in MR imaging of the knee: appearance and frequency. AJR Am J Roentgenol 1989; 153 (2): 341–4
Shelbourne KD, Jennings RW, Vahey TN. Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing. Am J Knee Surg 1999; 12 (4): 209–13
Lee JK, Yao L. Tibial collateral ligament bursa: MR imaging. Radiology 1991; 178 (3): 855–7
Seebacher JR, Inglis AE, Marshall JL, et al. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64 (4): 536–41
Bui-Mansfield LT, Youngberg RA, Warme W, et al. Potential cost savings of MR imaging obtained before arthroscopy of the knee: evaluation of 50 consecutive patients. AJR Am J Roentgenol 1997; 168 (4): 913–8
Carmichael IW, MacLeod AM, Travlos J. MRI can prevent unnecessary arthroscopy. J Bone Joint Surg Br 1997; 79 (4): 624–5
Kneeland JB, Hyde JS. High-resolution MR imaging with local coils. Radiology 1989; 171 (1): 1–7
Burstein DB, Fritts HM, Fischer DA. Diagnosis of meniscal and cruciate ligament tears using MRI: evaluation of two scanning techniques. Minn Med 1991; 74 (6): 29–32
Turner DA, Rapoport MI, Erwin WD, et al. Truncation artifact: a potential pitfall in MR imaging of the menisci of the knee. Radiology 1991; 179 (3): 629–33
Rubin DA, Paletta GA. Current concepts and controversies in meniscal imaging. Magn Reson Imaging Clin N Am 2000; 8 (2): 243–70
De Smet AA, Graf BK. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol 1994; 162 (4): 905–11
Justice WW, Quinn SF. Error patterns in the MR imaging evaluation of menisci of the knee. Radiology 1995; 196: 617–21
Kojima KY, Demlow TA, Szumowski J, et al. Coronal fat suppression fast spin echo images of the knee: evaluation of 202 patients with arthroscopic correlation. Magn Reson Imaging 1996; 14 (9): 1017–22
Rubin DA, Kettering JM, Towers JD, et al. MR imaging of knees having isolated and combined ligament injuries. AJR Am J Roentgenol 1998; 170 (5): 1207–13
Crues JV, Ryu R, Morgan FW. Meniscal pathology: the expanding role of magnetic resonance imaging. Clin Orthop 1990 (252): 80–7
Stoller DW, Martin C, Crues JV, et al. Meniscal tears: pathologic correlation with MR imaging. Radiology 1987; 163 (3): 731–5
De Smet AA, Norris MA, Yandow DR, et al. MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surface. AJR Am J Roentgenol 1993; 161 (1): 101–7
Fowler PJ, Lubliner JA. The predictive value of five clinical signs in the evaluation of meniscal pathology. Arthroscopy 1989; 5 (3): 184–6
Shelbourne KD, Martini DJ, McCarroll JR, et al. Correlation of joint line tenderness and meniscal lesions in patients with acute anterior cruciate ligament tears. AmJ Sports Med 1995; 23 (2): 166–9
Duncan JB, Hunter R, Purnell M, et al. Meniscal injuries associated with acute anterior cruciate ligament tears in alpine skiers. Am J Sports Med 1995; 23 (2): 170–2
Paletta GA, Levine DS, O’Brien SJ, et al. Patterns of meniscal injury associated with acute anterior cruciate ligament injury in skiers. Am J Sports Med 1992; 20 (5): 542–7
Dandy DJ. The arthroscopic anatomy of symptomatic meniscal lesions. J Bone Joint Surg Br 1990; 72 (4): 628–33
Fitzgibbons RE, Shelbourne KD. ‘Aggressive’ nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med 1995; 23 (2): 156–9
Matava MJ, Eck K, Totty W, et al. Magnetic resonance imaging as a tool to predict meniscal reparability. Am J Sports Med 1999; 27 (4): 436–43
Modl JM, Sether LA, Haughton VM, et al. Articular cartilage: correlation of histologic zones with signal intensity at MR imaging. Radiology 1991; 181 (3): 853–5
Chandnani VP, Ho C, Chu P, et al. Knee hyaline cartilage evaluated with MR imaging: a cadaveric study involving multiple imaging sequences and intra-articular injection of gadolinium and saline solution. Radiology 1991; 178 (2): 557–61
Gylys-Morin VM, Hajek PC, Sartoris DJ, et al. Articular cartilage defects: detectability in cadaver knees with MR. AJR Am J Roentgenol 1987; 148 (6): 1153–7
Rubin DA. Magnetic resonance imaging of chondral and osteochondral injuries. Top Magn Reson Imaging 1998; 9 (6): 348–59
Rangger C, Kathrein A, Freund MC, et al. Bone bruise of the knee: histology and cryosections in 5 cases. Acta Orthop Scand 1998; 69 (3): 291–4
Arndt WF, Truax AL, Barnett FM, et al. MR diagnosis of bone contusions of the knee: comparison of coronal T2-weighted fast spin-echo with fat saturation and fast spin-echo STIR images with conventional STIR images. AJR Am J Roentgenol 1996; 166 (1): 119–24
Graf BK, Cook DA, De Smet AA, et al. ‘Bone bruises’ on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 1993; 21 (2): 220–3
De Smet AA, Ilahi OA, Graf Bk. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 1996; 25: 159–63
Kaplan PA, Gehl RH, Dussault RG, et al. Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology 1999; 211 (3): 747–53
Vellet AD, Marks PH, Fowler PJ, et al. Occult posttraumatic osteochondral lesions of the knee: prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology 1991; 178 (1): 271–6
Barrow BA, Fajman WA, Parker LM, et al. Tibial plateau fractures: evaluation with MR imaging. Radiographics 1994; 14 (3): 553–9
Wilppula E, Bakalim G. Ligamentous tear concomitant with tibial condylar fracture. Acta Orthop Scand 1972; 43 (4): 292–300
Blum GM, Tirman FJ, Cruz JV. Osseous and cartilaginous trauma. In: Mink JH, Reicher MA, Crues IH, editors. Magnetic resonance imaging of the knee. New York (NY): Raven, 1987: 295–332
Applegate GR, Flannigan BD, Tolin BS, et al. MR diagnosis of recurrent tears in the knee: value of intra-articular contrast material [see comments]. AJR Am J Roentgenol 1993; 161 (4): 821–5
De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 1996; 25 (2): 159–63
Mesgarzadeh M, Sapega AA, Bonakdarpour A, et al. Osteochondritis dissecans: analysis of mechanical stability with radiography, scintigraphy, and MR imaging. Radiology 1987; 165 (3): 775–80
De Smet AA, Ilahi OA, Graf BK. Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings. Skeletal Radiol 1997; 26 (8): 463–7
Chan WP, Lang P, Stevens MP, et al. Osteoarthritis of the knee: comparison of radiography, CT, and MR imaging to assess extent and severity. AJR Am J Roentgenol 1991; 157 (4): 799–806
McCauley TR, Kier R, Lynch KJ, et al. Chondromalacia patellae: diagnosis with MR imaging. AJR Am J Roentgenol 1992; 158 (1): 101–5
Yulish BS, Montanez J, Goodfellow DB, et al. Chondromalacia patellae: assessment with MR imaging. Radiology 1987; 164 (3): 763–6
Carter C, Sweetnam R. Familial joint laxity and recurrent dislocation of the patella. J Bone Joint Surg 1958; 40B: 664–7
Fulkerson JP, Hungerford DS. Disorders of the patellofemoral joint. Baltimore (MD): Williams & Wilkins, 1990
Heywood AWB. Recurrent dislocation of the patella. J Bone Joint Surg Br 1961; 43: 508
Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971; 101 (1): 101–4
Kujala UM, Osterman K, Kormano M, et al. Patellofemoral relationships in recurrent patellar dislocation. J Bone Joint Surg Br 1989; 71 (5): 788–92
Lance E, Deutsch AL, Mink JH. Prior lateral patellar dislocation: MR imaging findings. Radiology 1993; 189 (3): 905–7
Malghem J, Maldague B. Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. Radiology 1989; 170 (2): 507–10
Hughston J. Subluxation of the patella. J Bone Joint Surg 1968; 50A: 1003–26
Jenson CM, Roosen JU. Acute traumatic dislocation of the patella. J Trauma 1985; 25: 160–2
Smillie IS. Injuries of the knee joint. Baltimore (MD): Williams & Williams, 1962
Cofield RH, Bryan RS. Acute dislocation of the patella: results of conservative treatment. J Trauma 1977; 17 (7): 526–31
Kirsch MD, Fitzgerald SW, Friedman H, et al. Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol 1993; 161 (1): 109–13
Quinn SF, Brown TR, Demlow TA. MR imaging of patellar retinacular ligament injuries. J Magn Reson Imaging 1993; 3 (6): 843–7
Sprintzer CE, Courneya DL, Burk DL, et al. Medial retinacular complex injury in acute patellar dislocation: MR findings and surgical implications. AJR Am J Roentgenol 1997; 168: 117–22
Virolainen H, Visuri T, Kuusela T. Acute dislocation of the patella: MR findings. Radiology 1993; 189 (1): 243–6
Gilbert TJ, Johnson E, Detlie T, et al. Radiologic case study. Patellar dislocation: medial retinacular tears, avulsion fractures, and osteochondral fragments. Orthopedics 1993; 16 (6): 729, 732–6
Cash JD, Hughston JC. Treatment of acute patellar dislocation. Am J Sports Med 1988; 16 (3): 244–9
Chen SC, Ramanathan EB. The treatment of patellar instability by lateral release. J Bone Joint Surg Br 1984; 66 (3): 344–8
Dainer RD, Barrack RL, Buckley SL, et al. Arthroscopic treatment of acute patellar dislocations. Arthroscopy 1988; 4 (4): 267–71
Fisher RL. Conservative treatment of patellofemoral pain. Orthop Clin North Am 1986; 17 (2): 269–72
Harilainen A, Sandelin J. Prospective long-term results of operative treatment in primary dislocation of the patella. Knee Surg Sports Traumatol Arthrosc 1993; 1 (2): 100–3
Shellock FG, Mink JH, Deutsch AL, et al. Patellar tracking abnormalities: clinical experience with kinematic MR imaging in 130 patients. Radiology 1989; 172 (3): 799–804
Totty WG, Matava MJ. Imaging the postoperative meniscus. Magn Reson Imaging Clin N Am 2000; 8 (2): 271–83
Recht MP, Parker RD, Irizarry JM. Second time around: evaluating the postoperative anterior cruciate ligament. Magn Reson Imaging Clin N Am 2000; 8 (2): 285–97
Moeser P, Bechtold RE, Clark T, et al. MR imaging of anterior cruciate ligament repair. J Comput Assist Tomogr 1989; 13 (1): 105–9
Rak KM, Gillogly SD, Schaefer RA, et al. Anterior cruciate ligament reconstruction: evaluation with MR imaging. Radiology 1991; 178 (2): 553–6
Bronstein R, Kirk P, Hurley J. The usefulness of MRI in evaluating menisci after meniscus repair. Orthopedics 1992; 15 (2): 149–52
Lim PS, Schweitzer ME, Bhatia M, et al. Repeat tear of postoperative meniscus: potential MR imaging signs. Radiology 1999; 210 (1): 183–8
Arnoczky SP, Cooper TG, Stadelmaier DM, et al. Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 1994; 10 (5): 552–7
Muellner T, Egkher A, Nikolic A, et al. Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years [published erratum appears in Am J Sports Med 1999 May-Jun; 27 (3): 379]. Am J Sports Med 1999; 27 (1): 16–20
Deutsch AL, Mink JH, Fox JM, et al. Peripheral meniscal tears: MR findings after conservative treatment or arthroscopic repair. Radiology 1990; 176 (2): 485–8
Kent RH, Pope CF, Lynch JK, et al. Magnetic resonance imaging of the surgically repaired meniscus: six-month follow-up. Magn Reson Imaging 1991; 9 (3): 335–41
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Prickett, W.D., Ward, S.I. & Matava, M.J. Magnetic Resonance Imaging of the Knee. Sports Med 31, 997–1019 (2001). https://doi.org/10.2165/00007256-200131140-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200131140-00004