title: Bone injury associated with anterior cruciate ligament and meniscal tears: assessment with bone single photon emission computed tomography.
abstract: OBJECTIVE
  Acute injury of the menisci and ligaments about the knee joint is often associated with accompanying bone injury. The role of bone single photon emission computed tomography (SPECT) was assessed in this clinical setting.
  
  
  METHODS
  Knee SPECT was performed in 94 patients with suspected ACL, meniscal tear, or both and was correlated with arthroscopy (n = 74), magnetic resonance imaging (MRI) (n = 37), or both. Scintigraphic findings were categorized based on their anatomic location and on uptake intensity (0-3 grade scale).
  
  
  RESULTS
  Correlation with arthroscopy: Eleven patients had a normal arthroscopy of which in 10, SPECT images detected no abnormality. Sixty-three patients had abnormal arthroscopic findings, whereas all had abnormal SPECT studies. Thirty-eight patients had an anterior cruciate ligament (ACL) tear on arthroscopy. In this type of injury SPECT images detected increased uptake in the posterior aspect of the lateral tibial plateau (LTPp) with a positive predictive value (PPV) of 93% and a negative predictive value (NPV) of 97%. In 55% of the patients, increased uptake was also detected in the region of the middle sulcus of the lateral femoral condyle (LFCm): a "kissing" pattern. Tear of the medial meniscus was diagnosed by arthroscopy in 43 patients. SPECT images detected increased uptake in the medial tibial plateau (MTP) with a PPV of 78% and a NPV of 83%. Correlation with MRI: all seven cortical fractures seen on MRI were detected on SPECT. Twenty-eight patients had MRI findings suggestive of an ACL injury. Accompanying bone bruises were seen in 18 of them (64%). On SPECT images, all 28 patients with an ACL tear had increased uptake in the LTPp. Intensity of uptake in patients with associated bone bruise, however, was significantly higher; mean intensity grade 2.4 +/- 0.7 in case of accompanying bone bruise compared with 1.4 +/- 0.8 in case of an ACL tear without associated bone injury, P< 0.01.
  
  
  CONCLUSIONS
  Results of the study suggest that bone SPECT is valuable in acute knee trauma for assessment of ACL, meniscal tears, or both and for detection of associated bone injury.
authors.affiliation: Department of Nuclear Medicine1, Tel-Aviv Sourasky Medical Center, Israel. evensap@tasmc.health.gov.il
authors.forename: Einat
authors.initials: E
authors.lastname: Even-Sapir
authors.forename: Ron
authors.initials: R
authors.lastname: Arbel
authors.forename: Hedva
authors.initials: H
authors.lastname: Lerman
authors.forename: Gideon
authors.initials: G
authors.lastname: Flusser
authors.forename: Gennady
authors.initials: G
authors.lastname: Livshitz
authors.forename: Nachum
authors.initials: N
authors.lastname: Halperin
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging*; D000070598:Anterior Cruciate Ligament Injuries; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging*; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging*; D008875:Middle Aged; D000070600:Tibial Meniscus Injuries; D015899:Tomography, Emission-Computed, Single-Photon