CHICAGO, Nov. 30 /PRNewswire/ -- New imaging discoveries may improve
physicians' ability to diagnose and treat two serious injuries affecting
football players, according to two studies presented this week at the annual
meeting of the Radiological Society of North America (RSNA).
In the first study, researchers reviewed 101 magnetic resonance imaging
(MRI) knee exams of 330 candidates for the 2005 professional football draft
and found 57 tears of the lateral meniscus, a flat, disc-shaped ligament that
supports the outer knee joint, and 26 tears of the medial meniscus, which
supports the inner knee joint.
"These findings are remarkable because the authors of most previous
studies have reported a predominance of medial meniscal injuries," said
Jeffrey Towers, M.D., lead author of the study and associate professor of
radiology at the University of Pittsburgh Medical Center in Pennsylvania.
At first, Dr. Towers suspected that the unusually high percentage of
lateral meniscal tears was associated with anterior cruciate ligament (ACL)
tears. ACL tears are fairly common among elite college football players, and
80 percent of meniscal tears that occur in association with ACL tears are in
the outer knee joint.
"Tackling is usually done from the outside of the knee, imparting a load
that traps the lateral meniscus in addition to tearing the ACL," Dr. Towers
said.
However, the study revealed that while 18 lateral and eight medial
meniscal tears were found in conjunction with ACL tears, 36 lateral and 18
medial tears were isolated injuries. The findings also included evidence of
three prior lateral tears.
"What we found is that almost three-quarters of the lateral meniscal tears
were not in the setting of ACL tears," Dr. Towers said.
Dr. Towers believes that the discovery of this high incidence of lateral
meniscal tears among elite athletes may have a significant impact on improving
physicians' ability to diagnose and treat this condition.
"The fact that we found a concentration of lateral meniscal tears could
mean that there's something about this sport that predisposes athletes to this
injury," Dr. Towers said. "We found the highest incidence of lateral meniscal
tears in linemen and defensive secondary players. Now that we recognize this,
there may be ways to address the players who are most at risk for this
injury."
In a second paper, Dr. Towers and colleagues identified for the first time
an indirect sign of syndesmotic tear, a frequently misdiagnosed injury more
commonly known as high ankle sprain. Currently, the condition is most commonly
diagnosed by uncomfortable physical examination of the syndesmosis, a large
ligament above the ankle.
"In syndesmotic tear, the biggest ligament that holds the tibia and fibula
together is injured," Dr. Towers explained. "The fibula can move away from the
tibia, and the cylindrical groove which forms the ankle can widen under load.
The problem is that routine x-rays may not show it, because it's not grossly
misaligned. It's during athletic activity when the injury becomes most
apparent."
Left undiagnosed, high ankle sprain can impede an athlete's performance
and lead to arthritis. "The treatment for high ankle sprain is different and
generally longer than for a typical ankle sprain," Dr. Towers said. "If it is
not recognized, and you send somebody out to play, the ligaments heal
improperly, the ankle doesn't fit as tightly as it should, and often the
result is arthritis."
The researchers used MRI and x-rays to study 18 candidates for the 2005
professional football draft who were found to have a history of high ankle
sprain. Fourteen x-rays showed an abnormal growth of new bone, known as
periostosis, at the lower part of the tibia, the large bone between the knee
and foot. Two MRI exams revealed abnormal swelling due to fluid at the same
site.
According to Dr. Towers, this periostosis provides physicians with an
indirect sign of high ankle sprain that is decisive in diagnosing this
difficult-to-detect injury.
"Even if I don't have MR images that include the entire syndesmosis, which
goes into the lower leg," Dr. Towers said, "if I look at an ankle and see this
posterior periostosis, I can now be fairly sure of a syndesmotic injury."
Co-authors on both studies are Derek Armfield, M.D., James Bradley, M.D.,
John Norwig, M.E.D., from University of Pittsburgh Medical Center and Kenneth
Buckwalter, M.D., from Indiana University Medical Center, which coordinates
imaging for the professional football draft.
RSNA is an association of more than 38,000 radiologists, radiation
oncologists, medical physicists and related scientists committed to promoting
excellence in radiology through education and by fostering research, with the
ultimate goal of improving patient care. The Society is based in Oak Brook,
Ill.
AT A GLANCE
-- New findings on ligament injuries in football players will help in
diagnosis and treatment.
-- Linemen and defensive secondary players may be predisposed to tears of
the outer knee ligament.
-- High ankle sprain can now be diagnosed without uncomfortable physical
examination of the ligaments.
-- Left undiagnosed, high ankle sprain can impede athletic performance and
lead to arthritis.
SOURCE Radiological Society of North America
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NOTE TO EDITORS: Copies of RSNA 2005 news releases and electronic
images will be available online at RSNA.org/press05 beginning
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