Magnetic resonance imaging of the knee
More details
Hide details
Loma Linda University Medical Center, USA
University of New Mexico School of Medicine, USA
Northwestern University Feinberg School of Medicine, USA
Submission date: 2020-06-03
Final revision date: 2020-07-22
Acceptance date: 2020-07-23
Publication date: 2020-09-11
Pol J Radiol, 2020; 85: 509-531
Knee pain is frequently seen in patients of all ages, with a wide range of possible aetiologies. Magnetic resonance imaging (MRI) of the knee is a common diagnostic examination performed for detecting and characterising acute and chronic internal derangement injuries of the knee and helps guide patient management. This article reviews the current clinical practice of MRI evaluation and interpretation of meniscal, ligamentous, cartilaginous, and synovial disorders within the knee that are commonly encountered.
Qi ZH, Li CF, Li ZF, et al. Preliminary study of 3T 1H MR spectroscopy in bone and soft tissue tumors. Chin Med J 2009; 122: 39-43.
Chhabra A, Lee PP, Bizzell C, et al. 3 Tesla MR neurography – technique, interpretation, and pitfalls. Skeletal Radiol 2011; 40: 1249-1260.
Koff MF, Burge AJ, Koch KM, et al. Imaging near orthopedic hardware. J Magn Reson Imaging 2017; 46: 24-39.
Miller JD, Nazarian S, Halperin HR. Implantable Electronic Cardiac Devices and Compatibility With Magnetic Resonance Imaging. J Am Coll Cardiol 2016; 68: 1590-1598.
American College of Radiology. ACR–SPR–SSR practice parameter for the performance and interpretation of magnetic resonance imaging (MRI) of the knee. Available from:
Link TM, Neumann J, Li X. Prestructural cartilage assessment using MRI. J Magn Reson Imaging 2017; 45: 949-965.
Ugas MA, Huynh BH, Fox MG, et al. MR arthrography: impact of steroids, local anesthetics, and iodinated contrast material on gadolinium signal intensity in phantoms at 1.5 and 3.0 T. Radiology 2014; 272: 475-483.
Chung C, Isaza I, Angulo M, et al. MR arthrography of the knee: how, why, when. Radiol Clin N Am 2005; 43: 733-746.
Rastogi A, Davis K, Ross A, et al. Fundamentals of joint injection. AJR Am J Roentgenol 2016; 207: 484-494.
Chu CR, Izzo NJ, Coyle CH, et al. The in vitro effects of bupivacaine on articular chondrocytes. J Bone Joint Surg Br 2008; 90: 814–820.
Fox AJ, Bedi A, Rodeo SA. The basic science of human knee menisci: structure, composition, and function. Sports Health 2012; 4: 340-351.
Nguyen J, de Smet AA, Graf B, et al. MR Imaging based diagnosis and classification of meniscal tears. Radiographics 2014; 34: 981-999.
Englund M, Guermazi A, Lohmander S. The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiol Clin North Am 2009; 47: 703-712.
McDevitt C, Webber R. Ultrastructure and biochemistry of meniscal cartilage. Clin Orthop Relat Res 1990; 252: 8-18.
De Smet AA. How I diagnose meniscal tears on MRI. AJR Am J Roentgenol 2012; 199: 481-499.
Berlet G, Fowler P. The anterior horn of the medial meniscus. Am J Sports Med 1998; 26: 540-543.
Chan CM, Goldblatt JP. Unilateral meniscomeniscal ligament. Orthopedics 2012; 35: e1815-1817.
Shankman S, Beltran J, Melamed E, et al. Anterior horn of the lateral meniscus, another potential pitfall in MR imaging of the knee. Radio­logy 1997; 204: 181-184.
De Abreu M, Chung C, Trudell D, et al. Meniscofemoral ligaments: patterns of tears and pseudotears of the menisci using cadaveric and clinical material. Skeletal Radiology 2007; 36: 729-735.
Peduto A, Nyguen A, Trudell D, et al. Popliteal meniscal fascicles: anatomic considerations using MR arthrography in cadavers. AJR Am J Roentgenol 2008; 190: 442-448.
Sanders TG, Linares RC, Lawhorn KW, et al. Oblique meniscomeniscal ligament: another potential pitfall for a meniscal tear-anatomic description and appearance at MR imaging in three cases. Radiology 1999; 213: 213-216.
Bolog NV, Andreisek G. Insights reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them. Imaging 2016; 7: 385-398.
Resnick D, Kang H. In: Internal Derangements of Joints Emphasis on MR Imaging. Saunders 1997; 16: 629.
Araki Y, Yamamoto H, Nakamura H, et al. MR diagnosis of discoid lateral menisci of the knee. Eur J Radiol 1994; 18: 92-95.
Woods G, Whelan M. Discoid meniscus. Clin Sports Med 1990; 9: 695-706.
Kim Y, Ihn J, Park S, et al. An arthroscopic analysis of lateral meniscal variants and a comparison with MRI findings. Knee Surg Sports Traumatol Arthrosc 2006; 14: 20-26.
De Smet AA, Norris M, Yandow D, 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: 101-107.
De Smet AA, Tuite M. Use of the “two slice touch” rule for MRI diagnosis of meniscal tears. AJR Am J Roentgenol 2006; 187: 911-914.
Kaplan P, Nelson N, Garvin K, et al. MR of the knee: the significance of high signal in the meniscus that does not clearly extend to the surface. AJR Am J Roentgenol 1991; 156: 333-336.
Crema M, Hunter D, Roemer F. The relationship between prevalent medial meniscus intrasubstance signal changes and incident medial meniscal tears in women over a 1 year period assessed with 3.0 T MRI. Skeletal Radiology 2011; 40: 1017-1023.
Barrie H. The pathogenesis and significance of meniscal cysts. J Bone Joint Surg Br 1979; 61B: 184-189.
De Smet AA, Graf B, del Rio A. Association of perimeniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy. AJR Am J Roentgenol 2011; 196: W180-186.
Choi C, Choi Y, Lee J, et al. Magnetic Resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthro­scopy 2010; 26: 1602-1606.
Mohankumar R, Palisch A, Khan W, et al. Meniscal ossicle: posttraumatic origin and association with posterior meniscal root tears. AJR Am J Roentgenol 2014; 203: 1040-1046.
Nair R, Dubey N. MR Imaging of the hypermobile lateral meniscus of the knee: a case report. Acta Med Acad 2019; 48: 225-229.
Rubin D. MR imaging of the knee menisci. Radiol. Clin North Am 2007; 45: 1033-1053.
Ferrer-Roca O, Vilalta C. Lesions of the meniscus II. Horizontal cleavages and lateral cysts. Clin Orthop Relat Res 1980; 146: 301-307.
McKnight A, Southgate J, Price A, et al. Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol 2010; 39: 279-283.
De Smet AA, Graf B. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol 1994; 162: 905-911.
Crues J, Ryu R, Morgan F. Meniscal pathology: the expanding role of magnetic resonance imaging. Clin Orthop Relat Res 1990; 252: 80-87.
Kaushik S, Erickson JK, Palmer WE, et al. Effect of chondrocalcinosis on the MR imaging of knee menisci. AJR Am J Roentgenol 2001; 177: 905-909.
Gilat R, Cole BJ. Meniscal allograft transplantation: indications, techniques, outcomes. Arthroscopy 2020; 36: 938-939.
Potter HG, Rodeo SA, Wickiewicz TL, et al. MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes. Radio­logy 1996; 198: 509-514.
Naraghi AM, White LM. Imaging of athletic injuries of knee ligaments and menisci: sports imaging series. Radiology 2016; 281: 23-40.
De Franco MJ, Bach BR Jr. A comprehensive review of partial anterior cruciate ligament tears. J Bone Joint Surg Am 2009; 91: 198-208.
Boden BP, Dean GS, Feagin JA Jr, et al. Mechanisms of anterior cruciate ligament injury. Orthopedics 2000; 23: 573-578.
Prodromos CC, Han Y, Rogowski J, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23: 1320-1325.e6.
Van Dyck P, Vanhoenacker FM, Gielen JL, et al. Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears? Skeletal Radiol 2011; 40: 701-707.
Umans H, Wimpfheimer O, Haramati N, et al. Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. AJR Am J Roentgenol 1995; 165: 893-897.
Yao L, Gentili A, Petrus L, et al. Partial ACL rupture: an MR diagnosis? Skeletal Radiol 1995; 24: 247-251.
Van Dyck P, de Smet E, Veryser J, et al. Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 2012; 20: 256-261.
Sampson MJ, Jackson MP, Moran CJ, et al. Three Tesla MRI for the diagnosis of meniscal and anterior cruciate ligament pathology: a comparison to arthroscopic findings. Clin Radiol 2008; 63: 1106-1111.
Gallimore GW Jr, Harms SE. Knee injuries: high-resolution MR imaging. Radiology 1986; 160: 457-461.
Turner DA, Prodromos CC, Petasnick JP, et al. Acute injury of the ligaments of the knee: magnetic resonance evaluation. Radiology 1985; 154: 717-722.
Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Radiographics 2002; 22: 765-774.
Manaster BJ, Remley K, Newman AP, et al. Knee ligament reconstruction: plain film analysis. AJR Am J Roentgenol 1988; 150: 337-342.
Meyers AB, Haims AH, Menn K, et al. Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol 2010; 194: 476-484.
Sanders TG. MR imaging of postoperative ligaments of the knee. Semin Musculoskelet Radiol 2002; 6: 19-33.
Roberts CC, Towers JD, Spangehl MJ, et al. Advanced MR imaging of the cruciate ligaments. Magn Reson Imaging Clin N Am 2007; 15: 73-86.
De Froda SF, Karamchedu NP, Owens BD, et al. Tibial tunnel widening following anterior cruciate ligament reconstruction: a retrospective seven-year study evaluating the effects of initial graft tensioning and graft selection. Knee 2018; 25: 1107-1114.
Bencardino JT, Beltran J, Feldman MI, et al. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 2009; 29: 2115-2126.
Anderson MA, Simeone FJ, Palmer WE,. Acute posterior cruciate ligament injuries: effect of location, severity, and associated injuries on surgical management. Skeletal Radiol 2018; 47: 1523-1532.
Rodriguez W Jr, Vinson EN, Helms CA, et al. MRI appearance of posterior cruciate ligament tears. AJR Am J Roentgenol 2008; 191: 1031.
Bollen S. Epidemiology of knee injuries: diagnosis and triage. Br J Sports Med 2000; 34: 227-228.
Schulz MS, Russe K, Weiler A, et al. Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 2003; 123: 186-191.
McMonagle JS, Helms CA, Garrett WE Jr, et al. Tram-track appearance of the posterior cruciate ligament (PCL): correlations with mucoid degeneration, ligamentous stability, and differentiation from PCL tears. AJR Am J Roentgenol 2013; 201: 394-399.
Jung YB, Jung HJ, Yang JJ, et al. Characterization of spontaneous healing of chronic posterior cruciate ligament injury: Analysis of instability and magnetic resonance imaging. J Magn Reson Imaging 2008; 27: 1336-1340.
Devitt BM, Dissanayake R, Clair J, et al. isolated posterior cruciate reconstruction results in improved functional outcome but low rates of return to preinjury level of sport: a systematic review and meta-analysis. Orthop J Sports Med 2018; 6: 1-12.
La Prade RF, Engebretsen AH, Ly TV, et al. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89: 2000-2010.
Mohankumar R, White LM, Naraghi A. Pitfalls and pearls in MRI of the knee. AJR Am J Roentgenol 2014; 203: 516-530.
Andrews K, Lu A, Mckean L, et al. Review: medial collateral ligament injuries. J Orthop 2017; 14: 550-554.
De Maeseneer M, Shahabpour M, Pouders C. MRI spectrum of medial collateral ligament injuries and pitfalls in diagnosis. JBR-BTR 2010; 93: 97-103.
Lundquist RB, Matcuk GR Jr, Schein AJ, et al. Posteromedial corner of the knee: the neglected corner. Radiographics 2015; 35: 1123-1137.
Dold AP, Swensen S, Strauss E, et al. the posteromedial corner of the knee: anatomy, pathology, and management strategies. J Am Acad Orthop Surg 2017; 25: 752-761.
Mansour R, Yoong P, McKean D, et al. The iliotibial band in acute knee trauma: patterns of injury on MR imaging. Skeletal Radiol 2014; 43: 1369-1375.
Vinson EN, Major NM, Helms CA. The posterolateral corner of the knee. AJR Am J Roentgenol 2008; 190: 449-458.
Rosas HG. Unraveling the posterolateral corner of the knee. Radiographics 2016; 36: 1776-1791.
De Maeseneer M, Shahabpour M, Vanderdood K, et al. Posterolateral supporting structures of the knee: findings on anatomic dissection, anatomic slices and MR images. Eur Radiol 2001; 11: 2170-2177.
Flores DV, Mejía Gómez C, Pathria MN. Layered approach to the anterior knee: normal anatomy and disorders associated with anterior knee pain. Radiographics 2018; 38: 2069-2101.
Yablon CM, Pai D, Dong Q, et al. Magnetic resonance imaging of the extensor mechanism. Magn Reson Imaging Clin N Am 2014; 22: 601-620.
Yu JS, Petersilge C, Sartoris DJ, et al. MR imaging of injuries of the extensor mechanism of the knee. Radiographics 1994; 14: 541-551.
Wangwinyuvirat M, Dirim B, Pastore D, et al. Prepatellar quadriceps continuation: MRI of cadavers with gross anatomic and histologic correlation. AJR Am J Roentgenol 2009; 192: W111-116.
Tuong B, White J, Louis L, et al. Get a kick out of this: the spectrum of knee extensor mechanism injuries. Br J Sports Med 2011; 45: 140-146.
Karantanas AH, Zibis AH, Papanikolaou N. Increased signal intensity on fat-suppressed three-dimensional T1-weighted pulse sequences in patellar tendon: magic angle effect? Skeletal Radiol 2001; 30: 67-71.
Starok M, Lenchik L, Trudell D, et al. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. AJR Am J Roentgenol 1997; 168: 1493-1499.
Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 2002; 225: 736-743.
Middleton KK, Gruber S, Shubin Stein BE. why and where to move the tibial tubercle: indications and techniques for tibial tubercle osteotomy. Sports Med Arthrosc Rev 2019; 27: 154-160.
De Smet AA, Fisher DR, Graf BK, et al. Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects. AJR Am J Roentgenol 1990; 155: 549-553.
Aichroth P. Osteochondritis dissecans of the knee: a clinical survey. J Bone Joint Surg 1971; 53B: 440-447.
Mestriner LA. Osteochondritis dissecans of the knee: diagnosis and treatment. Rev Bras Ortop 2012; 47: 553-562.
Choi YS, Potter HG, Chun TJ. MR imaging of cartilage repair in the knee and ankle. Radiographics 2008; 28: 1043-1059.
Potter HG, Foo LF. Magnetic resonance imaging of articular cartilage. Am J Sports Med 2006; 34: 661-677.
Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003; 85A: 58-69.
Guermazi A, Roemer FW, Alizai H, et al. State of the art: MR imaging after knee cartilage repair surgery. Radiology 2015; 277: 23-43.
Farr J, Cole B, Dhawan A, et al. Clinical cartilage restoration. Clin Orthop Relat Res 2011; 469: 2696-2705.
Link TM, Mischung J, Woortler K, et al. Normal and pathological MR findings in osteochondral autografts with longitudinal follow-up. Eur Radiol 2006; 16: 88-96.
Yamamato T, Bullough PG. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg 82: 858-2000.
Ahlbuck S, Bauer GC, Bohne WH. Spontaneous osteonecrosis of the knee. Arthritis Rheum 1968; 11:705-733.
Turan A, Celtikci P, Tufan A, et al. Basic radiological assessment of synovial disease: a pictorial essay. Eur J Rheumatol 2017; 4: 166-174.
Steinback LS, Stevens KJ. Imaging of cysts and bursae about the knee. Radiol Clin N Am 2013; 51: 433-454.
Ozdemir ZM, Kahraman AS, Karakaplan M, et al. Peroneal intraneural ganglion cyst arising from proximal tibiofibular joint: advantages of magnetic resonance imaging on preoperative diagnosis.
J Turgut Ozal Med Cent 2014; 21: 300-303.
Journals System - logo
Scroll to top