technetium-tc-99m-medronate and Knee-Injuries

The aim of this study was to ascertain whether knee SPET can localize lesion sites in patients with internal derangements of the knee. We performed knee SPET as a pre-arthroscopic examination in 63 consecutive patients. SPET imaging was performed with a triple-headed SPET camera 4 h after the injection of 99Tcm-methylene diphosphonate. Arthroscopic diagnoses were as follows: 28 medial meniscus injuries, 24 lateral meniscus injuries, 31 anterior cruciate ligament (ACL) injuries, three posterior cruciate ligament injuries and one medial collateral ligament injury. Of 30 patients with crescent-shaped increased activity at the medial tibial plateau, 22 had medial meniscus injuries (positive predictive value: PPV 73%); of 17 patients with crescent-shaped activity at the lateral tibial plateau, 13 had lateral meniscus injuries (PPV 76%). Of 18 patients with increased activity at ACL attachment sites (primary sign), 17 had ACL injuries (PPV 94%). Of 27 patients with increased activity at bone impaction sites of ACL injury (secondary sign), 22 had ACL injuries (PPV 81%). Of 32 patients who had either a primary or secondary sign, 26 had ACL injuries (PPV 81%). We conclude that knee SPET is very useful in the management of internal derangements of the knee, particularly in determining the need for arthroscopy by localizing lesion sites.

Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Female; Humans; Knee Injuries; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A clinical, radiographic, and scintigraphic comparative study was performed on 57 consecutive successful patellar tendon anterior cruciate ligament reconstructions for chronic laxity. Patients were divided into 3 matched groups according to the medial meniscal treatment. Group A included 18 patients with medial meniscal repairs; Group B, 19 patients with partial medial meniscectomies; and Group C, 20 patients with normal menisci (controls). The average followup was 55 months. At clinical examination, patients in Group B had more activity-related pain than those in Group C (p = 0.04). The anteroposterior weight-bearing views in extension showed more degenerative changes in the medial compartment in Group B than in the other 2 groups (Group A versus B, p = 0.01; Group C versus B, p < 0.001). Scintigraphy showed an increased uptake in the operated knee as compared with the normal side (11%), but no differences among the 3 study groups. The patients with partial meniscectomies had more pain and degenerative radiographically evident changes than the control group. Medial meniscal repair offers a better chance than partial meniscectomy to preserve the articular cartilage of the medial compartment. Bone homeostasis, as detected by bone scanning, remains slightly altered in successful reconstructions as compared with the opposite normal side.

Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Female; Humans; Knee Injuries; Male; Menisci, Tibial; Outcome Assessment, Health Care; Patella; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Meniscus Injuries

To evaluate the role of 99m-technetium methylene diphosphonate (Tc-99m MDP) bone scintigraphy on the detection of joint damage in asymptomatic alpine ski racers.. This study included 20 male asymptomatic alpine ski racers (age range: 18-21 years). None of the skiers had a history of ski crashes. Bone scan findings of the racers were examined with Tc-99m MDP bone scintigraphy during the active racing season and the inactive training season. Planar anterior and posterior images of hip, knee, and ankle joints were obtained 4 h after intravenous injection of 20 mCi Tc-99m MDP. All images were interpreted visually by 2 experienced nuclear medicine physicians. Free regions of interest were drawn on hip, knee, and ankle joints, as well as background regions. Joint-to-background ratios were calculated for each joint, and the uptake ratios of both right and left joints during active ski season were compared to those during the inactive training period.. Uptake ratios of the right and left hip, knee, and ankle joints were significantly higher during the active racing period than those calculated during the inactive period (P < 0.005).. Bone scintigraphy may have an important role in detecting joint injuries of hip, knee, and ankle joints in asymptomatic alpine ski racers and can be used successfully when MRI is unavailable.

Topics: Adolescent; Adult; Ankle Injuries; Asymptomatic Diseases; Hip Injuries; Humans; Knee Injuries; Lower Extremity; Male; Radionuclide Imaging; Radiopharmaceuticals; Skiing; Technetium Tc 99m Medronate; Young Adult

SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and a conventional computerised tomography (CT). SPECT/CT allows accurate anatomical localisation of metabolic tracer activity. It allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors. The purpose of this study was to investigate whether the SPECT/CT tracer uptake (intensity and distribution) correlates with the stability and laxity of the knee joint and the position and orientation of the tibial and femoral tunnels in patients after anterior cruciate ligament (ACL) reconstruction.. A consecutive series of knees (n=66), with symptoms of pain and/or instability after ACL reconstruction were prospectively evaluated using clinical examination and 99mTc-HDP-SPECT/CT. Clinical laxity testing was performed using the Rolimeter (Ormed, Freiburg, Germany) including Lachman testing (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), anterior drawer test (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), pivot shift test (positive versus negative) and patient-based subjective instability (yes versus no). For analysis of SPECT/CT tracer uptake a previously validated SPECT/CT localisation scheme consisting of 17 tibial, nine femoral and four patellar regions on standardised axial, coronal, and sagittal slices was used. The tracer activity on SPECT/CT was localised and recorded using a 3D volumetric and quantitative analysis software. Mean, standard deviation, minimum and maximum of grading for each area of the localisation scheme were recorded. The position and orientation of the tibial and femoral tunnel was assessed using a previously published method on 3D-CT.. Correlation of instability, pivot shift as well as clinical laxity testing with 99mTc-HDP-SPECT/CT tracer uptake intensity and distribution showed no significant correlation. 99mTc-HDP-SPECT/CT tracer uptake correlated significantly with the position and orientation of the ACL graft. A more horizontal femoral graft position showed significantly increased tracer uptake within the superior and posterior femoral regions. A more posteriorly-placed femoral insertion site showed significantly more tracer uptake within the femoral and tibial tunnel regions. A more vertical or a less medial tibial tunnel orientation showed significant increased uptake within the tibial and femoral tunnel regions. A more anterior tibial tunnel position showed significantly more tracer uptake in the femoral and tibial tunnel regions as well as the entire tibiofemoral joint.. SPECT/CT tracer uptake intensity and distribution showed a significant correlation with the femoral and tibial tunnel position and orientation in patients with symptomatic knees after ACL reconstruction. No correlation was found with stability or clinical laxity. SPECT/CT tracer uptake distribution has the potential to give us important information on joint homeostasis and remodelling after ACL reconstruction. It might help to predict ACL graft failure and improve our surgical ACL reconstruction technique in finding the optimal tunnel and graft position and orientation.

Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Female; Femur; Humans; Joint Instability; Knee Injuries; Knee Joint; Male; Multimodal Imaging; Patella; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tendons; Tibia; Tomography, X-Ray Computed; Young Adult

The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI).. Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed.. At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm(3); range, 1,200-39,200 mm(3)). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p = 0.004; MCL signal changes p = 0.002). Only MCL signal changes predicted pain during exercise significantly (p = 0.001).. In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL.

Topics: Adult; Aged; Arthralgia; Chronic Disease; Exercise Test; Female; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Rest; Sensitivity and Specificity; Technetium Tc 99m Medronate

To evaluate stress fractures in leg (particularly around the knee, tibia, and femur) and knee pathology in active asymptomatic (no symptoms in the preceding month) soccer players.. The study included 42 asymptomatic soccer players (21 women, 21 men; age range 19-31 years). Players from seven teams in the major female professional and amateur male soccer leagues were examined by technetium-99m-methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy during the soccer season. Four hours after intravenous injection of 20 mCi (99m)Tc-MDP, standard imaging included anterior planar spot images of the legs, lateral images of the knee, and single photon emission computed tomography (SPECT).. Although the players were asymptomatic, increased tracer uptake, indicating stress fracture, was found in 28 (66%). Most of the stress fractures were in the tibia (62%) and femur (5%). In the 42 subjects (84 legs), 35 sites (42%) showed rupture of the posterior horn of the lateral meniscus and bone bruising of the tibial plateau, 16 sites (19%) showed rupture of the anterior horn of the medial meniscus, 11 sites (13%) showed bone bruising of the lateral femoral condyle, eight sites (10%) showed bone bruising of the medial femoral condyle, and there was avulsion injury to the infrapatellar tendon insertion in the anterior tibia in 34 sites (40%). There were 11 anterior cruciate ligament injuries.. Bone SPECT is very accurate, easy to perform, cost effective, may give valuable information before magnetic resonance imaging studies in the detection of meniscal tears, and may be used successfully when magnetic resonance imaging is unavailable.

Topics: Adult; Female; Fractures, Stress; Humans; Knee Injuries; Knee Joint; Leg Injuries; Male; Radiopharmaceuticals; Soccer; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Recent studies have shown that SPECT bone scintigraphy is valuable to detect meniscal tears of the knee. This has not been formally assessed in a prospective study, and no substantive study has compared bone SPECT with other noninvasive diagnostic methods. One hundred consecutive patients referred to an orthopedic surgeon with undiagnosed knee pain were assessed by clinical examination, MRI, SPECT bone scintigraphy, and arthroscopy. The MRI and SPECT bone scan findings were reported blinded to other information. Using arthroscopy as a gold standard, both MRI and SPECT showed high diagnostic ability to detect meniscal tears, with respective sensitivity rate, specificity rates, and positive and negative predictive accuracies of 80%, 71%, 84%, and 71% for MRI and 84%, 80%, 88%, and 76% for SPECT. Some meniscal tears were detected by MRI alone (n = 5) or SPECT alone (n = 8). SPECT bone scintigraphy is a suitable alternative to MRI to detect meniscal tears. The comparable diagnostic ability of SPECT bone scintigraphy implies that it can be used successfully when MRI is unavailable or unsuitable.

Topics: Adult; Aged; Arthroscopy; Humans; Knee Injuries; Magnetic Resonance Imaging; Middle Aged; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tibial Meniscus Injuries; Tomography, Emission-Computed, Single-Photon

We report two cases, with magnetic resonance imaging correlation, of acute lateral collateral ligament tear of the knee following trauma with findings on bone scintigraphy with single-photon emission tomography (SPET). The typical bone scan features are presented. In addition, the advantages of the use of SPET in the detection of associated lesions are discussed.

Topics: Adult; Collateral Ligaments; Female; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

This retrospective analysis of SPECT bone scans of the knee was undertaken to define typical bone scan appearances and to assess the sensitivity of this method. We looked at 14 patients, mostly with chronic knee pain, who had anterior cruciate ligament (ACL) tears detected by MRI.. Of the 14 patients, 10 were referred for bone scanning following injury and 4 complained of chronic knee pain without injury. Planar scans were performed 4 hr after the injection of 750 MBq of 99mTc-MDP. Tomographic images were obtained by a 64 x 20-sec acquisition over 360 degrees using a high-resolution collimator. MRI imaging included axial and sagittal, T1 weighted and coronal fast field echo (FFE) sequences. Ten patients also had arthroscopy performed.. MRI scans showed 6 lone ACL tears and 8 combined with other ligamentous injuries. SPECT scans showed abnormalities in 10 patients in the region of ACL insertions but only 4 planar studies were abnormal. SPECT identified focal activity at the upper (n = 8) or lower (n = 2) insertion of the ACL. Six of 10 arthroscopies confirmed ACL tears, 2 complete and 4 partial. Overall, agreement was found with MRI in 10 of 14 cases and in 8 of 10 with arthroscopy. Abnormalities were identified in 10 of 11 regions of other ligament or bone injury identified by MRI.. SPECT bone scanning of the knee is superior to planar imaging in detecting ACL injury and is a sensitive technique. Focal activity may be seen at either end of ACL attachment but more commonly at the upper femoral insertion. Knee SPECT may be a valuable examination in suspected ACL injury, particularly if MRI is not available, is equivocal or where clinical signs are absent.

Topics: Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Female; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Calcinosis; Exostoses; Femoral Fractures; Fractures, Ununited; Humans; Knee; Knee Injuries; Male; Ossification, Heterotopic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Fascia Lata; Female; Humans; Knee Injuries; Radionuclide Imaging; Running; Syndrome; Technetium Tc 99m Medronate

A 30-year-old man had severe left anterior knee pain after a trivial injury. A three-phase bone scan diagnosed this condition to be reflex sympathetic dystrophy, which was subsequently confirmed by sympathetic blockade.

Topics: Adult; Diagnosis, Differential; Humans; Knee Injuries; Knee Joint; Male; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Technetium Tc 99m Medronate

Twelve athletes presenting acute knee injury with normal radiological findings underwent both three-phase radionuclide bone imaging (TPBI) and magnetic resonance imaging (MRI). The association of these highly sensitive diagnostic procedures detected occult fractures in all patients. The areas of signal intensity alterations on MRI corresponded to those of increased radionuclide uptake in blood pool images. However, the same areas seemed to be more extended on delayed TPB images. TPBI yielded early diagnostic information about lesion sites and functional activities, while MRI provided better anatomical definition and specific information about associated soft tissue lesions and served to establish the correct therapeutic approach and follow-up.

Topics: Adolescent; Adult; Athletic Injuries; Female; Femoral Fractures; Humans; Knee Injuries; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tibial Fractures

Bone scintigraphy is used to detect radiographically silent fractures. Magnetic resonance imaging (MRI) is currently used to screen knee injuries for cartilage and ligament damage. MRI also delineates bone marrow and fractures. We investigated the bone scintigraphic findings in patients who had subchondral bone injuries demonstrated on MRI. Thirteen patients underwent MRI, three-phase bone scintigraphy with SPECT, and arthroscopic surgery after sustaining acute traumatic hemarthrosis of a knee. They all had clinically unsuspected subchondral bone injuries demonstrated on MRI with normal radiographs and normal overlying articular cartilage at arthroscopy, consistent with occult fractures. All showed focal bone repair on scintigraphy. Two of the 13 patients showed additional bone injuries only on bone scan. Two other patients scintigraphically showed focal bone repair at the medial femoral condyle due to avulsion of the medial collateral ligament. SPECT was easier to interpret than multi-view planar imaging. Bone scintigraphy confirms subchondral fractures demonstrated on MRI but also demonstrates ligament avulsion injuries and additional more subtle bone injuries.

Topics: Adolescent; Adult; Athletic Injuries; Female; Fractures, Bone; Humans; Knee Injuries; Ligaments, Articular; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The scintigraphic appearance of an overuse injury at the insertion of the iliotibial band is described. This injury was depicted on three-phase bone scintigraphy as focally increased radionuclide concentration in the anterolateral tibial condyle (lateral tibial tubercle) where the iliotibial band inserts. Overuse injuries involving the insertion of the iliotibial band are uncommon and are not to be confused with a stress fracture or other bony lesion involving the lateral tibial condyle.

Topics: Adult; Fascia Lata; Humans; Ilium; Knee Injuries; Male; Physical Endurance; Radionuclide Imaging; Running; Technetium Tc 99m Medronate; Tibia

Topics: Adult; Humans; Knee Injuries; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Meniscus Injuries

In the assessment of acute knee pain following recent trauma frequently related to sporting activities, bone scintigraphy was performed on 52 patients; in 40 of these patients, scintigraphy immediately preceded arthroscopy. SPECT was critical in providing delineation and sitting of the abnormalities; this would not have been feasible with conventional planar imaging in 45 of the patients. Multiple sites of focal uptake were frequently visualized at ligamentous insertions or in intra-articular areas of cartilaginous erosion. Damaged anterior cruciate ligaments were only identified in 5 out of 10 patients, occurring when there was avulsion of the tibial attachment, but changes resulting from patellar injury were demonstrated in all 8 patients. The most characteristic scintigraphic change resulted from meniscal tears, which was diagnosed in 31 out of 35 patients in whom the lesion had been suspected clinically. In the identification of this common injury, SPECT had a sensitivity of 88%, specificity of 87%, and diagnostic accuracy of 88%. Thus, although trauma readily induces scintigraphic abnormalities in and around the knee, the patterns of alteration associated with particular lesions can be identified by SPECT and can provide considerable assistance in management, particularly in determining the need for arthroscopy.

Topics: Anterior Cruciate Ligament Injuries; Arthroscopy; Athletic Injuries; Female; Fractures, Stress; Humans; Knee; Knee Injuries; Male; Patella; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tibial Meniscus Injuries; Tomography, Emission-Computed, Single-Photon

Young patients with symptoms of anterior knee discomfort represent a most difficult and often enigmatic clinical group, in large part because of the highly subjective nature of the condition. A primary clinical research goal over the past several years has been a search for reliable objective indicators of a presumed underlying pathologic process to account for the symptoms. We believe that the use of the bone scan along with other clinical and experimental data has provided a new and previously unappreciated perspective of a dynamic osseous process occurring in many such patients. With further investigation, this process may clarify certain confusing aspects of the symptoms experienced by patients with patellofemoral pain. The technique and its clinical applications are still in its infancy, yet it appears to hold promise for the future. It is hoped that exposure to this method of evaluation will serve as a basis for an understanding of the benefits, limitations, and implications of this technique as further developments occur.

Topics: Adolescent; Adult; Arthroscopy; Cartilage Diseases; Computers; Female; Femur; Homeostasis; Humans; Knee Injuries; Knee Joint; Male; Middle Aged; Models, Biological; Osteoclasts; Pain; Patella; Prostaglandins E; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Technetium Tc 99m Medronate

Scintimetry with 99Tcm MDP was performed in 32 growth regions in 8 children with localized growth disturbances after surgery or injury. The results were compared with the simultaneously performed growth rate analysis using roentgen stereophotogrammetry. A quantitative and qualitative analysis of the nuclide bone images of the anterior view was performed. Numeric ratios, obtained by comparing count rate levels of injured or operated growth region with the corresponding contralateral region, are presented and a satisfactory correlation with the roentgen stereophotogrammetric growth rate analysis was found. Nuclide bone-imaging of growth regions at the knee and ankle provides valuable and significant information about growth and was found to be a clinically useful method when combined with standard radiographic techniques to evaluate growth conditions.

Topics: Adolescent; Age Determination by Skeleton; Bone and Bones; Bone Development; Child; Computers; Diphosphonates; Female; Femoral Fractures; Femur; Follow-Up Studies; Growth Disorders; Humans; Knee Injuries; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibia