Because of the excellent soft tissue evaluation of MRI in detecting various meniscal and ligamentous abnormalities, it is considered the first line of diagnosis of injuries of the knee with an emphasis on post-traumatic sequel (instability). Radiologists have to be familiar with the various characteristic MRI appearances of the various structures forming the PCL of the knee to be able to diagnose their injuries in favor of better management and functional outcomes in particular if the injury was not clinically suspected, especially those with concomitant ACL or PCL injuries that require reconstruction [6].
Regarding the mechanisms of injury targeting the PCL of the knee, we found that 20 (66.7%) patients were subjected to non-contact external rotation, and 10 (33.3%) patients were exposed to direct hit applied on the tibial anteromedial aspect in a fully extended knee.
These results agreed with Rosas et al. [7] who proposed that these injuries are caused either as a result of direct impacts applied to the tibial anteromedial aspect in a hyperextended knee or by non-contact hyperextension of the knee with external rotation.
Regarding the incidence of either different single or multiple PCL structures injured in our study, 66.66% of the patients showed multiple injured structures of the PCL at the same incident, while only 33.33% of the patients had only one injured structure of the PLC structures at a time including either the LCL or the popliteus musculotendinous complex.
These findings agreed with Essilfie et al. [8] who stated that the PLC is rarely injured in isolation and commonly seen in association with multi-ligamentous injury of the knee.
Close results were also found by Laprade et al. [9] who stated that injuries of the PLC were combined injuries of the ligaments and tendons in 72–87%.
Our study depicted that the LCL in addition to the popliteus musculotendinous complex and biceps femoris tendon forms the essential stabilizing structures for the integrity of the PLC of the knee; and also, the most common structures to be injured constitute about 80%, 70%, and 33.33%, respectively.
These results agreed with Aga M et al. [10] who found that injuries of the LCL are the most common injured structure of the PLC representing (22.3%) of the patients, followed by the iliotibial band (11.3%), biceps tendon (5.9%), and popliteus muscle (5.3%).
These results were also agreed with Theodorous et al. [11] who found LCL injury in all (100%) of the patients in their study, followed by biceps femoris tendon injuries representing 79% of the patients and popliteus musculotendinous complex injury in 36% of the patients.
Collins et al. [12] also found that 100% of the patients in their study had injury to the LCL, followed by injuries to the popliteus muscle and tendon in 95% of the patients, while 77.3% of the patients had injury to the biceps femoris tendon.
Regarding the incidence of different patterns of LCL injuries, 18 (75:00%) of the LCL injured patients in our study showed intra-substance tear or sprain, 4 (16.6%) showed a complete tear and discontinuity of the LCL fibers, and 2 (8.3%) patients showed avulsion from the femoral condyle.
Compared to Kohan et al. [13], our findings were quite different regarding the LCL injuries as their study showed avulsion injury to the LCL either from the fibula or from the femur in 85% of their cases, while sprain of the LCL was only found in 15%.
Colins et al. [12] also found different results, 86.4% of the LCL injuries showed complete tear, while 13.6% showed sprain injury partial tear, 50% of the biceps femoris injuries showed complete tear, while 27.3% showed sprain injury partial tear.
These differences with their higher numbers of avulsion injuries may be attributed to their selection bias including only patients who underwent surgical intervention.
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