Basic Imaging Principles of Tendons and Ligaments
Tendons and ligaments may be subject to acute or chronic sports-related injury. This chapter reviews the structural properties of tendons and ligaments that give rise to their unique imaging features and account for patterns of injury seen. The superb sof
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ts 1 I ntroduction 1.1 T endons 1.2 Ligaments
Abstract
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I maging of Tendons and Ligaments Ultrasound Imaging Magnetic Resonance Imaging (MRI) Radiographs and CT
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Conclusion
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Tendons and ligaments may be subject to acute or chronic sports-related injury. This chapter reviews the structural properties of tendons and ligaments that give rise to their unique imaging features and account for patterns of injury seen. The superb soft tissue contrast offered by ultrasound and MRI make them the most widely used imaging modalities for assessing tendons and ligaments, with the dynamic capabilities of ultrasound being particularly advantageous. We describe the important imaging features of normal tendons and ligaments and show examples of acute and chronic injuries. The chapter will also review the role radiographs and CT play in assessment of tendon and ligament injuries, particularly with reference to avulsion fractures and malalignment following ligament rupture. In some cases arthrography may better demonstrate the integrity of ligaments around a joint and this along with novel techniques such as elastography and dual energy CT are also discussed.
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R. Bakewell · E. L. Gerety Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK e-mail: [email protected]; [email protected] A. J. Grainger (*) Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK e-mail: [email protected]
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Introduction
Tendons and ligaments are vulnerable to sports- related injuries by both acute high-impact injury, due to traumatic incidents, and by chronic
Med Radiol Diagn Imaging (2020) https://doi.org/10.1007/174_2020_249, © Springer Nature Switzerland AG
R. Bakewell et al.
low-impact repetitive strain injury. Depending on the sport, different tendons and ligaments will be affected, with lower limb, weight-bearing injuries prevalent in almost all sports and upper limb injuries more commonly in overarm sports such as racket and throwing sports and swimming. The structure of tendons and ligaments makes them well suited to distribute mechanical loads between bones (ligaments) or between bone and muscles (tendons) and these properties affect their appearance with different imaging modalities.
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Tendons
Tendons connect muscle to bone and are of high tensile strength, transferring forces generated within the muscle to the bone. They comprise collagen molecules in a triple helix structure that is linked by hydrogen bonds (Ramachandran and Chandrasekharan 1968; Rich and Crick 1955, 1961). Collagen type I is the predominant collagen in tendons, with collagen type III being the second most abundant. Groups of five collagen molecules form pentafibrils/microfibrils which pack together to form fibrils. Collagen fibrils are hierarc
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