2009, Number 2
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MEDICC Review 2009; 11 (2)
Ultrasound diagnosis for preventing knee injuries in cuban high-performance athletes
Anillo R, Villanueva E, León D, Pena A
Language: English
References: 24
Page: 21-28
PDF size: 318.49 Kb.
ABSTRACT
Introduction Diagnostic evaluation of the musculoskeletal system
has traditionally been based on medical history, physical examination,
and x-rays (techniques that provide limited information), and more recently
on computerized axial tomography and magnetic resonance
imaging (both very expensive). Ultrasound, a non-invasive and less
expensive method, has become an indispensable tool for diagnosing
overuse sports injuries. The Imaging Department at the Cuban
Sports Medicine Institute (abbreviated in Spanish as IMD) developed
a preventive ultrasound diagnostic imaging method and has applied
it for the last 15 years as part of the IMD’s medical management of
high-performance athletes.
Objectives Identify normal ultrasound patterns for knee structures
and extensor mechanism alignment, and perform ultrasound imaging
of the knee on asymptomatic, high-performance athletes to detect
alterations and endogenous predisposing factors to overuse sports
injuries as a basis for adopting preventive action.
Methods A descriptive cross-sectional study was conducted of 300
non-athletes (control) and 100 Cuban Olympic athletes (preselected
for the 2000 Olympic Games in Sydney, Australia). The IMD’s Preventive
Ultrasound Diagnostic Imaging Method was used to perform static
and dynamic ultrasound examinations of both knees of all subjects
(800 knees total) to determine normal patterns, detect structural alterations
in the knee, and determine extensor mechanism malalignment.
For the latter, Anillo’s Patellofemoral Congruence Ultrasound Method
was applied to determine the degree of patellar lateralization (RAB
angle). Data was processed using descriptive statistics. To compare
the ratio of ultrasound knee alterations detected, the Chi-square test
was used. Percentiles were calculated based on data from the 600
non-athlete knees and were processed using the SPSS statistics application.
Results Of the 100 athletes studied, 57 were found to have subclinical
alterations in one or both knees, distributed as follows: synovitis (30),
extensor mechanism malalignment (26), infrapatellar fat pad distortion
(15), meniscal echostructure modification (14), ligament echostructure
alteration (11), and articular cartilage alteration (7). Analysis of the control
group findings established that RAB angle values greater than 13° for
both sexes suggest excessive patellar lateralization with respect to the
axial axis of the femur, potentially an endogenous risk factor favoring injury.
Conclusions Preventive ultrasound diagnostic imaging of the knee,
performed using IMD’s ultrasound scanning methodology and incorporating the normal ultrasound patterns described in this study, enables
diagnosis of distortions in the articular and periarticular echostructure
prior to the onset of clinical symptoms, as well as observation of endogenous
predisposing factors linked to overuse sports injuries. As a result, appropriate measures can be adopted to prevent such injuries and to tailor medical management of high-performance athletes.
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