CHICAGO - New imaging discoveries may improve physicians' ability to diagnose and treat two serious injuries affecting football players, according to two studies.

In the first study, researchers reviewed 101 magnetic resonance imaging (MRI) knee exams of 330 candidates for the 2005 professional football draft and found 57 tears of the lateral meniscus, a flat, disc-shaped ligament that supports the outer knee joint, and 26 tears of the medial meniscus, which supports the inner knee joint.

"These findings are remarkable because the authors of most previous studies have reported a predominance of medial meniscal injuries," said Jeffrey Towers, M.D., lead author of the study and associate professor of radiology at the University of Pittsburgh Medical Center in Pennsylvania.
At first, Dr. Towers suspected that the unusually high percentage of lateral meniscal tears was associated with anterior cruciate ligament (ACL) tears. ACL tears are fairly common among elite college football players, and 80 percent of meniscal tears that occur in association with ACL tears are in the outer knee joint.

"Tackling is usually done from the outside of the knee, imparting a load that traps the lateral meniscus in addition to tearing the ACL," Dr. Towers said.

However, the study revealed that while 18 lateral and eight medial meniscal tears were found in conjunction with ACL tears, 36 lateral and 18 medial tears were isolated injuries. The findings also included evidence of three prior lateral tears.

"What we found is that almost three-quarters of the lateral meniscal tears were not in the setting of ACL tears," Dr. Towers said.

Dr. Towers believes that the discovery of this high incidence of lateral meniscal tears among elite athletes may have a significant impact on improving physicians' ability to diagnose and treat this condition.

"The fact that we found a concentration of lateral meniscal tears could mean that there's something about this sport that predisposes athletes to this injury," Dr. Towers said. "We found the highest incidence of lateral meniscal tears in linemen and defensive secondary players. Now that we recognize this, there may be ways to address the players who are most at risk for this injury."

In a second paper, Dr. Towers and colleagues identified for the first time an indirect sign of syndesmotic tear, a frequently misdiagnosed injury more commonly known as high ankle sprain. Currently, the condition is most commonly diagnosed by uncomfortable physical examination of the syndesmosis, a large ligament above the ankle.

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