 Hello everyone. My name is Dr. Rishikesh Ugra. I'm a third year resident in department of the radio diagnosis, Krishna Institute of Medical Sciences Karate. I'm going to present a paper on comparative evaluation of ultrasound and magnetic resonance imaging in detection and grading of sport-related ACL injuries using orthroscopy as a gold standard. So as we all know, internal injury of the knee joint accounts for almost half of the all sport injuries. Physical examination technique using the assessment of internal knee injury has its limitation and it lacks sufficient sensitivity and specificity. MRI represents the optimal imaging in the evaluation of knee injury which is far more accurate and is non-invasive method of diagnosing the ligament, meniscal, cartilage and muscular structures injury. Now ultrasound, it has been a little less popular as a diagnostic tool in the field of orthopedics. A normal anterior cruciate ligament is delineated as a hypoequic structure in sagittal and transverse sections on ultrasound. And cruciate ligaments of the knee, they can be seen on MRI imaging as a band of low signal intensity in contrast with high signal intensity of surrounding fat and other tissues. So aim of this study is to evaluate the role of ultrasoundography and MRI in ACL injury in the sports patients. So objectives, the objectives are to investigate the diagnostic accuracy of ultrasound and of MRI and comparing them with orthroscopy as a reference standard. So this is a cross-sectional and observational study. Total 42 patients were taken. So inclusion criteria is all the patients with clinical diagnosis of knee injury in sports were taken with the ACL injury based on the persistence of symptoms for minimum of 3 months. And the patients with previous history of any knee trauma, previous history of knee surgery and history of steroid injection in the affected knee were excluded. And the patients in whom MRI is contraindicated were also excluded from this study. So sonography, the ultrasound scans were performed on Siemens-Accusin ultrasound machine. We used a high frequency linear transducer. Now in order to examine the ACL knee joint has to be flexed more than 90 degree during its maximal internal rotation. On subject to section, the middle half of ACL is seen as a straight hyperquick band. And if there is no evidence of such a hyperquick structure and if there is associated joint diffusion, it is to be considered as ruptured ACL. On MRI, this examination was carried out on our Siemens-Magnetome-Avianto 1.5 tesla MR machine. The study procedure was the patient kept in supine position. The extremity coil was wrapped around the knee. The FOV was kept between 14 to 16 and 3 to 4 mm slices were obtained. And this imaging is done with a full extension in the neutral position. Now we have acquired T1 and T2 weighted images along with STER and PDFS images in porous axial and surgical sections. Now grading of ACL is done as grade 0 is intact ligament, grade 1 is a partial tier with less than 50% of disrupted fibres. Grade 2 is also a partial tier but with more than 50% of disrupted fibres. And grade 3 is a complete tier. Now these are the sets of images. In the first case, we can see this is a normal knee and we can see that we have a linear hyperquick band which represents the normal ACL. And in the knee with trauma, we can see that this band is replaced by a hyper-ecogenic thickened structure which represents a high grade partial thickness here. Now in the MRI T2 weighted MRI image, we can see the high grade partial thickness tier of the ACL in the same patient. In the next case, we can see in the right knee, we have a normal ACL and in the left knee with the history of trauma, we can see the ACL fibres, they are bulky and heterogeneous, representing the complete tier. Now in the same patient, we have a sagittal PDFS MRI image which is showing us a full thickness tier of the ACL. And in the third case, again, we have the normal ACL in the right knee and we can see a full thickness tier of ACL on the left side. The sagittal PDFS image in the same patient, we can also appreciate that there is full thickness tier of ACL. Now the observations, these observations were grouped under three categories, the ultrasound grading, MR grading and orthoscopic grading. Now we can see out of 42 patients, 25 patients were labeled as a grade 3 tier on ultrasound, 29 patients were labeled a grade 3 ACL injury on MR and orthoscopy its findings were like 29% patients out of 42 were having grade 3 tier. Now the agreement between ultrasound and orthoscopic findings, like on ultrasound 25% like 25 patients out of 42 were labeled as the grade 3 tier. However, the 29 patients out of the 42 patients were having the grade 3 tier in orthoscopy. So the above table and statistics shows us that there is a good agreement between the ultrasound and the orthoscopy. And as we can see in these tables, 29 patients out of 42 were given as a grade 3 ACL tier on MRI and 29 patients out of 42 were found out to be of grade 3 injury on orthoscopy. So now these above table and stats, they show us that there is a very good agreement between MRI and orthoscopic findings. Now the findings we have just seen, these are represented in a bar diagram in this slide. Now for ACL partial tier, that is a grade 1 and grade 2 injury. Now ultrasound it has a diagnostic accuracy of 84.61% and MRI had a diagnostic accuracy of 100%. Now when it comes to a complete tier that is grade 3 injury, now ultrasound will show a more diagnostic is showing a more diagnostic accuracy than it was showing in the cases of partial tier. Now when ultrasound is showing almost 90.48% of diagnostic accuracy in complete tier and MRI is showing almost 100% diagnostic accuracy in complete that is a grade 3 injuries. Now discussion on ultrasound out of 42 patient of ACL tier, 25 were found to have grade 3 tier, 6 of a grade 2 tier, 5 patients of grade 1 tier and 6 patients they were found to be normal. On MRI out of 42 patients of ACL injuries, 29 cases were having a grade 3 tier, 4 patients of grade 2, again 4 patients of grade 1 tier and 5 cases were found to be normal. On arthroscopy out of this 42 patients 29 patients were found with a grade 3 that is complete tier, 2 cases of grade 2 tier, 5 cases of grade 1 tier and 6 patients were found to be normal. Now coming to the conclusion of the study, now ultrasound can be used as a screening modality of choice for grading of this ACL injury. Why? Because it has a very good correlation, there was a very good correlation between what are the like the arthroscopic findings and ultrasound findings. Now it is easily available and it is a cheap modality. Now MRI, it is the most accurate tool in grading of the ACL tier but now MRI has a limitation of a cost and time. Now limitation of our study are that this study was conducted on a limited number of patient of 42 patients only and these normal patients they were not followed. These are the references. Thank you so much.