Cruc Ligament

8/13/2019 Cruc Ligament

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Imaging anterior cruciate

ligament tear helpful tips

Imaging anterior cruciate

ligament tear helpful tips

James F Griffith

Department of Imaging and Interventional Oncology

The Chinese University of Hong Kong

Prince of Wales Hospital

Anatomy

ACL

Anatomy

ACL

AM PL

Anterior tibialateral femoral condyle

Anteromedial and posterolateral bundles

Intermediate bundle

Encased in synovial envelope

Intra-articular but extra-synovial in location

Limited blood supply from medial geniculate a.

AnatomyAnatomy

Bundles act synergistically to prevent anterior tibialtranslation in flexion and extension

Contributes to screw home movement. Femurrotates medially at end of extension

Normal ACL obl sagittal planeNormal ACL obl sagittal plane

450

Oldrini GetalSkel Radiol 2012

Normal ACL coronal & axial planeNormal ACL coronal & axial plane

LFC

*LFC

*

Normal ACL oblique coronal planeNormal ACL oblique coronal plane

LFC

HongSHetalJCompTom2003


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Normal ACL oblique axial planeNormal ACL oblique axial plane

NgAWetalSkel Radiol 2011

Oblique axial imaging ACLOblique axial imaging ACL

anteromedialMFCanteromedial

Tibial insertion

posterolateral

LTC

posterolateral

NgAW,GriffithJF etalSkel Radiol 2011


LFC

anteromedialanteromedial

osterolateral posterolateral

Mid-substance

LTC



LFC

anteromedial

anteromedial

Femoral attachment

posterolateral

posterolateral


Oblique axial intermediate bundleOblique axial intermediate bundle

NgAWetalSkel Radiol 2011

ACL tearACL tear

Most commonly torn ligament in the knee

Typical mechanism : knee rotation with ankle

flexed

Only a few fibrescomplete tear Majority (~85%) are complete tears

Usually occur close to femoral attachment


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Clinical testsClinical tests

LachmannAnterior drawer Pivot shift

Anterior drawer / Lachmann test anterior instability

Pivot shift tests anterolateral instability

Pivot shift best most reliable indicator of ACL injury

ACL tear completeACL tear complete

DiscontinuityOedematous mass Mal-alignment

ACL tear completeACL tear complete

Mal-alignment with

attenuation

Mal-alignment with

re-attachment

Complete attrition

Anterior translationAnterior translation

>5mm

NgA,GriffithJFetalClin Imaging2012

Do mention in report as is associated with clinical instability

MRI imaging scenariosMRI imaging scenarios

Unequivocal ACL tearstop

Probable complete tear i.e. there is a severeear u s comp e e exon v ew

Probable partial tear i.e. there may be a tear but

how bad is it oblique axial view

Knee flexionKnee flexion

FlexionFlexion

Anterior synovial thickening

ExtensionExtensionExtensionExtension


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Complete ACL tear

FlexionFlexionExtensionExtension


High grade partial ACL tear

FlexionFlexionExtensionExtension

Partial ACL tearPartial ACL tear

50%) functionally unstableLow grade ( AM



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Partial ACL tear oblique axial viewPartial ACL tear oblique axial view

Partial AM with complete PL


ACL avulsion fractureACL avulsion fracture

ACL avulsion fracture very variableACL avulsion fracture very variable

GriffithJFetal,Arthroscopy2002

ACL avulsion fractureACL avulsion fracture

Mucoid degeneration & ganglion cystMucoid degeneration & ganglion cyst

Preservation of linear striations

Celery stick sign

Frequently with mucoid degeneration PCL

Mucoid degenn Mucoid degenn Ganglion cyst

ConclusionConclusion

ACL = still not an uncommon cause of contention

If unsure about complete ACL tearflexion view

If unsure about partial ACL tearaxial oblique view

Thank you!

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Cruc Ligament