54-year-old male with a twisting injury

Case
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Medial and lateral right knee pain. Instability. Limited range of motion. Swelling. Increased pain with weight. Partial weightbearing. All since one week twisted knee. No cortisone.

Long- and short-axis fat- and water-weighted images were performed.

  • ACL tear with pivot-shift injury. Stable nondisplaced depressed cortical and subcortical fracture of the lateral femoral terminal sulcus. Segond-type fracture or lateral capsular sign of the proximal lateral tibia. Comminuted mildly displaced cortical and subcortical fracture of the medial aspect of the fibular head. Stable slightly depressed subcortical fracture of the posterior aspect of the medial tibial plateau. Microtrabecular fracture of the posterior aspect of the lateral tibial plateau.
  • PCL MCL and LCL are intact. Swelling along the MCL and LCL consistent with grade 1 sprain. Flexors and extensors are intact. 
  • Lateral patellar tilt. Patella is laterally displaced. Remote fracture of the superomedial aspect of the patella. 2+ effusion. 
  • No medial meniscus or lateral meniscus tear. 
  • Posterolateral corner injury with injury to the popliteofibular ligament and arcuate ligament. Stressed inferior meniscopopliteal ligament and torn superior meniscopopliteal fascicle.
  • ACL tear with varus pivot-shift injury. Cortical and subcortical fractures of the lateral femoral terminal sulcus posterior medial and lateral tibial plateau. Segond-type fracture of the proximal lateral tibia. Cortical and subcortical fracture of the medial aspect of the fibular head. 
  • Posterolateral corner injury with injury to the popliteofibular ligament and arcuate ligament. Stressed inferior meniscopopliteal ligament and torn superior meniscopopliteal fascicle. 
  • Grade 1 sprain of the MCL and LCL. 

Related Diagnoses

Diagnosis Definitions

Anterior Cruciate Ligament (ACL) Tear

Knee, MSK, ACL tear,