Anterior Cruciate Ligament on MRI: Coronal View
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Knee anatomy.
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Cruciates.
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Anterior cruciate coronal projection on MRI,
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T2 MRI all the way in the back, posteriorly,
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where the insertion of the PCL in the deep posterior
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tibial notch below the tibial plateau is seen.
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But where is our ACL,
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which is a little bit thinner than the PCL?
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Well, it's starting to take off right there along the
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medial wall of the lateral femoral condyle.
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The next cut should show it to us.
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This is posterior. This is our cut.
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This is anterior. There's your ACL.
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There's your over-the-top position of your ACL.
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Let's keep following it forward.
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It should look like a water slide.
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It should be straight. The bundles,
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the anteromedial and posterolateral bundle.
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Posterior lateral being a little more substantive,
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should be parallel to one another.
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I'll allow a little bit of waviness to it as we age.
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The cruciate is also a little grayer as we age,
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but let's keep following it down.
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There's the anteromedial and posterolateral bundle.
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Keep going.
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Now they're starting to attach to the space
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between and anterior to the tibial spines.
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Now we're in front of the tibial spines,
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and the attachment is apparent.
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The coronal projection is your best projection for diagnosing
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tibial evulsion spine injuries to the ACL,
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but also distal ACL tears
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when there is a question in the sagittal projection.
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Let's keep going.
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Seeing the attachment on the surface of the tibia.
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And we said earlier that the ACL lies between the menisci.
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It certainly does.
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There's the anterior horn of the lateral meniscus.
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There's our attachment of the ACL.
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We also said earlier that there are some fibers from
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the ACL that go over towards the lateral meniscus.
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And there's one of them right there.
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This is a little harder to appreciate
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in the coronal projection than it was displayed in the sagittal projection.
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ACL in the coronal projection: straight
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water slide, pretty good for seeing the femoral component.
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Excellent for seeing the tibial component.
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Excellent for seeing accompanying tibial spine
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evulsions with injuries to the distal ACL.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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