Wk 5, Case 3 - Review

Patient History
15-year-old girl with twisting injury while playing volleyball 5 days prior. Rule out ACL tear.

Findings
Menisci:

Medial Meniscus: Posterior meniscocapsular tear (ramp 1 lesion).

Lateral Meniscus: Wrisberg rip longitudinal/ vertical outer third tear, extending approximately 1.0 cm in length.

Ligaments:

Anterior Cruciate Ligament: Complete ACL transection with anterior tibial translation consistent with ACL deficiency.

Posterior Cruciate Ligament: Intact.

Medial Collateral Ligament: Diffuse grade 3 injury involving the tibial collateral ligament, extending to involve the medial patellofemoral ligament, medial retinaculum, and meniscocapsular ligaments. Meniscocapsular detachment seen. Meniscofemoral ligament ruptured.

Lateral Collateral Ligament: Intact.

Posterolateral Corner Structures: Ruptured superior and inferior popliteal fascicles, swollen but intact (sprained) popliteofibular ligament, and sprained arcuate ligament. Biceps femoris tendon intact. Popliteus tendon and myotendinous junction intact. Low-grade lateral proximal soleus strain.

Posteromedial Corner Structures: Diffusely thickened swollen posterior oblique ligament with partial tear at the femoral attachment. Diffusely thickened swollen posteromedial capsule and oblique popliteal ligament. Posterior meniscocapsular disruption (ramp 1 lesion).

Extensor Mechanism:

Patellar Tendon: Intact.

Distal Quadriceps Tendon: Intact.
Medial Patellofemoral Ligament: Diffusely swollen lax medial patellofemoral ligament with high-grade injury at the femoral attachment.

Medial and Lateral Patellar Retinacula: Diffusely sprained medial retinaculum. Unremarkable lateral retinaculum.

Hoffa’s Fat Pad: Unremarkable.

Articulations:

Patellofemoral Compartment: Unremarkable.

Medial Compartment: Microtrabecular injury/osseous contusion posteromedial tibial plateau.

Lateral Compartment: Microtrabecular/osseous contusion injury with low-grade osteoedema posterolateral tibial plateau. Minimally depressed sulcus terminalis subchondral fracture with surrounding osteoedema.

General:

Bones: See above.

Effusion: Moderate-to-large sized hemarthrosis.

Baker’s Cyst: None.

Loose Bodies: None.

Soft tissue and neurovascular: Unremarkable.

Conclusion
Pivot-shift pattern of injury with the following findings:

1.Midsubstance ACL rupture (with anterior tibial translation).
2.Grade 3 MCL injury with severe laxity (involving tibial collateral ligament, meniscocapsular attachments, and rupture of the meniscofemoral ligament).
3.High-grade medial patellofemoral ligament injury and sprained medial patellar retinaculum.
4.Posteromedial corner injury with partial-thickness tear of the posterior oblique ligament, sprained oblique popliteal ligament (inferred) , and posterior meniscocapsular disruption (ramp 1 lesion).
5.Posterolateral corner injury with disrupted popliteal fascicles, sprained popliteofibular ligament and arcuate ligament.
6.Wrisberg rip lateral meniscus tear.
7.Minimally depressed sulcus terminalis subchondral fracture and corresponding osseous contusions of the posterolateral and posteromedial tibial plateau.
8.Moderate to large-sized hemarthrosis.