Patient History
Evaluate for ACL tear and meniscus tear. Injury 1 week ago, jumped and felt a pop. Pain in the medial aspect.
Findings
ACL and PCL are intact.
Medial Compartment: Thin and delicate trizonal 5cm vertical longitudinal tear involving the upper surface extending from the posterior horn to the body-anterior horn junction with displacement of the inner fragment into the intercondylar notch giving the appearance of a “double PCL” and displacing the anterior meniscal horn anteriorly to the tibial rim “double anterior horn.” No parameniscal cysts. Also on sagittal views, there is an absent bow-tie sign and there is a disproportionately small posterior horn.
No osteochondral injuries, chondromalacia or osteoarthritis. The medial collateral ligament is intact.
Lateral Compartment: No meniscal tears. No osteochondral injuries, chondromalacia or osteoarthritis. The lateral collateral ligament complex is intact.
Anterior Compartment: No patellofemoral dysplasia, osteochondral injuries, chondromalacia or osteoarthritis. Normal medial patellofemoral ligament and lateral patellar retinaculum.
Proximal Tibiofibular Joint: Normal.
Large joint effusion or hemarthrosis without internal debris or free bodies.
Extensor Compartment: Normal quadriceps and patellar tendons.
Flexor Compartment: Tiny fluid distension of the gastrocnemius/semimembranosus bursa. The rest of the flexor mechanism and neurovascular bundle are unremarkable.
Mild diffuse periarticular soft tissue swelling.
Impressions
1. Thin and delicate trizonal 5cm vertical longitudinal tear involving the upper surface of the posterior horn to the body-anterior horn junction with displacement of the inner fragment into the intercondylar notch with displacement of the anterior meniscal horn anteriorly to the tibial rim in keeping with a giant bucket-handle meniscal tear.
2. No pivot-shift injury of the left knee. Intact cruciate ligaments.
3. Large joint effusion or hemarthrosis without internal debris or free bodies.
