Patient History
14M football player, knee injury
Findings
Cruciate Ligaments: High-grade sprain of the ACL with fragmented avulsion fractures at its insertion on the tibial eminences and the intercondylar notch.
PCL is buckled but intact.
Bones: Passive anterior tibial translation.
Contusional mildly depressed osteochondral fracture at the anterior weightbearing surface of the lateral femoral condyle at the terminal sulcus.
Contusion nondepressed osteochondral fractures involving the posterior weightbearing surfaces of the tibial plateaus.
Well-circumscribed, subcortical, lobulated, polycystic lesion located in the posterior aspect of the proximal tibial metadiaphysis with a narrow transition zone and associated osteoedema, without cortical breakthrough or periosteal reactions measuring 1.4cm x 1.8cm x 4.5cm (AP, transverse and CC) with diffuse enhancement and a thin sclerotic rim in keeping with a nonossifying fibroma (NOF).
Menisci:A 3 cm vertical longitudinal tear involving the upper surface of the medial meniscus body and anterior horn outer edge with disruption of the meniscocapsular junction and meniscofemoral ligament in keeping with a ramp 2 lesion.
Lateral meniscus is intact.
Medial Collateral Ligament: Low-grade sprain.
Lateral Collateral Ligament Complex: Torn arcuate and popliteofibular ligaments. Low-grade sprain of the popliteus myotendinous junction. Fibular collateral ligament and biceps tendon are intact.
Medial Compartment: No chondromalacia or osteoarthrosis. No osteochondral defects.
Lateral Compartment: No chondromalacia or osteoarthrosis. No osteochondral defects.
Anterior Compartment: No patellofemoral dysplasia. No patellar dislocation or subluxation. No osteochondral defects, chondromalacia or osteoarthrosis.
Extensor Compartment: Normal patellar and quadriceps tendons.
Flexor Compartment: Normal.
Unremarkable neurovascular bundle.
No soft tissue masses or cysts.
Large joint effusion/hemarthrosis without internal debris or free bodies.
Diffuse periarticular soft tissue swelling.
Impressions
1. Right knee pivot-shift injury with sprain of the ACL that remains attached to a fragmented and avulsed fracture at its insertion on the tibial eminences in the intercondylar notch. Passive anterior tibial translation.
2. Depressed osteochondral fragment of the anterior non weight bearing surface of the lateral femoral condyle at the terminal sulcus and the contusional nondisplaced microfractures at the posterior weight bearing surfaces of the tibial plateaus.
3. A 3 cm ramp 2 lesion of the body and anterior horn medial meniscus with disruption of the meniscofemoral ligament.
4. Torn arcuate and popliteofibular ligaments with low-grade sprain of the popliteus myotendinous junction at the posterolateral knee corner.
5. Large joint effusion/hemarthrosis with no internal debris or free bodies. Diffuse periarticular soft tissue swelling.
