ACL graft partial tear with semimembranosus bursitis

Case contributed by Ali Alsmair
Diagnosis almost certain

Presentation

Limping, knee pain, history of ACL graft reconstruction, to assess the ACL graft.

Patient Data

Age: 45 years
Gender: Male

Anterior tibial translation is noted (about 10 mm).

There is an area of longitudinal increased signal intensity resembling that of intrasubstance fluid within the distal intraarticular portion of the ACL graft, measuring about 16 mm in length, indicative of a partial ACL graft tear. Normal alignment of the ACL graft. No complete tear.

The PCL is diffusely thickened with increased signal intensity on T1, PD and fat-sat images, with intact fibers, consistent with PCL mucoid degeneration.

Signs of sutural repair and thinning of the posterior horn of the medial meniscus.

8 x 10 x 23 mm well-defined fluid around the semimembranosus tendon, consistent with semimembranosus bursitis.

2.5 x 10 x 37 mm Baker cyst is noted.

Type A femoral trochlear dysplasia is noted, with lateral patellar subluxation (about 8 mm).

Minimal joint effusion.

Case Discussion

The patient was previously operated on for ACL and meniscal injury. Now he has new symptoms explained by ACL graft partial injury and semimembranosus bursitis.

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