Presentation
Pain and swelling of the knee with limited range of motion. History of anterior cruciate ligament reconstruction two years ago.
Patient Data
Relative anterior position of the tibial tunnel in relation to the Blumensaat line.
The reconstructed anterior cruciate ligament graft is thickened, showing intrasubstance interstitial signal, yet no evidence of complete fibres disruption.
Mottled heterogeneous signal of opposing tibial and femoral articular surfaces, eliciting high STIR signal possibly representing reflex sympathetic dystrophy.
Torn posterior horn of the medial meniscus.
Mild knee joint effusion.
Case Discussion
Anterior cruciate ligament graft roof impingement is one of the complications of anterior cruciate ligament reconstruction. In this case, the anterior position of the tibial tunnel, located anterior to the Blumensaat line (a line drawn along the roof of the intercondylar notch of the femur), along with the elevated signal of the graft near its femoral attachment, raises the possibility of roof impingement.
Impingement of the anterior cruciate ligament graft can result in graft tear due to shearing forces.
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