Anterior cruciate ligament tear - pediatric
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Large joint effusion. Ruptured Baker’s cyst.
Menisci are intact.
Periligamentous hyperintensity around the medial collateral ligament with hyperintensity of the medial meniscocapsular ligaments. There is mild hyperintensity around the proximal lateral collateral ligament although the lateral collateral ligament is intact.
Posterior cruciate ligament is intact. Near complete tear of the anterior cruciate ligament with redundant fibers within the anterior intercondylar notch, there is straightening of the lateral collateral ligament and 10mm of anterior tibial translation.
There is osteochondral impaction fracture of the lateral sulcus terminalis with associated cortical fracture (best demonstrated on the coronal T1) and mild articular surface depression. Further impaction fracture of the posterolateral tibial plateau. There is marrow edema predominantly within the non-weightbearing surface of the medial femoral condyle likely representing edema secondary to meniscocapsular injury although osteochondral impaction injury is also possible.
Partially imaged in the posterolateral femoral shaft is a lesion that is predominantly hyperintense and most likely represents a cortical desmoid or fibrous cortical defect. More superiorly is a similar partially imaged lesion.
Pivot shift mechanism of injury has resulted in a high-grade near complete tear of the anterior cruciate ligament with a grade II injury of the medial collateral ligament and grade I injury of the proximal lateral collateral ligament.