Anterior cruciate ligament tear with posteromedial corner injury, bucket-handle meniscal tear and chondral delamination
Presentation
Previous twisting injury.
Patient Data
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Complete proximal ACL tear, with fluid visible in the expected location of the proximal fibers.
Bucket-handle tear of the lateral meniscus.
Small non-displaced avulsion fracture of the posteromedial tibial plateau at the insertion of the semimembranosus tendon, with adjacent bone marrow and soft-tissue edema. The semimembranosus tendon appears strained but intact. Decreased volume and edema of the posterior horn of the medial meniscus near the posterior root. Some edema adjacent to the distal part of the posterior oblique ligament, but the ligament appears intact. The oblique popliteal ligament is intact.
Small horizontal tear of the free edge of the medial meniscal body.
Small area of chondral delamination in the centromedial part of the femoral trochlea, with discreet adjacent bone marrow edema.
Case Discussion
In this case several injuries are presented which have strong association with ACL tear:
- posteromedial corner injury of the knee: here relatively low-grade injuries are visible, involving the medial meniscus and the semimembranosus tendon
- bucket-handle meniscal tear
Chondral delamination is a result of shearing forces, which may occur during twisting injuries, causing separation of the cartilage from the subchondral bone. The overlying cartilage can initially look normally on imaging and at arthroscopy, as no chondral fissure may be present. However, the lesion may progress even to a full-thickness chondral defect, so careful assessment and reporting is important.
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