Avulsion fractures of anterior and posterior cruciate ligaments

Case contributed by Prashant Kandel

Presentation

History of fall injury while working in garage and sustained injury over left knee 3 weeks back.

Patient Data

Age: 40 years
Gender: Male

There is ACL avulsion fracture of the tibial eminence involving the tibial attachment of ACL associated with adjacent edema. There is slight posterior displacement of the avulsed fracture fragment. There is low grade partial tear along the femoral attachment of ACL (Grade I).

There is PCL avulsion fracture of postero-lateral intercondylar surface of tibial plateau involving the tibial attachment of PCL associated with curly, wavy appearance of PCL and adjacent T2/ PD FS high signal intensity suggesting PCL partial tear with its loosening. There is upward displacement of the avulsed fracture fragment.

There is a linear, horizontal T2/ PD FS high signal intensity which doesn’t reach the articular surface involving the posterior horn of medial meniscus suggesting meniscal injury grade 2a.

There is T2/ PD FS heterogenous signal intensity with thickening and partial discontinuation (>50%) of its fibers involving the menisco-femoral ligament of medial meniscus suggesting MCL injury Grade 2.

There is simple linear fracture involving the epiphyseal region of the lateral tibial condyle.

There is supero-lateral bipartite patella.

There are multiple, linear T2/ PD FS high signal intensities in the femoral and tibial condyles suggesting edema.

There is mild knee joint effusion. There are few supra-patellar plicae.

There is fracture of tibial eminence corresponding with the tibial attachment of ACL.

There is also fracture of postero-lateral intercondylar surface of tibial plateau corresponding to the tibial attachment of PCL.

There are few, tiny fracture fragments seen at the site of above-mentioned fractures.

There is an accessory fragment noted at the superolateral aspect of patella suggesting bipartite patella.

Case Discussion

There is ACL avulsion fracture with involvement of most of the tibial eminence suggesting grade 3b – Meyers and McKeevers classification.

There is PCL avulsion fracture involving the tibial attachment of PCL associated with upward displacement of avulsed fracture fragment suggesting type II PCL avulsion fracture.

There are three main types of bipartite patella, among them the superolateral type is the most common one.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.