Multi-ligamentous knee injury - ACL, MCL, fibular collateral

Case contributed by Dr Dai Roberts


Lost control skiing, heard pop and immediate pain in knee.

Patient Data

Age: 25 years
Gender: Male

Complete ACL tear with a pivot shift injury pattern and an impacted posterolateral tibial plateau fracture.  

Horizontal longitudinal tear of the mid and posterior thirds of the medial meniscus.  High grade, if not complete, MCL injury with marked overlying edema.  Bone edema is evident in the medial aspect of the medial tibial plateau. 

Displaced segond fracture.   The fibular collateral ligament and distal popliteus tendon are thickened and edematous due to partial-thickness tearing.  No displaced lateral meniscus tear.

Large knee joint effusion and extensive surrounding subcutaneous edema.  

Case Discussion

A structured approach to reporting multi-ligament knee injuries will aid the reporter and ensure all injuries are identified, with often distracting edema in the soft tissues.  

ACL and MCL tears can occur together, and the fibula collateral ligament makes up one of the lateral collateral stabilizing structures.  The O'Donoghue unhappy triad is one such collection of injuries.

Segond fractures, easier to appreciate on radiographs, are associated with ACL tears. Its radiographic finding should alert the reader to recommend an MRI.

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Case information

rID: 77809
Published: 13th Jun 2020
Last edited: 29th Jul 2020
Inclusion in quiz mode: Included

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