Presentation
Knee pain and instability following trauma.
Patient Data
Age: 20 years
Gender: Male
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Coronal PD fat sat
Complete disruption of MCL (grade 3 injury) involving the distal tibial attachment with displacement of the distal MCL superficial to pes anserinus reflecting a Stener-like injury injury pattern.
Further injuries:
- complete ACL tear
- partial tear of PCL near the tibial insertion
- bucket-handle tear of the posterior horn of lateral meniscus with very thin peripheral remnant with the displaced segment is located in the intercondylar notch and posterior to the anterior ho
- radial tear in the periphery of the anterior horn of lateral meniscus
- multidirectional tear of the posterior horn of medial meniscus
- edema and irregularity in the place of OPL, POL, posterior capsule, popliteofibular ligament, fibular insertion of biceps femoris tendon, distal of ITB and tibial insertion of semimembranous tendon suggestive of injury
- grade 1 and 2 muscle injuries according to the BAMIC/BAC classification more prominent in popliteus and anterior tibialis muscles
- bone marrow edema/contusion in tibial plateau, fibular head and medial femoral condyle
Case Discussion
Stener-like lesions of medial collateral ligament avulsions, most often with pes anserinus interposition, are frequently associated with multiligamentous injury. MRI diagnosis is important because interposition prevents healing and particularly if the anterior cruciate ligament is involved secondary valgus instability is suspected and often necessitates surgical repair or reconstruction.
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