Fact-sheet: Anterior cruciate ligament injury
Updated on 09/17/2021 at 12:16 PM
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Definition
Complete or partial anterior cruciate ligament injury, generally post-traumatic.
Clinical features
Anterior drawer sign
Radiography
Anterior drawer sign on the lateral view.
Segond fracture: corresponds to an avulsion of the lateral tibial plateau, indicating an ACL tear.
Depression of more than 1.5-2 mm of the lateral femoral condyle sulcus.
Avulsion of the anterior tibial spine (especially in children)
CT
Generally not performed (MRI).
Fractures associated with ACL injury: Segond fracture, fracture of the posteromedial tibial plateau rim, lateral femoral condyle notch, avulsion of the anterior tibial spine.
If arthro-CT: assessment of associated chondral and meniscal lesions
MRI
Direct signs:
- discontinuity of the ACL fibers, complete or partial tear
- intermediate signal on T1, hyperintense on T2
- loss of parallelism between the ACL and Blumensaat's line.
Indirect signs:
- lateral femoral condyle notch with subchondral edema (hypo-T1/hyper-T2), and bone marrow edema in the posterior aspect of the underlying lateral tibial plateau
- avulsion of the anterior tibial spine (especially in children)
- anterior drawer sign
- Segond fracture
- increased PCL angulation.
Associated lesions to look for:
- Posterolateral corner injury
- Lateral meniscal tear more often than medial
Differential diagnosis
Mucoid degeneration of the ACL.
Bucket-handle meniscal tear