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Pediatrics
Diagnosis
Musculoskeletal
Trauma: Lower Extremity
ACL Injuries
ACL Injuries
Arthur B. Meyers, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Anterior cruciate ligament (ACL)

          • Definitions

            • ACL has anteromedial & posterolateral bundles
            • ACL tears can be complete or partial
              • Partial tears may involve single bundle

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • Gross Pathologic & Surgical Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Kushare I et al: High Incidence of Intra-articular Injuries With Segond Fractures of the tibia in the pediatric and adolescent population. J Pediatr Orthop. 41(8):514-9, 2021
                                  2. Adams AJ et al: Pediatric type II tibial spine fractures: addressing the treatment controversy with a mixed-effects model. Orthop J Sports Med. 7(8):2325967119866162, 2019
                                  3. Dingel A et al: Pediatric ACL tears: natural history. J Pediatr Orthop. 39(Issue 6, Supplement 1 Suppl 1):S47-9, 2019
                                  4. Green D et al: A new, MRI-based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and Mckeever. Knee Surg Sports Traumatol Arthrosc. 27(1):86-92, 2019
                                  5. Beck NA et al: ACL tears in school-aged children and adolescents over 20 years. Pediatrics. 139(3), 2017
                                  6. Zabierek S et al: Femoral avulsion fracture of ACL proximal attachment in male scuba diver: case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 25(4):1328-30, 2017
                                  7. Dunn KL et al: Early operative versus delayed or nonoperative treatment of anterior cruciate ligament injuries in pediatric patients. J Athl Train. 51(5):425-7, 2016
                                  8. Zbojniewicz AM et al: Post-operative imaging of anterior cruciate ligament reconstruction techniques across the spectrum of skeletal maturity. Skeletal Radiol. 45(4):517-30, 2016
                                  9. Grimberg A et al: Deep lateral notch sign and double notch sign in complete tears of the anterior cruciate ligament: MR imaging evaluation. Skeletal Radiol. 44(3):385-91, 2015
                                  10. Murali J et al: Congenital absence of the anterior cruciate ligament. Am J Orthop (Belle Mead NJ). 44(8):E283-5, 2015
                                  11. Kosaka M et al: Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue. Knee. 21(1):54-7, 2014
                                  12. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                  13. Ng AW et al: MRI diagnosis of ACL bundle tears: value of oblique axial imaging. Skeletal Radiol. 42(2):209-17, 2013
                                  14. Berruto M et al: Congenital absence of the cruciate ligaments. Knee Surg Sports Traumatol Arthrosc. 20(8):1622-5, 2012
                                  15. Lykissas MG et al: All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients: a surgical technique using a split tibial tunnel. Arthrosc Tech. 1(1):e133-9, 2012
                                  16. Meyers AB et al: Stump entrapment of the anterior cruciate ligament in late childhood and adolescence. Pediatr Radiol. 41(8):1040-6, 2011
                                  17. Milewski MD et al: Anterior cruciate ligament reconstruction in the young athlete: a treatment algorithm for the skeletally immature. Clin Sports Med. 30(4):801-10, 2011
                                  18. Samora WP 3rd et al: Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes. J Pediatr Orthop. 31(3):272-6, 2011
                                  19. Su WR et al: A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B. 20(1):17-21, 2011
                                  20. Van Dyck P et al: Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears? Skeletal Radiol. 40(6):701-7, 2011
                                  21. Yoo WJ et al: Growth plate disturbance after transphyseal reconstruction of the anterior cruciate ligament in skeletally immature adolescent patients: an MR imaging study. J Pediatr Orthop. 31(6):691-6, 2011
                                  22. Finlayson CJ et al: Current concepts of diagnosis and management of ACL injuries in skeletally immature athletes. Phys Sportsmed. 38(2):90-101, 2010
                                  23. Meyers AB et al: Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol. 194(2):476-84, 2010
                                  24. Laundre BJ et al: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. AJR Am J Roentgenol. 193(2):515-23, 2009
                                  25. Duc SR et al: Internal knee derangement assessed with 3-minute three-dimensional isovoxel true FISP MR sequence: preliminary study. Radiology. 246(2):526-35, 2008
                                  26. Park LS et al: Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol. 36(5):399-403, 2007
                                  27. Strub WM: The arcuate sign. Radiology. 244(2):620-1, 2007
                                  28. Brody JM et al: Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology. 239(3):805-10, 2006
                                  29. Prince JS et al: MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. AJR Am J Roentgenol. 185(3):756-62, 2005
                                  30. Accousti WK et al: Tibial eminence fractures. Orthop Clin North Am. 34(3):365-75, 2003
                                  31. Hall FM: Radiographic features of anterior cruciate ligament tear. Radiology. 222(2):576, 2002
                                  32. Campos JC et al: Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology. 219(2):381-6, 2001
                                  33. Pao DG: The lateral femoral notch sign. Radiology. 219(3):800-1, 2001
                                  34. Sanders TG et al: Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 20 Spec No:S135-51, 2000
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Anterior cruciate ligament (ACL)

                                          • Definitions

                                            • ACL has anteromedial & posterolateral bundles
                                            • ACL tears can be complete or partial
                                              • Partial tears may involve single bundle

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • Gross Pathologic & Surgical Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Kushare I et al: High Incidence of Intra-articular Injuries With Segond Fractures of the tibia in the pediatric and adolescent population. J Pediatr Orthop. 41(8):514-9, 2021
                                                                  2. Adams AJ et al: Pediatric type II tibial spine fractures: addressing the treatment controversy with a mixed-effects model. Orthop J Sports Med. 7(8):2325967119866162, 2019
                                                                  3. Dingel A et al: Pediatric ACL tears: natural history. J Pediatr Orthop. 39(Issue 6, Supplement 1 Suppl 1):S47-9, 2019
                                                                  4. Green D et al: A new, MRI-based classification system for tibial spine fractures changes clinical treatment recommendations when compared to Myers and Mckeever. Knee Surg Sports Traumatol Arthrosc. 27(1):86-92, 2019
                                                                  5. Beck NA et al: ACL tears in school-aged children and adolescents over 20 years. Pediatrics. 139(3), 2017
                                                                  6. Zabierek S et al: Femoral avulsion fracture of ACL proximal attachment in male scuba diver: case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 25(4):1328-30, 2017
                                                                  7. Dunn KL et al: Early operative versus delayed or nonoperative treatment of anterior cruciate ligament injuries in pediatric patients. J Athl Train. 51(5):425-7, 2016
                                                                  8. Zbojniewicz AM et al: Post-operative imaging of anterior cruciate ligament reconstruction techniques across the spectrum of skeletal maturity. Skeletal Radiol. 45(4):517-30, 2016
                                                                  9. Grimberg A et al: Deep lateral notch sign and double notch sign in complete tears of the anterior cruciate ligament: MR imaging evaluation. Skeletal Radiol. 44(3):385-91, 2015
                                                                  10. Murali J et al: Congenital absence of the anterior cruciate ligament. Am J Orthop (Belle Mead NJ). 44(8):E283-5, 2015
                                                                  11. Kosaka M et al: Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue. Knee. 21(1):54-7, 2014
                                                                  12. Merrow AC et al: Avulsion fractures of the pediatric knee. Pediatr Radiol. 44(11):1436-45; quiz 1433-6, 2014
                                                                  13. Ng AW et al: MRI diagnosis of ACL bundle tears: value of oblique axial imaging. Skeletal Radiol. 42(2):209-17, 2013
                                                                  14. Berruto M et al: Congenital absence of the cruciate ligaments. Knee Surg Sports Traumatol Arthrosc. 20(8):1622-5, 2012
                                                                  15. Lykissas MG et al: All-epiphyseal anterior cruciate ligament reconstruction in skeletally immature patients: a surgical technique using a split tibial tunnel. Arthrosc Tech. 1(1):e133-9, 2012
                                                                  16. Meyers AB et al: Stump entrapment of the anterior cruciate ligament in late childhood and adolescence. Pediatr Radiol. 41(8):1040-6, 2011
                                                                  17. Milewski MD et al: Anterior cruciate ligament reconstruction in the young athlete: a treatment algorithm for the skeletally immature. Clin Sports Med. 30(4):801-10, 2011
                                                                  18. Samora WP 3rd et al: Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes. J Pediatr Orthop. 31(3):272-6, 2011
                                                                  19. Su WR et al: A simple, modified arthroscopic suture fixation of avulsion fracture of the tibial intercondylar eminence in children. J Pediatr Orthop B. 20(1):17-21, 2011
                                                                  20. Van Dyck P et al: Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears? Skeletal Radiol. 40(6):701-7, 2011
                                                                  21. Yoo WJ et al: Growth plate disturbance after transphyseal reconstruction of the anterior cruciate ligament in skeletally immature adolescent patients: an MR imaging study. J Pediatr Orthop. 31(6):691-6, 2011
                                                                  22. Finlayson CJ et al: Current concepts of diagnosis and management of ACL injuries in skeletally immature athletes. Phys Sportsmed. 38(2):90-101, 2010
                                                                  23. Meyers AB et al: Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol. 194(2):476-84, 2010
                                                                  24. Laundre BJ et al: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. AJR Am J Roentgenol. 193(2):515-23, 2009
                                                                  25. Duc SR et al: Internal knee derangement assessed with 3-minute three-dimensional isovoxel true FISP MR sequence: preliminary study. Radiology. 246(2):526-35, 2008
                                                                  26. Park LS et al: Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol. 36(5):399-403, 2007
                                                                  27. Strub WM: The arcuate sign. Radiology. 244(2):620-1, 2007
                                                                  28. Brody JM et al: Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology. 239(3):805-10, 2006
                                                                  29. Prince JS et al: MRI of anterior cruciate ligament injuries and associated findings in the pediatric knee: changes with skeletal maturation. AJR Am J Roentgenol. 185(3):756-62, 2005
                                                                  30. Accousti WK et al: Tibial eminence fractures. Orthop Clin North Am. 34(3):365-75, 2003
                                                                  31. Hall FM: Radiographic features of anterior cruciate ligament tear. Radiology. 222(2):576, 2002
                                                                  32. Campos JC et al: Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology. 219(2):381-6, 2001
                                                                  33. Pao DG: The lateral femoral notch sign. Radiology. 219(3):800-1, 2001
                                                                  34. Sanders TG et al: Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics. 20 Spec No:S135-51, 2000