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Musculoskeletal
Diagnosis
Trauma
Knee
Ligaments
Anterior Cruciate Ligament Injury
Anterior Cruciate Ligament Injury
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Imaging

    • Pathology

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Anterior cruciate ligament tear/rupture

          • Definitions

            • Partial or complete functional disruption of anterior cruciate ligament (ACL) mechanism

          IMAGING

          • General Features

            • Radiographic Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Filbay SR et al: Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 33(1):33-47, 2019
                                      2. Griffith JF et al: Top-ten tips for imaging the ACL. Semin Musculoskelet Radiol. 23(4):444-52, 2019
                                      3. Lefevre N et al: Partial tears of the anterior cruciate ligament: diagnostic performance of isotropic three-dimensional fast spin echo (3D-FSE-Cube) MRI. Eur J Orthop Surg Traumatol. 24(1):85-91, 2014
                                      4. Park HJ et al: Comparison between arthroscopic findings and 1.5-T and 3-T MRI of oblique coronal and sagittal planes of the knee for evaluation of selective bundle injury of the anterior cruciate ligament. AJR Am J Roentgenol. 203(2):W199-206, 2014
                                      5. Ng AW et al: MRI diagnosis of ACL bundle tears: value of oblique axial imaging. Skeletal Radiol. 42(2):209-17, 2013
                                      6. Van Dyck P et al: Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis? Skeletal Radiol. 41(3):273-80, 2012
                                      7. Aglietti P et al: Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med. 38(1):25-34, 2010
                                      8. Smith TO et al: Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 18(3):304-11, 2010
                                      9. Todd MS et al: The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med. 38(1):63-7, 2010
                                      10. van Eck CF et al: Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc. 18(9):1184-8, 2010
                                      11. Brophy RH et al: Effect of anterior cruciate ligament reconstruction and meniscectomy on length of career in National Football League athletes: a case control study. Am J Sports Med. 37(11):2102-7, 2009
                                      12. Cohen SB et al: MRI measurement of the 2 bundles of the normal anterior cruciate ligament. Orthopedics. 32(9), 2009
                                      13. Giuliani JR et al: Anterior cruciate ligament anatomy: a review of the anteromedial and posterolateral bundles. J Knee Surg. 22(2):148-54, 2009
                                      14. Nin JR et al: Has platelet-rich plasma any role in anterior cruciate ligament allograft healing? Arthroscopy. 25(11):1206-13, 2009
                                      15. Sonnery-Cottet B et al: Arthroscopic identification of isolated tear of the posterolateral bundle of the anterior cruciate ligament. Arthroscopy. 25(7):728-32, 2009
                                      16. Sun K et al: Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Arthroscopy. 25(7):750-9, 2009
                                      17. Yoon KH et al: Standard anterior cruciate ligament reconstruction versus isolated single-bundle augmentation with hamstring autograft. Arthroscopy. 25(11):1265-74, 2009
                                      18. Cha JH et al: Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol. 37(9):821-6, 2008
                                      19. De Smet AA et al: Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. AJR Am J Roentgenol. 191(1):93-9, 2008
                                      20. Nishimori M et al: Articular cartilage injury of the posterior lateral tibial plateau associated with acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 16(3):270-4, 2008
                                      21. Vinson EN et al: Association of peripheral vertical meniscal tears with anterior cruciate ligament tears. Skeletal Radiol. 37(7):645-51, 2008
                                      22. Viskontas DG et al: Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med. 36(5):927-33, 2008
                                      23. Klass D et al: MR imaging of acute anterior cruciate ligament injuries. Knee. 14(5):339-47, 2007
                                      24. Starman JS et al: Assessment of normal ACL double bundle anatomy in standard viewing planes by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 15(5):493-9, 2007
                                      25. Petersen W et al: Partial rupture of the anterior cruciate ligament. Arthroscopy. 22(11):1143-5, 2006
                                      26. Stevens KJ et al: Anterior cruciate ligament tears and associated injuries. Top Magn Reson Imaging. 17(5):347-62, 2006
                                      27. 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
                                      28. Fayad LM et al: MR imaging of anterior cruciate ligament tears: is there a gender gap? Skeletal Radiol. 32(11):639-46, 2003
                                      29. Ho CP et al: MR imaging of knee anterior cruciate ligament and associated injuries in skiers. Magn Reson Imaging Clin N Am. 7(1):117-30, 1999
                                      30. Kaplan PA et al: Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology. 211(3):747-53, 1999
                                      31. Dimond PM et al: A comparison of MRI findings in patients with acute and chronic ACL tears. Am J Knee Surg. 11(3):153-9, 1998
                                      32. Roychowdhury S et al: Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images. AJR Am J Roentgenol. 168(6):1487-91, 1997
                                      33. Barry KP et al: Accuracy of MRI patterns in evaluating anterior cruciate ligament tears. Skeletal Radiol. 25(4):365-70, 1996
                                      34. Robertson PL et al: Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology. 193(3):829-34, 1994
                                      35. Jones AR et al: A deep lateral femoral notch as a sign of acutely torn anterior cruciate ligament. Injury. 24(9):601-2, 1993
                                      36. Remer EM et al: Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics. 12(5):901-15, 1992
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Synonyms

                                                • Anterior cruciate ligament tear/rupture

                                              • Definitions

                                                • Partial or complete functional disruption of anterior cruciate ligament (ACL) mechanism

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Demographics

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Filbay SR et al: Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 33(1):33-47, 2019
                                                                          2. Griffith JF et al: Top-ten tips for imaging the ACL. Semin Musculoskelet Radiol. 23(4):444-52, 2019
                                                                          3. Lefevre N et al: Partial tears of the anterior cruciate ligament: diagnostic performance of isotropic three-dimensional fast spin echo (3D-FSE-Cube) MRI. Eur J Orthop Surg Traumatol. 24(1):85-91, 2014
                                                                          4. Park HJ et al: Comparison between arthroscopic findings and 1.5-T and 3-T MRI of oblique coronal and sagittal planes of the knee for evaluation of selective bundle injury of the anterior cruciate ligament. AJR Am J Roentgenol. 203(2):W199-206, 2014
                                                                          5. Ng AW et al: MRI diagnosis of ACL bundle tears: value of oblique axial imaging. Skeletal Radiol. 42(2):209-17, 2013
                                                                          6. Van Dyck P et al: Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis? Skeletal Radiol. 41(3):273-80, 2012
                                                                          7. Aglietti P et al: Comparison between single-and double-bundle anterior cruciate ligament reconstruction: a prospective, randomized, single-blinded clinical trial. Am J Sports Med. 38(1):25-34, 2010
                                                                          8. Smith TO et al: Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 18(3):304-11, 2010
                                                                          9. Todd MS et al: The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med. 38(1):63-7, 2010
                                                                          10. van Eck CF et al: Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc. 18(9):1184-8, 2010
                                                                          11. Brophy RH et al: Effect of anterior cruciate ligament reconstruction and meniscectomy on length of career in National Football League athletes: a case control study. Am J Sports Med. 37(11):2102-7, 2009
                                                                          12. Cohen SB et al: MRI measurement of the 2 bundles of the normal anterior cruciate ligament. Orthopedics. 32(9), 2009
                                                                          13. Giuliani JR et al: Anterior cruciate ligament anatomy: a review of the anteromedial and posterolateral bundles. J Knee Surg. 22(2):148-54, 2009
                                                                          14. Nin JR et al: Has platelet-rich plasma any role in anterior cruciate ligament allograft healing? Arthroscopy. 25(11):1206-13, 2009
                                                                          15. Sonnery-Cottet B et al: Arthroscopic identification of isolated tear of the posterolateral bundle of the anterior cruciate ligament. Arthroscopy. 25(7):728-32, 2009
                                                                          16. Sun K et al: Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Arthroscopy. 25(7):750-9, 2009
                                                                          17. Yoon KH et al: Standard anterior cruciate ligament reconstruction versus isolated single-bundle augmentation with hamstring autograft. Arthroscopy. 25(11):1265-74, 2009
                                                                          18. Cha JH et al: Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol. 37(9):821-6, 2008
                                                                          19. De Smet AA et al: Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. AJR Am J Roentgenol. 191(1):93-9, 2008
                                                                          20. Nishimori M et al: Articular cartilage injury of the posterior lateral tibial plateau associated with acute anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc. 16(3):270-4, 2008
                                                                          21. Vinson EN et al: Association of peripheral vertical meniscal tears with anterior cruciate ligament tears. Skeletal Radiol. 37(7):645-51, 2008
                                                                          22. Viskontas DG et al: Bone bruises associated with ACL rupture: correlation with injury mechanism. Am J Sports Med. 36(5):927-33, 2008
                                                                          23. Klass D et al: MR imaging of acute anterior cruciate ligament injuries. Knee. 14(5):339-47, 2007
                                                                          24. Starman JS et al: Assessment of normal ACL double bundle anatomy in standard viewing planes by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 15(5):493-9, 2007
                                                                          25. Petersen W et al: Partial rupture of the anterior cruciate ligament. Arthroscopy. 22(11):1143-5, 2006
                                                                          26. Stevens KJ et al: Anterior cruciate ligament tears and associated injuries. Top Magn Reson Imaging. 17(5):347-62, 2006
                                                                          27. 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
                                                                          28. Fayad LM et al: MR imaging of anterior cruciate ligament tears: is there a gender gap? Skeletal Radiol. 32(11):639-46, 2003
                                                                          29. Ho CP et al: MR imaging of knee anterior cruciate ligament and associated injuries in skiers. Magn Reson Imaging Clin N Am. 7(1):117-30, 1999
                                                                          30. Kaplan PA et al: Bone contusions of the posterior lip of the medial tibial plateau (contrecoup injury) and associated internal derangements of the knee at MR imaging. Radiology. 211(3):747-53, 1999
                                                                          31. Dimond PM et al: A comparison of MRI findings in patients with acute and chronic ACL tears. Am J Knee Surg. 11(3):153-9, 1998
                                                                          32. Roychowdhury S et al: Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images. AJR Am J Roentgenol. 168(6):1487-91, 1997
                                                                          33. Barry KP et al: Accuracy of MRI patterns in evaluating anterior cruciate ligament tears. Skeletal Radiol. 25(4):365-70, 1996
                                                                          34. Robertson PL et al: Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology. 193(3):829-34, 1994
                                                                          35. Jones AR et al: A deep lateral femoral notch as a sign of acutely torn anterior cruciate ligament. Injury. 24(9):601-2, 1993
                                                                          36. Remer EM et al: Anterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiographics. 12(5):901-15, 1992