2 back to back patients. Image 1 shows intact ACL (orange ar | Figure 1

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2 back to back patients. Image 1 shows intact ACL (orange arrow). Image 2 shows disarray of ACL with essentially full thickness tear.

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30m 18 months post ACL repair

30 yo M presents four days after L ACL tear and possible patellar tendon rupture. Positive drawer sign. Severe swelling, ecchymoses both anteriorly and posteriorly, and inability to flex and extend knee. Reports past history of b/l ACL tears.

Sagittal T2-W MRI shows the avulsion fracture (arrow) of the tibial spine and a large lipohemarthrosis (arrowhead). The lipohemarthrosis causes a parfait effect with blood layering most dependently (furthest from the arrowhead), effusion fluid in the middle, and fat floating on top. Tibial spine avulsion fractures are associated with anterior cruciate ligament (ACL) injuries. The ACL originates from the medial and anterior aspect of the tibial plateau and inserts on the lateral femoral condyle. Children are more likely to have tibial spine avulsions than an ACL rupture because the bone is weaker than the ligament. #FridayQuizDay #Quiz

Sagittal T2 weighted MR of the knee in an adolescent shows disruption of the anterior cruciate ligament (arrow). ACL injuries typically occur when an athlete pivots and a valgus stress is applied to the knee in flexion. ACL injuries are more common in boys when the physis is not completely closed (as in this case). #MSKMonday