Sagittal T2-W MRI shows the avulsion fracture (arrow) of the | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

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 #FridayQuiz

More about this case

Resolved

Why you should join Figure 1

Similar cases



Sagittal FS T2-weighted MRI and lateral radiograph (prior post) show a displaced fracture of the tibial spine/intercondylar eminence (black arrows) with a large joint effusion (white arrows). The tibial fragment has been avulsed by the ACL (orange arrow), which is intact. Note the open growth plates of the femur and tibia. As opposed to the classic midsubstance ACL tears seen in older children/adults, this pattern of ACL injury is more frequently found in skeletally immature patients. #FridayQuizDay](https://app.figure1.com/case-detail/01a68688-88b0-4c0b-91a2-30ed5e7ef1f1)



Avulsion of the ACL](https://app.figure1.com/case-detail/41897be9-a50f-4151-aff7-a223e6ac5b50)



AP and lateral radiographs of the knee show a small avulsion fragment along the lateral aspect of the tibial epiphysis and a large knee effusion. This type of fracture represents an avulsion of the lateral collateral ligament and is known as a Segond fracture. It is important to recognize as it is almost always associated with an ACL injury. #MSKMonday](https://app.figure1.com/case-detail/55c9b20c-bfdd-46ec-8d3d-6babdb91ef7c)



Sagittal T2 FS MR image in the same patient shows a complete disruption of the mid to proximal anterior cruciate ligament (ACL). This is the typical ligamentous injury associated with a Segond fracture (as seen on the prior MR image). The Segond fracture is classically due to avulsion of the tibial attachment of the lateral capsular ligament. As in this case, avulsion fractures may show little underlying marrow edema. True ligamentous disruption of the ACL is much more common in adolescent girls than boys. #FridayQuizDay](https://app.figure1.com/case-detail/88174e65-5d4b-405e-99e5-182dd02e515b)