AP and lateral radiographs of the knee show a small avulsion | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

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


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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

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

19 year old football player presents with knee pain after being tackled. Physical exam findings were positive for swelling and a positive anterior drawer test (anterior translation of the tibia with respect to the femur). Sagittal T2 MRI demonstrates extensive edema and a mid substance ACL tear (arrow). Associated findings not shown include a classic pattern of bone bruising involving the lateral femoral condyle and the posterolateral tibial plateau. Key point: the ACL is the most commonly injured ligament of the knee, especially in athletes.