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Insights into Imaging
Published in: Insights into Imaging 3/2013

Open Access 01-06-2013 | Pictorial Review

Spectrum of injuries associated with paediatric ACL tears: an MRI pictorial review

Authors: Jacob L. Jaremko, Zachary D. Guenther, Lennart B. O. Jans, Peter J. MacMahon

Published in: Insights into Imaging | Issue 3/2013

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Abstract

Objective

Magnetic resonance imaging (MRI) findings in anterior cruciate ligament (ACL) injury are well known, but most published reviews show obvious examples of associated injuries and give little focus to paediatric patients. Here, we demonstrate the spectrum of MRI appearances at common sites of associated injury in adolescents with ACL tears, emphasising age-specific issues.

Methods

Pictorial review using images from children with surgically confirmed ACL tears after athletic injury.

Results

ACL injury usually occurs with axial rotation in the valgus near full extension. The MRI findings can be obvious and important to management (ACL rupture), subtle but clinically important (lateral meniscus posterior attachment avulsion), obvious and unimportant to management (femoral condyle impaction injury), or subtle and possibly important (medial meniscocapsular junction tear). Paediatric-specific issues of note include tibial spine avulsion, normal difficulty visualising a thin ACL and posterolateral corner structures, and differentiation between incompletely closed physis and impaction fracture.

Conclusion

ACL tear is only the most obvious sign of a complex injury involving multiple structures. Awareness of the spectrum of secondary findings illustrated here and the features distinguishing them from normal variation can aid in accurate assessment of ACL tears and related injuries, enabling effective treatment planning and assessment of prognosis.

Teaching points

• The ACL in children normally appears thin or attenuated, while thickening and oedema suggest tear.
• Displaced medial meniscal tears are significantly more common later post-injury than immediately.
• The meniscofemoral ligaments merge with the posterior lateral meniscus, complicating tear assessment.
• Tibial plateau impaction fractures can be difficult to distinguish from a partially closed physis.
• Axial MR sequences are more sensitive/specific than coronal for diagnosis of medial collateral ligament (MCL) injury.
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Metadata
Title
Spectrum of injuries associated with paediatric ACL tears: an MRI pictorial review
Authors
Jacob L. Jaremko
Zachary D. Guenther
Lennart B. O. Jans
Peter J. MacMahon
Publication date
01-06-2013
Publisher
Springer Berlin Heidelberg
Published in
Insights into Imaging / Issue 3/2013
Electronic ISSN: 1869-4101
DOI
https://doi.org/10.1007/s13244-013-0250-z

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