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

Jaremko JL, Guenther ZD, Jans LB, Macmahon PJ - Insights Imaging (2013)

Bottom Line: ACL injury usually occurs with axial rotation in the valgus near full extension.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.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. • 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Diagnostic Imaging, 2A2.42 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2B7, jjaremko@ualberta.ca.

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.

No MeSH data available.


Related in: MedlinePlus

Medial meniscus bucket handle tears. Coronal PD images of left knees in three teenagers show (a) normal medial meniscal body, (b, c) bucket handle tears. In b and c, the straight arrows point to irregular, torn medial meniscal body which is smaller than normal, and the curved arrows show the flipped portion of the medial meniscus which appears as an unexpected low signal structure below the PCL in the intercondylar region. This is the “bucket-handle”, which connects to the remainder of the meniscus near the anterior and posterior attachments
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Fig5: Medial meniscus bucket handle tears. Coronal PD images of left knees in three teenagers show (a) normal medial meniscal body, (b, c) bucket handle tears. In b and c, the straight arrows point to irregular, torn medial meniscal body which is smaller than normal, and the curved arrows show the flipped portion of the medial meniscus which appears as an unexpected low signal structure below the PCL in the intercondylar region. This is the “bucket-handle”, which connects to the remainder of the meniscus near the anterior and posterior attachments

Mentions: More serious injury to the medial meniscus is significantly more common later post ACL injury [1, 21, 22]. One possible explanation is that displaced flap tears or bucket handle tears of the medial meniscus may develop due to ongoing joint instability rather than occurring directly at time of initial injury. Bucket handle tears are recognised by a combination of findings (Fig. 5).Fig. 5


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

Jaremko JL, Guenther ZD, Jans LB, Macmahon PJ - Insights Imaging (2013)

Medial meniscus bucket handle tears. Coronal PD images of left knees in three teenagers show (a) normal medial meniscal body, (b, c) bucket handle tears. In b and c, the straight arrows point to irregular, torn medial meniscal body which is smaller than normal, and the curved arrows show the flipped portion of the medial meniscus which appears as an unexpected low signal structure below the PCL in the intercondylar region. This is the “bucket-handle”, which connects to the remainder of the meniscus near the anterior and posterior attachments
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675256&req=5

Fig5: Medial meniscus bucket handle tears. Coronal PD images of left knees in three teenagers show (a) normal medial meniscal body, (b, c) bucket handle tears. In b and c, the straight arrows point to irregular, torn medial meniscal body which is smaller than normal, and the curved arrows show the flipped portion of the medial meniscus which appears as an unexpected low signal structure below the PCL in the intercondylar region. This is the “bucket-handle”, which connects to the remainder of the meniscus near the anterior and posterior attachments
Mentions: More serious injury to the medial meniscus is significantly more common later post ACL injury [1, 21, 22]. One possible explanation is that displaced flap tears or bucket handle tears of the medial meniscus may develop due to ongoing joint instability rather than occurring directly at time of initial injury. Bucket handle tears are recognised by a combination of findings (Fig. 5).Fig. 5

Bottom Line: ACL injury usually occurs with axial rotation in the valgus near full extension.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.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. • 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Diagnostic Imaging, 2A2.42 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2B7, jjaremko@ualberta.ca.

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.

No MeSH data available.


Related in: MedlinePlus