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MR Evaluation of the "Arcuate" Sign of Posterolateral Knee Instability

¹ Department of Diagnostic Radiology, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, 344-2 Shinyong-dong, Iksan, Jeonbuk, 570-711, South Korea.
² Image Care of Troy, 451 Hoosick St., Troy, NY 12180.

View larger version (117K): [in a new window]   Fig. 1A. —50-year-old woman who was struck by automobile. Anteroposterior (A) and lateral (B) radiographs of knee show avulsed fracture fragments displaced upward from fibular head (arrow). This finding, known as "arcuate" sign, represents avulsion of posterolateral ligamentous complex.

View larger version (125K): [in a new window]   Fig. 1B. —50-year-old woman who was struck by automobile. Anteroposterior (A) and lateral (B) radiographs of knee show avulsed fracture fragments displaced upward from fibular head (arrow). This finding, known as "arcuate" sign, represents avulsion of posterolateral ligamentous complex.

View larger version (134K): [in a new window]   Fig. 2A. —33-year-old man who was in automobile crash. Lateral radiograph of knee shows avulsed fracture fragment displaced upward from fibular head (arrow).

View larger version (164K): [in a new window]   Fig. 1C. —50-year-old woman who was struck by automobile. Sagittal proton density—weighted MR image (TR/TE, 2700-20) shows avulsed fracture fragment of fibular head (arrow) attached to proximally retracted fibular collateral ligament and biceps femoris tendon.

View larger version (155K): [in a new window]   Fig. 2B. —33-year-old man who was in automobile crash. Coronal proton density-weighted MR image (TR/TE, 2950-20) shows small avulsed fracture fragment of fibular head (arrow) attached to proximally retracted fibular collateral ligament.

View larger version (140K): [in a new window]   Fig. 3A. —44-year-old man who was in automobile crash. Axial T2*-weighted gradient-echo MR image (TR/TE, 330/12; flip angle, 40°) shows diffusely increased signal intensity (asterisk) without visible posterolateral capsular structures. M = medial, L = lateral.

View larger version (163K): [in a new window]   Fig. 4B. —26-year-old man who was struck by automobile. Sagittal T2-weighted MR image (2950/90) shows incomplete avulsion of anterior cruciate ligament from its tibial attachment (black arrow) and rupture (asterisk) of posterior joint capsule (white arrows) at its distal portion with high-signal-intensity area.

View larger version (187K): [in a new window]   Fig. 1D. —50-year-old woman who was struck by automobile. Sagittal T2-weighted MR image (2950/90) shows complete avulsion of anterior cruciate ligament from its tibial attachment (arrow).

View larger version (160K): [in a new window]   Fig. 4C. —26-year-old man who was struck by automobile. Sagittal T2-weighted MR image (2950/90) shows tear of posterior cruciate ligament at its mid substance (arrow).

View larger version (167K): [in a new window]   Fig. 2C. —33-year-old man who was in automobile crash. Coronal (C) and sagittal (D) T2-weighted MR images (2950/90) show typical locations of bone bruises on both anteromedial femoral and tibial condyles (arrows). Dark, round nodular signal intensities (open arrow, C) suggest metallic artifacts from automobile crash. Cortical depression of anteromedial femoral condyle (arrowheads, D) and swelling of overlying soft tissue with few small artifacts (open arrow, D) may suggest direct impaction.

View larger version (145K): [in a new window]   Fig. 2D. —33-year-old man who was in automobile crash. Coronal (C) and sagittal (D) T2-weighted MR images (2950/90) show typical locations of bone bruises on both anteromedial femoral and tibial condyles (arrows). Dark, round nodular signal intensities (open arrow, C) suggest metallic artifacts from automobile crash. Cortical depression of anteromedial femoral condyle (arrowheads, D) and swelling of overlying soft tissue with few small artifacts (open arrow, D) may suggest direct impaction.

View larger version (133K): [in a new window]   Fig. 4A. —26-year-old man who was struck by automobile. Sagittal T2-weighted MR image (TR/TE, 2950/90) shows discontinuity of popliteus tendon at myotendinous junction (long arrow) and swelling of popliteus muscle with increased signal intensity (short arrow). Irregular thickened posterolateral capsule with increased signal intensity (arrowheads) can be seen.

View larger version (112K): [in a new window]   Fig. 3B. —44-year-old man who was in automobile crash. Coronal T2-weighted spin-echo MR image (TR/TE, 2950/90) shows discontinuity of lateral capsular ligament with some thickening of proximally retracted ligament (arrow). Abnormal area of bone marrow signal intensity can be seen in proximal tibia. M = medial, L = lateral.

View larger version (130K): [in a new window]   Fig. 4D. —26-year-old man who was struck by automobile. Lateral radiograph of knee shows very tiny fragment (black arrow) of avulsion fracture displacing superiorly from head of fibula. Note irregular surface at top of styloid process of the fibular head (white arrow) instead of smooth and well-corticated outline of styloid process on nontraumatic side (not shown).

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