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MRI of Anterior Cruciate Ligament Injuries and Associated Findings in the Pediatric Knee: Changes with Skeletal Maturation

¹ Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.
³ Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.

View larger version (141K): [in a new window]   Fig. 1A —Coronal turbo or fast spin-echo proton density-weighted images show examples of categories of skeletal maturity. Image of 9-year-old boy from group 1 shows cartilage signal intensity across entire physis (arrow).

View larger version (150K): [in a new window]   Fig. 1B —Coronal turbo or fast spin-echo proton density-weighted images show examples of categories of skeletal maturity. Image of 14-year-old boy from group 2 shows incomplete physeal signal (arrow), but physeal plane is still visible.

View larger version (101K): [in a new window]   Fig. 1C —Coronal turbo or fast spin-echo proton density-weighted images show examples of categories of skeletal maturity. Image of 18-year-old girl from group 3 shows no physeal signal intensity can be seen.

View larger version (153K): [in a new window]   Fig. 2A —Types of anterior cruciate ligament (ACL) injury. Sagittal fast spin-echo proton density-weighted image shows complete midsubstance tear with both abnormal course and increased signal intensity of ACL in 17-year-old boy (group 2).

View larger version (132K): [in a new window]   Fig. 2B —Types of anterior cruciate ligament (ACL) injury. Sagittal turbo spin-echo proton density-weighted image shows normal course but abnormal high internal signal consistent with partial tear of ACL in 15-year-old boy (group 2).

View larger version (175K): [in a new window]   Fig. 2C —Types of anterior cruciate ligament (ACL) injury. Sagittal turbo spin-echo T2-weighted image shows avulsion fracture of tibial spine (arrow) and hemarthrosis (asterisk) in 12-year-old boy (group 1). ACL has normal course, but abnormal internal signal from associated partial tear.

View larger version (186K): [in a new window]   Fig. 3 —Associated meniscal injuries. Sagittal conventional spin-echo proton density-weighted image in 14-year-old girl (group 2) with complete anterior cruciate ligament tear shows complex tear of posterior horn of medial meniscus.

View larger version (133K): [in a new window]   Fig. 4A —Ligamentous injuries associated with anterior cruciate ligament injuries. Coronal turbo spin-echo proton density-weighted image in 17-year-old boy (group 2) shows high signal adjacent to medial femoral condyle and discontinuity of medial collateral ligament (arrow).

View larger version (168K): [in a new window]   Fig. 4B —Ligamentous injuries associated with anterior cruciate ligament injuries. Sagittal conventional spin-echo proton density-weighted image in 15-year-old boy (group 2) shows buckled, thickened posterior cruciate ligament with abnormal increased signal intensity.

View larger version (140K): [in a new window]   Fig. 5 —Joint effusions. Axial fast spin-echo T2-weighted image shows lipohemarthrosis in 11-year-old boy (group 1) with fluid-fluid levels of three different signal intensities. Anterior or top layer (arrow) is of low signal intensity on this fat-saturated image.

View larger version (143K): [in a new window]   Fig. 6A —Secondary imaging findings. Sagittal fast spin-echo T2-weighted image through lateral condyle of 14-year-old boy (group 1) shows MRI correlate of deep lateral condylar sulcus sign (arrow): "lateral femoral condylar notch sign."

View larger version (146K): [in a new window]   Fig. 6B —Secondary imaging findings. Sagittal fast spin-echo T2-weighted image in 16-year-old girl (group 3) shows bone marrow contusion as high signal in marrow of lateral femoral condyle and posterior aspect of lateral tibial plateau.

View larger version (150K): [in a new window]   Fig. 6C —Secondary imaging findings. Sagittal fast spin-echo proton density-weighted image in 13-year-old girl (group 1) shows measurement of anterior tibial translation. In this patient with complete tear of anterior cruciate ligament, there is 17 mm of translation (between vertical lines).

View larger version (174K): [in a new window]   Fig. 6D —Secondary imaging findings. Sagittal conventional spin-echo proton density-weighted image in 16-year-old girl (group 3) with complete tear of anterior cruciate ligament shows uncovering of posterior horn of lateral meniscus (dashed line).

View larger version (147K): [in a new window]   Fig. 6E —Secondary imaging findings. Coronal fast spin-echo T2-weighted image of 14-year-old boy (group 1) (same patient as in A) shows Segond fracture (arrow).

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