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MRI Appearance of Posterior Cruciate Ligament Tears

William Rodriguez, Jr.1, Emily N. Vinson1, Clyde A. Helms1 and Alison P. Toth2

1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.
2 Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.


Figure 1
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  		Fig. 1A —54-year-old man with normal posterior cruciate ligament (arrows). Sagittal fat-suppressed proton density–weighted MR image (TR/TE, 1,800/17) shows smooth, thin, continuous band of low signal intensity typical of normal posterior cruciate ligament.

 

Figure 2
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  		Fig. 1B —54-year-old man with normal posterior cruciate ligament (arrows). Sagittal fat-suppressed T2-weighted MR image (3,500/52) in same plane as A shows smooth, thin band of low signal intensity. Anteroposterior measurement of vertical segment is 4 mm, which is within range of normal.

 

Figure 3
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  		Fig. 2A —43-year-old woman with knee pain after injury sustained while playing softball. Sagittal fat-suppressed proton-density MR image (TR/TE, 2,000/20) shows abnormally thickened posterior cruciate ligament (PCL) (arrows) with increased signal intensity within ligament.

 

Figure 4
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  		Fig. 2B —43-year-old woman with knee pain after injury sustained while playing softball. Sagittal fat-suppressed T2-weighted MR image (3,500/69.1) shows abnormally thickened PCL (arrows) with anteroposterior measurement of 10 mm, which appears to maintain continuity as one structure. Signal intensity of PCL is relatively low in contrast to appearance in A.

 

Figure 5
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  		Fig. 2C —43-year-old woman with knee pain after injury sustained while playing softball. Coronal fat-suppressed T2-weighted MR image (3,000/69.2) shows markedly thickened PCL (arrows) in region of genu. At surgery, PCL was present and intact to probing though lax on posterior drawer test performed during arthroscopy. One operative diagnosis was PCL tear.

 

Figure 6
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  		Fig. 3A —17-year-old girl with knee pain after motor vehicle crash. Sagittal fat-suppressed proton density–weighted MR image (TR/TE, 2,000/20) of posterior cruciate ligament (PCL) near femoral attachment shows abnormal thickening (arrow) with intrasubstance fluid signal intensity.

 

Figure 7
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  		Fig. 3B —17-year-old girl with knee pain after motor vehicle crash. Sagittal fat-suppressed proton density–weighted MR image (2,000/20) of PCL one image plane lateral to A reveals abnormal thickening (arrows) with longitudinally oriented striations of fluid signal intensity.

 

Figure 8
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  		Fig. 3C —17-year-old girl with knee pain after motor vehicle crash. Sagittal fat-suppressed proton density–weighted MR image (2,000/20) of PCL tibial attachment immediately lateral to B shows abnormal thickening with intrasubstance striations (arrows) of fluid signal intensity. Lack of complete ligamentous disruption of this torn PCL is evident.

 

Figure 9
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  		Fig. 3D —17-year-old girl with knee pain after motor vehicle crash. Sagittal fat-suppressed T2-weighted MR image (3,500/69) of PCL in same imaging plane as B reveals abnormal thickening with striations (arrows) of intermediate signal intensity. Intrasubstance signal intensity appears relatively lower than in B. Anteroposterior measurement of this vertical segment is 10 mm, which is abnormal. At surgery, this PCL was described as torn. Patient underwent anterior cruciate ligament, PCL, and posterolateral corner reconstructions.

 

Figure 10
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  		Fig. 4 —59-year-old woman with knee pain after motor vehicle crash. Sagittal fat-suppressed T2-weighted MR image (TR/TE, 4,000/70) of posterior cruciate ligament (PCL) shows tibial avulsion fracture. Thin piece of cortical bone (arrow) is avulsed from tibia at insertion of PCL. PCL is redundant and retracted proximally.

 

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