ACL impaction injury

Case
A 34-year-old female recreational football player sustained an acute injury to her left knee during a game. She felt a popping sensation when she planted and pivoted, followed by immediate pain and swelling. She was unable to continue playing. On examination she was found to have a positive Lachman test and a pivot glide. There was also tenderness at the posterior lateral tibial plateau.

Findings
X-rays showed no fractures or dislocations. A subsequent MRI demonstrated a complete femoral avulsion of the ACL with Increased signal within the lateral femoral condyle and posterior tibial plateau. This high signal is consistent with osseous contusions/impaction injury.

Discussion
This player elected to have an ACL reconstruction and had an uncomplicated recovery. The impaction injury does not require any specific management.

Bone contusions (bruises) in association with acute ACL tears are a common finding on MRI, seen in about 70% of cases. These injuries are generally best seen on T2 weighted or STIR images. The location of the contusion correlates with the mechanism of injury and position of the knee. With a flexed knee/pivoting stress the bone bruises typically occur at the lateral femoral condyle and posterior tibial plateau. A hyperextension mechanism may result in contusions of the anterior femur and tibial plateau. Contusions seen on the medial side are more often associated with multi-ligament injuries.

While the presence of bone bruises may cause increased pain, there is no correlation between the presence of bone bruises and functional outcomes during rehabilitation. It is however unclear whether there is an increased risk of developing long-term chondral lesions and associated osteoarthritis when these bone bruises are present.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Bangoura
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Bangoura

TOUTE ENTORSE GRAVE DU GENOU PEUT ENTRAINER PROBABLEMENT UNE LESION DU LCA FREQUENTE EN FOOT BALL ET SKY CETTE BLESSURE COMPROMET LA STABILITE ANTERIEUR DU GENOU POUR AUTANT L INTERVENTION CHIRURGICALE N EST PAS SYSTEMATIQUE. L ARTICULATION DU GENOU COMPREND LES 02 LIGAMENTS LATERAUX ET LES 02 LIGAMENTS CROISES(ANTERIEUR ET POSTERIEUR) .TOUTE ENTORSE OU LUXATION DU GENOU PEUT LESER UN OU LES 02 LIGAMENTS CROISES. ET ENTRAINER UNE INSTABILITE CHRONIQUE DU GENOU.. EN SKY LES FEMMES SONT PLUS EXPOSEES A LA RUPTURE DU LCA EN PERIODE OVULATOIRE. LA RUPTURE DU LCA EST L APANAGE DU FOOTBALL HANDBALL TENIS RUGBY JUDO.… Read more »

Dr. Mohamed Farrag
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Dr. Mohamed Farrag

Proximal ACL origin tear