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Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?

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Abstract

Purpose

To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee.

Materials and methods

MR images of 97 patients with surgically confirmed ACL tear were retrospectively reviewed. According to arthroscopic and clinical examination, these patients had 36 stable and 61 unstable (9 partial and 52 complete) ACL tears. MR images were interpreted by two blinded reviewers and scored with respect to previously reported primary and secondary MR signs of ACL injury. Based on a comprehensive assessment of all the MR findings, ACLs were categorized as being stable or unstable. MR accuracy was calculated considering only primary MR signs and considering both primary and secondary MR signs of ACL injury, separately. Accuracy of each individual primary and secondary MR sign was calculated.

Results

Considering only primary MR signs, sensitivity, specificity, and accuracy of MR were 77, 92, and 82%, respectively. Considering both primary and secondary MR signs, sensitivity, specificity, and accuracy of MR were 59, 81, and 67%, respectively. Of all MR signs, discontinuity and abnormal orientation had highest test accuracy (79 and 87%, respectively). Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL were only seen in unstable ACLs (specificity 100%), but these secondary findings had low sensitivity (23%). Bone contusion around the lateral knee compartment was seen in both unstable and stable ACLs (accuracy 64%).

Conclusion

Previously reported MR imaging signs do not allow accurate distinction between clinically stable and unstable ACL injuries. Anterior tibial translation, uncovering of the posterior horn of the lateral meniscus, and hyperbuckled PCL, if present, are helpful signs in the diagnosis of an unstable tear. The presence of bone marrow edema around the lateral knee compartment is not predictive of ACL insufficiency.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Pieter Van Dyck, Jan L. Gielen, Filip M. Vanhoenacker & Paul M. Parizel

  2. Department of Radiology, AZ St-Maarten Duffel/Mechelen, Rooienberg 25, 2570, Duffel, Belgium

    Filip M. Vanhoenacker

  3. Department of Scientific Coordination and Biostatistics, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Kristien Wouters

  4. Department of Orthopedics, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Lieven Dossche

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  1. Pieter Van Dyck
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  2. Jan L. Gielen
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  4. Kristien Wouters
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Correspondence to Pieter Van Dyck.

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Van Dyck, P., Gielen, J.L., Vanhoenacker, F.M. et al. Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?. Skeletal Radiol 41, 273–280 (2012). https://doi.org/10.1007/s00256-011-1169-4

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  • DOI: https://doi.org/10.1007/s00256-011-1169-4

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