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FROM TODAY'S REPORTING
MRI EVALUATION OF A HIGH-GRADE LCL TEAR: WHAT TO LOOK FOR AND HOW TO REPORT
This case demonstrates the MRI assessment of a lateral collateral ligament (LCL) tear of the knee using a coronal PD fat-saturated sequence.
WHAT ARE THE KEY IMAGING FEATURES TO LOOK FOR LCL TEAR
PROXIMAL LCL SIGNAL
There is increased signal intensity at the femoral attachment of the LCL, indicating a tear and disruption of the ligamentous fibers.Â
FIBER DEFINITION
The fibers within the proximal LCL appear ill-defined.
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DISTAL LCL COMPARISON
The mid and distal LCL has a normal appearance (Green arrow) with well-defined fibers and low signal intensity. Use normal as an internal reference to diagnose abnormal.
TEAR GRADING
Grading is subjective and I would describe it as mild moderate or severe depending on the extent of fibre involvement. In this case the extent of abnormal signal and fiber disruption in the proximal LCL is consistent with a high-grade tear.
RUPTURE vs HIGH-GRADE TEAR
While the tear is severe, there is no complete discontinuity of the ligament. The remaining LCL does not exhibits a wavy appearance which you would expect to see if the ligament has ruptured from its attachment.
BONE INTEGRITY
Also, look at the bony attachment site for evidence of oedema or cortical disruption to assess for an avulsion fracture. In this case there is no abnormal bone marrow signal.
HOW TO REPORT IT
There is a high-grade tear of the proximal LCL at its femoral attachment without evidence of complete rupture or associated bony injury.
READ MORE
AJR MR Imaging of the Anatomy of and Injuries to the Lateral and Posterolateral Aspects of the Knee, Click HERE
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