pcl avulsion fracture ct

101, No. Biceps femoris tendon avulsion fracture. Arcuate complex avulsion fracture. There is edema within the adjacent bone marrow. Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device Clemens Gwinner, M.D., Sebastian Kopf, M.D., Arnd Hoburg, M.D., Norbert P. Haas, M.D., and Tobias M. Jung, M.D. A spectrum of entities are involved in injury to the inferior aspect of the patella and the proximal patellar tendon, including “jumper’s knee,” patellar sleeve avulsion, and Sinding-Larsen-Johansson syndrome. Anteroposterior (a) and lateral (b) radiographs of the right knee show a bone fragment (arrow) arising from the posterolateral aspect of the knee joint. As is the case with most avulsion injuries, CT often demonstrates the fracture fragment to better advantage. 198, No. A large joint effusion is also present. Figure 13b. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 6, Avicenna Journal of Clinical Medicine, Vol. Arcuate complex avulsion fracture. 18, No. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. (b, c) Sagittal fast spin-echo proton-density–weighted (b) and fat-suppressed proton-density–weighted (c) MR images show avulsion of the quadriceps tendon (arrow) from its attachment site along the superior aspect of the patella. McGovern Medical School Figure 15c. AJR Am J Roentgenol. Viewer, Radiographic Review of Avulsion Fractures RadioGraphics Fundamentals | Online Presentation, Avulsion fracture of the tibial eminence in an adult with a unique mechanism of injury, Management of knee dislocation prior to ligament reconstruction: What is the current evidence? These patients often present with pain at the lateral joint line and with anterolateral rotational instability (,2,,4). The wide variation in clinical management of this condition, ranging from immobilization and casting to local steroid injection or rarely surgical management, reflects the continuing controversy about the exact etiology of this entity. (a, b) Coronal fast spin-echo proton-density–weighted (a) and fat-suppressed T2-weighted (b) MR images show avulsion and retraction of the biceps femoris tendon (arrow) from its insertion on the lateral fibular head. Avulsion fracture of the quadriceps tendon is usually apparent clinically. 3, American Journal of Roentgenology, Vol. Segond fracture: avulsion of lateral tibial rim cortex due to anterolateral ligament (ALL) Sometimes involves iliotibial band (ITB) more anteriorly. Because of incomplete delineation, type I or type II fractures could not be completely measured on radiographs. Additional injuries that are associated with PCL avulsion fracture include disruption of the medial and lateral collateral ligament complexes, medial and lateral meniscal tears, and focal bone contusions of the anterior tibia and lateral femoral condyle (,16). Computed tomography of tibial plateau fractures. Biceps femoris tendon avulsion fracture. Christopher C. Dodson . 9, 11 December 2017 | Hong Kong Journal of Emergency Medicine, Vol. The radiographic posterior drawer is indicative of PCL tear. 11, 10 June 2014 | Skeletal Radiology, Vol. View larger version (385K) Fig. Semimembranosus tendon avulsion fracture. Despite the fact that injury to the PCL may be an isolated finding, concurrent damage to the other major stabilizing structures of the knee is common. It is one of several ligaments that connect the thighbone to the shinbone. 14, No. Figure 3a. Viewer Biceps femoris tendon avulsion fracture. Osgood-Schlatter disease. Iliotibial band avulsion fracture. Segond fracture. Biceps femoris tendon avulsion fracture. (a) Lateral radiograph of the right knee shows an avulsion fracture of the tibial tuberosity (arrow) and soft-tissue swelling, findings consistent with Osgood-Schlatter disease. At MR imaging, a discrete bone fragment is noted attached to an otherwise intact PCL and separated from the remainder of the tibia (,Fig 6,) (,16). Avulsion fractures of the posterior cruciate ligament (PCL) are uncommon. 6.3 Two different patients with X-rays… 3, American Journal of Roentgenology, Vol. Seminars in Roentgenology, Vol. 2009;29 (2): 585-597. Semimembranosus tendon avulsion fracture. Although most ACL tears involve the midsubstance of the ligament, avulsion of its tibial attachment occurs in a minority of cases and is more common in children than adults (,10). Originally described by the French surgeon Paul Segond in 1879 after a series of cadaveric experiments (,1), this fracture involves cortical avulsion of the tibial insertion of the middle third of the lateral capsular ligament (,2). (a) Anteroposterior oblique radiograph of the left knee shows a bone fragment (arrow) within the knee joint. While lateral radiographs may reveal patella alta deformity (an abnormally elevated position of the patella with respect to the femur) and one or multiple tiny osseous fragments adjacent to the inferior pole of the patella, the exact extent of damage is frequently underestimated, necessitating further evaluation with MR imaging (,Fig 14). Finding is suggestive of a hangman’s fracture of the neural arches of C2. Arcuate complex avulsion fracture. (b) Coronal fast spin-echo proton-density–weighted MR image shows the tiny bone fragment (white arrow), which represents an avulsion of the deep capsular component of the medial collateral ligament. Then, the endobutton … Reverse Segond fracture. Coronal fast spin-echo proton-density–weighted MR image of the left knee shows avulsion of the iliotibial band (black arrow) from its attachment site on the Gerdy tubercle of the anterior tibia (white arrow).Download as PowerPointOpen in Image (a) Lateral radiograph of the right knee shows chronic avulsion of the quadriceps tendon, which contains calcification (arrow). 3, JCR: Journal of Clinical Rheumatology, Vol. Visualization of the fragment on the lateral view is frequently limited by its superimposition over the posterior tibia (,,Fig 7b). They result from forceful displacement in a flexed knee or from hyperextension. Anteroposterior (a) and lateral (b) radiographs of the right knee show a bone fragment (arrow) arising from the posterolateral aspect of the knee joint. 2, 24 September 2015 | Emergency Radiology, Vol. The exact origin of the fragment is difficult to discern on this view. 30, No. 1984;142 (6): 1181-6. (a) Anteroposterior radiograph of the right knee shows an elliptic bone fragment (arrow) arising from the medial tibial plateau. To simplify surgery, the posterolateral portal was omitted. Prompt diagnosis of these typically destabilizing injuries is the first step in preventing the long-term consequences of delayed treatment, specifically the chronic morbidity associated with posttraumatic osteoarthritis. 21, No. Computed tomography of tibial plateau fractures. In most medical centers, MRI is the standard technique used to diagnose ACL, PCL, and meniscal injuries. Viewer Intra-articular surgery required 3 arthroscopic portals, the anterolateral, anteromedial, and posteromedial portals. 10, 24 September 2011 | Skeletal Radiology, Vol. (a, b) Coronal fast spin-echo proton-density–weighted (a) and fat-suppressed T2-weighted (b) MR images show avulsion of the arcuate complex (arrow) from the styloid process of the fibular head (the arcuate sign). This is particularly true with regard to the interpretation of conventional radiographs. (a) Anteroposterior radiograph of the right knee shows an elliptic bone fragment (arrowhead) with its long axis oriented horizontally arising from the fibular head. Figure 4b. 18, No. Anterior aspect of spinous process of C2 commonly misses PCL by 2 mm. MR imaging should be performed in all cases of Segond fracture due to the extensively documented association of this injury with disruption of the anterior cruciate ligament (ACL) and meniscal tear (,5). This is why PCL avulsion fracture is an easily missed diagnosis resulting in knee instability and arthritis development. 43, No. Irregularity of the donor site from the tibial cortex is also seen (black arrow).Download as PowerPointOpen in Image 8, No. The exact donor site of the fragment cannot be accurately discerned on these views. 21, No. (b) Lateral radiograph shows the avulsed fracture fragment (arrow). Although much more commonly associated with Segond fracture and midsubstance ACL tear, a clinically ACL-deficient knee may also arise secondary to avulsion of the ACL from its distal insertion site just medial and anterior to the tibial eminence. Another entity that has been increasingly discussed in the recent radiology literature is injury to the arcuate complex and posterolateral corner of the knee. (a) Anteroposterior radiograph of the right knee shows an elliptic bone fragment (arrowhead) with its long axis oriented horizontally arising from the fibular head. (c, d) Sagittal fast spin-echo proton-density–weighted (c) and fat-suppressed T2-weighted (d) MR images show the avulsed fragment (arrow) arising from the styloid process of the fibula.Download as PowerPointOpen in Image Posterior cruciate ligament (PCL) avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated PCL lesion. At conventional radiography, a small bone fragment is usually identified arising from the inferior patella. The avulsed fragment is often small and may be appreciated only on the anteroposterior view. The femur is the only bone in the thigh and the longest bone in the body. Inferior patellar pole fragmentation in children: just a normal variant? Figure 6b. As is the case with most avulsion injuries, CT often demonstrates the fracture fragment to better advantage. December 2014; The Orthopaedic Journal of Sports Medicine 2(3 Suppl); DOI: 10.1177/2325967114S00185 Lateral radiograph of the left knee shows a tiny avulsed fracture fragment (arrow) arising from the inferior aspect of the patella. 205, No. 2. Rafii M, Firooznia H, Golimbu C et-al. Fracture length, width, and depth of 19 PCL tibial avulsion fractures on CT. 43, No. 21, No. Viewer Dr. Ellman, most recently with the Steadman Clinic in Vail, is a fellowship trained, board-certified orthopedic surgeon specializing in hip, knee and shoulder injuries. (b) Sagittal fast spin-echo fat-suppressed T2-weighted MR image shows the avulsed fragment (arrow) with adjacent marrow edema and a moderate-sized joint effusion.Download as PowerPointOpen in Image There is edema within the adjacent bone marrow. (a) Lateral radiograph of the right knee shows chronic avulsion of the quadriceps tendon, which contains calcification (arrow). Bone matrix is 90 to 95% composed of elastic … ... Additional injuries that are associated with PCL avulsion fracture include disruption of the medial and lateral collateral ligament complexes, medial and lateral meniscal tears, and focal bone contusions of the anterior tibia and lateral femoral condyle (, 16). 1, Medicinos teorija ir praktika, Vol. 56, No. (b) Sagittal fast spin-echo fat-suppressed T2-weighted MR image shows the avulsed fragment (arrow) with adjacent marrow edema and a moderate-sized joint effusion.Download as PowerPointOpen in Image The fragment is not as well seen because it is superimposed on the posterior tibial plateau. Irregularity of the donor site from the tibial cortex is also seen (black arrow). (a) Anteroposterior radiograph of the left knee shows an elliptic bone fragment (arrow) arising from the lateral tibial plateau (the lateral capsular sign). Jumper’s knee is a pain syndrome involving the proximal or distal insertion of the patellar tendon and resulting from chronic stress and inflammation, commonly seen in young athletes. Anteroposterior (a) and lateral (b) radiographs of the left knee show a bone fragment in the intercondylar notch (arrow). CT, computerized tomography. The prevalence of avulsion injuries continues to rise as our population has become increasingly involved in sporting and other athletic activities, particularly over the past few decades. The fragment is not as well seen because it is superimposed on the posterior tibial plateau.Download as PowerPointOpen in Image The superficial layer of the band consists of its primary tendinous component and inserts onto the Gerdy tubercle along the anterolateral tibia, while its deep layer inserts on the intermuscular septum of the distal femur (,17,,25). 8A —17-year-old boy with posterior cruciate ligament (PCL) avulsion fracture. 200, No. The biceps femoris tendon consists of two heads and travels along the posterolateral aspect of the knee, just deep to the iliotibial tract. (a) Anteroposterior oblique radiograph of the left knee shows a bone fragment (arrow) within the knee joint. Viewer Figure 11a. 57, No. PCL avulsion fracture. The exact origin of the fragment is difficult to discern on this view. 2, Magnetic Resonance Imaging Clinics of North America, Vol. Markhardt B, Gross J, Monu J. Schatzker Classification of Tibial Plateau Fractures: Use of CT and MR Imaging Improves Assessment1. Spondylolysis classifications include dysplasic (congenital – born with, e.g. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 3, Diagnostic and Interventional Imaging, Vol. Enter your email address below and we will send you the reset instructions. PCL posterior cruciate ligament Fig. (a) Sagittal fast spin-echo proton-density–weighted MR image shows an avulsion of the semimembranosus tendon (arrow) at its insertion site on the posteromedial aspect of the tibia. Osgood-Schlatter disease. (a) Anteroposterior radiograph of the left knee shows an elliptic bone fragment (arrow) arising from the lateral tibial plateau (the lateral capsular sign). Figure 7b. (b) Coronal fast spin-echo proton-density–weighted MR image shows the tiny bone fragment (white arrow), which represents an avulsion of the deep capsular component of the medial collateral ligament. This distal insertion frequently forms a conjoined tendon along with the insertion of the lateral collateral ligament (,17,,25). Thus, it is crucial for the radiologist to recognize the reverse Segond fracture, as further evaluation with MR imaging is recommended in these cases to elucidate the extent of suspected underlying ligamentous and meniscal injury, as well as to determine the need for surgical intervention (,,Fig 2b) (,9). Part 2—Areas of Weakness Beyond Bone and Cartilage Transitions, Clinical and Arthroscopic Evaluation of Posterior Cruciate Ligament and Posterolateral Corner Injuries of the Knee, Magnetic Resonance Imaging of Posterior Cruciate and Posterolateral Corner Injuries of the Knee, What’s in a name? 1, 9 May 2013 | Insights into Imaging, Vol. (b) Coronal fast spin-echo T1-weighted MR image shows the nondisplaced avulsion fracture of the lateral tibial plateau (arrow) with marrow edema along the lateral tibial rim.Download as PowerPointOpen in Image PCL avulsion fracture. The aim of the study was point out this … (b) Coronal fast spin-echo proton-density–weighted MR image shows the tiny bone fragment (white arrow), which represents an avulsion of the deep capsular component of the medial collateral ligament. Figure 8c. MRI scans have been shown to be less optimal in the assessment of chronic PCL injuries … Eleven of the 21 … Viewer. The knee is an intricate joint with numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to complex injuries after trauma. There is edema within the adjacent bone marrow. Viewer 8B —17-year-old boy with posterior cruciate ligament (PCL) avulsion fracture. This fracture involves a fragment similar to that of the Segond fracture except that it is located on the opposite side of the knee, arising from the medial aspect of the proximal tibia. Viewer. Discuss the innocuous appearance of these fractures at radiography and the clinical significance of failure to promptly recognize and treat them. After the initial report in 1997 (,8), there have been an increasing number of case reports of this type of fracture over the past decade. PCL avulsion fracture. Become a Gold Supporter and see no ads. This study describes an arthroscopic pullout fixation technique for small and comminuted avulsion fractures of the posterior cruciate ligament from the tibia. Arcuate complex avulsion fracture. MR imaging is useful to confirm the exact etiology of the avulsed fragment visualized at conventional radiography and in most cases will clearly demonstrate avulsion of the insertion of the biceps femoris tendon (,Fig 11,,,). While the significance of the complex structures of the posterolateral corner of the knee is well documented, the posteromedial corner of the knee is also crucial to the stability of the knee joint. 5, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Vol. Biceps femoris tendon avulsion fracture. Isolated combined PCL and ACL avulsion fractures is a rare condition. While much of the focus of avulsion fractures of the knee is placed on the flexor compartment, avulsions of the extensor mechanism are not infrequent. Advanced imaging modalities, particularly magnetic resonance imaging, are helpful and can provide valuable additional information for adequately defining the extent of damage. CT is very helpful in accurately defining the extent of the bony injury and facilitates orthopedic intervention. In younger patients, the most common pattern of fracture is splitting, while older, more osteoporotic patients, depression fractures typically are sustained. Figure 5a. Sagittal fast spin-echo proton-density–weighted (a) and fat-suppressed T2-weighted (b) MR images show an avulsed bone fragment (arrow) arising from the posterior tibial plateau with an intact PCL. Figure 2a. (b) Coronal fast spin-echo T1-weighted MR image shows the nondisplaced avulsion fracture of the lateral tibial plateau (arrow) with marrow edema along the lateral tibial rim.Download as PowerPointOpen in Image (b) Lateral radiograph shows that the avulsed fragment (arrow) arises from the posterior tibial plateau. (a) Lateral radiograph of the right knee shows chronic avulsion of the quadriceps tendon, which contains calcification (arrow). Other advanced imaging is used selectively for diagnosing chondral lesions, intra-articular fractures, and diagnostic challenges . Conveying this information to the referring clinician is crucial and represents the first step toward additional evaluation and probable orthopedic referral. Viewer. Conveying this information to the referring clinician is crucial and represents the first step toward additional evaluation and probable orthopedic referral. ACL avulsion fracture. Figure 12a. More recent cadaveric studies have suggested that the pathophysiology of Segond fracture is complex and may involve avulsion of the iliotibial tract and anterior oblique band as well (,3). The posteromedial corner consists of three main structures: the semimembranosus tendon, posterior joint capsule, and posterior oblique ligament (,26). 3, Radiologic Clinics of North America, Vol. 6.2 a and b X-ray and CT respectively showing reverse segond fracture, which is osseous avulsion of meniscotibial ligament. The quadriceps muscle group consists of four muscles that serve as the primary extensors of the knee: the vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. Anteroposterior (a) and lateral (b) radiographs of the right knee show a bone fragment (arrow) arising from the posterolateral aspect of the knee joint. By recognizing the significance of these injuries at initial presentation, radiologists can facilitate appropriate patient work-up and prevent the chronic morbidity associated with delayed treatment. Figure 8d. (b, c) Sagittal fast spin-echo proton-density–weighted (b) and fat-suppressed proton-density–weighted (c) MR images show avulsion of the quadriceps tendon (arrow) from its attachment site along the superior aspect of the patella. (a) Anteroposterior oblique radiograph of the left knee shows a bone fragment (arrow) within the knee joint. 5, 22 February 2018 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 1, 19 April 2017 | BMC Musculoskeletal Disorders, Vol. (b, c) Sagittal fast spin-echo proton-density–weighted (b) and fat-suppressed T2-weighted (c) MR images obtained in another patient show an avulsion fracture of the tibial tuberosity (arrow) with mild adjacent soft-tissue swelling, a small joint effusion, and infrapatellar bursitis.Download as PowerPointOpen in Image The posterior cruciate ligament is in the back of the knee. Note the difference in orientation and appearance of the fragment in comparison with those of the arcuate sign (cf ,Fig 8,,,). Anteroposterior (a) and lateral (b) radiographs of the left knee show a bone fragment in the intercondylar notch (arrow). Thickening of the patellar tendon is often identified without definite evidence of tear or avulsion (,4). A fracture is a break or crack in a bone that often results from an injury. This case shows a posterior cruciate ligament avulsion fracture with fracture at the posteromedian articular surface of the upper tibia. Figure 14. Posterolateral and Posteromedial Corner Injuries of the Knee, Magnetic Resonance Imaging of the Extensor Mechanism, Magnetic Resonance Imaging of the Pediatric Knee, A Biomechanical Approach to Interpreting Magnetic Resonance Imaging of Knee Injuries, Isolated avulsion fracture at the medial head of the gastrocnemius muscle, A 30-year-old woman with acute knee injury, Radiographies du genou traumatique : attention aux petits signes qui révèlent de grandes lésions, Acute traumatic knee radiographs: Beware of lesions of little expression but of great significance, MRI of Sports Injuries in Children and Adolescents: What’s Different from Adults, Semimembranosus tendon avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament tear and capsular rupture, Spectrum of injuries associated with paediatric ACL tears: an MRI pictorial review, Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm, Radiología de las fracturas: algo más que un trazo, Marginal Value of Radiographs in the Interpretation of MR Images Obtained for Pediatric Knee Pain, Lésions sentinelles en traumatologie ostéoarticulaire : les signes à ne pas méconnaître, Sentinel lesions in osteoarticular traumatology: Signs to watch out for, The “sliver sign”: a specific radiographic sign of acute lateral patellar dislocation, Apport de l’IRM dans le diagnostic des ruptures traumatiques du ligament croisé antérieur, The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament, MRI of Pediatric Patients: Part 2, Normal Variants and Abnormalities of the Knee, Aplicaciones de la tomografía computarizada multidetector en la patología traumática de las extremidades, MR Imaging of ACL Injuries in Pediatric and Adolescent Patients, How We Manage the Multiple Ligament Injured (Dislocated) Knee, Unraveling the Posterolateral Corner of the Knee, US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions, Layered Approach to the Anterior Knee: Normal Anatomy and Disorders Associated with Anterior Knee Pain, Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series, MRI Predictors of Posterolateral Corner Instability: A Decision Tree Analysis of Patients with Acute Anterior Cruciate Ligament Tear, Avulsion Fractures of the Knee: A Pictorial Review, Radiographic, MDCT and MRI Imaging Features of Avulsion Fractures of the Knee: A Review of the Pathophysiology and Prognostic Implications, Findings Imaging and Clinical Significance of Avulsion Fractures in the Knee, Near full thickness quadriceps tendon tear. The Schatzker classification is used in tibial plateau fractures. Viewer. 4, BMC Musculoskeletal Disorders, Vol. Figure 11b. Displaced injury leads to PCL deficiency & hence disability & pain. Injuries are often due to a blow to the knee while it is bent. Therefore, posterior cervical line (PCL) cannot be applied. PCL avulsion fracture is less common. (b) Lateral radiograph shows the avulsed fracture fragment (arrow). 18, 29 January 2014 | Skeletal Radiology, Vol. (a) Lateral radiograph of the right knee shows chronic avulsion of the quadriceps tendon, which contains calcification (arrow). Sagittal fast spin-echo proton-density–weighted (a) and fat-suppressed T2-weighted (b) MR images show an avulsed bone fragment (arrow) arising from the posterior tibial plateau with an intact PCL.Download as PowerPointOpen in Image 1, 12 September 2018 | RadioGraphics, Vol. Viewer. Quadriceps tendon avulsion fracture. The exact origin of the fragment is difficult to discern on this view. Like avulsion fractures of the quadriceps tendon, this injury tends to occur in isolation and has no known associations with damage to the other major stabilizing structures of the knee. Figure 11d.

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