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Anterior Cruciate Ligament Tears and Associated Meniscal Lesions: Assessment at Dual-Detector Spiral CT Arthrography¹

¹ From the Departments of Radiology (B.C.V.B., F.E.L., B.M., J.M.) and Orthopedic Surgery (P.P., J.E.D.), Cliniques Universitaires St Luc, Université Catholique de Louvain, 10 avenue Hippocrate, 1200 Brussels, Belgium. Received June 11, 2001; revision requested July 12; revision received August 28; accepted September 28. Address correspondence to B.C.V.B. (e-mail: vandeberg@rdgn.ucl.ac.be).

View larger version (126K): [in a new window]   Figure 1a. (a) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) obtained after spiral CT arthrography of the left knee in a 42-year-old man who had sustained trauma to the knee 8 weeks previously shows that the anterior contour of the ACL is convex (small arrows). The presence of intraligamentous contrast material (large arrow) running perpendicular to the long axis of the ACL suggests ligament disruption. (b) Coronal oblique reformation (window width, 1,000 HU; window level, 200 HU) shows contrast material (large solid arrow) delineating a cleavage plane within the ACL. The body of the medial meniscus (small solid arrow) is abnormally small, and a meniscal fragment (open arrow) is present in the intercondylar space. At arthroscopy, an ACL tear and a displaced bucket-handle tear of the medial meniscus were revealed.

View larger version (135K): [in a new window]   Figure 1b. (a) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) obtained after spiral CT arthrography of the left knee in a 42-year-old man who had sustained trauma to the knee 8 weeks previously shows that the anterior contour of the ACL is convex (small arrows). The presence of intraligamentous contrast material (large arrow) running perpendicular to the long axis of the ACL suggests ligament disruption. (b) Coronal oblique reformation (window width, 1,000 HU; window level, 200 HU) shows contrast material (large solid arrow) delineating a cleavage plane within the ACL. The body of the medial meniscus (small solid arrow) is abnormally small, and a meniscal fragment (open arrow) is present in the intercondylar space. At arthroscopy, an ACL tear and a displaced bucket-handle tear of the medial meniscus were revealed.

View larger version (125K): [in a new window]   Figure 2a. (a) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) of spiral CT arthrography data obtained 55 weeks after trauma to the left knee in a 31-year-old man shows accumulation of contrast material (arrows) in an area where the ACL is expected to be present. (b) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) shows a complex tear (black arrow) of the posterior horn of the lateral meniscus and anterior translocation of the tibia (white arrow). P = posterior. (c) On a coronal reformation (window width, 1,000 HU; window level, 200 HU), contrast material (large black arrow in center of image) is present between the medial aspect of the lateral condyle and the posterior cruciate ligament (small arrows) in an area where the ACL is expected to be found. A complex tear (large black arrow on right side of image) is visible in the body of the medial meniscus. Tears of the ACL and of both menisci were revealed at arthroscopy. L = left.

View larger version (127K): [in a new window]   Figure 2b. (a) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) of spiral CT arthrography data obtained 55 weeks after trauma to the left knee in a 31-year-old man shows accumulation of contrast material (arrows) in an area where the ACL is expected to be present. (b) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) shows a complex tear (black arrow) of the posterior horn of the lateral meniscus and anterior translocation of the tibia (white arrow). P = posterior. (c) On a coronal reformation (window width, 1,000 HU; window level, 200 HU), contrast material (large black arrow in center of image) is present between the medial aspect of the lateral condyle and the posterior cruciate ligament (small arrows) in an area where the ACL is expected to be found. A complex tear (large black arrow on right side of image) is visible in the body of the medial meniscus. Tears of the ACL and of both menisci were revealed at arthroscopy. L = left.

View larger version (137K): [in a new window]   Figure 2c. (a) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) of spiral CT arthrography data obtained 55 weeks after trauma to the left knee in a 31-year-old man shows accumulation of contrast material (arrows) in an area where the ACL is expected to be present. (b) Sagittal reformation (window width, 1,000 HU; window level, 200 HU) shows a complex tear (black arrow) of the posterior horn of the lateral meniscus and anterior translocation of the tibia (white arrow). P = posterior. (c) On a coronal reformation (window width, 1,000 HU; window level, 200 HU), contrast material (large black arrow in center of image) is present between the medial aspect of the lateral condyle and the posterior cruciate ligament (small arrows) in an area where the ACL is expected to be found. A complex tear (large black arrow on right side of image) is visible in the body of the medial meniscus. Tears of the ACL and of both menisci were revealed at arthroscopy. L = left.

View larger version (119K): [in a new window]   Figure 3a. (a) Sagittal reformation (window width, 2,000 HU; window level, 400 HU) obtained after spiral CT arthrography of the left knee in a 41-year-old man shows a normal ACL (small arrows) with a straight anterior contour. A linear streak of contrast material (large arrow) that courses parallel to the ACL is present in the distal third of the ACL. (b) Coronal oblique reformation (window width, 2,000 HU; window level, 400 HU) along the plane of the ACL also shows contrast material (arrow) in the distal third of the ACL. At arthroscopy, the ACL was found to be normal. Most likely, the contrast material is accumulated between fascicles of the ACL.

View larger version (126K): [in a new window]   Figure 3b. (a) Sagittal reformation (window width, 2,000 HU; window level, 400 HU) obtained after spiral CT arthrography of the left knee in a 41-year-old man shows a normal ACL (small arrows) with a straight anterior contour. A linear streak of contrast material (large arrow) that courses parallel to the ACL is present in the distal third of the ACL. (b) Coronal oblique reformation (window width, 2,000 HU; window level, 400 HU) along the plane of the ACL also shows contrast material (arrow) in the distal third of the ACL. At arthroscopy, the ACL was found to be normal. Most likely, the contrast material is accumulated between fascicles of the ACL.