false
Catalog
Best Practice Case Studies
Knee Lateral Collateral Ligament Tear
Knee Lateral Collateral Ligament Tear
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 18-year-old male football player presents for evaluation on the sideline after injury on his left knee. Concerned for lateral collar ligament injury and posterior lateral corner injury. The patient in this case presented with this knee radiograph. Here in our AP radiograph we can see a non-displaced fracture, the fibular head is seen here, and also seen on this image right here. Stress views are sometimes done to evaluate for asymmetric widening of the knee joint. The patient in this case underwent various stress tests demonstrating this asymmetric widening in the lateral compartment as we can see here compared to the contralateral side. However, various stress testing is not part of the routine workup in patients with knee injury in the emergency setting. The patient also underwent MRI knee without contrast. Here on our coronal T1 imaging we can see just subtle hypo-intensity along the expected course of the fibular collar ligament. And on our axial PD fat set imaging we can see this edema just superficial to the fibular collar ligament and also likely deep to the fibrous right here which is suggestive of underlying sprain. Additionally, we can see this edema just at the posterior lateral corner concerning for underlying posterior lateral corner injury. Here on our sagittal T2 fat set and PD imaging we can see that there is bone contusion in the medial femoral condyle and medial tibial plateaus we see here. On our sagittal PD here we could not see any discrete fracture line. On our coronal T2 fat set imaging again we can see this bone contusion in the medial femoral condyle and the tibial plateau and some sprain injury to the fibular collar ligament which would have been expected in this region. This is on a different patient. Here a quick review of our normal medial collar ligament. We can see a dark band arising from the distal femur to the tibia without any irregularity. This is in comparison to this partial tear of the MCL on the other patient. We can see this irregular proximal medial collar ligament. In our fluid sensitive images we can see that there is edema superficial, deep and within the fibrous itself consistent with grade 2 sprain. Grade 1 sprain would demonstrate abnormal signal just superficial to the ligament itself. Again this is on a different patient. Here on our coronal T2 fat set imaging we can see that there is indistinct and not visualized lateral collar ligament at the femoral attachment right here. On our T1 imaging we can see that there is no longer hypo intense band at the expected location of the fibular collar ligament. These findings are consistent with grade 3 sprain or a high grade sprain.
Video Summary
An 18-year-old football player sustained a left knee injury. Radiographs revealed a non-displaced fibular head fracture. Stress tests showed asymmetric widening in the lateral knee compartment, though this isn't routinely performed in emergencies. MRI indicated a subtle sprain of the fibular collateral ligament and posterior lateral corner injury, with bone contusion in the medial femoral condyle and tibial plateau. Another patient comparison revealed a medial collateral ligament tear visible on imaging. The findings include edema, consistent with a grade 2 or 3 sprain, depending on the presence and intensity of the edema and fiber irregularities.
Meta Tag
Edition
2nd Edition
Related Case
2nd Edition, CASE 31
Topic
Knee
Keywords
2nd Edition, CASE 31
2nd Edition
Knee
knee injury
fibular head fracture
collateral ligament sprain
posterior lateral corner injury
bone contusion
×
Please select your language
1
English