title: Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?
abstract: OBJECTIVE
  To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee.
  
  
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium. pieter.van.dyck@uza.be
authors.forename: Pieter
authors.initials: P
authors.lastname: Van Dyck
authors.forename: Jan L
authors.initials: JL
authors.lastname: Gielen
authors.forename: Filip M
authors.initials: FM
authors.lastname: Vanhoenacker
authors.forename: Kristien
authors.initials: K
authors.lastname: Wouters
authors.forename: Lieven
authors.initials: L
authors.lastname: Dossche
authors.forename: Paul M
authors.initials: PM
authors.lastname: Parizel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000473:pathology*; D000070598:Anterior Cruciate Ligament Injuries; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012421:Rupture / Q000473:pathology; D012680:Sensitivity and Specificity; D055815:Young Adult