Using MR imaging to diagnose partial tears of the anterior cruciate ligament: value of axial images.

OBJECTIVE: The purpose of this study was to determine the usefulness of axial MR imaging for diagnosing partial anterior cruciate ligament (ACL) tears and to determine if patients could be categorized as having stable or unstable partial ACL tears on the basis of criteria of axial MR imaging.

MATERIALS AND METHODS: We reviewed 238 patients who, over a 2-year period, underwent both MR imaging of the knee and arthroscopic evaluation of the ACL. According to arthroscopic examination, these patients had 143 normal ACLs, 67 complete ACL tears, and 28 partial tears. The 28 partial tears included 20 stable tears (no ACL deficiency) and eight unstable partial tears having ACL deficiency or requiring ACL reconstructive surgery. The axial MR images were retrospectively reviewed by two interpreters who were unaware of the arthroscopic findings, and decisions were reached by consensus. The ACL was classified according to its axial configuration and continuity.

RESULTS: By axial MR imaging criteria, we found 109 elliptical ACLs, 45 attenuated ACLs, three ACLs with increased intrasubstance signal intensity, six isolated ACL bundle signs, 19 ACLs that could not be visualized, and 56 cloudlike mass signs. Arthroscopically normal ACLs and stable partial tears were difficult to distinguish reliably on axial MR images. Unstable partial ACL tears could not be distinguished from complete ACL tears. However, using axial MR imaging, our observers were able to segregate stable ACLs (normal ligaments and stable partial tears) from unstable ACLs (unstable partial tears and complete tears) with 100% sensitivity and 96% specificity.

CONCLUSION: Axial MR imaging of the ACL may provide important diagnostic information for patients who have ACL injury. On axial MR images, stable ACLs were elliptical, attenuated, or showed as areas of increased intrasubstance signal intensity. At arthroscopy, attenuated ACLs represented normal ACLs (76%) and stable partial tears (24%). On axial MR images, the configurations that indicated unstable ligaments were isolated ACL bundle, nonvisualized ACL, and cloudlike mass.