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ACL complete tear MRI knee ligament
**Imaging Modality:** Sagittal T2-weighted fat-saturated Magnetic Resonance Imaging (MRI) of the knee.
This composite diagnostic image presents multiple MRI views (sagittal, coronal, and axial) of a human knee joint, illustrating chronic ligamentous injury and joint malalignment. A: Sagittal view demonstrating significant anterior tibial subluxation, where the proximal tibia is displaced anteriorly relative to the femoral condyles, measured at approximately 2.45 cm. B: Sagittal view showing a shortened and thickened posterior cruciate ligament (PCL). B, C, D: Sequential sagittal and coronal slices highlight the complete absence of visible anterior cruciate ligament (ACL) fibers. D, E: Coronal and axial views specifically demonstrate the 'empty notch sign' within the femoral intercondylar notch, a classic radiological indicator of a complete ACL tear or chronic ACL deficiency. The imaging collectively illustrates fixed anterior tibial knee subluxation associated with combined ACL and PCL pathology, likely resulting from high-energy trauma or chronic instability. These findings are critical for preoperative planning in complex ligamentous reconstructions or quadricepsplasty procedures.
"anterior cruciate ligament" AND "reconstruction" AND "treatment"
Patient: Mr. S Chandra Siddartha | 18 yrs, Male | MRI Knee | 7 Feb 2026
DIAGNOSIS (from MRI Report)
| Finding | Meaning |
|---|---|
| Complete mid-substance tear of ACL with mildly retracted tibial and femoral attachment fibers | Full-thickness rupture of the Anterior Cruciate Ligament - the primary stabilizer of the knee against anterior tibial displacement |
| Mild buckling of PCL | The Posterior Cruciate Ligament is lax/buckled - this is a secondary sign of ACL insufficiency (the PCL buckles when the tibia shifts forward due to absent ACL tension) |
| Mild PDFS hyperintense joint collection extending to suprapatellar and bilateral parafemoral recess | Knee joint effusion (fluid collection) - common after acute ligament injury |
MRI Image Reference
TREATMENT
Phase 1: Immediate / Acute Management (First 2-4 weeks)
- RICE protocol: Rest, Ice, Compression, Elevation
- Knee brace (immobilizer or hinged brace) to control swelling and pain
- NSAIDs (e.g. ibuprofen, diclofenac) for pain and inflammation
- Physiotherapy - prehabilitation: Before surgery, strengthen quads and reduce swelling - this significantly improves surgical outcomes (Córdoba et al., 2023)
- Crutches for partial weight-bearing if pain limits walking
Phase 2: Surgery - ACL Reconstruction
- Arthroscopic ACL reconstruction is the gold standard
- Graft choices:
- Bone-patellar tendon-bone (BPTB) autograft - excellent for high-activity patients
- Four-strand hamstring tendon autograft - less donor site morbidity
- Graft is fixed in bone tunnels in the femur and tibia using screws or fixation devices
- Timing: Surgery is best delayed 2-6 weeks after injury to allow swelling to settle. Early surgery (within days of injury) increases risk of arthrofibrosis
- Graft re-rupture rate is approximately 1% per year
Phase 3: Rehabilitation After Surgery
| Phase | Timing | Goals |
|---|---|---|
| Early | Days 1-2 post-op | Knee extension restoration, control swelling, start straight-leg raises |
| Mid | Weeks 2-6 | Full range of motion, progressive weight-bearing, quad strengthening |
| Late | Months 2-6 | Closed kinetic chain exercises, proprioception, jogging |
| Return to sport | 9-12 months | Functional tests, sport-specific drills - return to full sport takes up to 1 year |
- Avoid open kinetic chain exercises in early phase (protects the graft)
- Blood flow restriction (BFR) training - effective for preventing quad atrophy with low loads
- No postoperative bracing has been shown to offer additional benefit in most patients
- Postoperative rehab is "crucial to a favourable outcome" per Bailey & Love
PCL Buckling
Summary for the Treating Orthopaedic Surgeon (Dr. Suresh Kumar Pambi)
This 18-year-old male has a complete mid-substance ACL tear with reactive joint effusion. Given his age and activity level, ACL reconstruction (arthroscopic, autograft) is the preferred treatment. Prehabilitation, then surgery at 2-6 weeks after injury, followed by a structured 9-12 month rehabilitation program is the recommended pathway.
Disclaimer: This is for educational reference only. All treatment decisions must be made by the patient's orthopaedic surgeon based on full clinical assessment.