Joseph Christian Giaconi MD, Abstract Co-Author: Nothing to Disclose

Louis William Muscarella MD, Presenter: Nothing to Disclose

Kara Lauko RN, Abstract Co-Author: Nothing to Disclose

Justin Saliman, Abstract Co-Author: Nothing to Disclose

There appears to be a correlation between occurrence of ACL avulsion from the femoral insertion and age of subject. Younger subjects are less likely to present with femoral ACL avulsion.

The current standard of care for anterior cruciate ligament (ACL) repair is a total graft replacement which entails high morbidity and a long recovery time. A relatively new type of surgery for patients that have a 'clean' avulsion of the ACL from the femoral insertion is tacking down the native ligament. This surgery carries a much shorter recovery time without an invasive bone tunneling procedure. The frequency of this particular ACL tear has not been specifically assessed. We describe the location of ACL tears with the use of magnetic resonance (MR) imaging and hence the applicability of this new procedure.

MR images obtained in 100 patients aged 14-63 with acute ACL tears imaged over a 2 year and 9 month period were retrospectively reviewed by two experienced radiologist. The ACL tears were evaluated by consensus review and placed into six separate categories based on location. These locations include femoral and tibial ACL avulsion as well as tears of the proximal one-third, the junction of the middle and proximal one-third, the middle one-third and the distal one-third of the ACL. The frequency of the location of tears were further classified by gender and age. 

Avulsion of the ACL from the femoral insertion occurred in 7 of the 100 acute ACL ligament tears evaluated. There was a correlation between increasing age and number of femoral avulsion tears with none occurring in subjects under 26 years of age. Tears at the junction of the proximal and middle third and middle one-third are the most common amongst both men and women of all ages. Overall, these tears account for 42% and 38% respectively. Upon examination of the proximal one-third tears, it was found that 75% of them occurred in females and of this number, 77% were over the age of 35. Finally, an inverse ratio was noted between increasing age and middle one-third tears. As individuals aged, the number of middle one-third tears decreased, from 16 in those under 26, to 7 in those over 40.

Giaconi, J, Muscarella, L, Lauko, K, Saliman, J, MR Evaluation of Location and Frequency of Anterior Cruciate Ligament Tears .  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12032934.html