This patient has an ACL tear, along with what other injuries?

This 55-year-old male has right knee pain after a fall down an embankment. He has an ACL tear, but what other injuries are present in this complex case? What is indicated by the arrows? You are shown these five static images, plus a GIF rotating a sagittal series.

This patient has an ACL tear (pink arrows) with pivot shift osseous edema, joint effusion and posterior capsular disruption. Other items to note:

  • Complex tear of the medial meniscus with fragment displaced into the posterior intercondylar notch (images 4 and 5, arrows).
  • Posterior central or deep lateral meniscus capsular attachment tear, with mostly vertical Wrisberg rent or rip tear (image 3, arrow). The meniscopopliteal fascicles are also injured laterally (blue arrows).
  • Posterolateral corner injury with arcuate sprain (orange arrows) or tear, plus stretch injury of the popliteal fibular ligament (yellow arrow).
  • Disrupted posterior ligament of the knee injury (image 1, arrow).
  • Longitudinal interstitial split tear of the fibular collateral ligament.
  • Patellofemoral chondromalacia.

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