Study on MRI Spectrum of ACL Tears in Pediatric Age Group: A Case Series

Background: Due to high outdoor activities, anterior cruciate ligament (ACL) injuries are common among adolescents. These ligamentous tears of knee are always associated with other injuries. We showed the range of injuries that we see in the pediatrics adolescent population. Various knee injuries, such as meniscal tears and bone marrow oedema, are not picked up by routine radiography. Magnetic resonance imaging (MRI) is critical in the development of this spectrum.

Methods: Five male patients aged 13 to 18 years (average age 15 years) who had various types of knee trauma, had undergone knee MRI scans and were evaluated for a variety of ACL tears and associated manifestations. The ACL, the menisco-femoral connection, or the medial collateral ligaments could all be involved in a focal injury. Bony avulsion fractures are also common in children due to their immature skeleton. According to the description of the specific injury, the study plays a significant role in management. Patients with a history of past knee injury or disease were excluded from the study.

Results: The majority of the patients were in pediatric adolescent group (average age 15 years). Left knee was injured in 60% as compared to right knee in 40% of the cases. Meniscal tears were involved in 20% cases but were 40% among those who were having bony injury. These were picked up only in MRI study while plain skiagram was normal. In 40% of the cases, the posterior cruciate ligament (PCL) was implicated.

Conclusion: In paediatric and adolescent children, ACL tears and accompanying injuries have a different spectrum and should not be diagnosed or treated in the same way as in adult cases. Because of epiphyseal nonunion in this age range, MRI assessment plays a critical role in the description of such traumatic injuries.