Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance

PURPOSE: To describe the magnetic resonance (MR) imaging appearance of anterior cruciate ligament (ACL) stump entrapment in patients who presented with decreased knee extension after rupturing the ACL. MATERIALS AND METHODS: MR images in 15 patients who had presented with a block to terminal knee extension after sustaining an ACL tear were retrospectively reviewed. The MR imaging appearances of entrapped ACL stumps were defined and correlated with arthroscopic and histologic findings. RESULTS: The entrapped ACL stumps had two distinct appearances. Type 1 stumps (n = 11) were characterized by a nodular mass located at the anterior aspect of the intercondylar notch, interposed between the lateral femoral condyle and tibia. Type 2 stumps (n = 4) were characterized by a tonguelike free end and angulation of the stump. Histologic evaluation of the resected specimens showed distorted ACL fibers intermixed with variable fibrosis and inflammation. CONCLUSION: Entrapment of an ACL stump can limit knee extension. The two observed appearances of entrapped ACL stumps likely represent two points along a spectrum of appearances, which possibly includes the cyclops lesion.