Subscribe to RSS
DOI: 10.1055/s-0045-1802976
Common Mistakes in Imaging: Ligament Injuries of the Knee in Athletes
Authors

Abstract
Assessment of internal derangement is a common indication for imaging of the injured knee in athletes. The first line of imaging is conventional radiography, but magnetic resonance imaging is often required. Radiographic features of ligament injury can be subtle, even when the soft tissue injury is devastating, resulting in instability that may require surgery. Magnetic resonance imaging to assess for ligament injury has several potential pitfalls that can lead to interpretation errors. This article describes common errors when imaging knee ligament injuries in the athlete and discusses strategies to reduce inaccuracies in imaging technique and interpretation. Mistakes on magnetic resonance imaging and radiographs typically arise from the timing of imaging (early/acute versus delayed/chronic), technical factors, potential mimics of pathology, and the inherent limitations of radiography.
Publication History
Article published online:
07 October 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Mohankumar R, White LM, Naraghi A. Pitfalls and pearls in MRI of the knee. AJR Am J Roentgenol 2014; 203 (03) 516-530
- 2 Crain EH, Fithian DC, Paxton EW, Luetzow WF. Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees?. Arthroscopy 2005; 21 (01) 19-24
- 3 Vahey TN, Broome DR, Kayes KJ, Shelbourne KD. Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging. Radiology 1991; 181 (01) 251-253
- 4 Van Dyck P, Vanhoenacker FM, Gielen JL. et al. Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears?. Skeletal Radiol 2011; 40 (06) 701-707
- 5 Vanhoenacker F, De Vos N, Van Dyck P. Common mistakes and pitfalls in magnetic resonance imaging of the knee. J Belg Soc Radiol 2016; 100 (01) 99
- 6 Butler P, Mitchell A, Healy JC, Ellis H. Applied Radiological Anatomy. Cambridge, UK: Cambridge University Press; 2012
- 7 Faruch-Bilfeld M, Lapegue F, Chiavassa H, Sans N. Imaging of meniscus and ligament injuries of the knee. Diagn Interv Imaging 2016; 97 (7–8): 749-765
- 8 Watson ST, Pichiotino ER, Adams Jr JD. Medial collateral ligament reconstruction with dual adjustable-loop suspensory fixation: a technique guide. Arthrosc Tech 2021; 10 (03) e621-e628
- 9 Lundquist RB, Matcuk Jr GR, Schein AJ. et al. Posteromedial corner of the knee: the neglected corner. Radiographics 2015; 35 (04) 1123-1137
- 10 Schweitzer ME, Tran D, Deely DM, Hume EL. Medial collateral ligament injuries: evaluation of multiple signs, prevalence and location of associated bone bruises, and assessment with MR imaging. Radiology 1995; 194 (03) 825-829
- 11 Morgan C, Watura C, Flaherty D, Sookur P, Gibbons CE. The association of bone bruising and grade of MCL injury in patients sustaining isolated MCL injuries. Skeletal Radiol 2022; 51 (05) 1073-1080
- 12 Sanders TG, Medynski MA, Feller JF, Lawhorn KW. Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. Radiographics 2000; 20 (Spec No): S135-S151
- 13 Wen DY, Propeck T, Kane SM, Godbee MT, Rall KL. MRI description of knee medial collateral ligament abnormalities in the absence of trauma: edema related to osteoarthritis and medial meniscal tears. Magn Reson Imaging 2007; 25 (02) 209-214
- 14 Blankenbaker DG, De Smet AA, Fine JP. Is intra-articular pathology associated with MCL edema on MR imaging of the non-traumatic knee?. Skeletal Radiol 2005; 34 (08) 462-467
- 15 Dold AP, Swensen S, Strauss E, Alaia M. The posteromedial corner of the knee: anatomy, pathology, and management strategies. J Am Acad Orthop Surg 2017; 25 (11) 752-761
- 16 Loredo R, Hodler J, Pedowitz R, Yeh LR, Trudell D, Resnick D. Posteromedial corner of the knee: MR imaging with gross anatomic correlation. Skeletal Radiol 1999; 28 (06) 305-311
- 17 Cothran RL, McGuire PM, Helms CA, Major NM, Attarian DE. MR imaging of infrapatellar plica injury. AJR Am J Roentgenol 2003; 180 (05) 1443-1447
- 18 Berlet GC, Fowler PJ. The anterior horn of the medical meniscus. An anatomic study of its insertion. Am J Sports Med 1998; 26 (04) 540-543
- 19 Ohkoshi Y, Takeuchi T, Inoue C, Hashimoto T, Shigenobu K, Yamane S. Arthroscopic studies of variants of the anterior horn of the medical meniscus. Arthroscopy 1997; 13 (06) 725-730
- 20 Cha JG, Min KD, Han JK. et al. Anomalous insertion of the medial meniscus into the anterior cruciate ligament: the MR appearance. Br J Radiol 2008; 81 (961) 20-24
- 21 McCormack D, McGrath J. Anteromedial meniscofemoral ligament. Clin Anat 1992; 5 (06) 485-487
- 22 Kim YG, Ihn JC, Park SK, Kyung HS. An arthroscopic analysis of lateral meniscal variants and a comparison with MRI findings. Knee Surg Sports Traumatol Arthrosc 2006; 14 (01) 20-26
- 23 Trinh JM, De Verbizier J, Lecocq Texeira S. et al. Imaging appearance and prevalence of the anteromedial meniscofemoral ligament: a potential pitfall to anterior cruciate ligament analysis on MRI. Eur J Radiol 2019; 119: 108645
- 24 Sikka RS, Dhami R, Dunlay R, Boyd JL. Isolated fibular collateral ligament injuries in athletes. Sports Med Arthrosc Rev 2015; 23 (01) 17-21
- 25 Alexander AA, Yeager AN, Motamedi K, Seeger LL. Increased signal of the fibular collateral ligament of the knee on MRI, clinically significant?. Clin Imaging 2023; 98: 22-25
- 26 Choi JY, Chang CB, Kim TK, Hong SH, Kang HS. Magnetic resonance imaging findings of the lateral collateral ligament and popliteus tendon in symptomatic knees without instability. Arthroscopy 2015; 31 (04) 665-672
- 27 Park LS, Jacobson JA, Jamadar DA, Caoili E, Kalume-Brigido M, Wojtys E. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol 2007; 36 (05) 399-403
- 28 Aydingöz U, Kaya A, Atay OA, Oztürk MH, Doral MN. MR imaging of the anterior intermeniscal ligament: classification according to insertion sites. Eur Radiol 2002; 12 (04) 824-829
- 29 Sanders TG, Linares RC, Lawhorn KW, Tirman PFJ, Houser C. Oblique meniscomeniscal ligament: another potential pitfall for a meniscal tear—anatomic description and appearance at MR imaging in three cases. Radiology 1999; 213 (01) 213-216
- 30 Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol 1988; 151 (06) 1163-1167
- 31 Gottsegen CJ, Eyer BA, White EA, Learch TJ, Forrester D. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics 2008; 28 (06) 1755-1770
- 32 Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013; 223 (04) 321-328
- 33 Porrino Jr J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS. The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol 2015; 204 (02) 367-373
- 34 Pao DG. The lateral femoral notch sign. Radiology 2001; 219 (03) 800-801
- 35 Kaplan PA, Walker CW, Kilcoyne RF, Brown DE, Tusek D, Dussault RG. Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging. Radiology 1992; 183 (03) 835-838
- 36 Hunter JC, Chapman JR. Isolated avulsion of the posterior cruciate ligament: an uncommon dashboard injury. AJR Am J Roentgenol 1995; 164 (05) 1190
- 37 Recondo JA, Salvador E, Villanúa JA, Barrera MC, Gervás C, Alústiza JM. Lateral stabilizing structures of the knee: functional anatomy and injuries assessed with MR imaging. Radiographics 2000; 20 (Spec No): S91-S102