Download PDF
Semin Musculoskelet Radiol 2025; 29(03): 390-402
DOI: 10.1055/s-0045-1806795
Review Article

Complete and Partial Tears of the Anterior Cruciate Ligament: Acute and Evolution

Wassef Khaled 
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
2   Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
,
Antoine Gerometta
3   Department of Sports Surgery, Clinique du Sport, Paris, France
,
Henri Guerini
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
2   Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
,
Quentin Monzani
2   Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
4   Department of Radiology, AP-HP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
,
Eric Pessis
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
,
Raphaël Campagna
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
,
Fadila Mihoubi Bouvier
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
2   Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
,
Jean-Luc Drapé
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
,
Antoine Feydy
1   Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Anterior cruciate ligament tears represent a prevalent injury in sports that involves rotational movements and rapid changes in direction, such as pivot-contact sports. The anterior cruciate ligament serves as the primary stabilizer of the knee, preventing anterior tibial translation and medial tibial rotation. Although clinical examination is essential for diagnosis, magnetic resonance imaging plays a crucial role in confirming complete tears and evaluating associated injuries, particularly meniscal injuries. Diagnosis relies on both direct and secondary signs that are instrumental in assessing knee laxity and stability. Despite advancements in imaging techniques, challenges persist in using magnetic resonance imaging to distinguish between complete and partial tears, evaluate knee instability, and determine the potential for anterior cruciate ligament healing.

Keywords

anterior cruciate ligament - magnetic resonance imaging - instability - tear


Publication History

Article published online:
20 May 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dolk DC, Hedevik H, Stigson H, Wretenberg P, Kvist J, Stålman A. Nationwide incidence of anterior cruciate ligament reconstruction in higher-level athletes in Sweden: a cohort study from the Swedish National Knee Ligament Registry linked to six sports organisations. Br J Sports Med 2024 ; November 21 (Epub ahead of print)
    Search in Google Scholar
  • 2 Sanders TL, Maradit Kremers H, Bryan AJ. et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 2016; 44 (06) 1502-1507
    Search in Google Scholar
  • 3 Śmigielski R, Zdanowicz U, Drwięga M, Ciszek B, Ciszkowska-Łysoń B, Siebold R. Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3143-3150
    Search in Google Scholar
  • 4 Śmigielski R, Zdanowicz U, Drwięga M, Ciszek B, Williams A. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction. Bone Joint J 2016; 98-B (08) 1020-1026
    Search in Google Scholar
  • 5 Gabriel MT, Wong EK, Woo SLY, Yagi M, Debski RE. Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 2004; 22 (01) 85-89
    Search in Google Scholar
  • 6 Amis AA. The functions of the fibre bundles of the anterior cruciate ligament in anterior drawer, rotational laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc 2012; 20 (04) 613-620
    Search in Google Scholar
  • 7 Esfandiarpour F, Shakourirad A, Talebian Moghaddam S, Olyaei G, Eslami A, Farahmand F. Comparison of kinematics of ACL-deficient and healthy knees during passive flexion and isometric leg press. Knee 2013; 20 (06) 505-510
    Search in Google Scholar
  • 8 Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W. The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 2007; 35 (02) 223-227
    Search in Google Scholar
  • 9 Bayer S, Meredith SJ, Wilson KW. et al. Knee morphological risk factors for anterior cruciate ligament injury: a systematic review. J Bone Joint Surg Am 2020; 102 (08) 703-718
    Search in Google Scholar
  • 10 Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 2846-2852
    Search in Google Scholar
  • 11 Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol 2019; 33 (01) 33-47
    Search in Google Scholar
  • 12 Logerstedt DS, Scalzitti D, Risberg MA. et al. Knee stability and movement coordination impairments: knee ligament sprain revision 2017. J Orthop Sports Phys Ther 2017; 47 (11) A1-A47
    Search in Google Scholar
  • 13 Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 2006; 36 (05) 267-288
    Search in Google Scholar
  • 14 Décary S, Ouellet P, Vendittoli PA, Roy JS, Desmeules F. Diagnostic validity of physical examination tests for common knee disorders: an overview of systematic reviews and meta-analysis. Phys Ther Sport 2017; 23: 143-155
    Search in Google Scholar
  • 15 Sokal PA, Norris R, Maddox TW, Oldershaw RA. The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30 (10) 3287-3303
    Search in Google Scholar
  • 16 Kent RN, Imhauser CW, Thein R. et al. Engagement of the secondary ligamentous and meniscal restraints relative to the anterior cruciate ligament predicts anterior knee laxity. Am J Sports Med 2020; 48 (01) 109-116
    Search in Google Scholar
  • 17 Frobell RB, Lohmander LS, Roos HP. Acute rotational trauma to the knee: poor agreement between clinical assessment and magnetic resonance imaging findings. Scand J Med Sci Sports 2007; 17 (02) 109-114
    Search in Google Scholar
  • 18 James EW, Williams BT, LaPrade RF. Stress radiography for the diagnosis of knee ligament injuries: a systematic review. Clin Orthop Relat Res 2014; 472 (09) 2644-2657
    Search in Google Scholar
  • 19 Franklin JL, Rosenberg TD, Paulos LE, France EP. Radiographic assessment of instability of the knee due to rupture of the anterior cruciate ligament. A quadriceps-contraction technique. J Bone Joint Surg Am 1991; 73 (03) 365-372
    Search in Google Scholar
  • 20 Lefevre N, Bohu Y, Naouri JF, Klouche S, Herman S. Validity of GNRB® arthrometer compared to Telos™ in the assessment of partial anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 2014; 22 (02) 285-290
    Search in Google Scholar
  • 21 Mouton C, Theisen D, Seil R. Objective measurements of static anterior and rotational knee laxity. Curr Rev Musculoskelet Med 2016; 9 (02) 139-147
    Search in Google Scholar
  • 22 Panisset JC, Ntagiopoulos PG, Saggin PR, Dejour D. A comparison of Telos™ stress radiography versus Rolimeter™ in the diagnosis of different patterns of anterior cruciate ligament tears. Orthop Traumatol Surg Res 2012; 98 (07) 751-758
    Search in Google Scholar
  • 23 Bachmann LM, Haberzeth S, Steurer J, ter Riet G. The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review. Ann Intern Med 2004; 140 (02) 121-124
    Search in Google Scholar
  • 24 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
    Search in Google Scholar
  • 25 Phua SKA, Lim JY, Li T, Ho SWL. The Segond fracture: a narrative review of the anatomy, biomechanics and clinical implications. J Clin Orthop Trauma 2023; 38: 102127
    Search in Google Scholar
  • 26 Cobby MJ, Schweitzer ME, Resnick D. The deep lateral femoral notch: an indirect sign of a torn anterior cruciate ligament. Radiology 1992; 184 (03) 855-858
    Search in Google Scholar
  • 27 Schreiner G, Fucaloro S, Ward M. et al. The diagnostic accuracy of ultrasound in assessing anterior cruciate ligament tears: a systematic review and meta-analysis. Skeletal Radiol 2025 ; January 14 (Epub ahead of print)
    Search in Google Scholar
  • 28 Cheng Q, Zhao FC. Comparison of 1.5- and 3.0-T magnetic resonance imaging for evaluating lesions of the knee: a systematic review and meta-analysis (PRISMA-compliant article). Medicine (Baltimore) 2018; 97 (38) e12401
    Search in Google Scholar
  • 29 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
    Search in Google Scholar
  • 30 Kam CK, Chee DWY, Peh WCG. Magnetic resonance imaging of cruciate ligament injuries of the knee. Can Assoc Radiol J 2010; 61 (02) 80-89
    Search in Google Scholar
  • 31 Chen C, Liu X, Wu P. et al. High-resolution oblique coronal MRI at optimal flexed-knee angle: a novel imaging method for enhanced anterior cruciate ligament tear diagnosis. J Orthop Surg Res 2024; 19 (01) 456
    Search in Google Scholar
  • 32 Xu Z, Chen Y, Zhu J, Zhang L, Wu P. Comparison of the use of magnetic resonance imaging of partial anterior cruciate ligament tears using maximum knee flexion in the lateral decubitus position with routine knee positioning. Med Sci Monit 2021; 27: e932228
    Search in Google Scholar
  • 33 Parkar AP, Adriaensen MEAPM. ESR essentials: MRI of the knee-practice recommendations by ESSR. Eur Radiol 2024; 34 (10) 6590-6599
    Search in Google Scholar
  • 34 Altahawi F, Pierce J, Aslan M, Li X, Winalski CS, Subhas N. 3D MRI of the knee. Semin Musculoskelet Radiol 2021; 25 (03) 455-467
    Search in Google Scholar
  • 35 Gentili A, Seeger LL, Yao L, Do HM. Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology 1994; 193 (03) 835-840
    Search in Google Scholar
  • 36 Papalia R, Torre G, Vasta S. et al. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence. Open Access J Sports Med 2015; 6: 37-48
    Search in Google Scholar
  • 37 Snearly WN, Kaplan PA, Dussault RG. Lateral-compartment bone contusions in adolescents with intact anterior cruciate ligaments. Radiology 1996; 198 (01) 205-208
    Search in Google Scholar
  • 38 Kim-Wang SY, Scribani MB, Whiteside MB, DeFrate LE, Lassiter TE, Wittstein JR. Distribution of bone contusion patterns in acute noncontact anterior cruciate ligament-torn knees. Am J Sports Med 2021; 49 (02) 404-409
    Search in Google Scholar
  • 39 Agostinone P, Di Paolo S, Lucidi GA, Dal Fabbro G, Grassi A, Zaffagnini S. Severe bicompartmental bone bruise is associated with rotatory instability in anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2022; 30 (05) 1725-1732
    Search in Google Scholar
  • 40 Wittstein J, Vinson E, Garrett W. Comparison between sexes of bone contusions and meniscal tear patterns in noncontact anterior cruciate ligament injuries. Am J Sports Med 2014; 42 (06) 1401-1407
    Search in Google Scholar
  • 41 Beel W, Mouton C, Tradati D, Nührenbörger C, Seil R. Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc 2022; 30 (01) 184-191
    Search in Google Scholar
  • 42 Hardy A, Klouche S, Szarzynski P. et al. A threshold value of 3.5 mm of passive anterior tibial subluxation on MRI is highly specific for complete ACL tears. Knee Surg Sports Traumatol Arthrosc 2019; 27 (03) 885-892
    Search in Google Scholar
  • 43 Brandser EA, Riley MA, Berbaum KS, el-Khoury GY, Bennett DL. MR imaging of anterior cruciate ligament injury: independent value of primary and secondary signs. AJR Am J Roentgenol 1996; 167 (01) 121-126
    Search in Google Scholar
  • 44 McCauley TR, Moses M, Kier R, Lynch JK, Barton JW, Jokl P. MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings. AJR Am J Roentgenol 1994; 162 (01) 115-119
    Search in Google Scholar
  • 45 Vassalou EE, Klontzas ME, Kouvidis GK, Matalliotaki PI, Karantanas AH. Rotational knee laxity in anterior cruciate ligament deficiency: an additional secondary sign on MRI. AJR Am J Roentgenol 2016; 206 (01) 151-154
    Search in Google Scholar
  • 46 Cristiani R, van de Bunt F, Kvist J, Stålman A. High prevalence of associated injuries in anterior cruciate ligament tears: a detailed magnetic resonance imaging analysis of 254 patients. Skeletal Radiol 2024; 53 (11) 2417-2427
    Search in Google Scholar
  • 47 Minami T, Muneta T, Sekiya I. et al. Lateral meniscus posterior root tear contributes to anterolateral rotational instability and meniscus extrusion in anterior cruciate ligament-injured patients. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1174-1181
    Search in Google Scholar
  • 48 Puzzitiello RN, Agarwalla A, Zuke WA, Garcia GH, Forsythe B. Imaging diagnosis of injury to the anterolateral ligament in patients with anterior cruciate ligaments: association of anterolateral ligament injury with other types of knee pathology and grade of pivot-shift examination: a systematic review. Arthroscopy 2018; 34 (09) 2728-2738
    Search in Google Scholar
  • 49 Sonnery-Cottet B, Colombet P. Partial tears of the anterior cruciate ligament. Orthop Traumatol Surg Res 2016; 102 (1, Suppl): S59-S67
    Search in Google Scholar
  • 50 Jog AV, Smith TJ, Pipitone PS, Toorkey BC, Morgan CD, Bartolozzi AR. Is a partial anterior cruciate ligament tear truly partial? a clinical, arthroscopic, and histologic investigation. Arthroscopy 2020; 36 (06) 1706-1713
    Search in Google Scholar
  • 51 Van Dyck P, De Smet E, Veryser J. et al. Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 2012; 20 (02) 256-261
    Search in Google Scholar
  • 52 Huang GS, Lee CH, Chan WP, Lee HS, Chen CY, Yu JS. Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance. Radiology 2002; 225 (02) 537-540
    Search in Google Scholar
  • 53 Lefevre N, Naouri JF, Bohu Y, Klouche S, Herman S. Sensitivity and specificity of bell-hammer tear as an indirect sign of partial anterior cruciate ligament rupture on magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2014; 22 (05) 1112-1118
    Search in Google Scholar
  • 54 Volokhina YV, Syed HM, Pham PH, Blackburn AK. Two helpful MRI signs for evaluation of posterolateral bundle tears of the anterior cruciate ligament: a pilot study. Orthop J Sports Med 2015; 3 (08) 2325967115597641
    Search in Google Scholar
  • 55 Tokgoz MA, Oklaz EB, Ak O, Guler Oklaz EB, Ataoglu MB, Kanatli U. The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears. Arch Orthop Trauma Surg 2024; 144 (05) 2181-2187
    Search in Google Scholar
  • 56 Celikyay F, Yuksekkaya R, Bilgic E. A retrospective comparison of ACL tear and mucoid degeneration MRI findings and an emphasis on evaluating of ACL, Blumensaat, and PCL angles. J Belg Soc Radiol 2020; 104 (01) 36
    Search in Google Scholar
  • 57 Manner HM, Radler C, Ganger R, Grill F. Dysplasia of the cruciate ligaments: radiographic assessment and classification. J Bone Joint Surg Am 2006; 88 (01) 130-137
    Search in Google Scholar
  • 58 Anderson AF, Awh MH, Anderson CN. The anterior meniscofemoral ligament of the medial meniscus: case series. Am J Sports Med 2004; 32 (04) 1035-1040
    Search in Google Scholar
  • 59 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
    Search in Google Scholar
  • 60 Tan K, Yoong P, Toms AP. Normal anatomical variants of the menisci and cruciate ligaments that may mimic disease. Clin Radiol 2014; 69 (11) 1178-1185
    Search in Google Scholar
  • 61 Filbay SR. Early ACL reconstruction is required to prevent additional knee injury: a misconception not supported by high-quality evidence. Br J Sports Med 2019; 53 (08) 459-461
    Search in Google Scholar
  • 62 Filbay SR, Roemer FW, Lohmander LS. et al. Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial. Br J Sports Med 2023; 57 (02) 91-98
    Search in Google Scholar
  • 63 Pitsillides A, Stasinopoulos D, Giannakou K. Healing potential of the anterior cruciate ligament in terms of fiber continuity after a complete rupture: a systematic review. J Bodyw Mov Ther 2021; 28: 246-254
    Search in Google Scholar
  • 64 Ihara H, Miwa M, Deya K, Torisu K. MRI of anterior cruciate ligament healing. J Comput Assist Tomogr 1996; 20 (02) 317-321
    Search in Google Scholar
  • 65 Costa-Paz M, Ayerza MA, Tanoira I, Astoul J, Muscolo DL. Spontaneous healing in complete ACL ruptures: a clinical and MRI study. Clin Orthop Relat Res 2012; 470 (04) 979-985
    Search in Google Scholar
  • 66 van Melick N, van Cingel REH, Brooijmans F. et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med 2016; 50 (24) 1506-1515
    Search in Google Scholar
  • 67 Beaufils P, Hulet C, Dhénain M, Nizard R, Nourissat G, Pujol N. Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthop Traumatol Surg Res 2009; 95 (06) 437-442
    Search in Google Scholar