Two Helpful MRI Signs for Evaluation of Posterolateral Bundle Tears of the Anterior Cruciate Ligament: A Pilot Study

BACKGROUND: Diagnosis of partial anterior cruciate ligament (ACL) tears is difficult on magnetic resonance imaging (MRI), particularly the isolated tears of the posterolateral bundle. PURPOSE: To describe 2 MRI signs of partial ACL tear involving the posterolateral bundle on conventional knee MRI sequences, specifically, the “gap” and “footprint” signs. STUDY DESIGN: Case-control study. METHODS: We retrospectively reviewed the MRI appearance of the ACL in 11 patients with arthroscopically proven partial ACL tears isolated to the posterolateral bundle, as well as in 10 patients with arthroscopically proven intact ACLs, and evaluated for the presence of gap and/or footprint signs. RESULTS: There was high degree of sensitivity and specificity associated with the MRI findings of “gap” and “footprint” signs with arthroscopically proven isolated posterolateral bundle tears. CONCLUSION: Gap and footprint signs are suggestive of posterolateral bundle tear of the ACL, and the presence of 1 or both of these imaging findings should alert the radiologist to the possibility of a posterolateral bundle tear.