A Retrospective Comparison of ACL Tear and Mucoid Degeneration MRI Findings and an Emphasis on Evaluating of ACL, Blumensaat, and PCL Angles

Objective: To determine MRI findings that can differentiate anterior cruciate ligament (ACL) tears from mucoid degeneration.

Material and methods: Thirty-seven patients with complete ACL tears and 43 with ACL mucoid degeneration were included in this study. Discontinuity, the abnormal signal intensity of the ACL on fat-saturated-PD weighted images, contusions, a deep lateral femoral notch, anterior tibial translation, uncovered posterior horn of the lateral meniscus, a celery stalk appearance, thickening, ganglion cysts, intraosseous cysts, the ACL, Blumensaat, and posterior cruciate ligament (PCL) angles were evaluated. Optimum threshold values, sensitivity, specificity, and 95% CIs for the angles were calculated to predict the tear.

Results: The prevalence of the significant findings in a tear versus mucoid degeneration, respectively, was as follows: discontinuity (97% vs. 0%, p < 0.001), contusions (65% vs. 2%, p < 0.001), the deep lateral femoral notch (22% vs. 0%, p = 0.001), anterior tibial translation (70% vs. 14%, p < 0.001), uncovered the lateral meniscus (46% vs. 7%, p < 0.001), a celery stalk appearance (0% vs. 66%, p < 0.001), thickening (19% vs. 100%, p < 0.001), ganglion cysts (14% vs. 70%, p < 0.001), and intraosseous cysts (8% vs. 63%, p < 0.001). Threshold values of ACL, Blumensaat, and PCL angles to predict the tear were ≤36° (78% sensitivity, 91% specificity), >11° (84%, 81%), and ≤96° (65%, 91%), respectively.

Conclusion: A celery stalk appearance in the mucoid degeneration and discontinuity in an ACL tear are important in the differential diagnosis. ACL, Blumensaat, and PCL angles can be helpful in settings of diagnostic uncertainty.

Keywords: ACL; mucoid degeneration; tear.