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Anterior cruciate ligament mucoid degeneration and ganglion cyst

Case contributed by Pavan Borra
Diagnosis almost certain

Presentation

Pain and stiffness for 4 months. Old history of injury.

Patient Data

Age: 40 years
Gender: Female

Thickened anterior cruciate ligament with celery stalk appearance and T2/PD fat sat intrasubstance hyperintense signals reflecting mucoid degeneration of the anterior cruciate ligament.

A T2 hyperintense cyst of 19 x 18 mm in the intercondylar fossa adjacent to the femoral attachment of anterior cruciate ligament, consistent with ganglion cyst.

A horizontal tear is noted at the anterior horn of the lateral meniscus.

Case Discussion

The etiology of ACL ganglion cysts is uncertain. Remote ligamentous trauma and mucoid degeneration play a role in the development of the cysts. MR imaging appearances are discrete fluid signal cystic structure within or on the surface of ACL. They have a tendency to extend into surrounding intra-articular or osseous structures.

Diffuse thickening with intra-ligamentous T2 hyperintensity and splaying of intact ACL fibers with a celery stalk appearance is consistent with mucoid degeneration of anterior cruciate ligament.

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