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Joseph Junewick, MD FACR
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ACL Rupture with Nodular Synovitis

Case Detail

Anatomy: Musculoskeletal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

15 year old with knee pain and locking for several months after injury.


Case Images


Diagnosis

ACL Rupture with Nodular Synovitis

Findings

MR – Sagittal T1, FS-T2, IR and post-gadolinium FS-T1 images show complete disruption of the anterior cruciate ligament with florid nodular synovitis in the intercondylar notch and Hoffa’s fat.

Discussion

Localized nodular synovitis is a benign proliferative disorder found most frequently in the tendon sheaths of the small joints of the fingers and toes but also larger joint, notably the knee joint. The cause of localized nodular synovitis is unclear, although it has been suggested that it is an inflammatory process (toxic, traumatic, allergic incitement) or a benign neoplasm of the synovium. The infrapatellar fat pad was the most common site of involvement followed by the suprapatellar pouch and intercondylar notch. When the cruciate ligaments are involved, localized nodular synovitis tends to more commonly affect the posterior cruciate ligament. The clinical manifestations of localized nodular synovitis of the knee include pain, swelling or fullness, joint-line tenderness, restricted knee motion, and a palpable mass. Knee locking is common with large infrapatellar fat pad lesions.

Reference

Huang G, Lee C, Chan W, et al. Localized Nodular Synovitis of the Knee: MR Imaging Appearance and Clinical Correlates in 21 Patients. AJR (2003); 181:539-543.

Meyers AB, Laor T, Zbojniewicz AM. Stump entrapment of the anterior cruciate ligament in late childhood and adolescence. Pediatric Radiol (2011); 1041-1046.

Contributor

Neil McCullough, MD



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