[ MUSCULOSKELETAL IMAGING ]

FIGURE 1. Midline sagittal proton density fat suppressed magnetic resonance image FIGURE 2. Coronal proton density fat suppressed magnetic resonance image through
demonstrating the distal aspect of the anterior cruciate ligament flipped anteriorly (circle) the anterior aspect of the knee showing the distal fragment of the anterior cruciate ligament
with concomitant joint effusion (arrow). projecting anteriorly (circle) with concomitant joint effusion (arrow).

Limited Knee Extension Following

Anterior Cruciate Ligament Injury
SHANNON L. SNOW, PT, MPT, Physical Therapist, Evans Army Community Hospital, Fort Carson, CO.
SHAUN J. O’LAUGHLIN, PT, DPT, Physical Therapist, Evans Army Community Hospital, Fort Carson, CO.

T
he patient was a 24-year-old
male with a 1-month history of right
knee pain following a twisting injury.
He reported an audible pop with imme-
diate swelling at the time of injury and an
inability to bear weight. The patient was
seen by his physician and radiographs
of the right knee were taken and inter-
preted as normal. He was then referred to
physical therapy.
At the time of the initial physical ther-
apy visit, the patient presented with an
antalgic gait and a 5° loss of active and
passive right knee extension. Moderate
right knee effusion was noted, and there
was a positive Lachman’s test. Magnetic
resonance imaging of the right knee was
ordered by the physical therapist because
of concern over an anterior cruciate
ligament injury.
Magnetic resonance imaging revealed
a complete tear of the anterior cruciate
ligament, with the distal aspect of the
anterior cruciate ligament flipped anteri-
orly (FIGURES 1 AND 2). It was hypothesized
that the positioning of the distal segment
of the anterior cruciate ligament contrib-
uted to the loss of full knee extension in
this patient. This hypothesis was based on
the results of a study by Huang et al,1 who
evaluated the magnetic resonance images
of 15 patients who presented with limited
terminal knee extension after sustaining
an anterior cruciate ligament tear. In
all of the cases, these authors deter-
mined that the distal segment of the torn
anterior cruciate ligament was flipped
anteriorly and entrapped, which limited
full knee extension.
After recognition of the anterior
cruciate ligament tear, the patient was
referred to an orthopaedic surgeon
and underwent an anterior cruciate
ligament reconstruction 2 weeks later. T
J Orthop Sports Phys Ther. 2009;39(8):
635. doi:10.2519/jospt.2009.0408

Reference
1. 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;225:537-540.
The opinions expressed herein are those of the authors and do not necessarily reflect the opinions of the Department of Defense, the United States Army, or other federal
agencies.

journal of orthopaedic & sports physical therapy | volume 39 | number 8 | august 2009 | 635