Status post ACL reconstruction, with ACL tear (not fixed), biceps avulsion, injury September 2015. Right knee instability. Evaluate right knee for healing of posterolateral corner. Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: I see no articular cartilage defects. Evaluation of the lateral femoral condyle is limited by metal susceptibility artifact resulting from an orthopedic screw. There is also a surgical tunnel within the fibular head. A couple of small ossicles are noted proximal to the fibular styloid likely representing ununited fracture fragments, the larger ossicle perhaps representing an old avulsion of the popliteofibular ligament.LIGAMENTS: The patient has undergone lateral collateral ligament reconstruction. The graft extends from the surgical tunnel in the fibular head toward the artifact created by the orthopedic screw which protrudes slightly from the lateral femoral condyle. Although the most proximal fibers of the graft are difficult to evaluate due to the metal susceptibility artifact, I suspect that it is intact. There is intermediate signal intensity surrounding the graft and extending superiorly beyond the orthopedic screw along the undersurface of the lateral retinaculum and iliotibial band that I suspect represents scarring. The iliotibial band itself appears thickened, but can be followed to its insertion on Gerdy's tubercle. The posterior fibers of the lateral retinaculum and adjacent lateral deep crural fascia also appear thickened with abnormal signal intensity, particularly in the vicinity of the aforementioned orthopedic screw, which I suspect represents a combination of chronic tearing and adjacent scar tissue. The distal tendon of the biceps femoris can be followed to its insertion on the fibula; it appears thickened at its insertion on the fibula, with mildly increased signal intensity, perhaps representing prior insertional injury and subsequent scarring, but I see no fluid-filled disruption currently. The medial collateral ligament appears intact. The posterior cruciate ligament appears intact. A structure resembling of the anterior cruciate ligament is noted extending from the distal femur to the proximal tibia; however, it appears thinned and may represent only one of the two bundles, with the other bundle being chronically torn and no longer visible. Alternatively, this may reflect scar tissue that has formed along a completely disrupted ACL, but I suspect this is less likely.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL
Surgical changes of LCL reconstruction as described above. Although detailed evaluation is limited by metal susceptibility artifact, I suspect that the graft is intact. There is, however, what I believe to be the extensive adjacent scar tissue, and perhaps chronic tearing of the adjacent lateral retinaculum. Other findings as above.