ACL mucoid degeneration and tibial nerve schwannoma

Discussion:

MRI knees in patient's over 50 are less frequently performed, due to the increasing prevalence of osteoarthritis and meniscal tears, and confirming such pathologies are unlikely to change the clinical management.  In older patients, MRI is still performed if there is severe knee pain and osteonecrosis and/or insufficiency fracture are suspected.  

This case excellently demonstrates the celery stalk sign of an ACL with mucoid degeneration.  In younger patients with an ACL which has edematous expansion and there is an associated pivot-shift bone contusion pattern, high grade partial thickness tearing of the ACL can have a similar appearance. Therefore, care should be taken not to attribute all ACLs with this appearance as just mucoid degeneration.  

The case also displays a good example of a peripheral nerve sheath tumor, likely a schwannoma, with fusiform thickening, a split fat sign and a perineural tail.  

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