Dr. Ebraheim's animated educational video describes avulsion fractures and bone bruises around the knee.
Medial collateral ligament avulsion
•It can be avulsed with a piece of bone from the femur. It is a proximal avulsion fracture.
Pellegrini-Stieda syndrome
•The injury is sometimes indicated by calcification occurring on the medial epicondyle. Chronic calcification seen on x-rays on the medial epicondyle of the femur.
Anterior cruciate ligament avulsion
•Avulsion of a piece of bone from the tibial eminence anteriorly. Avulsion of a piece of bone can be seen on the AP and lateral x-rays. ACL avulsion fracture may be an isolated injury or it may sometimes be associated with other injuries and fractures such as tibial plateau fractures. Tibial spine fractures in children mimic ACL avulsion fracture in adults.
Posterior cruciate ligament avulsion
•Avulsion of a piece of bone posteriorly. This is the most common presentation of avulsion of PCL.
Fibular head avulsion (arcuate sign)
•Fibular head avulsion fracture will indicate that the posterolateral corner is involved. Fibular head avulsion fracture will indicate that the posterolateral corner is involved. The arcuate sign should be recognized as a significant injury. Sometimes the avulsed piece is too small and the injury can be missed. If not diagnosed and dealt with properly then posterolateral instability of the knee can occur. Failure to diagnose it may result in failure of the cruciate ligaments because the posterolateral corner instability was not diagnosed or treated properly.
The arrangement of the insertion of ligaments or tendon into the fibular head from anterior to posterior:
1-Lateral collateral ligament
2-Popliteofibular ligament
3-Biceps femoris tendon.
Lateral capsule segond (indicates torn ACL)
Bone bruises
Lateral subluxation of the patella causing a contusion (bruise) on the medial aspect of the patella and on the lateral femoral condyle.
ACL tears may cause bone bruises laterally on the middle of the femoral condyle and on the posterior aspect of the tibia laterally. How do you know it is lateral? Check for the fibula on MRI. None bruise laterally indicates an ACL tear. Fat within the aspirate if the knee, indicates an occult fracture. Because fat is less dense than blood, it floats on the surface. The blood is heavier so it stays at the bottom. The presence of fat/fluid level is diagnostic of a fracture even if a fracture is not seen on x-ray (occult). Fat/fluid level is seen in some cases of tibial plateau fractures, chondral injuries and patellar fractures (not seen on x-rays). Lipohemarthrosis is seen better with cross-table lateral view of the knee.

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