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The tibial tunnel measures 13.2 x 8.8mm in maximal height and width, but
there is a thin calcific rind in the tunnel…and the dimensions along the
inner calcification measure 7.2 x 7.5mm Attenuation of 7.5-28HU
Femoral tunnel measures 8 x 6 mm with attenuation 55-70 HU in the tunnel.
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We don’t always do the Cor Obl PD, but I thought the graft looked very
attenuated with probable high grade partial tear of the proximal graft near
the femoral tunnel. But I am so uncomfortable looking at these…what do
you think?
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Sag shows a little proximal bright signal…looks intact, but Sag can be
misleading
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See proximal bright signal but not sure if there is proximal tear in Cor
images through the graft.. The right hand image shows a chondral defect of
the LFC
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Ax T1 and PDFS….it seems there is peripheral ossification of the tibial
tunnel, so even though there is bright PDFS signal, I think the smaller
dimensions inside that thin rind of calcification on CT of the tibial
tunnel are more accurate. Is that right?
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Most of the femoral tunnel contains mature ossification, except right at
the aperture. As opposed to the tibial tunnel which is bright. The arrow
shows the LFC chondral defect.
I called the orthopedist to see if the patient has ACL instability on exam.
She is completely unstable…which makes sense, since she went to the
trouble of getting CT to assess tunnel widening prior to revision.
But I’m not sure how I would have reported the graft status if the CT had
not been ordered.
What do you think?
I do not routinely report CT for tunnel widening.
What is the proper approach?
Does the attenuation / signal in the tunnel matter at all?
