Thirty-six consecutive magnetic resonance (MR) images of the knee in patients with acute anterior cruciate ligament (ACL) tears from skiing accidents, in whom diagnosis was made by physical examination, was confirmed by arthroscopy and MR imaging in all cases. Twenty-two occult fractures (61%) were identified in the 36 knees. In all cases, initial radiographs showed no evidence of fracture or other osseous abnormality. The most common pattern is an isolated occult fracture of the posterior aspect of the lateral tibial condyle (LTC); the second most common pattern results from a pivot shift phenomenon, which involves a posterior LTC occult fracture associated with an occult fracture of the lateral femoral condyle (LFC). In those patients with large bony injuries and potential articular cartilage damage, an extended period of protected weight-bearing may be needed.
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