Aim
To determine the preoperative sensitivity of MRI in proximal ACL ruptures that required ACL repair surgery.
Methods
A retrospective analysis was performed of all ACL repair procedures performed by a single surgeon between January 2024 and December 2025 with a preoperative MRI report available. Data collected included intraoperative arthroscopic findings, ACL testing under anaesthesia (Lachman, anterior drawer, pivot shift), and time from injury to MRI.
Results
72 patients met the inclusion criteria. Median time from injury to MRI was 34 days and from injury to surgery was 90 days. MRI identified an ACL tear in 42 patients (58.3%). False negative MRI reports had a median time of 53 days from injury to MRI, compared to 20 days for true positives. Grade 2 Lachman had a true positive MRI rate of 71% versus 44% for Grade 1 Lachman (p = 0.038).
Conclusion
For proximal ACL avulsion injuries undergoing ACL repair surgery, MRI showed a diagnostic sensitivity of 58.3%. Time from injury to MRI is a critical factor affecting this sensitivity. Clinical assessment-based treatment counselling is recommended for this injury pattern, with MRI used as an adjunct.
