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hello everyone and welcome to msk unknown k-series k71 this is an amazing case and I can guarantee you that many of you have not ever seen this case so we have coronal and sagittal CT images through the knee and notice that this patient has had an ACL reconstruction we can see the tunnel of the ACL graph or the ACL reconstruction here so thats an important part of the piece for this case so the station has an ACL reconstruction and the question that I have for you is what is the most likely diagnosis status post ACL reconstruction am I showing you a case of arthrofibrosis tibial tunnel syndrome graph rupture or ephemeral blowout fracture whats the most likely diagnosis so if we take a look at the cases the choices arthrofibrosis thats typically a focal form of fibrosis that occurs anterior to The graft so that will typically occur right here in this region and its usually an MRI diagnosis its typically dark on T1 dark on T2 it limits terminal extension of the knee status post ACL