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Seventy-nine magnetic resonance (MR) studies of the knee were reviewed in an evaluation of the ability of MR imaging to demonstrate arthroscopically proved anterior cruciate ligament (ACL) tears. MR findings were also compared with the findings of two commonly applied clinical tests of ACL instability: the Lachman test and the anterior drawer test. The sensitivity of MR imaging was 94% (17 of 18), compared with 78% (14 of 18) for the anterior drawer test and 89% (16 of 18) for the Lachman test. The specificity was 100% for all three. Three MR criteria were applied: irregularity or a wavy contour of the anterior margin of the ligament, high-signal-intensity change within the substance of the ligament on T2-weighted images, and discontinuity of that substance. The sagittal T2-weighted image was especially helpful, producing an "arthrographic" effect, in which the anterior margin of the ACL is outlined by high-signal-intensity joint fluid. By demonstrating ACL and other extrameniscal lesions, MR imaging may help clarify the mechanisms of knee injury.

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In a patient with Camurati-Engelmann disease, orbital and optic nerve decompression resulted in improvement of papilledema. Subsequent x-ray films of the optic canals, however, revealed reconstitution of osseous optic canals bilaterally, and papilledema has returned in one eye. Definitive treatment of this dysplastic metabolic bone disorder rests in the control of rapid abnormal bone formation.

Fracture of the distal humeral chondroepiphysis in the neonate is an unusual injury easily mistaken for a posterior dislocation of the elbow. Physical examination reveals the nature of the injury. Nonoperative management results in a satisfactory outcome, as demonstrated in the following illustrative case. CASE REPORTA 36-hour-old infant was noted at delivery to have a deformity of the right elbow. A difficult forcep delivery was required to assist a doublefootling breech presentation. The elbow was noted to be flaccid, but right shoulder and right wrist activity were normal. The baby was delivered at full term, weighed 3950 g and was otherwise normal. The initial roentgenograms appeared to demonstrate a posterior dislocation of the elbow. An attempt at reduction of the elbow was unsuccessful; hence, the patient was transferred to the Albany Medical Center Hospital. During transfer the right elbow was notably swollen and ecchymotic, but no circulatory compromise was evident. Active motion was limited to the shoulder, hand and fingers. Examination revealed proximal displacement of the epicondylar region, shortening of the acromiocondylar distance on the involved side, and an apparently painful "muffled" crepi-

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