During the past 3 decades, graft reconstruction of the anterior cruciate ligament (ACL) has become an accepted treatment for symptomatic ACL deficiency. The goal of surgery is to prevent joint instability, which may further damage articular cartilage and menisci. Graft failure is defined as pathologic laxity of the reconstructed ACL. The prevalence of recurrent instability after primary ACL reconstruction ranges from 1% to 8%. Early failures, those that occur within the first 6 months, often are secondary to poor surgical technique, failure of graft incorporation, or errors in rehabilitation. Late failures, those that occur more than 1 year after surgery, likely are related to new trauma and graft tearing. Other complications of ACL reconstruction include roof impingement, postoperative stiffness, tunnel widening due to cyst formation, iliotibial band friction syndrome, hardware failure, and infection. Magnetic resonance imaging is the preferred advanced imaging modality for the evaluation of symptomatic ACL graft reconstructions.

Ductal carcinoma in situ (DCIS) is a noninvasive cancer that accounts for 25% of all breast cancers diagnosed in the United States. DCIS is a heterogeneous disease process with varied clinical manifestations and a broad spectrum of imaging findings. With advances in technology, the ability to detect early-stage cancers has improved, and understanding the role of ultrasonography (US) in the multimodality era of detection and diagnosis is paramount. When calcifications are identified at mammography, US can be performed to evaluate for an invasive component and to allow possible US-guided biopsy. Use of high-frequency transducers, spectral compounding, and speckle reduction algorithms can aid in the detection of calcifications. Calcified DCIS most commonly manifests as echogenic foci located within a mass or duct, associated with internal microlobulations, or distributed in a branch pattern. Noncalcified DCIS, which is more often identified in symptomatic patients, may manifest as a hypoechoic mass with microlobulated margins and no posterior acoustic features, or it may have a "pseudomicrocystic" appearance. Harmonic imaging and coronal reconstruction may improve detection of noncalcified DCIS. The appearance of DCIS at "second-look" US can be subtle and may warrant a lower threshold for detection, given a higher pretest probability of malignancy. US features are nonspecific, and careful correlation with respect to lesion location, size, shape, and depth is needed. The presence of internal vascularity can help increase the positive predictive value of US in this setting. US is a useful adjunct to mammography and magnetic resonance imaging, and recognizing the US appearance of DCIS will aid in the detection and diagnosis of this disease entity.

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