Introduction: The bipartite medial cuneiform is an uncommon developmental osseous variant in the midfoot. To our knowledge, Magnetic Resonance Imaging (MRI) characteristics of a nonsymptomatic bipartite medial cuneiform have not been described in the orthopaedic literature. It is important for orthopaedic foot and ankle surgeons, musculoskeletal radiologists, and for podiatrists to identify this osseous variant as it may be mistakenly diagnosed as a fracture or not recognized as a source of non-traumatic or traumatic foot pain, which may sometimes even require surgical treatment.

MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low.

Magnetic resonance imaging is accurate for detecting traumatic injury of the Lisfranc ligament and for predicting Lisfranc joint complex instability when the plantar Lisfranc ligament bundle is used as a predictor. Rupture or grade-2 sprain of the plantar ligament between the first cuneiform and the bases of the second and third metatarsals is highly suggestive of an unstable midfoot, for which surgical stabilization has been recommended. The appearance of a normal ligament is suggestive of a stable midfoot, and documentation of its integrity may obviate the need for a manual stress radiographic evaluation under anesthesia for a patient with equivocal clinical and radiographic examinations.

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We report a case of a 63-year-old male with known adenocarcinoma of the lung who presented with knee pain which was initially diagnosed as mucoid degeneration of the anterior cruciate ligament (ACL) on magnetic resonance imaging (MRI). Due to persistent knee pain an interval MRI was performed, followed by image guided biopsy which showed metastatic adenocarcinoma of the lung infiltrating the ACL. This is the first reported case in the literature of an intra-articular metastasis mimicking mucoid degeneration of the ACL.

Compared with MRI, radiographs are limited in their evaluation of the size (particularly the AP dimension) and characteristics (fragmentation, cystic change, and AVN) of non-displaced OCLTs. The most common appearance of non-displaced OCLTs is an "ill-defined" lucency at the talar dome. When this appearance is also considered, the estimated retrospective sensitivity of radiographs improves considerably.

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