0:00

Now let's talk about the posterior tibial attachment site

0:04

of the posterior cruciate.

0:07

Many taught me many years ago

0:09

that when you look at it looks like a figure of seven

0:13

and you can see it here with a normal

0:16

posterior tibial attachment site.

0:19

When you have disruption of ocean injuries involving

0:24

that tibial attachment site, the figure of seven

0:28

will be disrupted here

0:30

before injury, what it looks like

0:33

here following injury disruption of the figure of seven.

0:37

So this is something that you can look for

0:40

with conventional radiography.

0:43

Briefly, a few words about posterior tibial attachment

0:48

site evulsion fractures, they're less common

0:52

and intrasubstance ligament tears,

0:54

they often result from posterior translation.

0:57

When the knee is flexed, they do occur

1:00

with a Honda knee injury.

1:01

I mentioned before, you will generally see them

1:05

with a higher degree of displacement of the bone fragment

1:09

and if the fragment is displaced,

1:11

a minor degree conservative treatment might be utilized.

1:15

I show you here examples.

1:17

Two examples of such avulsion fractures.

1:21

Here is another one with a large piece of bone, uh,

1:26

uls from the tibia.

1:28

And I wanna emphasize

1:29

that when you see this in the immature skeleton,

1:34

the amount of bone

1:35

that may be uls can be very minor or none at all.

1:39

So this sort of evulsion injury in a child

1:44

can produce a diagnostic problem

1:48

when we talk about femoral avulsions right at the attachment

1:52

of the posterior crusade ligament to the femur.

1:56

These are rare injuries.

1:58

More often they are soft tissue injuries,

2:00

not bone avulsions,

2:02

and at least some people suggest

2:04

that rather than doing a reconstruction of the ligament,

2:08

you may be able to reattach it.

2:11

There is an injury called the reverse sag fracture.

2:15

What it relates to is an injury involving the medial tibial

2:20

rim where the medial meniscal tibial ligament attaches.

2:24

It's associated with an avulsion fracture shown.

2:27

In this particular example, you can see the injuries

2:32

to the medial supporting structures.

2:34

You can see the elevation of the medial meniscus

2:37

and additional abnormalities are often seen,

2:41

including the posterior cruciate ligament

2:43

and some of the medial supporting structures.

2:49

When you have tears involving the posterior cruciate

2:53

ligament, there may be entrapment

2:56

of the nearby meniscal femoral

2:58

Ligaments. Here

2:59

you can see in a partially torn PCL,

3:04

here is the ligament of Humphrey.

3:08

Here in this example of tearing of the PCL,

3:13

you can see that there is entrapment of the ligament

3:16

of Humphrey within the torn fibers.

3:20

And one of the other interesting aspects that can occur is

3:25

that when you have tears, significant tears

3:28

of the posterior cruciate ligament,

3:31

the meniscal femoral ligaments

3:33

and particularly the iceberg ligament,

3:36

may become thickened over a period of time.

3:40

I'm kind of pointing that out

3:41

with the red arrows here at the time of in injury at the top

3:45

and five years later, that the ligament

3:49

of Berg has hypertrophy.

3:51

And indeed, there are articles that suggest

3:54

whenever you describe a tear

3:56

of the posterior cruciate ligament,

3:58

you should comment on whether

4:00

or not there are ligaments of rice berg

4:03

or Humphrey, or both.

4:05

And if they are prominent ligaments,

4:08

because those ligaments serve as kind

4:10

of minor posterior cruciate ligaments,

4:13

and some people suggest in fact the prognosis is better

4:18

for a PCL tear with a prominent ligament of berg,

4:24

just to show you an appearance

4:27

of a chronically torn posterior cruciate ligament,

4:31

the appearance later on can look almost normal.

4:35

Not in this case, but in some cases

4:37

it can look almost normal.

4:40

So what I've done in my allotted period of time is

4:43

to cover my single objective.

4:46

We've viewed the anatomy

4:47

and injury patterns mainly to the anterior cruciate ligament

4:51

with a few comments about the posterior cruciate ligament at

4:56

the very end of this lecture.