0:00

Next, we have a 27-year-old man

0:02

with non-contact soccer injury.

0:04

So the MCL looks pretty abnormal here.

0:07

You can see that there's, um, at least a moderate grade tear

0:11

of this, uh, tibia collateral ligament, the superficial MCL,

0:14

the deep medial meniscal femoral ligament.

0:16

You can see a margin here that that's a torn margin

0:19

that's completely torn.

0:21

And there's all this signal in the posterior oblique

0:24

and the medial meniscus.

0:28

You can see that there's a, a tear

0:29

of the medial meniscus at the posterior horn kind

0:32

of coursing toward into the body

0:34

and it's longitudinal vertical,

0:36

uh, at that peripheral third.

0:38

And there's also a tear here of the, uh,

0:41

meniscal capsular attachment.

0:42

This is the meniscal capsular ligament.

0:45

It almost looks like there's a,

0:46

a double longitudinal vertical tear here.

0:53

And the PCL looks okay. The ACL is torn.

0:57

Um, and notably it's, it's torn at the mid substance.

1:00

And as we get to the lateral compartment, you can see

1:05

that there's signal in the posterior horn

1:08

of the lateral meniscus.

1:11

Notice that this isn't a very clear longitudinal vertical

1:14

tear that continues with berg.

1:16

He does have a berg ligament, um,

1:18

which doesn't look totally normal,

1:19

but the, um, surfacing signal,

1:24

it's not, um, uh, there I would call a tear

1:27

of the posterior horn lateral meniscus,

1:29

but I wouldn't necessarily automatically write it

1:31

off as a berg rip.

1:33

And, uh, there's a reason why I'm mentioning this,

1:35

which I'll show soon.

1:37

And he has a posterior lateral corner injury as well.

1:40

You can see the, uh, bone marrow edema from, um,

1:42

from the impaction, the very typical pivot shift,

1:45

uh, mar edema pattern.

1:47

This is the, uh, pop lidio fibular ligament that was a vol

1:52

of the fibular styloid

1:56

and, um, the, uh, biceps femoris

2:00

and fibular collateral ligament.

2:01

There was, uh, some partial tearing there as well.

2:07

When we look at the axials, uh, you can see

2:09

that the medial patella femoral ligament was, uh, was torn.

2:15

And so this is,

2:20

uh, with o ani who's terrible triad, you're,

2:22

you're expecting to see a tear of the MCLA tear, VACL,

2:27

and, uh, often at that mid substance

2:30

and a, a medial meniscus tear.

2:32

And, uh, those were present. But, uh, as Dr.

2:35

Resnick had mentioned, the, uh, medial patella femoral, uh,

2:38

ligament tear, uh, now upgrades this to a, uh,

2:44

a tetra, and then the penad is the lateral meniscus.

2:48

And so, uh, he has like a penad plus

2:51

because he also had, uh, a avulsion.

2:54

Um, he had a posterior lateral corona injury,

2:56

which you would see with, um, a,

2:58

Uh, varus mechanism.

3:00

So oue terrible triad is usually, typically seen with, um,

3:03

ant medial rotatory instability.

3:05

And that's valgus, uh, external rotation, uh, mechanism.

3:09

So the medial meniscus here, um, given how extensively, uh,

3:13

disrupted it was from the capsule, you could see

3:15

that they could just, uh,

3:16

literally pull this medial meniscus similar

3:18

to a bucket handle, uh, displace it into the joint.

3:23

And here

3:28

is the empty wall, uh, the disrupted cruciate ligament.

3:36

And when they're getting to this lateral meniscus,

3:38

you can see that the root ligament looked pretty

3:40

good over here.

3:42

Uh, notice that this longitudinal vertical tear, it doesn't,

3:45

um, it basically stops centrally, like right over there.

3:50

And so it's not a berg rip, which you would expect

3:53

to be this unzipping, um, from, uh,

3:58

from the anterior translation

3:59

with a fixed meniscal femoral ligament.

4:01

This is just a longitudinal vertical, um, uh, tear of that,

4:06

uh, posterior horn.

4:08

So I wanted to show it

4:10

because, uh, not all longitudinal vertical tears in the

4:13

setting, uh, of, of

4:14

that posterior horn lateral meniscus in the setting

4:16

of an ACL tear, not all

4:17

of them are automatically gonna be risk for grips.

4:20

And so he had a very interesting mechanism

4:22

when I looked at his chart.

4:23

Uh, this was his clinic note.

4:25

He sustained a twisting injury

4:26

to his knee while playing soccer.

4:28

And it's interesting

4:29

'cause it described this, uh, series of events

4:32

where he kicked, planted and pushed off of his left knee.

4:34

And I, so, so I think that what ended up happening here was

4:37

that valgus, uh, external rotation, that ery mechanism.

4:41

And when he ex, when he, uh, subsequently extended his knee,

4:44

it, it, um, it relocated.

4:47

Uh, and I think that he had a contracoup, uh, varus.

4:50

Uh, and that's what caused his lower grade

4:51

poster lateral corner injury.

4:53

Uh.