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First case is a 17-year-old

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with twisting injury while playing football.

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So scrolling from medial to lateral, we can see the, uh,

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MCL, the tibial collateral ligament here.

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There's a lot of edema when we get to the, here's the body

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of the medial meniscus.

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When you, when you get to the posterior horn, you see

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that there's, uh,

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this high signal surrounding this posterior horn.

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So this is a, a ramp lesion.

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The, there's no distinc, um, meniscal capsular

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or meniscal tibial ligaments.

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And there's also, uh, bone marrow edema here.

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And we can see that the, uh, PCL has increased signal,

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uh, in the substance of it.

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There's, uh, definitely intact fibers that remain,

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but there's a moderate grade tear of this PCL, uh, in,

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in the, um, in the substance.

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The ACL is completely torn.

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And when we get to the lateral, um, meniscus, you can see

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that, um, he actually has a, uh, ligament of Humphrey,

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but the, there, there's, um,

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high signal within the posterior horn of

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that lateral meniscus that extends way too

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far, uh, laterally.

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And so, uh, this is a berg grip or berg grip.

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And, uh, one way to look at this is to count the number

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of slices, uh, lateral to the, uh, PCL, um, footprint.

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So this would be the first slice

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that you don't see that PCL in.

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And you see 2, 3, 4,

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and five, I mean, uh, once you hit the four, uh, um, slices.

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And that's, uh, pretty diagnostic of a, a berg grip.

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And in this case, um, this thing extends, um, quite a, uh,

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a distance away from the PCL.

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So that's, this is, um, a definite, uh, tear, um,

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of the posterior horn.

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And you can see a double notch this very deep, uh,

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osteochondral impaction, uh,

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it's at least a couple millimeters that depressed posterior

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to the true lateral condyle patella sulcus.

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And as we keep going laterally, uh,

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there's also a posterolateral corner injury,

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uh, which we're not gonna focus too much on.

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But whenever you're, you're seeing on this extensive multi

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ligamentous injury,

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you really should be checking the neurovascular structures.

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Um, I, I had thought that the perineal nerve was a little

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bit bright, um, near this fibular head,

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but, uh, according to the clinical notes, she was not, uh,

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or he was neurovascularly intact.

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And something I wanted to highlight here was

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that these were the radiographs four days

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before the MRI.

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And so this is a case of a knee dislocation, uh,

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when you get bi cruciate injuries.

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And certainly as you start to get, uh, other, uh, liga uh,

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ligamentous injuries, you really should, uh, uh,

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entertain the possibility of a prior dislocation

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That has been reduced.

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Um, and, and you can see that this, uh,

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this radiograph was taken in a dislocated position.

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So this patient went for arthroscopy,

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and the arthroscopy was four weeks, uh,

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after the, it was four to five weeks after the injury.

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And this is the intracon or notch.

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Um, given that there's a, uh, length of time

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after the injury, you can see

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that there's a lot of synovitis.

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Um, this was, um, an empty, uh, empty wall here

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that's consistent with the ACL tear.

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The PCL, uh, looked okay, um,

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after they, uh, debrided through all that, uh, synovitis,

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and this is

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the posterior horn of lateral meniscus.

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This, uh, probe is, um,

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dropping in through the top and the bottom.

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Um, and that, uh, connects up to the, um, uh,

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ligament of, uh, berg.

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So that's the Ryberg grip.

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And this was that deep, um,

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that, that osteochondral impaction.

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And what, uh, this thing was about a centimeter in diameter.

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It corresponds very nicely to the MRI.

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And there was, uh, a big blood clot that had actually,

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uh, formed and it filled in, uh,

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and was remodeling by this time it was,

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it was remodeling into fiber cartilage.

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And so it's similar, uh, to what you would, uh, hope to see

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with, um, marrow stimulation.

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But, uh, that, that was a nice, um, uh,

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arthroscopic correlate.

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And at the notch, um, they had debris it

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through the synovitis, and you can see

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that this is just the remnants stump of the, of the ACL.

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And they did a reconstruction.

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And for the lateral meniscus, uh, they, they repaired that

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There was a question in the chat about the wrist or grip.

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So I'll just spend a little bit, bit of time on it.

4:57

Um, it happens, obviously, uh,

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when you get anterior subluxation of the tibia

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and with the fixed meniscal femoral ligament, it, it unzips

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and causes this tearing, uh, right along the, uh, plane of,

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um, uh, of the berg ligament.

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And, uh, if you count the number of images lateral

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to the PCL with the first image,

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where you don't see the PCL labeled one, um,

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four images is pretty specific.

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Um, or you can make some measurements.

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Um, but generally you can see irregularity of the, uh,

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of those margins where there's that vertical cleft.

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And if it's irregular, then it's gonna be a tear.