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Stener Lesion

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Case is an 18-year-old with knee injury two weeks prior,

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and this is case three.

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We can see that the MCL, uh,

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looks abnormal when you correlate it here.

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You um, you actually see that it's,

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it's taken off distally.

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If we scroll through,

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I don't wanna spend too much time on the MCL,

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but, um, uh, you can see as we go, uh,

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beyond the joint line, several centimeters below,

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it should attach maybe six to seven, seven centimeters

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below the joint line onto the tibia.

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But this MCL is superficial to the pesan sinus tendons.

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So this was a, um, reverse, uh, this was a, uh,

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centerlike lesion of the knee,

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and

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this is the very nice, uh, ramp area

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of meniscocapsular meniscal tibial ligament.

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Um, sometimes it can look like separate attachments

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or it can look like one, but this is all certainly intact.

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This ramp area, the PCL looks pretty good.

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And when we get to the ACL, you see

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that there's increased signal in the ACL.

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Certainly there's, um, intact fibers,

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but for an 18-year-old this looks pretty abnormal.

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So let's interrogate this a little bit further.

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And on the, uh, for the ACL I,

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you pretty much have to look at all the planes.

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Um, you, many are used

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to looking at the sagittal first, but it's troubleshoot.

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You certainly need the axials

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and the Coronas to help you out.

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So on the axials,

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the inter medial bundle is higher than the posterolateral

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bundle, and you don't see any dark attachment.

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And, and, uh, you, um, a couple slices down,

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you still see, uh, this high signal.

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And so this is a partial tear

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of the ACL involving both bundles.

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And at arthroscopy, they noted

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that the ACL, um, there were abundant fibers,

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but when they probed, uh, it, it, it held tension.

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But approximately it was pretty irregular.

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And, um, but given the number of fibers, uh, that,

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that were there, how good it, uh, how good it felt,

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they didn't reconstruct it.

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Uh, and they also didn't fix the MCL thinner

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'cause they didn't know about that, um, preoperatively

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and these MCL thinner should be fixed.

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Um, but the, we've seen many cases where they're not,

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and they seem to do, uh, okay in some of these cases.

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So it's, it's, um, it would appear that not all of them need

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to be operatively managed.

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Uh, apparently. Um, now on the last follow up, uh,

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he, he was doing pretty well.

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So he's, um, he's gone a few years

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and he's done pretty well.

Report

Faculty

Donald Resnick, MD

Professor Emeritus, Department of Radiology

University of California, San Diego

Mini N. Pathria, MD, FRCP(C)

Division Chief, Musculoskeletal Imaging

University of California San Diego

Eric Y. Chang, MD

Adjunct Professor, Radiology

University of California, San Diego

Brady K. Huang, MD

Clinical Professor of Radiology

UC San Diego Medical Center

Tags

Musculoskeletal (MSK)

MRI

Knee