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PLC Big 3 & The Popliteus Fibular Ligament

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0:00

So I mentioned sort of the big three structures,

0:03

uh, you should be looking at.

0:04

And historically they've been referred to

0:06

as the fibular collateral ligament, the popps tendon,

0:09

and the popal fibular ligament.

0:12

Uh, while I might actually conjecture to say that maybe the,

0:16

the more important ones are the bicep femoral fibular

0:20

collateral in popps tendon rather than the popliteal

0:23

fibrillary ligament, which is a very small structure.

0:28

There was a study, uh, done in, uh,

0:30

radiology several years ago that looked at patients

0:33

with clinical posterolateral instability

0:37

and found that if these three major structures were

0:39

disrupted, these patients, uh, were likely

0:42

to have clinical laity.

0:43

And those included the fibular collateral ligament,

0:47

the pope tendon and the biceps femoral tendon.

0:51

You notice that the Pope fibular, uh,

0:54

ligament is not included in this, um, uh, analysis.

1:01

Certainly we can, uh, evaluate this with vari stress, uh,

1:04

radiographs as well.

1:05

This is often more done by the orthopedic surgeon

1:08

and it's been suggested

1:09

as a four millimeter side-to-side distance indicates like

1:13

high grade or grade three tear.

1:16

So let's talk about this guide,

1:17

the popliteal fibular ligament.

1:20

This too can be seen on your routine MR Images,

1:24

and it's often seen as this low signal intensity structure

1:27

emanating from the area of the fibular syl

1:30

and attaching to the pope tendon.

1:34

Here you can also see it on sagittal images.

1:36

Again, find the tip of the fibular styloid,

1:39

and you can often see it traveling from the fibular styloid

1:42

to the pope tendon.

1:44

Now in one paper, this has been, uh, shown

1:47

to be identified in at least half of patients,

1:50

and I think that's, uh, largely true in a lot of patients.

1:53

You should be able to identify the papillo fibular liquid.

1:57

And here's an example of one that's torn in a patient

1:59

with a poster lateral corner injury.

2:01

We can see that there's disruption of the mid substance

2:04

of the posterior, excuse me, the pope fibular ligament.

2:07

And oftentimes patients

2:09

with poster lateral Corona injuries will have intramuscular

2:12

edema of the Pope muscle reflecting a muscle strain.

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