0:00

Other smaller ligaments such

0:02

as the faveo fibular ligament can be incredibly hard to see.

0:06

And in some papers they've suggested

0:08

that this can only be identified in as little as 8%

0:11

of patients, and you'll more commonly see it when patients

0:15

have a well-formed faa.

0:18

And it can be seen as this, uh, thick, uh, structure

0:22

of low signal intensity similar to other ligaments.

0:25

And again, you'll notice here,

0:26

this is your lateral inferior geniculate vessel.

0:29

So this is a nice landmark for trying

0:31

to identify the faveo fibular ligament,

0:33

but again, not routinely seen.

0:37

What about the arcuate ligament?

0:39

The arcuate is even a smaller structure.

0:41

So again, if you find the, um,

0:44

inferior lateral Gena vessels behind it,

0:47

you should see the falo fibular ligament.

0:49

In this case, we don't see it,

0:50

but in front of it, in front of this fat plane is

0:53

where typically the arcuate ligament at lives.

0:56

And it's been suggested the literature

0:58

that these have an inverse relationship to each other.

1:02

So if you have a thicker faveo fibular ligament,

1:04

the arcuate ligament will be more di definitive

1:06

and vice versa.

1:08

It's important to also notice, uh, note that the fabelo,

1:11

you may still have a faveo fibular ligament in the absence

1:14

of an ossified favela.

1:17

So let's talk about arcuate, uh, ligament avulsion injuries

1:21

and more specifically fractures.

1:24

Here you can see two cases of where the tip

1:27

of the ulnar sil is a vols.

1:29

So now we know what attaches

1:30

to there in front the poppie fibular ligament

1:33

and behind it the fabelo fibular ligament.

1:36

And if we were lucky, maybe we could hallucinate an arcu

1:39

ligament right in front of these ICT vessels.

1:45

So the, here comes the diagnostic dilemma when we're trying

1:48

to consider whether we were doing with a poster,

1:51

lateral coronary injury.

1:52

So here's a patient who had an ACL tear.

1:55

The popliteal fibrillary ligament was torn

1:57

and is the in arcuate ligament tear?

1:59

Well, I already said that isolated, uh,

2:01

or excuse me, edema in the poster lateral corner may not be,

2:06

uh, as clinically relevant in terms

2:08

of a patient's having a significant poster

2:11

lateral corner injury.

2:15

So this has born, been born out in both the radiology

2:18

and orthopedic literature.

2:20

Again, those big three, um, of the, uh, biceps femorals,

2:24

the pope tendon, and the fibular collateral ligament.

2:27

These are significant predictors

2:29

of post later corona instability.

2:31

And most importantly, with the fibular collateral ligament

2:35

assessment of these smaller poster later corner structures

2:39

here, the popal fibular ligament

2:41

and those smaller ones that are hard

2:43

to find really did not improve diagnostic performance

2:47

of current MRI to help predict clinically significant

2:50

poster later instability.

2:52

And these are patients who require, uh,

2:54

post lateral reconstruction.

2:56

And this is also investigated even earlier

2:58

In the orthopedic literature, same big three structures.

3:02

They did found that in the majority

3:03

of patients they also have abnormal

3:05

popliteal fibular ligaments.

3:08

But identification of the arcu

3:10

and favell fibular ligaments was very hard

3:12

and not really necessary

3:14

to report a clinically unstable post later coronary injury.

3:17

So in the end, don't really worry about

3:19

those smaller structures.

3:21

Uh, you'll probably be okay if you can't find 'em.

3:25

So with that, I'd like to conclude, uh,

3:28

this is probably a more appropriate, uh,

3:31

title for this lecture.

3:32

That the lateral ligaments are complex

3:35

and they're comprised of two major structures.

3:37

The antola complex subdivided into the AOL L

3:41

and the iliotibial band and the poster lateral corner.

3:45

In my mind, the big three we talk about is the biceps

3:47

femoris, the poppie tendon,

3:49

and the fibular collateral ligament.

3:51

And you can add plus or minus the popliteal fbri ligament,

3:54

which is included in the original description

3:57

of the poster lateral corners.

4:00

So with that, I'd like to conclude

4:02

and thank you for your attention.