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Hello everybody and welcome to the third day of, uh,

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the course and the second day in which we will deal with

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problems, uh, related to the knee

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emphasizing throughout, uh, Mr.

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Uh, uh, imaging of the knee.

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I'm gonna just close one little thing here. Okay.

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My job in about 40

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or 45 minutes is

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to talk about the medial supporting structures of the knee,

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their anatomy and their patterns of injury.

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And I want to make one particular

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point at the very beginning.

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I'm not, the title of this lecture is not Medial ligaments

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of the knee, but Medial Supporting Structures.

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Because as you will see, as we go through these structures,

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it is more than just ligaments with which we deal.

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And that is why on Mr Imaging reports,

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I don't just say medial ligaments are normal,

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I say the medial supporting structures

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of the knee are normal.

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Two general objectives to review the important anatomy

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of the medial supporting structures of the knee,

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dividing those structures into three regions, anter, middle,

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and posterior regions.

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In addition, the second objective

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to describe in detail the patterns of failure

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of these various supporting structures with attention,

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again, to something I'd like to talk about, mechanisms

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of injury and the resulting soft tissue

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and bone abnormalities.

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Now let's begin with these two pictures

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and make a point that a lot of what we've learned

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about the anatomy

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and specifically the footprints

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of the medial supporting structure comes from LA Pod

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and his associates.

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And I would emphasize to all of those you listening

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that the name Lara is well known in the orthopedic

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and should be well known in the imaging literature as well.

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He has many terrific articles, many

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of which deal with anatomy.

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And what he did, as you can see with a picture on the right,

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he looked at the osseous anatomy on the medial aspect,

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mainly of the femur, but also of the tibia.

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And he identified three bone landmarks.

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And I've listed those at the top of this slide.

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You can see those landmarks on

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that particular drawing taken from his article.

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And I put little box around each of those three landmarks.

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The gray areas are the footprints

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of the various medial supporting structures

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about which I will talk.

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The medial epicondyle or me is the most anter

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and distal bone prominence, the adductor tubercle, uh,

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tubercle I abbreviated at in the specimen.

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And you can see that in the picture as well.

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Proximal location at the distal edge of the

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Supracondylar line, and the third osseous landmark.

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The tubercle of the gastrocnemius abbreviated gt distal

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and posterior to the adductor tubercle.

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So these are very important bony landmarks

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or elevations on the surface of the medial aspect of the

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medial femoral condyle.

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Now, as you go through the literature

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and the way to address these medial supporting structures,

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two particular patterns have been emphasized.

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I'm listing those on the left hand part of this slide.

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There is a pattern related to layers

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in which three layers are identified superficial, too deep.

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I've indicated them Layer one, layer two,

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and layer three in different colors corresponding

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to the colors on the images shown on the right layer.

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One is the fascia.

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Layer two is the superficial medial collateral ligament,

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often designated the tibial collateral ligament.

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And layer three is the deep portion

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of the medial collateral ligament and joint capsule.

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Now the problem with the layered approach is some

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of these layers fuse in various regions.

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For example, anteriorly layers one

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and two Fs in the region of the medial ret aum,

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and posteriorly layers two

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and three fuse in the region of the posterior bly ligament.

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So I like the second approach shown at the bottom

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of this slide, dividing the medial supporting structures in

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two thirds, enter mid

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and posterior we'll deal anteriorly mainly

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with the medial reticulum and RET macular ligaments.

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In the mid portion, we'll talk about the superficial

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and deep regions of the medial collateral ligament,

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and then we'll move to the posterior aspect

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and talk about some of the structures that are seen there,

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particularly the posterior obi ligament.