0:00

Let's move on and talk about the bone contusions

0:03

that we see with these particular injuries.

0:06

They dominate on the lateral aspect of the knee.

0:10

They may relate to the external force

0:13

that could be applied at the time of i, uh, of injury

0:17

or to the internal force

0:20

where these two par bones will collide.

0:23

Changes on the medial side are uncommon

0:28

and the one that I would emphasize is related

0:30

to tensile injury involving the deep

0:34

medial meniscal femoral ligament

0:36

with its direct attachment to bone.

0:39

So you may see something like this when there is an

0:42

injury in this location.

0:44

Here we can see the changes in the lateral compartment due

0:47

to contact of the lateral femoral condyle

0:51

and lateral tibial plateau.

0:54

Now what might be some things you could observe on your MR

0:58

examination that might influence therapy?

1:01

I brought this up yesterday, uh, as one

1:03

of the questions I asked Eric Chang,

1:06

and that is, does involvement

1:08

of the posteriorly ligament affect the treatment?

1:11

Because some people believe that's the most important

1:14

of the medial supporting structures.

1:17

That involvement when I see it, is typically soft tissue.

1:20

This is unusual, this is a bone,

1:23

but as Eric mentioned, in general, uh,

1:27

conservative treatment is what is chosen for injuries

1:31

of the medial supporting structures.

1:34

Here, by the way, is what you might see with the central arm

1:39

of the posterior bly ligament.

1:41

Remember, it attaches to the posterior horn

1:44

of the medial meniscus.

1:46

So when you have injuries involving the posterior bly

1:49

ligament, you may see edema at the meniscal capsular

1:54

junction adjacent to the posterior horn

1:57

of the medial meniscus.

1:59

But in general, this will be treated conservatively.

2:03

Other things that may influence the, the therapy

2:06

that is suggested would be are you dealing with a contusion

2:10

or are you dealing with a fracture?

2:13

Here, an example of a ous injury

2:15

with an osteochondral fracture involving a

2:18

lateral femoral condyle.

2:20

This one is not displaced,

2:22

so I imagine conservative treatment would be chosen.

2:26

In rare examples, you get intraarticular entrapment

2:30

of the torn ligament

2:31

and that will affect therapeutic strategy.

2:35

Here's an example. It's an old case showing you the widening

2:38

and the medial compartment.

2:40

You can appreciate the entrap ligament, the torn

2:43

and entrap ligament.

2:45

Just to show you another example, intraarticular entrapment

2:49

of the torn ligament, which is now occupying a portion

2:54

of the medial compartment of the wrist related to tearing

2:58

Of the distal part of the ligament.

3:02

And that brings us to something

3:03

that was mentioned earlier in this course,

3:05

and that is the centerlike lesion

3:08

that involves the distal aspect of the superficial portion

3:12

of the medial collateral ligament.

3:14

And what occurs here is that the distal torn fibers

3:20

of the superficial

3:21

or tibial collateral ligament shown

3:24

by the orange arrows are displaced, superficial

3:28

to the pest, an serine tendons shown by the yellow arrows.

3:33

In these cases, surgery may be required

3:36

because of the soft tissue interposed

3:39

between the ligament and bone.

3:41

I'll show you another example of that.

3:44

Uh, color coded the same way

3:47

the orange arrows representing the torn

3:50

tibial collateral ligament

3:52

and the yellow arrow indicating the position

3:55

of the pesan serene tendons deep to the torn

3:58

and retracted tibial collateral ligament.