0:00

Let's move on to the middle portion,

0:02

and here we deal first with the superficial part,

0:05

which we designate the tibial collateral ligament.

0:11

This ligament has one femoral

0:15

and two tibial attachments, one of those, uh,

0:18

two tibial attachments being emphasized in

0:21

the recent literature.

0:23

The femoral attachment is shown by the yellow circle.

0:26

It's located in a depression,

0:28

about three millimeters proximal

0:30

and five millimeters posterior to the osseous landmark,

0:34

the medial epicondyle.

0:36

There's no attachment of the superficial part of the

0:41

tibial collateral

0:42

or medial collateral ligament

0:44

to either the deep medial capsule ligament

0:47

or to the medial meniscus.

0:50

As we move distally, we see now the two tibial attachments

0:54

of the tibial collateral ligament.

0:57

The blue circle is indicating the more recently identified

1:01

proximal attachment.

1:02

It's a soft tissue region formed by the anterior

1:05

or tibial arm of the semimembranosus tendon,

1:09

and I'll talk briefly about that in a little while.

1:12

The distal tibial attachment is shown by the longer orange

1:17

oval, and you can see it with the orange arrow as well.

1:21

It's located anter to the postal medial crest

1:25

of the tibia itself and forms the floor of the pests

1:29

and serene bursa.

1:31

So one femoral attachment, and now two tibial attachments.

1:37

We come along and image it, and this is an old image,

1:40

but I just wanted to show you the course

1:42

of the superficial part of the medial collateral ligament.

1:46

We see mainly the distal attachment,

1:49

which is here proceeding out of the field of view.

1:52

Similar to the appearance in the coronal section image shown

1:57

on the left deep

2:01

to the tibial collateral ligament.

2:03

In the middle portion of the medial supporting structures,

2:07

we find another structure known

2:09

as the deep medial capsular ligament.

2:13

Those of you with a good memory, we'll,

2:15

remember we talked about a lateral capsular ligament,

2:19

a deep lateral capsular ligament yesterday,

2:21

but today we're looking at the deep medial

2:24

capsular ligament.

2:26

It's a thin strip deep to the tibial collateral ligament

2:29

with two particular components.

2:32

A longer component is this one here.

2:35

As you can see, the meniscal femoral component,

2:39

a shorter component running downward is the meniscal tibial,

2:43

uh, component, sometimes called the coronary ligament.

2:47

It is shorter and thicker than the meniscal

2:51

femoral ligament.

2:54

Now there is in fact a inconsistent bursa located

2:58

Between the superficial

3:00

and deep portions of the medial collateral ligament.

3:04

And indeed there's been some anatomy work done on this.

3:07

Sometimes it's a single bursa.

3:09

Sometimes there are septe

3:11

that divide this particular bursa into several portions.

3:15

Here's what it looks like.

3:17

Examples showing you fluid within

3:20

this medial collateral ligament bursa.

3:23

I have seen this most commonly, not in persons

3:26

who have bursitis,

3:28

but in persons who have meniscal extrusion, often associated

3:32

with meniscal tears or root ligament problems.

3:36

You will see collections of fluid within this person.