Meniscus Question and Answer Session
HIDEInteractive Transcript
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Thanks, Eric.
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I mean, you're terrific. I had a couple quick questions.
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We're running a little bit behind,
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so I'm gonna make these great.
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You mentioned the, uh, posteriorly ligament.
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I'm gonna be talking about medial
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supporting structures tomorrow.
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Does the orthopedic surgeon, I, I was taught that
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that was very important supporting structure
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on the medial side.
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Does it affect whether
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or not the surgeons operate if there's a medial
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supporting structure injury?
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I think it depends on the surgeon.
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Um, some of the surgeons that, that, that I've worked with,
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they, they really don't wanna operate on the MCL like it,
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it's, it's the, uh, it is the exception for them
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to operate on, on the MCL.
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Um, but others, uh, you know, the more extensive,
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certainly for distal tears and,
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and the posterior oblique, um, uh,
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they're gonna be unstable.
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So, uh, so's some surgeons
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that take into consideration those,
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those more extended patterns, uh, and do operate.
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But, um, many of the ones I've run into, uh, they,
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they prefer not to touch it.
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Okay. And then the other thing which you emphasize in a
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lot of your cases is the posterior root ligament
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of the lateral meniscus.
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So I just wanna clarify my thinking
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because I, I had learned recently
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that there were two attachments.
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Your research suggests there is maybe only one attachment
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with two types of fibers.
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So the general rule is, if there does it,
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how often does it attach to two tubercle, medial
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and lateral, and how often does it only attach to,
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for example, the lateral tubercle?
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'cause I always try to trace it to the tubercle
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of the intercon or notch.
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So is there any good general rule that we can use?
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So, uh, most of them attach to, most
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of them have short and long fibers.
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Most of these posterior roots of the lateral meniscus.
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And so they attach to both locations.
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It's somewhere along the lines of, uh,
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two thirds to three quarters.
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Um, there was one study that came out, I think that said
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that it was some 80 something percent had both
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of these, uh, attachments.
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But these are based off of imaging studies, uh, so
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that they're not, uh, necessarily perfect.
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I think there has to be a good anatomic study.
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Um, but, but that, uh, most patients have both,
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both atta both attachments.
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Okay. Th and then there are two questions that were,
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for me that are related.
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And that was, how do I tell a pseudo player
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of the rice bird from a rice bird rip?
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And in the articles that have addressed this,
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that it relates to how many sagittal images you see,
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the altered signal between the posterior horn
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of a lateral meniscus and the berg.
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And when you get up to two
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or three particular images that show an abnormal signal in
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that area, usually it is a iceberg rip.
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But there are cases, in fact where it's hard
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to tell the, uh, difference.
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We're gonna stop there. We're gonna take a full 10 minutes,
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uh, break, and then we'll return for two more lectures
3:01
and another case discussion.
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
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