0:00

The next case I wanna share is a 19-year-old woman

0:03

with non-contact left knee injury three weeks prior.

0:05

And this is meniscus case eight.

0:07

This is the first, um, the, the most medial slice

0:10

and we see on this, uh, PD image on the left.

0:14

And this is PD fat sat that the MCL looks, uh, abnormal.

0:18

When we correlate with the coronal, you can see that it's,

0:21

uh, undulating and the,

0:23

a deep medial meniscal femoral ligament.

0:25

Um, it looks like there was a prior,

0:28

the prior high grade injury.

0:29

It's very thick, increased with, uh, with increased signal.

0:34

The tibial collateral ligament, if you look at it on the,

0:36

uh, axial, there's, um,

0:39

a low grade tear at the femoral attachment.

0:43

Get back to the satchel here.

0:47

And as we go more lateral, you can see that there's

0:56

abnormal, um, contour

0:58

and also the surfacing signal at the, uh, medial meniscus.

1:01

It involves, uh, the peripheral third, uh, at the,

1:05

of the posterior horn.

1:07

And you can see that the, um, meniscocapsular

1:09

and meniscal tibial ligaments, they're, they're granulated

1:12

with increased signal, and so they,

1:13

they appear injured as well.

1:15

But this, um, there's definitely, uh,

1:18

a meniscal tear involving the meniscus.

1:20

Proper small little, um, flo right here.

1:30

And here's the PCL. Looks not too bad.

1:33

And then the ACL is completely torn.

1:36

There's flipped, uh, the fibers are flipped anteriorly.

1:39

Um, ant laterally actually kind of entrapped in there.

1:45

And here at the posterior root of the lateral meniscus,

1:48

this whole area looks like a big mess.

1:51

You can see that there's, um, some fibers of the, uh, push

1:55

to root of lateral meniscus still attached to the tibia,

1:58

but there's a huge radial tear here.

2:01

And there's a, uh, humphrey,

2:07

a ligament of Humphrey

2:10

that attaches here.

2:13

And let me show the axial.

2:17

On the axial image, we see this large radial tear.

2:20

It's oblique in configuration.

2:22

Um, it involves, so there's tearing of the poster root

2:24

of the lateral meniscus, but there's also tearing of, uh,

2:27

there, there's a oblique radial tear involving the

2:30

lateral meniscus itself.

2:32

Um, and it has, it,

2:35

it involves the posterior horn,

2:37

quite a ways from the attachment of the root.

2:39

Um, many people define the root as one centimeter, um,

2:43

from the tibial attachment.

2:44

And this thing is, uh, 17 millimeters.

2:47

It's, uh, involving, uh, a, a large portion

2:49

of the lateral meniscus.

2:52

So a arthroscopy, the, uh,

2:56

Christian Horn medial meniscus tear. The, the,

2:58

If they're not alerted to this,

3:00

it can be missed just like the ramp lesion.

3:03

And in fact, some people consider this a variant of the, uh,

3:05

or subtype of a ramp.

3:07

Um, but the superior surface on probing looks not too bad

3:10

on, um, on probing the inferior surface, this probe drops in

3:14

and, uh, this is called the hidden lesion

3:17

because it could be easily missed.

3:21

And what we're dealing with here is a,

3:26

um, lateral meniscus, oblique radial tear, or an LOR lesion.

3:30

This has gotten, um, increased, um,

3:33

attention in the orthopedic literature.

3:35

Um, this is seen in about 12% of,

3:38

uh, patients with ACL tears.

3:40

And by definition, they involve, um, lateral meniscus, um,

3:43

more than 10 millimeters from the root attachment,

3:46

and they could be partial or complete.

3:48

Uh, despite this area being relatively less vascular, uh,

3:53

the literature has said that repairing this, um, uh,

3:56

increases patient reported outcomes and,

3:58

and it can successfully heal.

4:01

So they're probing this, this oblique tear.

4:03

Uh, basically this, this is the, uh, the large

4:08

radial tear at the posterior horn.

4:11

It's, it's oblique in

4:13

configuration to the left of the screen.

4:15

This is the meniscal femoral ligament of, of Humphrey.

4:23

Here's the stump of the posterior root.

4:24

Of the lateral meniscus.

4:27

And let me just fast forward this a little bit.

4:29

Um, and that's coursing anterior to the PCL.

4:31

So that's, that's Humphrey.

4:34

And lemme just fast forward it to the end.

4:36

They, they, uh, did suture anchor repairs in all

4:38

inside technique and,

4:40

and repaired this, uh, Elmore lesion as well

4:45

as the, uh, the root to the, um, lateral meniscus.