0:00

Okay, we're gonna finish up in the last, uh, 20 minutes

0:03

or so by talking about some

0:05

of the diagnostic pitfalls that Oasis.

0:09

We'll talk about some anatomic structures,

0:12

a few physiologic effects, a few pathologic conditions,

0:15

and hopefully we'll have time at the very end

0:18

to talk about the postoperative meniscus.

0:21

So here are some of the normal anatomic structures

0:24

that can create diagnostic confusion.

0:27

We've talked about the poppie meniscal ligaments.

0:31

Here is that anteroinferior one,

0:33

right, that we talked about.

0:34

And so you can get a gap

0:37

of intermediate signal intensity in this region.

0:41

Okay? Okay.

0:43

That between that ligament

0:45

and the posterior horn of the lateral meniscus,

0:48

that can simulate a meniscal tear.

0:52

The ligaments of berg

0:54

and Humphrey can in fact create pseudo tears,

0:58

particularly involving the posterior horn

1:01

of the lateral meniscus.

1:03

Here we're dealing with a ligament of Humphrey at its point

1:07

of origin, and you can see in fact in the sagittal plane,

1:11

a region of intermediate signal

1:13

that simulates an obliquely oriented meniscal tear.

1:17

Similarly, in the coronal plane, altered signal intensity

1:21

where the rice bird ligament begins,

1:24

can simulate a tear in the posterior horn

1:28

of the lateral meniscus.

1:30

There are an medial meniscal femoral ligaments where a,

1:35

you may have a ligament.

1:37

This is uncommon that extends from the central portion

1:41

of the joint and connects to the anterior horn

1:44

of the medial meniscus.

1:46

Infrequently seen, it may be associated

1:49

with pathologic findings that include a higher frequency

1:54

of meniscal tears.

1:56

This is what it looks like

1:58

paralleling the anterior cruciate ligament connecting

2:01

to the anterior horn of the medial meniscus.

2:05

So this is an anterial medial meniscal femoral ligament.

2:09

Very rarely you may have a postal medial meniscal femoral

2:13

ligament, typically obliquely oriented, extending upward,

2:18

becoming intimate, often

2:20

with the posterior cruciate ligament simulating an

2:23

intraarticular body in the transverse plane.

2:27

There are several meniscal meniscal ligaments

2:30

that connect one meniscus with the opposite meniscus.

2:35

The most common one that we see is the anterior transverse

2:39

meniscal meniscal ligament.

2:41

And you can see what it looks like running from the very tip

2:45

of the anterior horn of the medial meniscus,

2:47

but the anterior horn

2:49

of the lateral meniscus not at the tip.

2:53

So you end up with a pseudo tear between

2:57

that particular ligament

2:58

And the anterior horn.

3:00

You can see it here and you can see it in this

3:03

particular image.

3:04

In particular, a pseudo dare related

3:07

to the anterior transverse meniscal meniscal ligament.

3:12

And because of that ligament,

3:14

you end up often best seen in the transverse plane

3:18

with a normal branching lateral meniscus.

3:21

Here is the anterior transverse meniscal meniscal ligament.

3:26

Here is the anterior root ligament of the lateral meniscus.

3:30

So you may see this sort of appearance,

3:32

a pseudo tear involving the very anterior aspect

3:37

of the lateral meniscus.

3:39

Another example showing you that, uh, same sort

3:43

of appearance, the branching appearance of the anterior horn

3:49

and, uh, the transverse meniscal ligament.

3:52

And this being the anterior root ligament producing this

3:57

area of altered signal, simulating a tear.

4:01

Rarely you will see a posterior ligament connecting one

4:06

meniscus with the other.

4:07

I've only seen two of these.

4:09

One of these was associated with many anomalies of the knee.

4:13

This is the other case showing you that transverse region

4:17

of low signal representing a ligament connecting the

4:20

posterior horn of the medial and lateral meniscus.

4:24

And then finally, the other type

4:26

of meniscal meniscal ligament is the obliquely oriented

4:31

meniscal meniscal ligament running from the anterior horn

4:35

of one meniscus to the posterior horn

4:38

of the opposite meniscus named

4:41

after the meniscus, whose anterior horn is involved.

4:45

The vast majority of these that I have seen

4:48

therefore are anterial medial O like

4:53

meniscal meniscal ligaments,

4:54

or medial O like meniscal meniscal ligaments,

4:57

because they run from the anterior horn

5:00

of the medial meniscus to the posterior horn of the lateral.

5:04

This is what it looks like in a transverse Mr image.

5:08

Here's another example of one.

5:11

This again is a medial O like meniscal meniscal ligament.

5:16

And as it reaches the posterior horn of the lateral,

5:19

a pseudo tear may be seen.

5:23

Very rare is an ipsilateral meniscal meniscal ligament,

5:27

a thin piece of tissue representing a ligament

5:31

that connects, in fact, the anter posterior horns.

5:35

And this is the only one that I have seen.

5:38

This was improved, uh, by arthroscopy,

5:41

but that's probably what one would look like.