Imaging the Post Surgical Knee
HIDEInteractive Transcript
0:01
So we're gonna take a slightly different turn
0:04
and look at postoperative ligaments in the reconstructed D.
0:08
We got a little bit of a sneak preview in the previous, uh,
0:11
talk in cases of, uh, different types
0:14
of reconstructions that you might encounter.
0:17
So here are objectives for this talk.
0:20
Uh, we're gonna talk about the rationales
0:22
for postoperative imaging, talk about the normal appearance,
0:25
and then the pathologic conditions
0:27
and associated complications.
0:29
And we're gonna spend, uh, the most, most
0:32
of the next 45 minutes, um,
0:33
talking about the anterior cruciate ligament.
0:37
And we'll spend a little bit of time on the medial side
0:40
of the knee, and as I alluded earlier, the lateral side,
0:42
and then finally end with the posterior cruciate ligament.
0:50
So I think anytime you open up an knee MRI case,
0:53
it's really important
0:54
to establish has the patient had previous surgery before,
0:57
because this changes a lot of the,
0:59
the way you interpret things going
1:02
forward with the rest of the case.
1:03
Now, Dr I know Dr. Resnick spoke about this.
1:06
Um, but the things you wanna look for are areas
1:09
of scarring or fibrosis.
1:11
And these could be in the, uh, p patella reac regions
1:15
or within hoffa's fat pad itself, as can be seen here.
1:20
And one of the most reliable places
1:22
to determine whether there's has been prior arthroscopy is
1:25
to look along the medial retina ulu.
1:28
And if you see focal scarring,
1:30
and that's, you know, low signal intensity fibrosis
1:33
because of collagen deposition,
1:35
you have a 45 times more likelihood
1:38
that you had had prior arthroscopy.
1:40
And here's the reference for this paper.
1:41
For those of you, uh, are interested.
1:43
This is actually, uh, one of Dr.
1:46
Resnick's paper and a funny story behind this, I believe,
1:49
correct me if I'm wrong, Dr.
1:50
Resnick, the first journal that you submitted
1:52
to rejected it on the basis of, you know, why would you, uh,
1:56
need to look for these findings?
1:58
Because you could always just look in the electronic medical
2:01
record and see if the patients had prior surgery.
2:04
But of course, a lot of us practice, uh,
2:06
in teleradiology practices.
2:08
We, where we have little to no operative information about
2:11
the patient and sometimes the patients don't even know, um,
2:14
whether they've had surgery or not.
2:16
So always good to know, um, moving into a case whether
2:20
that patient has had prior surgery.
2:23
And here's a, actually a clinical photograph
2:25
of my wife's knee after she recovered from ACL surgery.
2:29
And so you'll, uh, often see multiple, uh, scars from where,
2:33
uh, the cannulas were placed.
2:35
Usually the antral lateral, uh, portal is the arthroscope.
2:40
Um, the medial portal is the working portal, so that's
2:43
where they'll be passing instruments and the probe.
2:45
Um, sometimes you'll make, you might see an inflow portal,
2:49
s medially and, uh, my wife had a hamstring, um, harvest
2:53
for her ACL reconstruction.
2:55
So a bigger scar, uh, in the infra medial, uh, region
2:58
of the knee.
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
© 2026 Medality. All Rights Reserved.
