0:01

I'd like to scroll in the axial and coronal projection.

0:04

And my first projection will be an axial diagram at the level of the PCL

0:10

insertion on this tibial notch depression,

0:13

which lies below the tibial plateau.

0:16

The PCL, as mentioned, is about 38 mm in length and it has an anterior,

0:23

a middle, and then posterior and posterior oblique fibers.

0:27

The anterior and middle make up about 85% of the PCL.

0:30

So let's scroll in the axial projection.

0:32

We're down low in the tibial notch.

0:35

It's round, it's fat. There's an anterolateral and a posteromedial bundle.

0:40

We see them a little bit better right here.

0:42

Anterolateral and posteromedial lying directly

0:44

underneath the oblique popliteal ligament.

0:48

Now the anterolateral bundle will tighten in flexion

0:51

the posteromedial bundle will tighten in extension,

0:54

one sees their very close position to the medial and the lateral meniscus.

1:00

The PCL is arching up and anterior,

1:03

and so it's starting to move anterior.

1:06

Here's a nice separation between the anteromedial and posterior

1:10

lateral bundle right here. So anteromedial, posterolateral.

1:16

And the ACL has a much more linear configuration in cross-section,

1:21

whereas the PCL is either circular or oblong.

1:25

Let's keep scrolling, shall we?

1:27

We're going to follow the PCL as it moves anterior and snuggles

1:31

up against the inner aspect of the medial femoral condyle.

1:35

And finally, we see its footprint snuggled up against

1:38

the medial femoral condyle, with the more lateral ACL

1:42

on the lateral side against the inner aspect of the lateral femoral notch.

1:47

The coronal projection.

1:49

We see the insertion of the PCL on the tibia.

1:54

It's got a broad footprint.

1:56

And now we're going to follow it as it arcs up and anterior towards you.

2:01

And here it comes.

2:02

There is a structure that is coursing behind it that arises from the

2:07

supra posterior tip of the lateral meniscus and helps stabilize

2:10

it called the meniscofemoral ligament of wrisberg.

2:15

In front, there'll be a meniscofemoral ligament of Humphrey.

2:19

These structures may tighten in flexion and also with tibial internal

2:24

and external rotation, they are secondary stabilizers.

2:28

Our PCL, because of its arc towards you, it's rising up from the tibia,

2:34

may have a somewhat linear configuration and occasionally is confused

2:38

with the ACL, which is itself a more linear structure.

2:43

The ACL has now come into view as a linear structure compared with the

2:52

insert on the inner aspect of the medial femoral condyle.

2:55

And there it is. More round PCL, more linear ACL.

2:59

Let's keep coming forward. Now, here's our more round PCL.

3:02

Now, in a subset of individuals,

3:05

either the meniscofemoral ligament of Humphrey

3:09

or a separate fascicle called

3:11

the distal anterior bundle of the PCL may have its own sort of separate

3:15

insertion right here next to the highland cartilage of

3:20

the medial compartment.

3:22

If one images this on MRI coronally,

3:25

it may look like a separate structure and is sometimes confused with a

3:30

And this is a potential pitfall, the pseudo bucket handle tear.