0:00

Knee Anatomy.

0:01

Cruciates PCL Coronal Projection MRI.

0:04

We start out posteriorly,

0:07

where the PCL has its insertion in a deep notch below the tibial plateau,

0:14

But in very close contact with the posterior medial meniscus root.

0:18

And its associated root ligament and to a lesser extent,

0:21

the posterolateral meniscus root and its associated root ligament.

0:26

PCL is divided up into a medial bundle and an anterior bundle.

0:33

So the posterior medial bundle is seen here as sort of

0:36

a tall linear structure. It looks like a little hat.

0:38

And let's move a little bit more posterior.

0:41

And we see the two bundles come together.

0:43

Let's move a little bit more anterior and we can actually separate out

0:46

the two bundles separated by this little slit of inflammatory tissue.

0:51

Let's keep moving forward. There's the posteromedial bundle,

0:55

Anterolateral bundle. Let's keep going. Now the PCL is coming at you,

1:00

so you're catching it in cross-section. So it's going to look round.

1:04

This is a very important projection because sometimes when

1:07

the ACL tears, the sheath, which is common to the ACL,

1:11

and PCL will fill up, and it will obscure and almost bury the PCL.

1:16

So it's hard to see, you'll get all this tissue around it,

1:19

and you're thinking to yourself,

1:21

well, is this tissue around the PCL and hiding

1:24

it or is it actually a PCL tear?

1:27

And that's where the coronal comes in extremely handy.

1:31

For in this projection, if you are in cross-section to the PCL

1:35

or perpendicular to it, you'll actually see signal or tissue

1:40

inside the ligament that helps you decide,

1:42

indeed, yes, the PCL is torn.

1:46

Let's keep scrolling into the footplate or footprint to the PCL.

1:51

Medial bundle, lateral bundle, medial and lateral bundle.

1:55

And there is your footprint on the inner aspect of the

1:59

medial femoral condyle.

2:00

You can still hallucinate the two separate bundles.

2:03

I'll try and draw it for you. The division is right there.

2:08

So this would be the medial bundle, posterior medial bundle.

2:11

And here would be the anterolateral bundle of the PCL,

2:16

The anterior cruciate ligament, a lot straighter.

2:19

If I scroll it very quickly for comparison, a lot straighter.

2:23

Kind of like a water slide coming down than the PCL,

2:26

which when you image it in cross-section or perpendicularly,

2:31

is more of a rounded structure. And again,

2:33

it is critical to do this to differentiate swelling around the PCL in

2:38

its sheath versus a true tear that occurs

2:41

in the interstitium of the PCL.

PCL: Coronal on MRI

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0:00

Knee Anatomy.

0:01

Cruciates PCL Coronal Projection MRI.

0:04

We start out posteriorly,

0:07

where the PCL has its insertion in a deep notch below the tibial plateau,

0:14

But in very close contact with the posterior medial meniscus root.

0:18

And its associated root ligament and to a lesser extent,

0:21

the posterolateral meniscus root and its associated root ligament.

0:26

PCL is divided up into a medial bundle and an anterior bundle.

0:33

So the posterior medial bundle is seen here as sort of

0:36

a tall linear structure. It looks like a little hat.

0:38

And let's move a little bit more posterior.

0:41

And we see the two bundles come together.

0:43

Let's move a little bit more anterior and we can actually separate out

0:46

the two bundles separated by this little slit of inflammatory tissue.

0:51

Let's keep moving forward. There's the posteromedial bundle,

0:55

Anterolateral bundle. Let's keep going. Now the PCL is coming at you,

1:00

so you're catching it in cross-section. So it's going to look round.

1:04

This is a very important projection because sometimes when

1:07

the ACL tears, the sheath, which is common to the ACL,

1:11

and PCL will fill up, and it will obscure and almost bury the PCL.

1:16

So it's hard to see, you'll get all this tissue around it,

1:19

and you're thinking to yourself,

1:21

well, is this tissue around the PCL and hiding

1:24

it or is it actually a PCL tear?

1:27

And that's where the coronal comes in extremely handy.

1:31

For in this projection, if you are in cross-section to the PCL

1:35

or perpendicular to it, you'll actually see signal or tissue

1:40

inside the ligament that helps you decide,

1:42

indeed, yes, the PCL is torn.

1:46

Let's keep scrolling into the footplate or footprint to the PCL.

1:51

Medial bundle, lateral bundle, medial and lateral bundle.

1:55

And there is your footprint on the inner aspect of the

1:59

medial femoral condyle.

2:00

You can still hallucinate the two separate bundles.

2:03

I'll try and draw it for you. The division is right there.

2:08

So this would be the medial bundle, posterior medial bundle.

2:11

And here would be the anterolateral bundle of the PCL,

2:16

The anterior cruciate ligament, a lot straighter.

2:19

If I scroll it very quickly for comparison, a lot straighter.

2:23

Kind of like a water slide coming down than the PCL,

2:26

which when you image it in cross-section or perpendicularly,

2:31

is more of a rounded structure. And again,

2:33

it is critical to do this to differentiate swelling around the PCL in

2:38

its sheath versus a true tear that occurs

2:41

in the interstitium of the PCL.

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Lesson

MRI Mastery Series: Knee Pre Course Activities

Lesson

Knee - Anatomy of the Supporting Structures

Lesson

Supporting Structure Anatomy: Focus on the Posterior Corners

Lesson

Case Review: Supporting Structure Injuries

Lesson

Meniscus MRI

Lesson

Pivot Shift Injuries and Meniscal Pathology

Lesson

More Meniscus Tears with Case Examples

Lesson

Applying What You've Learned

PCL: Coronal on MRI