0:01

We have here a knee of a

0:03

skeletally mature person.

0:07

So probably somewhere in

0:08

their 18, 19, 20 years of age.

0:11

So I think you've realized by now

0:13

that the pediatric population, their

0:16

mechanism of injuries is different.

0:18

How they injure themselves is different.

0:21

But once they reach skeletal maturity,

0:23

they're effectively an adult.

0:25

So now we see adult patterns of injury.

0:27

So here's a great example of a person who had

0:31

a dashboard injury, and this, this is typically

0:34

the mechanism that you see for this injury is

0:36

that somebody is in an accident and hits their

0:38

anterior tibia, anterior proximal tibia on the

0:42

dashboard, or they're having activities, playing

0:45

football and they get hit anteriorly in a flexed

0:48

position in the proximal tibia, and it sort of

0:51

translocates the tibia in a posterior direction.

0:54

When that happens, you put unusual stress or

0:58

abnormal stress on this structure right here,

1:01

which is the PCL, or the

1:02

posterior cruciate ligament.

1:05

And as you can see, the image on your

1:07

left is a dual echo steady state,

1:09

or thin slice images.

1:11

The image in the middle is the

1:12

proton density sequence.

1:13

And the image on your right,

1:15

actually the image on the right is

1:16

the same as the image on your left.

1:17

Let me bring up another sequence here, which

1:19

is a fat-suppressed, fluid-sensitive sequence.

1:22

And you can see a lot of edema in the

1:24

periphery, in the soft tissues, and in the PCL.

1:28

So, there is a mid-substance tear in the PCL.

1:31

If this person was skeletally

1:33

immature, there would be a higher

1:35

likelihood, uh, of it avulsing.

1:39

And typically, when the PCL is avulsed

1:41

off the bone, it happens at its inferior

1:44

attachment site, uh, to the tibia.

1:46

So, it would come off right over here.

1:48

But since this patient is

1:50

skeletally mature, this person injured

1:53

uh, the mid-substance, and this is

1:55

basically a full-thickness tear.

1:57

Even though there looks like there are some

1:58

few strands going across, for all practical

2:01

purposes, this is a full-thickness tear.

2:05

Now, it can occur in the presence of

2:08

other ligamentous injuries, so it's

2:10

important that we look at the ACL, make

2:12

sure that's nice and normal, and it is.

2:15

Make sure we look at the coronal planes,

2:17

and make sure our, uh, lateral and

2:19

medial collateral ligaments are intact.

2:20

In fact, there is some injury

2:22

involving both sides, aren't there?

2:24

There is edema on either side of the

2:26

medial collateral ligament and even a

2:28

little longitudinal area of increased

2:30

signal, so there's at least a sprain

2:33

in the medial collateral ligament.

2:35

There's lots of fluid and edema on the

2:36

lateral side, but the ligament itself looks

2:40

relatively intact for much of its course.

2:44

So the major, really major

2:46

injury here is the PCL.

2:47

If it was a PCL injury in isolation, literature

2:51

says that it can probably be left alone.

2:53

It doesn't necessarily have

2:54

to be treated surgically.

2:57

But there's growing evidence that if they

3:00

don't get any kind of rehabilitation or

3:04

some management in a non-surgical

3:07

manner where they're, where they're, where

3:09

they get a little bit of physical therapy,

3:11

this can lead to severe

3:12

arthrosis later on in their life.

3:15

So hopefully the pediatric surgeon is aware

3:20

of various ways of dealing with this and

3:23

not just leaving it alone and saying that

3:24

oh, you know, rest and it'll heal better.

3:27

It is a problem later on in their

3:29

life if it is just completely left alone.33 00:01:17,845 --> 00:01:19,715 Let me bring up another sequence here, which

1:19

is a fat-suppressed, fluid-sensitive sequence.

1:22

And you can see a lot of edema in the

1:24

periphery, in the soft tissues, and in the PCL.

1:28

So, there is a mid-substance tear in the PCL.

1:31

If this person was skeletally

1:33

immature, there would be a higher

1:35

likelihood, uh, of it avulsing.

1:39

And typically, when the PCL is avulsed

1:41

off the bone, it happens at its inferior

1:44

attachment site, uh, to the tibia.

1:46

So, it would come off right over here.

1:48

But since this patient is

1:50

skeletally mature, this person injured

1:53

uh, the mid-substance, and this is

1:55

basically a full-thickness tear.

1:57

Even though there looks like there are some

1:58

few strands going across, for all practical

2:01

purposes, this is a full-thickness tear.

2:05

Now, it can occur in the presence of

2:08

other ligamentous injuries, so it's

2:10

important that we look at the ACL, make

2:12

sure that's nice and normal, and it is.

2:15

Make sure we look at the coronal planes,

2:17

and make sure our, uh, lateral and

2:19

medial collateral ligaments are intact.

2:20

In fact, there is some injury

2:22

involving both sides, aren't there?

2:24

There is edema on either side of the

2:26

medial collateral ligament and even a

2:28

little longitudinal area of increased

2:30

signal, so there's at least a sprain

2:33

in the medial collateral ligament.

2:35

There's lots of fluid and edema on the

2:36

lateral side, but the ligament itself looks

2:40

relatively intact for much of its course.

2:44

So the major, really major

2:46

injury here is the PCL.

2:47

If it was a PCL injury in isolation, literature

2:51

says that it can probably be left alone.

2:53

It doesn't necessarily have

2:54

to be treated surgically.

2:57

But there's growing evidence that if they

3:00

don't get any kind of rehabilitation or

3:04

some management in a non-surgical

3:07

manner where they're, where they're, where

3:09

they get a little bit of physical therapy,

3:11

this can lead to severe

3:12

arthrosis later on in their life.

3:15

So hopefully the pediatric surgeon is aware

3:20

of various ways of dealing with this and

3:23

not just leaving it alone and saying that

3:24

oh, you know, rest and it'll heal better.

3:27

It is a problem later on in their

3:29

life if it is just completely left alone.