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Basic Knee Imaging RSSA Durban 2008

Basic Knee Imaging RSSA Durban 2008 . Richard de Villiers Van Wageningen and Partners. Aims . Anatomy of the Meniscus Imaging protocol. Terminology. Speak the same language as your referrer Keep up to date with the relevant terminology. Anatomy. Meniscal anatomy Attachments.

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Basic Knee Imaging RSSA Durban 2008

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  1. Basic Knee ImagingRSSA Durban 2008 Richard de Villiers Van Wageningen and Partners

  2. Aims • Anatomy of the Meniscus • Imaging protocol

  3. Terminology • Speak the same language as your referrer • Keep up to date with the relevant terminology

  4. Anatomy • Meniscal anatomy • Attachments

  5. Basic anatomy Medial meniscus Lateral meniscus

  6. Morphology • Wedge-shaped • Semilunar ( C -shaped) • Surface • Superior • concave • Inferior • flat • Fibrocartilage (collagen fibres) • Fibres • superficial • circumferential hoop • radial tie

  7. A.Superficial layer a ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° mesh-like matrix of fine fibrils measuring 100μ

  8. Superficial layer a 100 micrometre

  9. ° ° ° ° ° ° ° ° ° ° ° ° ° c ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° B.Circumferential hoop fibres b rope-like collagen fibre bundles c. smaller radial fibres - reeinforcement

  10. a b

  11. ° ° ° ° ° ° ° ° ° ° ° ° ° c ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° C. Radial Tie fibres b -reinforcement

  12. Terminology Red-white zone Free edge Menisco-capsular junction Peripheral zone (outer) Red zone Central zone Inner White zone

  13. Vascularity • From the genicular vessels • Extent • Medial (10-30% of width) • Lateral (10-25% of width)

  14. Arnoczky SP (1992) In: Mow VC, Arnoczky SP, Jackson DW (Eds) Knee meniscus: Basic and clinical foundations. Raven Press, New York

  15. Zones

  16. Relevance • If tear involves outer, vascular 1/3 (3-5 mm from capsule) • Surgical repair / or conservative • If tear involves inner,-non-vascular 1/3 • Partial / total meniscectomy

  17. Medial Meniscus • Size (AH < PH) • AH ( 7.6 mm) • Body ( 9.6 mm) • PH ( 10.6mm)

  18. Lateral meniscus • Size ( AH = PH) • AH (10.2 mm) • Body (11.6 mm) • PH (10.6 mm)

  19. Attachments • Menisci maintained in optimal position • Various direct and indirect attachments to the tibia and femur. • Peripheral attachments to capsule

  20. Medial Meniscus • Attachments • AH • Transverse ligament • Anterior root ligament • Body (capsular) • Meniscofemoral • Meniscotibial ( coronary) • Minor capsular attachments • PH • Posterior root ligament

  21. Radiologist attending this lecture according to the attendance register

  22. Lateral meniscus • Attachments • AH • Transverse meniscal ligament • Root ligament • Body • Capsular ligaments • Superior and inferior • To ITB • NOT attached to the LCL • PH • Meniscofemoral ligaments • Humphrey and Wrisberg • Popliteomeniscal ligaments • Meniscal struts • Root ligament

  23. Transverse meniscal ligament • The menisci are attached to each other anteriorly by the transverseligament • 44 - 58 % incidence

  24. Transverse ligament

  25. Transverse meniscal ligament

  26. Root attachments Cannabis sativa – Durban Poison • Critical attachment sites to the central tibial plateau. • Resist hoop stress • Well-defined relations to each other and to the cruciate ligament insertions • The Meniscal Roots: Gross Anatomic Correlation with 3-T MRI FindingsAm. J. Roentgenol., May 2007; 188: W446 - W450 Jeffrey M. Brody, Michael J. Hulstyn, Braden C. Fleming, and Glenn A. Tung.

  27. Anterior root ligament of MM

  28. Anterior root ligament of MM

  29. Posterior root ligament of MM

  30. Posterior root attachment MM

  31. Anterior root ligament of lateral meniscus

  32. Posterior root ligament of lateral meniscus

  33. Meniscofemoral ligaments • Ligaments of Humphrey and Wrisberg. • Superomedially • Posterior horn of thelateral meniscus to the lateral aspect of the medial femoral condyle. • Name based on their location • Either 70% • Both 6% • Minor role            

  34. Ligament of Wrisberg • Posterior • Larger • Inserts into the medial femoral condyle.

  35. Ligament of Humphrey • Anterior • Smaller • 1/3 of PCL diameter

  36. Popliteomeniscal ligaments • Superior and inferior struts • Anchor the posterior horn of the lateral meniscus to the capsule

  37. Popliteomeniscal ligaments p

  38. MM capsular attachments Meniscotibial/femoral ligaments • MM attached via the deep portion of the MCL and the • meniscofemoral (f) and • meniscotibial (t) ligaments

  39. MM Capsular attachments Meniscotibial/femoral ligaments

  40. Minor capsular attachments • Periphery of menisci usually attach to capsule via synovial attachments

  41. MM synovial attachments to capsule

  42. LM to ITB

  43. LM not attached to LCL

  44. Oblique menisco-meniscal ligament • Normal variant • runs obliquely from the anterior horn of one meniscus to the posterior horn of the opposite meniscus. • 1% to 4% • mimic a meniscal tear

  45. Orthopod training to perform meniscectomy

  46. Our institution 1.5 T Siemens Symphony Dedicated knee coil Well-trained, dedicated MR technicians Sagittal, axial and coronal PD/ PDFS PD for anatomy PDFS for pathology Occasionally MR arthrogram ( ? CT > MR) Post-surgical ? Meniscal retear Stability of osteochondral lesion Plica WE-DESS 1mm cuts : subtle meniscal & chondral abN 3D MPR GRE Subtle meniscal abN T1 Fracture/ tumour T2 Ganglion/cyst PC-T1FS Synovitis Infection Tumour MRI Protocols

  47. Thank you • www.samsig.co.za

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