Get a Group Membership for your Organization. Free Trial
Pricing
Free TrialLogin

Case Review: PCL Injury Companion Discussion

HIDE
PrevNext

0:00

This is a companion to our PCL interstitial tear case.

0:03

In fact, it's the same case,

0:05

but emphasizing a critical teaching point,

0:08

which is other injuries,

0:11

for isolated PCLs are treated nonsurgically.

0:14

So, what are the injuries that we're most concerned with,

0:17

and which ones are we most likely to miss?

0:19

And the answer is very simple,

0:21

corner injuries.

0:23

So, let's take a look at the corners very quickly.

0:25

Here's our patient's interstitial PCL tear,

0:29

which we affirm in the short axis projection

0:32

with heavily water weighted imaging.

0:34

Looking inside the PCL,

0:36

seeing that both the medial bundle and the

0:39

lateral bundle have well defined, etched,

0:42

high signal intensity. Inside that,

0:45

we're not volume averaging the sheath,

0:48

but rather we have a tear that involves the fibers

0:51

themselves. So, now that we've established that,

0:54

let's go back to the posteromedial corner.

0:56

Here's the medial meniscus,

0:58

and in the posteromedial meniscus corner is

1:02

this structure. We follow it forward.

1:04

We run into the somewhat injured MCL.

1:07

There's a tibial collateral ligament,

1:09

the middle layer.

1:10

The capsule is a little bit swollen.

1:12

Now we go backwards to the posteromedial corner,

1:14

where we are most concerned about a

1:17

complementary injury to the PCL.

1:19

We see the pol attaching very nicely to the

1:23

superoposter corner of the medial meniscus.

1:26

There it is, right there,

1:27

that gray structure sweeping

1:28

in in an oblique pattern.

1:30

I'll even draw over it to highlight it for you.

1:33

Right there. Now I'm going to take it away.

1:36

Now I'm going to put it back.

1:40

Put it back.

1:41

Take it away. That's the pol,

1:44

or a portion of the pol,

1:46

the posterior oblique ligament of the knee.

1:49

Now let's keep scrolling. We come forward again,

1:51

and we see that there's been an MCL injury.

1:54

Now,

1:54

that could affect the management of PCL tears,

1:57

but unless it's high grade, it usually does not.

2:01

Let's look at the sagittal projection

2:03

on the posteromedial side.

2:05

There is the pol right there.

2:07

I'm going to blow it up for you.

2:08

There's the posterior oblique

2:09

ligament of the knee,

2:11

and there's a little bit of meniscocapsular

2:13

junction injury. But there's no major rupture,

2:17

for this would be one of our checkpoints

2:20

for the posteromedial corner.

2:21

So would the semimembranosus be a checkpoint

2:25

for the posteromedial corner?

2:28

Those would really be the main

2:29

ones in this setting.

2:31

Let's go over to the posterolateral corner,

2:33

because if you tear the PCL and the posterolateral

2:37

corner, you're going to get PLRI.

2:40

Posterolateral recurrent instability syndrome.

2:43

So let's check the posterolateral corner.

2:45

And especially let's check the popliteofibular

2:49

ligament. And it's there.

2:51

It's a little bit stretched out from this fluid.

2:54

That has come forth from a small microtubecular

2:58

fracture, the posterolateral tibia,

3:00

but it's present.

3:02

And the meniscocapsular reflections

3:05

are also present, specifically,

3:07

the superior portion of the popliteus hiatus.

3:11

The area of the arcuate, which is right here,

3:13

is not swollen. So our posterolateral corner,

3:16

a little bit stretched out, but otherwise okay.

3:19

One other checkpoint.

3:21

Want to make sure our fibular collateral ligament

3:24

is intact so that we don't get PLRI,

3:28

and our fibular collateral ligament is intact.

3:31

Now, what if our posteromedial corner was gone.

3:35

Along with a high grade injury of

3:37

the medial collateral ligament?

3:39

Then we might get anteromedial

3:41

recurrent instability. Amri.

3:43

so these are things that you think about

3:46

with posterior cruciate ligament tears,

3:48

making sure it's isolated to the pcl.

3:52

The bulk of your mcl and post medial

3:54

corner should be intact.

3:56

Your fcl or fibular collateral ligament and your

4:00

posterolateral corner should be intact.

4:04

And in this case, one other caveat.

4:06

let's take a look at our ACL.

4:08

It's not perfect.

4:10

Look up proximally.

4:12

The fibers are a little bit disorganized right

4:14

there. So there's a low grade proximal ACL injury.

4:18

So a lot of little dings and dongs and

4:20

nicks and knacks in this case,

4:22

but one that would be managed conservatively.

4:26

Let's move on to another one, shall we?

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Tags

Trauma

Musculoskeletal (MSK)

MRI

Knee

© 2024 MRI Online. All Rights Reserved.

Contact UsTerms of UsePrivacy Policy