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PCL: Coronal on MRI

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Knee Anatomy.

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Cruciates PCL Coronal Projection MRI.

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We start out posteriorly,

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

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

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And its associated root ligament and to a lesser extent,

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the posterolateral meniscus root and its associated root ligament.

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

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So the posterior medial bundle is seen here as sort of

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

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And let's move a little bit more posterior.

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And we see the two bundles come together.

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

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

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

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

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

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This is a very important projection because sometimes when

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

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

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

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and you're thinking to yourself,

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well, is this tissue around the PCL and hiding

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it or is it actually a PCL tear?

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

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

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

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inside the ligament that helps you decide,

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indeed, yes, the PCL is torn.

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

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Medial bundle, lateral bundle, medial and lateral bundle.

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And there is your footprint on the inner aspect of the

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medial femoral condyle.

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You can still hallucinate the two separate bundles.

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

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

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And here would be the anterolateral bundle of the PCL,

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The anterior cruciate ligament, a lot straighter.

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

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

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

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is more of a rounded structure. And again,

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

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its sheath versus a true tear that occurs

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in the interstitium of the PCL.

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Tags

Trauma

Musculoskeletal (MSK)

MRI

Knee

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