0:00

Now, let's go back over to the lateral side.

0:02

And this is the only case we're going

0:05

to seek to understand today.

0:07

And I want to focus on a few terms.

0:11

We're on the other side and I'd like

0:14

you to notice that as we scroll,

0:16

the meniscus really never comes back together.

0:18

There's always a connection to the bow tie.

0:21

That shouldn't happen. Right. If that happens,

0:23

you've got meniscal dysplasia.

0:26

The most common type of meniscal dysplasia is

0:29

either an incomplete or a complete form of

0:32

discoid lateral meniscus, which this is.

0:35

But I'm not so interested in the dysplasia

0:38

right now. I'm interested in some terms.

0:41

Okay, we've established that there is a dysplasia,

0:44

but look at the signal.

0:46

The signal is not just this sort of bunny

0:48

ear signal. In the outer third,

0:50

it keeps going into the middle

0:52

third and the inner third,

0:53

and it is equal in intensity compared to the

0:56

outer third. That can never, ever happen.

0:59

You are not allowed to have equal signal,

1:01

if that's a word,

1:02

in the inner third compared with the outer third,

1:05

disallowed. Does that mean it's surgical?

1:07

No. Does that mean it's abnormal?

1:10

Yes.

1:11

Lots of people have signal in the inner third.

1:14

In fact, everybody does, who's over 860,

1:16

because everybody over 860 has a cleavage tear,

1:19

but we're not going to operate on it.

1:21

So you got to learn to distinguish,

1:23

you got to learn when to hold

1:24

them and when to fold them,

1:26

because if you fold them once the meniscus is out,

1:30

you can never put it back in.

1:32

There is no procedure that works

1:35

where you can put it back in.

1:37

Another important aspect of assessing this signal

1:40

is the signal should never continue

1:42

running all the way through.

1:43

It should never run with equal

1:46

intensity through the body.

1:49

Let's see if I can convert back over for a minute.

1:52

I'll try it.

1:56

So let's see if that occurs here.

1:58

Well, it isn't quite equal.

1:59

It starts to faint in the middle third.

2:01

So I don't think that phenomenon is very

2:03

well illustrated here. But believe me,

2:05

this tear is communicating all the way

2:08

to the front. You might say, well,

2:10

there's a tear here, there's a tear here.

2:13

Maybe they're not connected. That's possible,

2:15

but that's stupid. That's stupid stuff.

2:20

You got a big giant tear that's the same shape as

2:23

the one in the back and they're not connected.

2:25

That's silly. Of course they have to be connected,

2:28

even if you don't see it.

2:29

It's just common sense.

2:31

And you already know you have a dysplastic

2:33

meniscus. And if you're a little educated,

2:35

you know that meniscus splits right in the middle

2:38

into two parts. So with a little bit of knowledge,

2:41

which can sometimes be dangerous,

2:42

you know that this entire cleavage

2:45

signal has to be one thing.

2:48

So don't try and over manipulate it.

2:50

Don't try and overthink it.

2:52

It's a meniscus that's turking into a turkey.

2:54

It's turning into a turkey sandwich.

2:56

What's happening is just this.

3:00

See if my drawing tool works.

3:02

Here it is in purple.

3:03

Here's my discoid meniscus.

3:05

The tear is just going right down the barrel,

3:07

the center of the meniscus,

3:09

right through those weaker collagen bands

3:11

that are normal, that conducts an ovium.

3:14

It's a little looser in there.

3:16

Unfortunately, in these dysplastic meniscai,

3:19

that loose area starts to come apart.

3:21

And if you put it on the table and

3:23

you turn it like this vertically,

3:24

turn the meniscus vertically,

3:26

the thing will go like this.

3:27

This half will fall that way,

3:29

that half will fall the other way.

3:30

The meniscus will fall into two pieces.

3:32

The two pieces of bread from

3:34

the sandwich fall apart,

3:35

and you got just a piece of turkey in the middle.

3:38

It's horrible saying, oh, my God, what do you do?

3:42

Nothing.

3:43

Currently, the state of the art is,

3:45

there is no good treatment for this scenario.

3:49

But that's not why we're here,

3:51

unfortunately.

3:52

at some point, the meniscus blows.

3:54

You got to leave it until it blows,

3:56

and then it has to be resected.

4:00

But there's more.

4:02

Let's talk about what's happening in the front.

4:05

In the front, we've got, as we said, this little,

4:07

tiny, round, globular thing,

4:10

which is a meniscal pseudocyst.

4:13

Why is it a pseudocyst?

4:14

Because it's not lined by epithelium or synovium.

4:17

It's lined by fibrous tissue as opposed to

4:20

a true cyst, which is epithelial line.

4:22

So we say there's a perimeniscal small

4:25

pseudocyst of meniscal origin

4:28

that is four x 3 size.

4:32

Sometimes you'll get them in the meniscus.

4:34

That's okay. Just describe it.

4:36

Sometimes out of the meniscus when they're really,

4:39

really big,

4:40

you may have to fix this and then resect from the

4:44

outside, so you may have to go outside and inside.

4:46

So then it really starts to matter if it's

4:49

not a meniscal tear. Like a ganglion.

4:51

It'll do something like this.

4:53

It'll make a big mass.

4:54

And it'll go above the meniscus.

4:57

So the tail goes above, or the tail may go below,

5:01

but it doesn't go in the center.

5:03

So it's like belly buttons.

5:04

Ganglia. Belly button. Audi. Audi.

5:08

Whereas meniscal pseudocyst. Belly button.

5:11

Right in the center. It's an innie.