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.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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