 Okay, this is an older woman, not going to say what's older, to be politically correct in the current environment, but she has a meniscus tear that is not unique to anybody over the age of 50. In fact, the overwhelming majority of people over 50 are going to have something like this that's maybe a little less severe. And what does she have? She has the typical chronic body cleavage tear and a pseudo extruded lax meniscus whose attachments have grown progressively more lax over time due to the altered hoop stresses and tension from the femur pressing down on the tibia. Part of this exacerbation of hoop stresses comes in the form of bony remodeling. The femoral condyle is not a nice half circle anymore. It kind of has a little bit of a deputy dew right here. It's also shifted. You can see the femur is shifted relative to the tibia and that doesn't do the lateral meniscus any good. In fact, it's a very unfriendly phenomenon to either meniscus. It's also a very unfriendly phenomenon to the knee notch because now you've got these spines that are pressing against or in some cases tugging on the cruciates, apparently or abnormally because you're no longer lying straight up and down. So you end up with some notch synovitis. So notch synovitis, remodeling, shift, and meniscal pseudo extrusion or meniscus displacement from meniscal capsular laxity, they all go hand in hand. These are not surgical menisca. You can't fix this. Persons lying on their back, the meniscus is not even sitting between the femur and the tibia. It's doing the patient no good supine. So imagine how little good it does them when they are standing up. Where should you see signal in the inner third of the meniscus? At least not in a normal person. You're going to see it in just about everybody, as we said, over the age of 50, certainly over the age of 60. These are a source of pain. They are not resected. They are usually either injected or they're treated with lubricant injected into the joint, steroid injected into the joint, or some unloader brace until finally the patient requires a total knee replacement. So one of the reasons why these tears are so often underdiagnosed, and maybe it's a good thing that you're underdiagnosing them because then they won't have an unnecessary resection. But if you're going to diagnose them, call them incidental, trisonal, horizontal cleavage tears in a degenerated knee. If you really want to slam the door shut on a surgery, call the tear degenerative, although some surgeons may object to that descriptor. Now again, one of the reasons why this tear is so often undercalled is because it's hard to see in the sagittal projection. It's coming straight at you. Right? It's kind of like a line. Here it is. There is the tear. It doesn't often articulate with an articulate surface because it's coming into the screen. It's going from medial to lateral. So you're cutting it like you're cutting through a turkey sandwich. So here's the turkey. The dark is a piece of bread, and the other dark is the other piece of bread. So that is the same tear as this, just coming straight at you into the sagittal projection. So just for emphasis, tears that are shaped like this into degenerated knees that begin in the inner third and kind of go straight out and get a little irregular and somewhat mushy looking. They're non-surgical tears. They're common. They're chronic. They're vegetative. They're even more common in women, and they're especially common in people who are overweight. Let's do another one, shall we?