 Okay, this is a youngish man, but not not a child not a juvenile. It's a man and Let's just take a quick look at the axial for a moment Those of you that do quite a bit of MRI may notice. There's an extra structure in here not this one That's supposed to your crucian ligament this one What is that thing? Well, it happens to be the anterior crucian ligament that is fat and bloody and laying down enterally That's not why we're here We're here to look at the sequela once again of a pivot shift and what it does to menisci You can see a little bit of fluid in the capsule and posteriorly On the medial side is the structure known as the posterior oblique ligament of the knee or posterior ligament of the knee Which we're going to talk about at a later date, but I did want you to see it here It is again seen right at the level of the meniscus Let's go to the sagittal projection and We have already established as a major pivot shift with an ACL tear There's the typical pivot shift bone injury There is the typical pivot shift bone injury of the tibia as well as the femur that you just saw and you've got The same bone injury in the postural medial tibia. So let's start on the medial side we said that the Tibia will translate anterior or the femur will translate posterior and then slam down on the back of the stretched capsule And that's exactly what is happened here. We've got bleeding in the capsule Then I know how many of remember we talked about the sliver tear The sliver tear is that thin tiny little vertical tear that sits right adjacent to the capsule and there it is and Once again that signal will persist. It'll become much less swollen Much less hot much less hyper intense over time, but it'll persist for many years if not forever So we don't want to call this a menisco-capsular separation But it is a menisco-capsular junction sprain or injury or bleed and there's also a peripheral one-third Red-red zone medial meniscus tear Let's continue on over to the lateral side. It's quite a bit of space here to house all this blood by the way So let's scroll laterally now and As we're on our way over to the lateral side you may have noticed this big Large structure that looks like a thumb that is the anterior cruciate ligament filled with blood bent forward we are here at the lateral meniscus root and the Posterior attachments of the lateral meniscus the superior and inferior fascicles are a little bit stubby and fat It should be a millimeter in thickness. So they're tooth. They're too thick But also the capsule which should tether This attachment right here. That is an attachment for these two structures That should be tethered to that see where the tether is broken. So there has been a posterior Capsular Disruption and that has allowed these attachments to squiggle up a little bit They also are torn if you keep scrolling right there. There's no attachment between the popliteus the capsule and the meniscus There should be a perforating linear structure coming back from this triangle inferiorly and From this triangle superiorly. So the postural lateral menisco-capsular and popliteal attachments have torn Let's look at the popliteus tendon because when that happens There is frequently an injury to the popliteo Fibular ligament either in the form of a rupture with a squiggly little tail rolled up in a ball or a wavy tail from a stretch and We have the wavy tail known as the mermaid sign There's the body of the mermaid and there's the wavy tail of the mermaid which should be a straight shot Right down as a black line from here to here. We don't have that. We have a gray somewhat Waddling wavy signal from the popliteus tendon as the popliteo fibular ligament This little stubby structure right here is what remains of the popliteo tibial ligament Let's look at the meniscus all the way near the root Here's the root and some of you may be struck by this structure right here, which is a swollen But present ligament of wristburg that is not a fragment of the meniscus That's the wristburg ligament leaving the postural superior inner free edge of the lateral meniscus and coursing super omedial as a ligament of structure So don't get confused by that Potential pitfall and you can see it reattaches right back into the triangle. So in this case We have injured the postural medial menisco capsular attachment with a vertical sliver tear on the medial side There's our sliver tear and on the lateral side We have disruption of the menisco popliteo and capsular fascicles Posteriorly along with an injury of the popliteo fibular ligament and a frank tear of the posterior capsule Let's just take a look at the coronal for a moment because this is such a nasty injury just out of curiosity The colliderals are not too bad-looking. There's the tibial collateral ligament and here is the fibular collateral ligament So there hasn't been a major varus or valgus force or a major twist associated with this injury Okay, let's do another one shall we?