 Now let's go back over to the lateral side and this is the only case we're gonna we're gonna seek to understand today And I want to I want to focus on a few terms And we're on the we're on the other side And I'd like you to notice that as we scroll the meniscus really never comes back together There's always a connection to the bowtie. That shouldn't happen, right? If that happens you've got meniscal dysplasia The most common type of meniscal dysplasia is in the either an incomplete or a complete form of disgoid lateral meniscus, which this is But I'm not so interested in the dysplasia right now. I'm interested in some terms Okay, we've established that there is a dysplasia, but look at the signal The signal is not just a sort of bunny ear signal in the outer third It keeps going into the middle third and the inner third and it is equal in intensity compared to the outer third That can never ever happen. You are not allowed to have equal signal if that's a word in the inner third compare with the outer third Disallowed. Does that mean it's surgical? No. Does that mean it's abnormal? Yes Lots of people have signal in the inner third. In fact everybody does who's over 860 because everybody over 860 has a cleavage tear But we're not going to operate on it So you've got to learn to distinguish. You've got to learn when to hold them and when to fold them Because if you fold them, once the meniscus is out, you can never put it back in There is no procedure that works where you can put it back in Another important aspect of assessing this signal is the signal should never continue running all the way through It should never run with equal intensity through the body Let's see if I can convert back over for a minute I'll try it. So let's see if that occurs here Well, it isn't quite equal. It starts to faint in the middle third. So I don't think that phenomenon is very well illustrated here But believe me, this tear is communicating all the way to the front You might say, well, there's a tear here. There's a tear here. Maybe they're not connected That's possible, but that's stupid. That's stupid stuff You've got a big giant tear that's the same shape as the one in the back, and they're not connected That's silly. Of course, they have to be connected, even if you don't see it. It's just common sense And you already know you have a dysplastic meniscus And if you're a little educated, you know that meniscus splits right in the middle into two parts So with a little bit of knowledge, which can sometimes be dangerous, you know that this entire cleavage signal has to be one thing So don't try and over manipulate it. Don't try and overthink it It's a meniscus that's turning into a turkey sandwich What's happening is just this See if my drawing tool works. Here it is. It's purple Here's my discoid meniscus. The tear is just going right down the barrel, the center of the meniscus Right through those weaker collagen bands that are normal that conducts an ovium It's a little looser in there Unfortunately, in these dysplastic menisci, that loose area starts to come apart And if you put it on the table and you turn it like this vertically, turn the meniscus vertically The thing will go like this. This half will fall that way. That half will fall the other way. The meniscus will fall into two pieces The two pieces of bread from the sandwich fall apart and you got just a piece of turkey in the middle It's horrible It's saying, oh my god, what do you do? Nothing Currently, the state of the art is there is no good treatment for this scenario But that's not why we're here Unfortunately at some point the meniscus blows. You got to leave it until it blows and then it has to be resected But there's more Let's talk about what's happening in the front In the front we've got, as we said, this little tiny round globular thing Which is a meniscal pseudosist Why is it a pseudosist? Because it's not lined by epithelium or synovium It's lined by fibrous tissue as opposed to a trussist which is epithelial line So we say there's a peri meniscal small pseudosist of meniscal origin That is, you know, four by three millimeters in size Sometimes you'll get them in the meniscus. That's okay Just describe it Sometimes out of the meniscus When they're really, really big, you may have to fix this and then resect from the outsides You may have to go outside and inside So then it really starts to matter If it's not a meniscal tear, like a ganglion, it'll do something like this It'll make a big mass and it'll go above the meniscus So the tail goes above or the tail may go below, but it doesn't go in the center So it's like belly buttons, ganglia, belly button outie, outie Whereas meniscal pseudosist, belly button right in the center, it's an innie