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Knee MRI Checklist
(sequence based)


Sagital FSE PD:
Cruciate ligaments

Anterior Cruciate Ligament
(
3.0T) (pd fat sat)
       Pitfalls:
           -Partial volume averaging with lat fem condyle
           -ACL myxoid degeneration/cyst (2)
           -Proximal tear (ACL anterior fibers should make an acute angle with the intercondylar notch roof
           -Partial/chronic tear
       Associations:
           -Typical bone marrow edema pattern (lat fem condyle at trochlear sulcus and post-lat tibial plateau)
           -Deep lat notch sign (lat fem condyle trochlear sulcus) (pf)
           -Lat meniscus tears > Med meniscus tears
           -O'Donoghue's Triad (ACL, MMT, MCL) (rare)
           -Segond Fx
           -Avulsion of the medial tibial spine (peds>adult)

Posterior Cruciate Ligament

       Pitfalls:
           -Ganglion (2)
           -Magic angle
         Associations:
           -Premature patello-femoral djd (chronic)

Extensor mechanism

           Patellar tendon
           Quadriceps tendon

 

Sagital CSE PD fat saturation:
Menisci (Longitudinal, Horizontal/Oblique tears, Bucket handle, Radial/Parrot beak)
Medial Meniscus

    Pitfalls:
           -Myxoid degeneration
           -Intrasubstance tear not extending to an articular surface
           -Magic angle
           -Transverse meniscal/transgeniculate ligament (ant horn)
    Associations:
           -Post horn >2x ant horn
           -PHMM undersurface may be an arthroscopic blind spot.
           -Meniscal ossicle (extremely rare)

Lateral Meniscus

    Pitfalls:
           -Meniscofemoral ligaments
               -Humphrey's may mimic a meniscal fragment
               -Wrisberg (post horn)
           -Popliteus tendon mimicking a vertical tear (post horn)
           -Transverse meniscal/transgeniculate ligament (ant horn)
    Associations:
           -Post horn = ant horn

           -Discoid Meniscus
           -Meniscal cyst (lat>med)

Cartilage
(chondromalacia, osteo-cohondral defect)

Bone marrow edema pattern

 

Coronal FSE PD fat saturation:
Medial supporting structures:

Tibial collateral ligament

    Pitfalls:
               -Fibrofatty tissue/bursa between superficial/deep layers of MCL
               -Chronic/healed MCL tears
    Associations:
               -Meniscocapsular separation
               -Pellegrini-Steida dz

Lateral supporting structures:
(and posterior lateral corner)
Fibular collateral ligament
(pd w/o fatsat)
    Associations:
                -ACL and PCL injuries (very rarely an isolated injury)
Arcuate ligament and posterior lateral capsule
    Associations:
                -Arcuate sign/fibular head avulsion fx
Popliteus tendon
Biceps Femoris tendon(T1 for anatomy)
Iliotibial band (T1 for anatomy)
Cartilage
Bone marrow edema

 

Axial STIR or 3.0T Axial FSE PD fat sat:
Cartilage
(3.0T pd fatsat)
    Association:
               -Chondromalacia patella
Effusion/Baker's cyst
   Associations:
                -loose boodies, hemorrhage, ruptured/dissecting

Med/Lat retinacula/patello-femoral ligaments:
    Association:
                -transient lateral patellar dislocation
Pes Anserinus: Sartorius, Gracillus, Semitendinosis
    Association:
                 -Pes Anserinus bursitis

 

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Alex Freitas, MD