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Updated: Mar 18

14 yaşlı dizi ağrıyan uşaqda MRT-də heçnə tapmamışıqsa fat padlara baxmaq lazımdır. Əgər fat padlar ill-defined dırlarsa o zaman həmən uşaqda diz ağrısının ən sıx rastlanan səbəblərindən olan patellofemoral maltracking vardır deməkdir.


MRT müayinəsində gördüyümüz bəzi sümük variantları

-Fabella bəzən fabellar sindrom törədir. Normal fabella ödemli olsa xəstə simptomatik və ya asimptomatik fabellar sindromu var deməkdir. Fabellar sindrom femoral kondilusun arxa hissəsini qıcıqlandıraraq onun remodellinginə gətirib çıxarır. Fabellar sindrom zamanı fabella ətrafında yumuşaq toxuma ödemi ola bilər və femoral kondilusun arxa səthində sürtünməyə bağlı çuxur əmələ gətirə bilər.

-Aksessor tibial spine - Parson tuberkulu

-Diskoid menisk anomaliyası ilə əlaqədar olan fibula başının hiperplaziyası vəya hipoplaziyası

-Blount xəstəliyi

-Prominent red marrow (qırmızı sümük iliyinin proliferasiyası səbəbləri - artıq çəki, nizamsız menstruasiya, aşağı hemoqlobin)


Sümük infarktı olan xəstələrdə adətən

- hipertrigliseridemia

-hiperxolesterolemiya

-bəzi trombogen problemlər, metabolik xəstəliklər araşdırılmalıdır.


Təsadüfi enxondromalarda ödem olmur. Lobulyar konturlara malikdir. Non-aqressiv xondroid lezion aşağıdakı xarakteristikaya malik olmalıdır - mature matrix +- kalsifikasiya və ya ossifikasiya, ödemi olmamalıdır, sharp zone of transition, lobulated grape-like edge, cartilage matrix should alüays be bright on T2.


Kortikal desmoid - klinik əhəmiyyətli insidentalomadır. Occurs at adductor magnus insertion.


PCL


- The PCL is curved, blacker and thicker (16-20 mm)

- Braided shape

- shares base with medial meniscus

- Humphrey anterior, meniscofemoral Wrisberg lig posterior

- broad complex anterior femoral (footprint) insertion

- anterolateral bundle minor, posteromedial bundle major


Most PCL tears are treated conservatively. If the fibular collateral and PCL are torn together usually have recurrent varus instability syndrome and the patient often has difficulty walking.

Common injury in wresters - PCL tear and MCL tear (all layers) together.


Meniscal cartilage of the knee


Fibrocartilage structures

- shock absorbers and they are stabilizers (meniscocapsular attachments).

-It is also responsibile for collecting fluid, it is a fluid mover.


The ouuter aspect of the meniscus is vascular. The middle and inner third are almost completely avascular. One of your challanges is to distinguishe incidental intrameniscal signal from relevant intrameniscal signal. There are some intrameniscal lesion that are relevant that may not be a tear - like an intrameniscal ossicle. The most common cause of an intrameniscal sgnal in a child is normal meniscal vascularity. But you can get meniscal contusions. How do you know? there is a contusion above it in the bone and in the hialine cartilage and below it, there is evidens of an impact.


DJD - loss of hialin cartilage, subchondral pseudocyst, a meniscus that swollen or athrophy, shape is irregular and the signal is becoming coalescent and starting to btrighten at the T2 wi.


Normal medial meniscus of the knee

- Large and open shape

- anterior horn is smaller than posterior horn

- Transverse meniscal ligaments of Winslow connects anterior horns

- capsule is tighter medially


Meniscii are fixed to the tibia via meniscal roots. Occasionally we see ligaments that goes from one root to the other root, or from one root in the back to the one root in the front.


Normal lateral meniscus

- small and C-shaped

- closed shaped

- anterior and posterior horns symmetrical


Inside the meniscus there are radial fibers, circumferential fibers and perforating fibers. Cpmbination of circumferential and perforating fibers allows for the passage of synovial fluid.

We have to describe the location of the meniscal tear - inner third, middle third or outer third.

Inner third tears don't heal, and is a hypovascular zone. Outer third tears usually heals. They usually don't need surgery. Middle zone is moderately vascular zone. Outer zone is the most vascular zone and usually heals.

locate if the tear is in anterior horn, body or posterior horn.


The medial meniscus more often contains signal in the posteromedial horn normally than in the other menisci.

Popliteus tendon is attached to posterolateral meniscus.

Meniscus sometimes contains bone - this is called meniscal ossicle.

Discoid meniscus with an absence of Wrisberg ligament - signs of instability.

50% of all discoid meniscus have IM tear.


Meniscal tears - horisontal tears are mostly degenerative and vertical tears are more traumatic.


Meniscocapsular injury - meniscocapsular junction is thick,

posteromedial corner meniscocapsular junction insult is a painfull injury.


Medial supporting structures of the knee


- Patellar retinaculum

Layer 1 - crural fascia

Layer 2 - superficial portion of the MCL

- Posterior oblique ligmanent -- oblique popliteal lig

Layer 2 - superficial oblique portion of MCL

Layer 3 - deep layer of the MCL


TIBIAL COLLATERAL AND ILIOTIBIAL BAND 56 48

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