Mri anatomy of knee Dr. Muhammad Bin Zulfiqar

This presentation is the first series of the MR imaging of Knee.
In this presentation MRI anatomy has been discussed. As we all know good knowledge of medical imaging three dimensional anatomy is key for good reporting.
Hope we all get benifitted.
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1. MRI ANATOMY OF KNEE DR. MUHAMMAD BIN ZULFIQAR PGR IV FCPS SIMS/SHL [email protected]

2. Agenda Our aim is to introduce MRI Anatomy of knee Anatomy of knee Basics of MRI Knee MRI Anatomy of knee

3. Bones and Joints -Largest & complex joint in the body . - It consists of 3 Joints: Medial Condylar Joint : Latral Condylar Joint : Patellofemoral Joint : Between the patella & the patellar surface of the femur. - The fibula is NOT directly involved in the joint .

4. ARTICULAR SURFACE THE ARTICULAR SURFACES OF KNEE JOINT ARE AS FOLLOWING. THE CONDYLES OF FEMUR. THE PATELLA. THE CONDYLES OF TIBIA.

5. ARTICULAR SURFACE

6. Patellar Anatomy

7. Ligaments Collateral ligament divided into Media collateral ligament Lateral collateral ligament Cruciate ligament also has two Anterior cruciate ligament Posterior cruciate ligament

8. Anatomy of The Knee— Menisci

9. Medial Meniscus Lateral Meniscus Posterior horn larger than anterior horn Anterior and posterior horns equal More open More closed Tightly attached Loosely attatched Anatomy of The Knee— Menisci

10. Anatomy of The Knee— Menisci

11. Protocol of examination Axial T1 localizer Sagittal T1, PD, T2 Coronal gradient echo, STIR If contrast is injected [ Axial, Sagittal and Coronal T1 WIs ]

12. T1 T2 Gradient STIR How to know the pulse sequence ?

13. Where ? Items to be evaluated Sagittal PD Coronal. Sagittal,coronal and axial. Coronal Axial Sagittal PD Sagittal T1& T2 Sagittal T2 Menisci (medial & lateral) Ligaments - Cruciate (ACL, PCL) - Collateral - Retinacular Tendons ( Quadriceps, Pattelar ) Bones Synovial effusion

14. Basics of MRI Tissues T1 T2 Fat Hyperintense Hyperintense Water Hypointense hyperintense Cortical bone Hypointense Hypointense Fibrous tissue Hypointense Hypointense Cartilage Isointense Isointense

15. T2W Axial Fat SAT

16. T2W Axial Fat SAT Quadricep femoris tendon Vastus lateralis muscle Femur Vastus medialis muscle Sartorius Muscle Gracilis muscle Semitendinosus muscle and tendon Semimembranosus muscle and tendon Popliteal vessels Biceps femoris muscle

17. T2W Axial Fat SAT Quadricep femoris tendon Vastus lateralis muscle Femur Vastus medialis muscle Sartorius Muscle Gracilis muscle Semitendinosus muscle and tendon Semimembranosus muscle and tendon Popliteal vessels Tibial nerve Common Peroneal nerve Biceps femoris muscle

18. T2W Axial Fat SAT Quadricep femoris tendon Vastus lateralis muscle Femur Vastus medialis muscle Sartorius Muscle Gracilis muscle Semitendinosus muscle and tendon Semimembranosus muscle and tendon Popliteal vessels Biceps femoris muscle

19. T2W Axial Fat SAT patella Vastus lateralis muscle Femur Vastus medialis muscle Sartorius Muscle Gracilis muscle Semitendinosus tendon Semimembranosus muscle and tendon Tibial nerve Common Peroneal nerve Biceps femoris muscle

20. T2W Axial Fat SAT Patella Vastus lateralis muscle Femur Vastus medialis muscle Sartorius Muscle Gracilis muscle Semitendinosus tendon Semimembranosus muscle and tendon Tibial nerve Common Peroneal nerve Biceps femoris muscle

21. T2W Axial Fat SAT Patella Vastus lateralis muscle Femur Vastus medialis muscle Sartorius Muscle Gracilis muscle Semitendinosus tendon Semimembranosus muscle and tendon Biceps femoris muscle

22. T2W Axial Fat SAT Patella Iliotibial tract Femur Vastus medialis muscle Sartorius Muscle Gracilis tendon Semimembranosus tendon Semitendinosus tendon Biceps femoris muscle

23. T2W Axial Fat SAT Patella Iliotibial tract Femur Sartorius Muscle Gracilis tendon Semimembranosus tendon Semitendinosus tendon T ibial nerve Common Peroneal nerve Biceps femoris muscle

24. T2W Axial Fat SAT Patella Iliotibial tract Femur Sartorius Muscle Gracilis tendon Semimembranosus tendon Semitendinosus tendon Medial head of gastrocnemius Popliteal artery and vein Biceps femoris muscle and tendon

25. T2W Axial Fat SAT Patella Femur Sartorius Muscle Semimembranosus tendon Semitendinosus tendon Medial head of gastrocnemius Popliteal artery and vein Biceps femoris muscle and tendon

26. T2W Axial Fat SAT Patella Femur Sartorius Muscle Semitendinosus tendon Medial head of gastrocnemius Popliteal artery and vein Lateral head of gastrocnemius Biceps femoris muscle and tendon

27. T2W Axial Fat SAT Femur Great saphenous vein Sartorius Muscle Semitendinosus tendon Medial head of gastrocnemius Popliteal artery and vein Biceps femoris muscle and tendon

28. T2W Axial Fat SAT Femur Great saphenous vein Sartorius Muscle Semitendinosus tendon Medial head of gastrocnemius Biceps femoris muscle and tendon

29. T2W Axial Fat SAT Patellar tendon Infrapatellar fat pad of Hoffa Lateral femoral condyle Medial femoral condyle Great saphenous vein Sartorius Muscle Semitendinosus tendon Medial head of gastrocnemius Posterior cruciate ligament Lateral head of gastrocnemius Biceps femoris muscle and tendon

30. T2W Axial Fat SAT Patellar tendon Infrapatellar fat pad of Hoffa Lateral femoral condyle Medial femoral condyle Great saphenous vein Semitendinosus tendon Medial head of gastrocnemius Posterior cruciate ligament Lateral head of gastrocnemius Biceps femoris muscle and tendon

31. T2W Axial Fat SAT Patellar tendon Infrapatellar fat pad of Hoffa Medial meniscus Great saphenous vein Sartorius muscle and tendon Semitendinosus tendon Medial head of gastrocnemius Posterior cruciate ligament Lateral head of gastrocnemius Lateral meniscus

32. T2W Axial Fat SAT Patellar tendon Lateral tibial plataeu Medial tibial plataeu Great saphenous vein Sartorius muscle and tendon Medial head of gastrocnemius Planter and Lateral head of gastrocnemius

33. T2W Axial Fat SAT Patellar tendon Tibia Sartorius tendon Medial head of gastrocnemius Popliteal Vessels (A and V) Lateral head of gastrocnemius

34. T2W Axial Fat SAT Patellar tendon Tibia Sartorius tendon Medial head of gastrocnemius Popliteal Vessels (A and V) Fibula

35. T2W Axial Fat SAT Patellar tendon Tibia Sartorius tendon Medial head of gastrocnemius Popliteal Vessels (A and V) Fibula

36. 1 Patellar tendon 2 Lateral patellar retinaculum 3 Medial patellar retinaculum 5 Semitendinosus tendon 6 Medial collateral ligament 7 Long (great) saphenous vein 8 Sartorius muscle 9 Gracilis tendon 10 Semimembranosus tendon 11 Lateral collateral ligament 12 Biceps femoris tendon 18 Medial meniscus 21 Popliteus muscle 22 Popliteus tendon 27 Infrapatellar fat pad TIWI

37. 4 Iliotibial tract 7 Long (great) saphenous vein 8 Sartorius muscle 10 Semimembranosus tendon 13 Posterior cruciate ligament 14 Anterior cruciate ligament 15 Medial head gastrocnemius muscle 16 Biceps femoris muscle 17 Lateral head gastrocnemius muscle 19 Popliteal artery TIWI

38. 19 Popliteal artery 20 Popliteal vein 22 Popliteus tendon 23 Common peroneal (fibular) nerve 24 Patella 25 Lateral condylar eminence 26 Short ( lesser ) saphenous vein 27 Infrapatellar fat pad 28 Deep fascia (fascia lata) 29 Tibial plateau 30 Medial condyle of femur 31 Lateral condyle of femur TIWI

39. Coronal TIWI and T2 FAT SAT

40. Patella Quadricep femoris tendon

41. Vastus medialis muscle Quadricep femoris tendon Patella Infrapatellar fat pad of hoffa Patellar tendon

42. Vastus medialis muscle Quadricep femoris tendon Lateral femoral condyle Tibia

43. Vastus medialis muscle Quadricep femoris tendon Vastus lateralis muscle Femur Iliotibial tract Tibia

44. Vastus medialis muscle Vastus lateralis muscle Femur Iliotibial tract Tibia

45. Vastus medialis muscle Vastus lateralis muscle Femur Medial meniscus Tibia

46. Vastus medialis muscle Vastus lateralis muscle Femur Medial meniscus Lateral Meniscus

47. Vastus medialis muscle Vastus lateralis muscle Femur Posterior cruciate ligament Medial meniscus Lateral Meniscus Tibia

48. Vastus medialis muscle Vastus lateralis muscle Femur Posterior cruciate ligament Medial meniscus Lateral Meniscus Tibia

49. Vastus medialis muscle Femur Vastus lateralis muscle Posterior cruciate ligament Anterior cruciate ligament Tibial collateral ligament Fibular collateral ligament Medial meniscus Lateral Meniscus Tibia fibula

50. Vastus medialis muscle Femur Vastus lateralis muscle Tractus ileotibial Posterior cruciate ligament Anterior cruciate ligament Medial meniscus Lateral Meniscus Tibia fibula

51. Vastus medialis muscle Vastus lateralis muscle Bicep femoris muscle Lateral head of gastrocnemius Medial head of gastrocnemius Femur Medial meniscus Lateral Meniscus Posterior cruciate ligament Tibia fibula

52. Sartorius muscle Vastus medialis muscle Vastus lateralis muscle Popliteal vessels Bicep femoris muscle Lateral head of gastrocnemius Femur Medial meniscus Lateral Meniscus Tibia Poplitius muscle fibula

53. Sartorius muscle Popliteal vessels Bicep femoris muscle femur Medial head of gastrocnemius Lateral head of gastrocnemius Tibia

54. Sartorius muscle Bicep femoris muscle Medial head of gastrocnemius Lateral head of gastrocnemius

55. Sartorius muscle Semimembranosus muscle Bicep femoris muscle

56. 1 Medial femoral condyle 2 Lateral femoral condyle 3 Head of fibula 9 Great (long) saphenous vein 11 Tendon of gracilis muscle 12 Popliteal artery 13 Common peroneal (fibular) nerve 14 Medial head of gastrocnemius muscle 15 Semimembranosus muscle 19 Lateral head of gastrocnemius 20 Biceps femoris muscle 21 Soleus muscle

57. 1 Medial femoral condyle 2 Lateral femoral condyle 5 Lateral collateral ligament 6 Iliotibial tract 8 Popliteus muscle 9 Great (long) saphenous vein 10 Sartorius muscle 16 Posterior horn medial meniscus 17 Posterior horn lateral meniscus 20 Biceps femoris muscle 22 Peroneus ( fibularis ) longus muscle

58. 1 Medial femoral condyle 2 Lateral femoral condyle 3 Head of fibula 4 Proximal tibiofibular joint 5 Lateral collateral ligament 22 Peroneus ( fibularis ) longus muscle 27 Tibial spine 28 Medial tibial condyle 29 Lateral tibial condyle 31 Lateral superior genicular artery 36 Medial inferior genicular artery 38 Tibialis posterior muscle 39 Root of posterior horn, medial meniscus 40 Tibialis anterior muscle 41 Tibial nerve

59. 1 Medial femoral condyle 2 Lateral femoral condyle 22 Peroneus ( fibularis ) longus muscle 25 Body of medial meniscus 26 Body of lateral meniscus 27 Tibial spine 28 Medial tibial condyle 29 Lateral tibial condyle 30 Vastus medialis muscle 31 Lateral superior genicular artery 32 Medial superior genicular artery 33 Medial collateral ligament deep portion 34 Medial collateral ligament superficial Portion 35 Pes anserinus (muscle attachments ) 37 Vastus lateralis muscle 40 Tibialis anterior muscle

60. Sagittal T2W FAT SAT

61. Sagittal T2W FAT SAT Vastus medialis muscle Femur Medial meniscus Tibia Medial head of gastrocnemius Gracilis tendon Gracilis muscle

62. Sagittal T2W FAT SAT Vastus medialis muscle Femur Medial meniscus Tibia Medial head of gastrocnemius Semitendinosus tendon

63. Sagittal T2W FAT SAT Vastus medialis muscle Femur Anterior horn of Medial meniscus Medial Tibial pletaeu Medial head of gastrocnemius Posterior horn of Medial meniscus Semitendinosus tendon Semimembranosus tendon

64. Sagittal T2W FAT SAT Vastus medialis muscle Femur Anterior horn of Medial meniscus Tibia Medial head of gastrocnemius Posterior horn of Medial meniscus Semitendinosus tendon Semimembranosus muscle

65. Sagittal T2W FAT SAT Femur Tibia Posterior horn of Medial meniscus Semitendinosus tendon Semimembranosus muscle

66. Sagittal T2W FAT SAT Femur Tibia Medial head of gastrocnemius Posterior horn of Medial meniscus Semitendinosus tendon Semimembranosus muscle

67. Sagittal T2W FAT SAT Femur Patella Patellar tendon Tibia Medial head of gastrocnemius Posterior cruciate ligament Semitendinosus muscle Semimembranosus muscle

68. Sagittal T2W FAT SAT Vastus medialis muscle Quadriceps tendon Patella Patellar tendon Anterior cruciate ligament Tibia Medial head of gastrocnemius Posterior cruciate ligament

69. Sagittal T2W FAT SAT Femur Quadriceps tendon Patella Patellar tendon Anterior cruciate ligament Tibia Medial head of gastrocnemius Posterior cruciate ligament Popliteal artery and vein

70. Sagittal T2W FAT SAT Femur Quadriceps tendon Patella Patellar tendon Tibia Popliteal artery and vein

71. Sagittal T2W FAT SAT Femur Quadriceps tendon Patella Patellar tendon Tibia

72. Sagittal T2W FAT SAT Femur Quadriceps tendon Patella Patellar tendon Tibia Posterior horn of lateral meniscus Lateral head gastrocnemius muscle

73. Sagittal T2W FAT SAT Quadriceps tendon Femur Anterior horn of lateral meniscus Tibia Posterior horn of lateral meniscus Lateral head gastrocnemius muscle

74. Sagittal T2W FAT SAT Femur Anterior horn of lateral meniscus Tibia Posterior horn of lateral meniscus Bicep femoris muscle

75. Sagittal T2W FAT SAT Vastus lateralis muscle Lateral femoral condyle Lateral tibial plateau Fibula Soleus Bicep femoris muscle

76. Sagittal T2W FAT SAT Vastus lateralis muscle Bicep femoris muscle Fibula

77. 2-Posterior cruciate ligament 4-Posterior horn medial meniscus 7 Medial condyle of femur 11 Medial superior genicular artery 13 Patellar tendon 17 Medial tibial plateau 24 Vastus medialis muscle 26-Infrapatellar fat pad 27-semimembranosus muscle 29-Semitendinosus tendon 34 Medial head of gastrocnemius tendon 35 Medial patellar retinaculum 37 Posterior joint capsule 38 Transverse ligament 39 Meniscofemoral ligament ( Wrisberg )

78. 28Semimembranosus tendon 30-Sartorius tendon 29-Semitendinosus tendon 31-Medial head of gastrocnemius muscle 32-Adductor tubercle 3-Anterior horn medial meniscus 4-Posterior horn medial meniscus 10-Median intermuscular septum 17-Medial tibial plateau 24-Vastus medialis muscle

79. 5 Anterior horn lateral meniscus 6 Posterior horn lateral meniscus 8 Lateral condyle of femur 9 Lateral superior genicular artery and veins 12 Quadriceps tendon 14 Patella 15 Epiphyseal line/scar 16 Lateral tibial plateau 18 Fibular head 19 Proximal tibiofibular joint 21 Popliteus muscle belly 22 Lateral head of gastrocnemius muscle 25 Tibialis anterior muscle 36 Lateral patellar retinaculum 41 Biceps femoris muscle 42 Plantaris muscle 44 Common peroneal (fibular) nerve

80. 1 Anterior cruciate ligament 12 Quadriceps tendon 13 Patellar tendon 14 Patella 16 Lateral tibial plateau 21 Popliteus muscle belly 22 Lateral head of gastrocnemius m 33 Popliteal artery 26-Infrapatellar fat pa 37 Posterior joint capsule 40 Tibial spine 43 Tibial tuberosity

81. Normal MR meniscal Anatomy

82. Medial meniscus Both horns are triangular in shape and have very sharp points . Medial meniscus: The posterior horn is always larger than the anterior horn.

83. Lateral meniscus On sagittal images the posterior horn is higher in position than the anterior horn.  Both horns are about the same size.

84. Take Home Message Knowledge of normal anatomy of knee, imaging protocol of MRI and MRI anatomy of knee is key in the diagnosis of Knee pathologies

85. THANK YOU