Mri anatomy of knee Dr. Muhammad Bin Zulfiqar

MRI ANATOMY OF KNEE

DR. MUHAMMAD BIN ZULFIQARPGR IV FCPS SIMS/[email protected]

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

Knee

Bones

Cartilage Synovial Fluid

Ligaments Menisci

Muscles

Others

Bones and Joints-Largest & complex joint in the body .

- It consists of 3 Joints:1) Medial Condylar Joint : 2) Latral Condylar Joint : 3) Patellofemoral Joint : Between the patella & the patellar surface of

the femur.- The fibula is NOT directly involved in the joint .

ARTICULAR SURFACETHE ARTICULAR SURFACES OF KNEE JOINT ARE AS FOLLOWING.• THE CONDYLES OF FEMUR.• THE PATELLA.• THE CONDYLES OF TIBIA.

ARTICULAR SURFACE

Patellar Anatomy

LigamentsCollateral ligament divided into • Media collateral ligament• Lateral collateral ligament

Cruciate ligament also has two• Anterior cruciate ligament• Posterior cruciate ligament

Anatomy of The Knee—Menisci

Medial Meniscus Lateral Meniscus

Posterior horn larger than anterior horn Anterior and posterior horns equal

More open More closed

Tightly attached Loosely attatched


Protocol of examination

• Axial T1 localizer• Sagittal T1, PD, T2• Coronal gradient echo, STIR

• If contrast is injected• [ Axial, Sagittal and Coronal T1 WIs ]

T1 T2 Gradient STIR

How to know the pulse sequence?

Where? Items to be evaluated

Sagittal PDCoronal.Sagittal,coronal and axial.CoronalAxialSagittal PDSagittal T1& T2Sagittal T2

Menisci (medial & lateral) Ligaments - Cruciate (ACL, PCL) - Collateral - Retinacular Tendons ( Quadriceps, Pattelar) Bones Synovial effusion

Basics of MRI

Tissues T1 T2

Fat Hyperintense Hyperintense

Water Hypointense hyperintense

Cortical bone Hypointense Hypointense

Fibrous tissue Hypointense Hypointense

Cartilage Isointense Isointense

T2W Axial Fat SAT

T2W Axial Fat SAT1. Quadricep femoris tendon2. Vastus lateralis muscle3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis muscle7. Semitendinosus muscle and tendon8. Semimembranosus muscle and tendon9. Popliteal vessels10. Biceps femoris muscle

T2W Axial Fat SAT1. Quadricep femoris tendon2. Vastus lateralis muscle3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis muscle7. Semitendinosus muscle and tendon8. Semimembranosus muscle and tendon9. Popliteal vessels10. Tibial nerve11. Common Peroneal nerve12. Biceps femoris muscle

T2W Axial Fat SAT1. Quadricep femoris tendon2. Vastus lateralis muscle3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis muscle7. Semitendinosus muscle and tendon8. Semimembranosus muscle and tendon9. Popliteal vessels10. Biceps femoris muscle

T2W Axial Fat SAT1. patella2. Vastus lateralis muscle3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis muscle7. Semitendinosus tendon8. Semimembranosus muscle and tendon9. Tibial nerve10. Common Peroneal nerve11. Biceps femoris muscle

T2W Axial Fat SAT1. Patella2. Vastus lateralis muscle3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis muscle7. Semitendinosus tendon8. Semimembranosus muscle and tendon9. Tibial nerve10. Common Peroneal nerve11. Biceps femoris muscle

T2W Axial Fat SAT1. Patella2. Vastus lateralis muscle3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis muscle7. Semitendinosus tendon8. Semimembranosus muscle and tendon9. Biceps femoris muscle

T2W Axial Fat SAT1. Patella2. Iliotibial tract3. Femur4. Vastus medialis muscle5. Sartorius Muscle6. Gracilis tendon7. Semimembranosus tendon8. Semitendinosus tendon9. Biceps femoris muscle

T2W Axial Fat SAT1. Patella2. Iliotibial tract3. Femur4. Sartorius Muscle5. Gracilis tendon6. Semimembranosus tendon7. Semitendinosus tendon8. Tibial nerve 9. Common Peroneal nerve10. Biceps femoris muscle

T2W Axial Fat SAT1. Patella2. Iliotibial tract3. Femur4. Sartorius Muscle5. Gracilis tendon6. Semimembranosus tendon7. Semitendinosus tendon8. Medial head of gastrocnemius9. Popliteal artery and vein10. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Patella2. Femur3. Sartorius Muscle4. Semimembranosus tendon5. Semitendinosus tendon6. Medial head of gastrocnemius7. Popliteal artery and vein8. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Patella2. Femur3. Sartorius Muscle4. Semitendinosus tendon5. Medial head of gastrocnemius6. Popliteal artery and vein7. Lateral head of gastrocnemius8. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Femur2. Great saphenous vein3. Sartorius Muscle4. Semitendinosus tendon5. Medial head of gastrocnemius6. Popliteal artery and vein7. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Femur2. Great saphenous vein3. Sartorius Muscle4. Semitendinosus tendon5. Medial head of gastrocnemius6. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Patellar tendon2. Infrapatellar fat pad of Hoffa3. Lateral femoral condyle4. Medial femoral condyle5. Great saphenous vein6. Sartorius Muscle7. Semitendinosus tendon8. Medial head of gastrocnemius9. Posterior cruciate ligament10. Lateral head of gastrocnemius11. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Patellar tendon2. Infrapatellar fat pad of Hoffa3. Lateral femoral condyle4. Medial femoral condyle5. Great saphenous vein6. Semitendinosus tendon7. Medial head of gastrocnemius8. Posterior cruciate ligament9. Lateral head of gastrocnemius10. Biceps femoris muscle and tendon

T2W Axial Fat SAT1. Patellar tendon2. Infrapatellar fat pad of Hoffa3. Medial meniscus4. Great saphenous vein5. Sartorius muscle and tendon6. Semitendinosus tendon7. Medial head of gastrocnemius8. Posterior cruciate ligament9. Lateral head of gastrocnemius10. Lateral meniscus

T2W Axial Fat SAT1. Patellar tendon2. Lateral tibial plataeu3. Medial tibial plataeu4. Great saphenous vein5. Sartorius muscle and tendon6. Medial head of gastrocnemius7. Planter and Lateral head of

gastrocnemius

T2W Axial Fat SAT1. Patellar tendon2. Tibia3. Sartorius tendon4. Medial head of gastrocnemius5. Popliteal Vessels (A and V)6. Lateral head of gastrocnemius

T2W Axial Fat SAT1. Patellar tendon2. Tibia3. Sartorius tendon4. Medial head of gastrocnemius5. Popliteal Vessels (A and V)6. Fibula

• 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

• 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

• 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

Coronal TIWI and T2 FAT SAT

1. Patella2. Quadricep femoris tendon

1. Vastus medialis muscle2. Quadricep femoris tendon3. Patella

1. Infrapatellar fat pad of hoffa2. Patellar tendon

1. Vastus medialis muscle2. Quadricep femoris tendon3. Lateral femoral condyle4. Tibia

1. Vastus medialis muscle2. Quadricep femoris tendon3. Vastus lateralis muscle

1. Femur2. Iliotibial tract3. Tibia

1. Vastus medialis muscle2. Vastus lateralis muscle3. Femur4. Iliotibial tract5. Tibia

1. Vastus medialis muscle2. Vastus lateralis muscle3. Femur4. Medial meniscus5. Tibia

1. Vastus medialis muscle2. Vastus lateralis muscle3. Femur4. Medial meniscus5. Lateral Meniscus

1. Vastus medialis muscle2. Vastus lateralis muscle3. Femur4. Posterior cruciate ligament

1. Medial meniscus2. Lateral Meniscus3. Tibia

1. Vastus medialis muscle2. Femur3. Vastus lateralis muscle4. Posterior cruciate ligament5. Anterior cruciate ligament6. Tibial collateral ligament

1. Fibular collateral ligament2. Medial meniscus3. Lateral Meniscus4. Tibia5. fibula

1. Vastus medialis muscle2. Femur3. Vastus lateralis muscle4. Tractus ileotibial5. Posterior cruciate ligament

1. Anterior cruciate ligament2. Medial meniscus3. Lateral Meniscus4. Tibia5. fibula

1. Vastus medialis muscle2. Vastus lateralis muscle3. Bicep femoris muscle4. Lateral head of gastrocnemius5. Medial head of gastrocnemius6. Femur

1. Medial meniscus2. Lateral Meniscus3. Posterior cruciate ligament4. Tibia5. fibula

1. Sartorius muscle2. Vastus medialis muscle3. Vastus lateralis muscle4. Popliteal vessels5. Bicep femoris muscle6. Lateral head of gastrocnemius

1. Femur2. Medial meniscus3. Lateral Meniscus4. Tibia5. Poplitius muscle6. fibula

1. Sartorius muscle2. Popliteal vessels3. Bicep femoris muscle4. femur

1. Medial head of gastrocnemius2. Lateral head of gastrocnemius3. Tibia

1. Sartorius muscle2. Bicep femoris muscle3. Medial head of gastrocnemius4. Lateral head of gastrocnemius

1. Sartorius muscle2. Semimembranosus muscle3. Bicep femoris muscle

• 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

• 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

• 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

• 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

Sagittal T2W FAT SAT

Sagittal T2W FAT SAT1. Vastus medialis muscle2. Femur3. Medial meniscus4. Tibia5. Medial head of gastrocnemius6. Gracilis tendon7. Gracilis muscle

Sagittal T2W FAT SAT1. Vastus medialis muscle2. Femur3. Medial meniscus4. Tibia5. Medial head of gastrocnemius6. Semitendinosus tendon

Sagittal T2W FAT SAT1. Vastus medialis muscle2. Femur3. Anterior horn of Medial meniscus4. Medial Tibial pletaeu5. Medial head of gastrocnemius6. Posterior horn of Medial meniscus7. Semitendinosus tendon8. Semimembranosus tendon

Sagittal T2W FAT SAT1. Vastus medialis muscle2. Femur3. Anterior horn of Medial meniscus4. Tibia5. Medial head of gastrocnemius6. Posterior horn of Medial meniscus7. Semitendinosus tendon8. Semimembranosus muscle

Sagittal T2W FAT SAT1. Femur2. Tibia3. Posterior horn of Medial meniscus4. Semitendinosus tendon5. Semimembranosus muscle

Sagittal T2W FAT SAT1. Femur2. Tibia3. Medial head of gastrocnemius4. Posterior horn of Medial meniscus5. Semitendinosus tendon6. Semimembranosus muscle

Sagittal T2W FAT SAT1. Femur2. Patella3. Patellar tendon4. Tibia5. Medial head of gastrocnemius6. Posterior cruciate ligament7. Semitendinosus muscle8. Semimembranosus muscle

Sagittal T2W FAT SAT1. Vastus medialis muscle2. Quadriceps tendon3. Patella4. Patellar tendon5. Anterior cruciate ligament6. Tibia7. Medial head of gastrocnemius8. Posterior cruciate ligament

Sagittal T2W FAT SAT1. Femur2. Quadriceps tendon3. Patella4. Patellar tendon5. Anterior cruciate ligament6. Tibia7. Medial head of gastrocnemius8. Posterior cruciate ligament9. Popliteal artery and vein

Sagittal T2W FAT SAT1. Femur2. Quadriceps tendon3. Patella4. Patellar tendon5. Tibia6. Popliteal artery and vein

Sagittal T2W FAT SAT1. Femur2. Quadriceps tendon3. Patella4. Patellar tendon5. Tibia

Sagittal T2W FAT SAT1. Femur2. Quadriceps tendon3. Patella4. Patellar tendon5. Tibia6. Posterior horn of lateral meniscus7. Lateral head gastrocnemius muscle

Sagittal T2W FAT SAT1. Quadriceps tendon2. Femur3. Anterior horn of lateral meniscus4. Tibia5. Posterior horn of lateral meniscus6. Lateral head gastrocnemius muscle

Sagittal T2W FAT SAT1. Femur2. Anterior horn of lateral meniscus3. Tibia4. Posterior horn of lateral meniscus5. Bicep femoris muscle

Sagittal T2W FAT SAT1. Vastus lateralis muscle2. Lateral femoral condyle3. Lateral tibial plateau4. Fibula5. Soleus6. Bicep femoris muscle

Sagittal T2W FAT SAT1. Vastus lateralis muscle2. Bicep femoris muscle3. Fibula

2-Posterior cruciate ligament4-Posterior horn medial meniscus7 Medial condyle of femur11 Medial superior genicular artery13 Patellar tendon17 Medial tibial plateau24 Vastus medialis muscle26-Infrapatellar fat pad

27-semimembranosus muscle29-Semitendinosus tendon34 Medial head of gastrocnemius tendon35 Medial patellar retinaculum37 Posterior joint capsule38 Transverse ligament39 Meniscofemoral ligament (Wrisberg)

28Semimembranosus tendon30-Sartorius tendon29-Semitendinosus tendon31-Medial head of gastrocnemius muscle32-Adductor tubercle

3-Anterior horn medial meniscus4-Posterior horn medial meniscus10-Median intermuscular septum17-Medial tibial plateau24-Vastus medialis muscle

• 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

• 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

Normal MR meniscal Anatomy

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.

Lateral meniscus

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

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

THANK YOU

Mri anatomy of knee Dr. Muhammad Bin Zulfiqar

Health & Medicine

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