<p begin="00:00:07.393" end="00:00:09.023" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.023" end="00:00:11.914" style="s2">with the musculoskeletal<br />exam type is used to perform</p>
<p begin="00:00:11.914" end="00:00:15.626" style="s2">an ultrasound examination of<br />the medial collateral ligament</p>
<p begin="00:00:15.626" end="00:00:16.752" style="s2">of the knee.</p>
<p begin="00:00:16.752" end="00:00:18.666" style="s2">The patient is in a supine position,</p>
<p begin="00:00:18.666" end="00:00:21.420" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:21.420" end="00:00:24.672" style="s2">The transducer is placed<br />longitudinally over the inner knee</p>
<p begin="00:00:24.672" end="00:00:27.541" style="s2">at the joint space, with the<br />orientation marker directed</p>
<p begin="00:00:27.541" end="00:00:29.498" style="s2">to the patient's head.</p>
<p begin="00:00:29.498" end="00:00:31.804" style="s2">The medial collateral<br />ligament can be seen as</p>
<p begin="00:00:31.804" end="00:00:34.336" style="s2">a compact, fibrillar patterned structure,</p>
<p begin="00:00:34.336" end="00:00:37.058" style="s2">superficial to the bright<br />hyperechoic distal femur</p>
<p begin="00:00:37.058" end="00:00:39.061" style="s2">and proximal tibia.</p>
<p begin="00:00:39.061" end="00:00:41.334" style="s2">The medial meniscus is<br />a triangular-shaped,</p>
<p begin="00:00:41.334" end="00:00:44.520" style="s2">hyperechoic structure<br />between the two bones.</p>
<p begin="00:00:44.520" end="00:00:47.454" style="s2">The medial collateral<br />ligament has a superficial</p>
<p begin="00:00:47.454" end="00:00:50.053" style="s2">and deep layer that should<br />be scanned from insertion</p>
<p begin="00:00:50.053" end="00:00:53.227" style="s2">on the femoral condyle down<br />to the darker, hyperechoic</p>
<p begin="00:00:53.227" end="00:00:55.566" style="s2">pes anserine tendon complex.</p>
<p begin="00:00:55.566" end="00:01:00.054" style="s2">The transducer is then rotated<br />90 degrees counterclockwise</p>
<p begin="00:01:00.054" end="00:01:02.259" style="s2">to obtain a short axis view.</p>
<p begin="00:01:02.259" end="00:01:05.175" style="s2">The medial collateral ligament<br />appears as a bilaminate,</p>
<p begin="00:01:05.175" end="00:01:09.156" style="s2">sheet-like structure, with<br />a darker, hypoechoic middle.</p>
<p begin="00:01:09.156" end="00:01:12.171" style="s2">The ligament should be scanned<br />from its proximal origin</p>
<p begin="00:01:12.171" end="00:01:16.338" style="s2">to its distal insertion to<br />complete the examination.</p>

<p begin="00:00:07.374" end="00:00:09.089" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.089" end="00:00:12.017" style="s2">with a musculoskeletal exam<br />type is used to perform</p>
<p begin="00:00:12.017" end="00:00:14.388" style="s2">an ultrasound examination of the Lateral</p>
<p begin="00:00:14.388" end="00:00:16.672" style="s2">Collateral Ligament of the Knee.</p>
<p begin="00:00:16.672" end="00:00:18.568" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.568" end="00:00:21.341" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:21.341" end="00:00:23.742" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.742" end="00:00:25.916" style="s2">over the outer knee at the joint space</p>
<p begin="00:00:25.916" end="00:00:27.753" style="s2">with the orientation marker directed</p>
<p begin="00:00:27.753" end="00:00:29.563" style="s2">to the patient's head.</p>
<p begin="00:00:29.563" end="00:00:32.682" style="s2">The fibular head is a<br />bright, hyperechoic structure</p>
<p begin="00:00:32.682" end="00:00:35.641" style="s2">where the biceps femoris muscle attaches.</p>
<p begin="00:00:35.641" end="00:00:37.553" style="s2">The transducer should be translated</p>
<p begin="00:00:37.553" end="00:00:39.726" style="s2">in a windshield wiper type maneuver</p>
<p begin="00:00:39.726" end="00:00:42.375" style="s2">to connect the fibula<br />and the femoral condyle</p>
<p begin="00:00:42.375" end="00:00:45.671" style="s2">to identify the Lateral<br />Collateral Ligament.</p>
<p begin="00:00:45.671" end="00:00:47.588" style="s2">The ligament can be seen as a packed,</p>
<p begin="00:00:47.588" end="00:00:50.143" style="s2">fibular patterned, tight,<br />elliptical structure</p>
<p begin="00:00:50.143" end="00:00:52.167" style="s2">arising from the lateral condyle,</p>
<p begin="00:00:52.167" end="00:00:54.630" style="s2">and inserting on the fibular head.</p>
<p begin="00:00:54.630" end="00:00:57.277" style="s2">The transducer is then rotated 90 degrees</p>
<p begin="00:00:57.277" end="00:01:00.799" style="s2">counterclockwise to<br />obtain a short-axis view.</p>
<p begin="00:01:00.799" end="00:01:02.914" style="s2">The Lateral Collateral Ligament appears</p>
<p begin="00:01:02.914" end="00:01:05.520" style="s2">as a sheet-like structure,<br />which should be scanned</p>
<p begin="00:01:05.520" end="00:01:07.742" style="s2">from its proximal to distal insertion</p>
<p begin="00:01:07.742" end="00:01:10.159" style="s2">to complete the examination.</p>

<p begin="00:00:07.292" end="00:00:08.981" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.981" end="00:00:11.121" style="s2">with a musculoskeletal examine type</p>
<p begin="00:00:11.121" end="00:00:13.777" style="s2">is used to perform an<br />ultrasound guided injection</p>
<p begin="00:00:13.777" end="00:00:16.673" style="s2">of the knee using a lateral approach.</p>
<p begin="00:00:16.673" end="00:00:18.782" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.782" end="00:00:20.520" style="s2">with the leg extended.</p>
<p begin="00:00:20.520" end="00:00:23.616" style="s2">The transducer is placed<br />just proximal to the patella</p>
<p begin="00:00:23.616" end="00:00:25.906" style="s2">in a long-axis fashion.</p>
<p begin="00:00:25.906" end="00:00:28.317" style="s2">The fibular pattern of<br />the quadriceps tendon</p>
<p begin="00:00:28.317" end="00:00:31.276" style="s2">in seen above the rounded,<br />bright hyperechoic surface</p>
<p begin="00:00:31.276" end="00:00:33.983" style="s2">of the distal femur and patella.</p>
<p begin="00:00:33.983" end="00:00:36.301" style="s2">The suprapatellar fat-pad and the darker</p>
<p begin="00:00:36.301" end="00:00:38.897" style="s2">hypoechoic suprapatellar bursa</p>
<p begin="00:00:38.897" end="00:00:40.829" style="s2">can be seen in this image.</p>
<p begin="00:00:40.829" end="00:00:43.760" style="s2">The transducer is rotated<br />90 degrees clockwise</p>
<p begin="00:00:43.760" end="00:00:46.149" style="s2">for a short-axis view of the bursa,</p>
<p begin="00:00:46.149" end="00:00:47.922" style="s2">which lies below the patellar tendon</p>
<p begin="00:00:47.922" end="00:00:50.137" style="s2">and above the bony cortex.</p>
<p begin="00:00:50.137" end="00:00:52.601" style="s2">The transducer is<br />adjusted so it is centered</p>
<p begin="00:00:52.601" end="00:00:55.199" style="s2">over the superapatellar bursa.</p>
<p begin="00:00:55.199" end="00:00:56.947" style="s2">The needle is inserted in the skin</p>
<p begin="00:00:56.947" end="00:00:58.889" style="s2">just proximal to the transducer,</p>
<p begin="00:00:58.889" end="00:01:01.243" style="s2">opposite the orientation marker.</p>
<p begin="00:01:01.243" end="00:01:03.766" style="s2">The needle is slowly<br />advanced to lie in-plane</p>
<p begin="00:01:03.766" end="00:01:06.557" style="s2">to the transducer beam,<br />and is seen as a bright,</p>
<p begin="00:01:06.557" end="00:01:09.116" style="s2">hyperechoic, linear structure.</p>
<p begin="00:01:09.116" end="00:01:11.776" style="s2">The needle is slowly advanced<br />under direct ultrasound</p>
<p begin="00:01:11.776" end="00:01:13.807" style="s2">visualization until the tip is seen</p>
<p begin="00:01:13.807" end="00:01:15.380" style="s2">to lie within the bursa,</p>
<p begin="00:01:15.380" end="00:01:19.297" style="s2">where the injection or<br />aspiration can be done.</p>

<p begin="00:00:07.188" end="00:00:08.845" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:08.845" end="00:00:11.064" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.064" end="00:00:13.476" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.476" end="00:00:15.738" style="s2">of the infrapatellar tendon.</p>
<p begin="00:00:15.738" end="00:00:17.577" style="s2">The patient is in a supine position</p>
<p begin="00:00:17.577" end="00:00:20.176" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:20.176" end="00:00:22.815" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:22.815" end="00:00:25.613" style="s2">just inferior to the<br />patella in the mid-line</p>
<p begin="00:00:25.613" end="00:00:26.858" style="s2">with the orientation marker</p>
<p begin="00:00:26.858" end="00:00:29.102" style="s2">directed to the patient's head.</p>
<p begin="00:00:29.102" end="00:00:31.030" style="s2">The bright hyperechoic patella</p>
<p begin="00:00:31.030" end="00:00:33.007" style="s2">is seen on the left of the image.</p>
<p begin="00:00:33.007" end="00:00:34.572" style="s2">The infrapatellar tendon</p>
<p begin="00:00:34.572" end="00:00:38.046" style="s2">is seen as a compact<br />fibrillar pattern structure</p>
<p begin="00:00:38.046" end="00:00:40.679" style="s2">which extends from the<br />patellar insertion distally</p>
<p begin="00:00:40.679" end="00:00:43.517" style="s2">to the anterior tibial tuberosity.</p>
<p begin="00:00:43.517" end="00:00:45.316" style="s2">The long axis examination</p>
<p begin="00:00:45.316" end="00:00:47.519" style="s2">is repeated medially and laterally</p>
<p begin="00:00:47.519" end="00:00:49.785" style="s2">to fully evaluate the tendon.</p>
<p begin="00:00:49.785" end="00:00:53.546" style="s2">The transducer is then rotated<br />90 degrees counter clockwise</p>
<p begin="00:00:53.546" end="00:00:55.964" style="s2">to obtain a short axis view.</p>
<p begin="00:00:55.964" end="00:00:59.087" style="s2">The infrapatellar tendon is<br />seen as a speckled pattern,</p>
<p begin="00:00:59.087" end="00:01:01.662" style="s2">elliptical structure distal to the patella</p>
<p begin="00:01:01.662" end="00:01:03.829" style="s2">and anterior to the tibia.</p>
<p begin="00:01:04.822" end="00:01:07.231" style="s2">The transducer is slowly moved distally</p>
<p begin="00:01:07.231" end="00:01:08.992" style="s2">as the tendon gradually thins</p>
<p begin="00:01:08.992" end="00:01:11.992" style="s2">to insert on the tibial tuberosity.</p>

<p begin="00:00:07.461" end="00:00:09.290" style="s2">- [Voiceover] A linear array transducer</p>
<p begin="00:00:09.290" end="00:00:11.314" style="s2">with a musculoskeletal exam type</p>
<p begin="00:00:11.314" end="00:00:13.933" style="s2">is used to perform an<br />ultrasound examination</p>
<p begin="00:00:13.933" end="00:00:16.052" style="s2">of the ilio-tibial band.</p>
<p begin="00:00:16.052" end="00:00:18.213" style="s2">The patient is in a supine position</p>
<p begin="00:00:18.213" end="00:00:20.812" style="s2">with the knee flexed 90 degrees.</p>
<p begin="00:00:20.812" end="00:00:23.354" style="s2">The transducer is placed longitudinally</p>
<p begin="00:00:23.354" end="00:00:26.365" style="s2">over the outer knee,<br />just proximal and medial</p>
<p begin="00:00:26.365" end="00:00:28.860" style="s2">to the fibular head at Gerdy's tubercle,</p>
<p begin="00:00:28.860" end="00:00:30.647" style="s2">with the orientation marker directed</p>
<p begin="00:00:30.647" end="00:00:32.635" style="s2">to the patient's head.</p>
<p begin="00:00:32.635" end="00:00:34.734" style="s2">The fibers of the ilio-tibial band</p>
<p begin="00:00:34.734" end="00:00:36.838" style="s2">are seen just superficial to the bright,</p>
<p begin="00:00:36.838" end="00:00:39.016" style="s2">hyperechoic Gerdy's tubercle.</p>
<p begin="00:00:39.016" end="00:00:41.254" style="s2">The ilio-tibial band is assessed</p>
<p begin="00:00:41.254" end="00:00:44.324" style="s2">as it cross the lateral femoral condyle.</p>
<p begin="00:00:44.324" end="00:00:47.169" style="s2">A small anechoic bursa may<br />be visible at this point</p>
<p begin="00:00:47.169" end="00:00:50.752" style="s2">in patients with<br />ilio-tibial band syndrome.</p>

<p begin="00:00:04.770" end="00:00:06.813" style="s2">- [Voiceover] The following<br />video is a description of the</p>
<p begin="00:00:06.813" end="00:00:10.262" style="s2">fuse quadriceps tendonosis<br />primarily to the rectus</p>
<p begin="00:00:10.262" end="00:00:11.838" style="s2">femurus portion.</p>
<p begin="00:00:11.838" end="00:00:13.081" style="s2">Here's the bony anatomy,</p>
<p begin="00:00:13.081" end="00:00:15.982" style="s2">associated with the suprapatellar region</p>
<p begin="00:00:15.982" end="00:00:17.695" style="s2">of the anterior knee.</p>
<p begin="00:00:17.695" end="00:00:21.917" style="s2">Superimposed CAT scan will<br />be modeling the quadricep</p>
<p begin="00:00:21.917" end="00:00:25.264" style="s2">tendon insertion to the<br />base of the patella,</p>
<p begin="00:00:25.264" end="00:00:28.097" style="s2">followed by the quadricep fat pad,</p>
<p begin="00:00:29.115" end="00:00:31.907" style="s2">which is seen here highlighted in yellow.</p>
<p begin="00:00:31.907" end="00:00:36.132" style="s2">Also here highlighted in<br />yellow is the prefemoral</p>
<p begin="00:00:36.132" end="00:00:40.299" style="s2">fat pad which surrounds the<br />anterior aspect of the femur.</p>
<p begin="00:00:41.765" end="00:00:43.404" style="s2">And highlighted here in blue is the</p>
<p begin="00:00:43.404" end="00:00:46.210" style="s2">Anterior Articular Hyaline Cartilage,</p>
<p begin="00:00:46.210" end="00:00:50.421" style="s2">and in light blue would be<br />the normal synovial recess,</p>
<p begin="00:00:50.421" end="00:00:52.334" style="s2">the Suprapatellar Bursa.</p>
<p begin="00:00:52.334" end="00:00:56.576" style="s2">Here is the corresponding<br />Normal Quadricep Tendon Image</p>
<p begin="00:00:56.576" end="00:01:00.016" style="s2">as the tendon fibers<br />insert to the highlighted</p>
<p begin="00:01:00.016" end="00:01:03.016" style="s2">Patellar base, the proximal surface.</p>
<p begin="00:01:04.580" end="00:01:08.953" style="s2">Highlighted here is the<br />anterior margin of the femur.</p>
<p begin="00:01:08.953" end="00:01:12.176" style="s2">Highlighted here in blue<br />is the fibrillar pattern</p>
<p begin="00:01:12.176" end="00:01:15.759" style="s2">of the normally situated<br />quadriceps tendon.</p>
<p begin="00:01:16.719" end="00:01:21.219" style="s2">Highlighted here in yellow<br />is the Quadricep Fat Pad,</p>
<p begin="00:01:21.219" end="00:01:25.696" style="s2">also highlighted here in yellow<br />is the Prefemoral Fat Pad,</p>
<p begin="00:01:25.696" end="00:01:28.789" style="s2">and next we have highlighted<br />here in light blue as the</p>
<p begin="00:01:28.789" end="00:01:32.314" style="s2">normally appearing synovial recess</p>
<p begin="00:01:32.314" end="00:01:34.804" style="s2">of the superpatellar bursa.</p>
<p begin="00:01:34.804" end="00:01:38.121" style="s2">To further demonstrate the<br />extensor mechanism of the</p>
<p begin="00:01:38.121" end="00:01:41.782" style="s2">quadricep tendon having the<br />patient tighten their quad</p>
<p begin="00:01:41.782" end="00:01:46.458" style="s2">will also force fluid into<br />the superpatellar recess.</p>
<p begin="00:01:46.458" end="00:01:48.992" style="s2">If no joint effusion is identified,</p>
<p begin="00:01:48.992" end="00:01:52.694" style="s2">this is one way to bring<br />out normal physiologic fluid</p>
<p begin="00:01:52.694" end="00:01:54.777" style="s2">between the two fat pads.</p>
<p begin="00:01:56.837" end="00:02:00.682" style="s2">This image shows a diffuse<br />formation of the more</p>
<p begin="00:02:00.682" end="00:02:04.268" style="s2">superficial layer of the quadricep tendon.</p>
<p begin="00:02:04.268" end="00:02:06.043" style="s2">Highlighted in white is a normal</p>
<p begin="00:02:06.043" end="00:02:09.012" style="s2">appearing base of the patella.</p>
<p begin="00:02:09.012" end="00:02:12.415" style="s2">Highlighted here is the<br />normal appearing interior</p>
<p begin="00:02:12.415" end="00:02:16.382" style="s2">surface of the femur followed<br />by a thickened quadricep</p>
<p begin="00:02:16.382" end="00:02:19.532" style="s2">tendon insertion proximal to its insertion</p>
<p begin="00:02:19.532" end="00:02:20.782" style="s2">of the patella.</p>
<p begin="00:02:22.255" end="00:02:25.073" style="s2">Highlighted here in yellow<br />is the normal appearing</p>
<p begin="00:02:25.073" end="00:02:29.472" style="s2">quadriceps fat pad followed<br />by the normal appearing</p>
<p begin="00:02:29.472" end="00:02:31.055" style="s2">prefemoral fat pad.</p>
<p begin="00:02:32.286" end="00:02:36.698" style="s2">Here we have in light blue<br />a more normal appearing</p>
<p begin="00:02:36.698" end="00:02:39.823" style="s2">physiologic amount of synovial fluid,</p>
<p begin="00:02:39.823" end="00:02:42.494" style="s2">and then red represents<br />the superficial layer</p>
<p begin="00:02:42.494" end="00:02:45.618" style="s2">of the quadricep tendon<br />which is now diffuse,</p>
<p begin="00:02:45.618" end="00:02:49.096" style="s2">indicating diffuse<br />tendonosis of the rectus</p>
<p begin="00:02:49.096" end="00:02:50.429" style="s2">femurus portion.</p>

<p begin="00:00:09.961" end="00:00:12.478" style="s2">- Next we're going to<br />view the patella tendon</p>
<p begin="00:00:12.478" end="00:00:14.561" style="s2">in its longitudinal view.</p>
<p begin="00:00:15.568" end="00:00:19.401" style="s2">I'm going to place the<br />transducer just beneath</p>
<p begin="00:00:20.518" end="00:00:23.988" style="s2">the patient's patella, maintaining contact</p>
<p begin="00:00:23.988" end="00:00:25.821" style="s2">on the patient's knee.</p>
<p begin="00:00:26.918" end="00:00:29.447" style="s2">Here we see the fibers<br />of the patellar tendon,</p>
<p begin="00:00:29.447" end="00:00:31.794" style="s2">attaching on the patella.</p>
<p begin="00:00:31.794" end="00:00:34.143" style="s2">Next we're going to follow<br />these fibers distally</p>
<p begin="00:00:34.143" end="00:00:37.153" style="s2">as they attach on the tibial tubercle.</p>
<p begin="00:00:37.153" end="00:00:38.621" style="s2">And here we see the distal attachment</p>
<p begin="00:00:38.621" end="00:00:40.538" style="s2">on the tibial tubercle.</p>
<p begin="00:00:42.457" end="00:00:46.162" style="s2">Generally, I'll scan the<br />patellar tendon three times,</p>
<p begin="00:00:46.162" end="00:00:49.530" style="s2">once in the center, and<br />then once to each side,</p>
<p begin="00:00:49.530" end="00:00:51.869" style="s2">to view the entire tendon.</p>
<p begin="00:00:51.869" end="00:00:55.286" style="s2">In this case medially and next laterally.</p>
<p begin="00:01:05.601" end="00:01:07.440" style="s2">Next we're going to<br />view the patellar tendon</p>
<p begin="00:01:07.440" end="00:01:09.812" style="s2">in cross-sectional view.</p>
<p begin="00:01:09.812" end="00:01:11.617" style="s2">I'm going to place the transducer</p>
<p begin="00:01:11.617" end="00:01:14.824" style="s2">beneath the patient's patella,</p>
<p begin="00:01:14.824" end="00:01:17.741" style="s2">just overlying the patellar tendon.</p>
<p begin="00:01:19.514" end="00:01:22.200" style="s2">In here we're going to<br />see a circular pattern</p>
<p begin="00:01:22.200" end="00:01:24.182" style="s2">of the patellar tendon in cross-section,</p>
<p begin="00:01:24.182" end="00:01:26.881" style="s2">looking for any abnormalities.</p>
<p begin="00:01:26.881" end="00:01:29.906" style="s2">I'm going to scan distally<br />down to the tibial tubercle,</p>
<p begin="00:01:29.906" end="00:01:32.374" style="s2">slowly looking for irregularities.</p>
<p begin="00:01:32.374" end="00:01:34.045" style="s2">We'll begin to see the<br />tendon slowly disappearing</p>
<p begin="00:01:34.045" end="00:01:36.545" style="s2">and into the tibial tubercle.</p>

<p begin="00:00:09.660" end="00:00:12.635" style="s2">- Next we're going to examine<br />the patient's medial meniscus</p>
<p begin="00:00:12.635" end="00:00:14.523" style="s2">and medial collateral ligament.</p>
<p begin="00:00:14.523" end="00:00:17.067" style="s2">The medial collateral<br />ligament lies just on top</p>
<p begin="00:00:17.067" end="00:00:21.067" style="s2">of the meniscus and can<br />be seen on the same image.</p>
<p begin="00:00:21.067" end="00:00:22.351" style="s2">To identify this structure</p>
<p begin="00:00:22.351" end="00:00:24.887" style="s2">I'm going to place my tranducer</p>
<p begin="00:00:24.887" end="00:00:27.186" style="s2">in the longitudinal plane</p>
<p begin="00:00:27.186" end="00:00:29.269" style="s2">and palpate the patient's</p>
<p begin="00:00:30.736" end="00:00:32.982" style="s2">joint in the center.</p>
<p begin="00:00:32.982" end="00:00:35.482" style="s2">Place the probe over that area</p>
<p begin="00:00:36.889" end="00:00:40.236" style="s2">and center the meniscus<br />in my screen for viewing.</p>
<p begin="00:00:40.236" end="00:00:44.481" style="s2">The medial meniscus is<br />a wedge-like structure.</p>
<p begin="00:00:44.481" end="00:00:46.812" style="s2">To determine if there is acute trauma</p>
<p begin="00:00:46.812" end="00:00:50.060" style="s2">we can put color doppler on the meniscus.</p>
<p begin="00:00:50.060" end="00:00:52.372" style="s2">Here there's no significant trauma</p>
<p begin="00:00:52.372" end="00:00:55.582" style="s2">or suggestion of any<br />increased vascularity.</p>
<p begin="00:00:55.582" end="00:00:58.526" style="s2">In addition we can zoom<br />in to the meniscus.</p>
<p begin="00:00:58.526" end="00:01:01.955" style="s2">I do this by pressing the zoom button,</p>
<p begin="00:01:01.955" end="00:01:05.117" style="s2">squaring the image, centering it</p>
<p begin="00:01:05.117" end="00:01:07.945" style="s2">and pressing the zoom once again.</p>
<p begin="00:01:07.945" end="00:01:10.177" style="s2">And here I visualize the meniscus</p>
<p begin="00:01:10.177" end="00:01:12.937" style="s2">which appears healthy with<br />no significant trauma.</p>
<p begin="00:01:12.937" end="00:01:14.481" style="s2">Overlying the meniscus</p>
<p begin="00:01:14.481" end="00:01:17.833" style="s2">lies the medial collateral ligament.</p>
<p begin="00:01:17.833" end="00:01:20.865" style="s2">Which is a band-like<br />structure that we can see</p>
<p begin="00:01:20.865" end="00:01:23.782" style="s2">directly above the medial meniscus.</p>
<p begin="00:01:24.770" end="00:01:27.694" style="s2">I recommend starting<br />at the medial mensicus</p>
<p begin="00:01:27.694" end="00:01:30.698" style="s2">to identify the medial collateral ligament</p>
<p begin="00:01:30.698" end="00:01:33.441" style="s2">and then tracing the<br />ligament at it's proximal</p>
<p begin="00:01:33.441" end="00:01:35.769" style="s2">and then distal insertion.</p>
<p begin="00:01:35.769" end="00:01:39.211" style="s2">We begin by following<br />from the medial meniscus.</p>
<p begin="00:01:39.211" end="00:01:42.102" style="s2">Seeing the medial collateral ligament</p>
<p begin="00:01:42.102" end="00:01:45.674" style="s2">approximately to the femoral condyle.</p>
<p begin="00:01:45.674" end="00:01:47.685" style="s2">It's important to have<br />knowledge of the anatomy</p>
<p begin="00:01:47.685" end="00:01:48.705" style="s2">and know that the direction</p>
<p begin="00:01:48.705" end="00:01:51.983" style="s2">that the medial collateral<br />ligament travels.</p>
<p begin="00:01:51.983" end="00:01:52.922" style="s2">So we're going to travel</p>
<p begin="00:01:52.922" end="00:01:57.366" style="s2">the medial collateral<br />ligament approximately</p>
<p begin="00:01:57.366" end="00:02:01.183" style="s2">while looking at the screen<br />to maintain an accurate image.</p>
<p begin="00:02:01.183" end="00:02:04.262" style="s2">We see the medial collateral<br />ligament bending down</p>
<p begin="00:02:04.262" end="00:02:07.129" style="s2">and heading towards the attachment</p>
<p begin="00:02:07.129" end="00:02:09.605" style="s2">at its proximal end here.</p>
<p begin="00:02:09.605" end="00:02:11.348" style="s2">We're going to begin at our starting point</p>
<p begin="00:02:11.348" end="00:02:13.692" style="s2">which will be the medial meniscus</p>
<p begin="00:02:13.692" end="00:02:15.566" style="s2">and follow it distally</p>
<p begin="00:02:15.566" end="00:02:17.487" style="s2">along to its insertion.</p>
<p begin="00:02:17.487" end="00:02:20.173" style="s2">Following along here<br />you see the thick band</p>
<p begin="00:02:20.173" end="00:02:22.350" style="s2">of the medial collateral ligament.</p>
<p begin="00:02:22.350" end="00:02:25.115" style="s2">It actually inserts quite distally</p>
<p begin="00:02:25.115" end="00:02:28.425" style="s2">and what we can also see down<br />here are important structures</p>
<p begin="00:02:28.425" end="00:02:32.028" style="s2">known as the pes anserine tendons.</p>
<p begin="00:02:32.028" end="00:02:34.402" style="s2">These appear at the right of the screen</p>
<p begin="00:02:34.402" end="00:02:37.569" style="s2">as three discrete tendons of darkness.</p>

<p begin="00:00:09.866" end="00:00:11.390" style="s2">- Next, we're gonna move laterally</p>
<p begin="00:00:11.390" end="00:00:13.801" style="s2">and examine the patient's lateral meniscus</p>
<p begin="00:00:13.801" end="00:00:17.193" style="s2">and lateral collateral ligament.</p>
<p begin="00:00:17.193" end="00:00:18.361" style="s2">It's an important landmark</p>
<p begin="00:00:18.361" end="00:00:19.832" style="s2">so we're gonna hold the transducer</p>
<p begin="00:00:19.832" end="00:00:22.582" style="s2">with the notch facing superiorly.</p>
<p begin="00:00:23.920" end="00:00:27.073" style="s2">An important landmark on the<br />patient is the fibular head.</p>
<p begin="00:00:27.073" end="00:00:30.548" style="s2">I'm going to palpate the fibular head</p>
<p begin="00:00:30.548" end="00:00:32.327" style="s2">and place the transducer so that</p>
<p begin="00:00:32.327" end="00:00:34.265" style="s2">the bottom edge of the transducer</p>
<p begin="00:00:34.265" end="00:00:36.827" style="s2">is in contact with the<br />patient's fibular head.</p>
<p begin="00:00:36.827" end="00:00:38.922" style="s2">And that should give us a direct view</p>
<p begin="00:00:38.922" end="00:00:40.852" style="s2">of the lateral meniscus.</p>
<p begin="00:00:40.852" end="00:00:42.158" style="s2">It's important to keep your image</p>
<p begin="00:00:42.158" end="00:00:45.175" style="s2">at the center of the screen<br />to get the best view.</p>
<p begin="00:00:45.175" end="00:00:48.327" style="s2">Here we can see the<br />patient's lateral meniscus.</p>
<p begin="00:00:48.327" end="00:00:49.727" style="s2">Overlying the meniscus is</p>
<p begin="00:00:49.727" end="00:00:53.903" style="s2">the lateral collateral ligament<br />which we'll look at next.</p>
<p begin="00:00:53.903" end="00:00:56.711" style="s2">The meniscus appears as<br />a wedge-shaped structure</p>
<p begin="00:00:56.711" end="00:00:59.816" style="s2">with a homogeneous pattern throughout.</p>
<p begin="00:00:59.816" end="00:01:04.339" style="s2">A tear may show dark<br />patterns within the meniscus</p>
<p begin="00:01:04.339" end="00:01:09.184" style="s2">as well as fluid leaking into<br />the surrounding joint space.</p>
<p begin="00:01:09.184" end="00:01:11.516" style="s2">If we suspect meniscal trauma,</p>
<p begin="00:01:11.516" end="00:01:13.665" style="s2">sometimes we'll use color Doppler</p>
<p begin="00:01:13.665" end="00:01:16.097" style="s2">and see if there's an acute inflammation</p>
<p begin="00:01:16.097" end="00:01:19.267" style="s2">or significant injury demonstrated.</p>
<p begin="00:01:19.267" end="00:01:22.350" style="s2">To do this, I activate color Doppler.</p>
<p begin="00:01:25.350" end="00:01:28.155" style="s2">And if there was any acute trauma,</p>
<p begin="00:01:28.155" end="00:01:30.919" style="s2">once the probe is<br />stabilized and not moving,</p>
<p begin="00:01:30.919" end="00:01:32.955" style="s2">we'd see the increased vascular activity,</p>
<p begin="00:01:32.955" end="00:01:34.288" style="s2">which we do not.</p>
<p begin="00:01:35.621" end="00:01:38.470" style="s2">An additional feature<br />that we may be able to do</p>
<p begin="00:01:38.470" end="00:01:40.719" style="s2">is to zoom in on a structure.</p>
<p begin="00:01:40.719" end="00:01:43.052" style="s2">To do this, I'll press zoom.</p>
<p begin="00:01:45.507" end="00:01:47.587" style="s2">Center over the desired region</p>
<p begin="00:01:47.587" end="00:01:49.337" style="s2">and press zoom again.</p>
<p begin="00:01:51.009" end="00:01:52.866" style="s2">And now I see a blown up image</p>
<p begin="00:01:52.866" end="00:01:55.071" style="s2">of the patient's lateral meniscus.</p>
<p begin="00:01:55.071" end="00:01:58.320" style="s2">As well as the surrounding<br />lateral collateral ligament,</p>
<p begin="00:01:58.320" end="00:02:02.165" style="s2">which is the band seen<br />at the top of the screen.</p>
<p begin="00:02:02.165" end="00:02:04.623" style="s2">Again, seeing a homogeneous<br />image of the meniscus</p>
<p begin="00:02:04.623" end="00:02:07.123" style="s2">with no indication of tearing.</p>
<p begin="00:02:08.308" end="00:02:09.678" style="s2">The next structure to image</p>
<p begin="00:02:09.678" end="00:02:12.572" style="s2">lies just above the lateral meniscus,</p>
<p begin="00:02:12.572" end="00:02:15.170" style="s2">which is the lateral collateral ligament.</p>
<p begin="00:02:15.170" end="00:02:17.776" style="s2">Maintain the transducer<br />in the superior position</p>
<p begin="00:02:17.776" end="00:02:21.327" style="s2">with the notch facing<br />towards the patient's head.</p>
<p begin="00:02:21.327" end="00:02:23.989" style="s2">An important landmark is the fibular head.</p>
<p begin="00:02:23.989" end="00:02:25.368" style="s2">I like to keep the fibular head</p>
<p begin="00:02:25.368" end="00:02:28.179" style="s2">in the center of the<br />transducer beneath it.</p>
<p begin="00:02:28.179" end="00:02:30.846" style="s2">Which will allow me to visualize</p>
<p begin="00:02:31.707" end="00:02:35.461" style="s2">the distal attachment of the<br />lateral collateral ligament.</p>
<p begin="00:02:35.461" end="00:02:36.933" style="s2">Here we can see fibers of</p>
<p begin="00:02:36.933" end="00:02:38.409" style="s2">the lateral collateral ligament</p>
<p begin="00:02:38.409" end="00:02:40.868" style="s2">attaching on the fibular head.</p>
<p begin="00:02:40.868" end="00:02:43.858" style="s2">Next what we do is trace this<br />lateral collateral ligament</p>
<p begin="00:02:43.858" end="00:02:47.616" style="s2">up to its attachment on the<br />lateral femoral condyle.</p>
<p begin="00:02:47.616" end="00:02:50.415" style="s2">We follow the lateral collateral ligament</p>
<p begin="00:02:50.415" end="00:02:53.374" style="s2">as it continues to pass above the condyle.</p>
<p begin="00:02:53.374" end="00:02:57.541" style="s2">And eventually we'll taper<br />back onto the upper condyle.</p>