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Findings There is a complex medial meniscal tear with fragments along the free edge and a superiorly displaced fragment towards the root attachment of the posterior horn. In additon, there is a band of tissue coursing from the posterior horn lateral meniscus to the anterior horn medial meniscus root attachment interposed between residual, attenuated fibers of a chronically torn ACL and the PCL.
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Diagnosis: Oblique meniscomeniscal ligament Many normal variants are seen of the menisci and particularly well known are the attachments of the transverse meniscal ligament and meniscofemoral ligaments. Much less common but important to recognize is the oblique meniscomeniscal ligament that extends from the posterior horn of one meniscus to the anterior horn of the other meniscus. This yields a band of tissue that extends along the intercondylar notch and can be confused for a bucket handle fragment. However, in the case of the ligament, the meniscus is not deficient and the band of tissue runs between the ACL and PCL where as if there was a bucket handle tear, the donor meniscus would be abnormal and deficient and the band of tissue is seen adjacent to but not between the cruciate ligaments. This case does have an underlying medial meniscal tear with a superiorly displaced fragment towards the notch which can make things confusing for the radiologist and arthroscopist. It is imperative to alert the arthroscopist to the two different processes so that only pathologic tissue is treated/resected and the normal structures are not resected.
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References Oblique Meniscomeniscal Ligament: Another Potential Pitfall for a Meniscal Tear — Anatomic Description and Appearance at MR Imaging in Three Cases. Timothy G. Sanders, MD, Ricardo C. Linares, MD, Keith W. Lawhorn, MD, Phillip F. J. Tirman, MD, and Craig Houser, MD. DOI: http://dx.doi.org/10.1148/radiology.213.1.r99oc20213 Oblique Meniscomeniscal Ligament. John F. Carroll, M.D. Radsource
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