HSS What's the Diagnosis Case #122

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What’s the Diagnosis – Case 122

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Findings There is a root tear of the posterior horn medial meniscus and areas of full thickness cartilage loss of the medial condyle, medial plateau, and lateral plateau. These findings are likely the source of the patient’s pain and in this case warranted arthroscopic debridement. In addition however, there is a band of tissue coursing along the anterior/synovial reflection of the ACL that extended to the anterior horn medial meniscus that was questioned for a displaced meniscal fragment.

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Diagnosis: Anteromedial Meniscofemoral Ligament Different than many of the cases presented in the past the area in question represents a normal, albeit rare variant. Important in this situation so as the surgeon does not mistake this process for a displaced fragment of meniscus. Well known is the transverse meniscal ligament extending from the anterior horn of the lateral meniscus to the anterior horn medial meniscus. Infrequently an oblique meniscal meniscal or intermeniscal ligament can be seen. This extends from the anterior horn of one meniscus to the posterior horn of the other and is named for the anterior horn attachment on the medial or lateral side. The ligament shown here is the most uncommon normal variant. This ligament also sometimes called the anterior meniscofemoral ligament extends along the course of the ACL to insert into the anterior horn of the medial meniscus. It looks similar to the infrapatellar plica or ligamentum mucosum but does not run into Hoffa’s fat pad/inferior pole of the patella. We typically think of only two structures in the notch, the ACL and PCL. Anything else we think is going to be a displaced mensical fragment but these normal, variant ligaments also need to be entertained. A helpful clue often is that there does not seem to be a deficiency of any meniscus to be the donor site but also keeping in mind normal variant anatomy is crucial.

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