Black arrow points to a complete tear of the lateral capsule with unrooting of the lateral meniscus. MRI Findings. The medial and lateral gastrocnemius tendons together with the soleus muscle form the calf. The accessory belly has a femoral midline origin at the femur (arrowheads) well proximal to the origin of the medial and lateral heads, with the two medial heads (asterisks) surrounding the popliteal artery (A) and vein (V) and the tibial nerve (N). Skeletal Radiology 1996:25:621-624, 16 Zipple JT, Hammer RL, Loubert PV. The sagittal proton density-weighted fat-suppressed MRI images through the medial aspect of the knee demonstrate intramuscular edema at the anteromedial aspect of the medial gastrocnemius (arrow), without intramuscular tear or hematoma. Surg. Orthopedics July 2012:35(7):1122-1124, 12 Fang CSJ, McCarthy CL, McNally EG. As with other Bakers cysts, treatment of the underlying cause of the joint effusion is indicated, as the cysts are manifestations of fluid decompressing out of the joint due to higher intra-articular pressure. The Synovasure test has greatly improved our ability to diagnose infection and helps differentiate inflammation and other causes of knee pain from infection. Fat saturation is employed on some of the fluid-weighted sequences to better detect the presence of edema in the soft tissues or bone marrow. J Orthop Sports Ther 2003:33: 1-7, 17 Koplas MC, Grooff P, Piraino D, Recht M. Third head of the gastrocnemius: an MR imaging study based on 1,039 consecutive knee examinations. Reference article, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-2145. Soft tissue edema is present adjacent to the calcific deposit. Occasionally, the surgeon will request a bone scan, radioactive WBC labeled scan, or MARS MRI. At CT, coronal reformats are usually the best to appreciate the coalition. Sagittal T1-weighted (TE=20 ms) and a corresponding STIR image in a 49 year-old male demonstrates focal intermediate signal on the T1-weighted image at a location in the medial gastrocnemius tendon making this suspicious for magic angle artifact; no abnormality is seen on the STIR image. Yun S, Jin W, Kim G et al. Describe varicose veins, including extent to which any resulting edema is relieved by elevation of extremity. Coronal MRI of a posterolateral corner injury to a left knee. Taniguchi A, Tanaka Y, Kadono K, Takakura Y, Kurumatani N. C Sign for Diagnosis of Talocalcaneal Coalition. No posterior symptoms were reported. Degenerative proximal tendinosis at the medial or lateral gastrocnemius may develop into interstitial or partial-thickness tendon tearing. This artifact can be seen on short TE images (such as T1s) in regions where a tendon is oriented at 55 degrees to the main magnetic field, such as the medial gastrocnemius tendon about 2 cm distal to the femoral origin; correlation with T2 weighted images will help to exclude focal pathology (11a). Specifically, this is just below the inferior margin of the patella and anterior to the lateral trochlear ridge. Sagittal proton density images with fat saturation at the medial aspect of the knee (1a,1b) are provided. excessive tendon beyond tendon capacity, in particular, activities with a high-energy storage component (e.g. A small amount of fat tissue is normally present deep to the tendon fibers towards the midline, and often a small amount of fluid is present normally at the adjacent recess at the posterior capsular femoral insertion (6a). Edema (swelling), warmth, redness or tenderness in the calf. It is a strong band made of connective tissue and collagenous fibers that originate from the anteromedial aspect of the intercondylar region of the tibial plateau and extends posteromedially to attach to the lateral femoral condyle. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss. the popliteus muscle and the PCL and to the medial femoral condyle via the meniscofemoral Swelling/edema Instability Impaired function Gait impairment meniscal tear using MRI are in the range of 82-96%.3 It is relevant to note that meniscus tears are Summary. On bone scan,increased radionuclide uptake at the site of the coalition may occur due to altered biomechanics at the joint, although this is a non-specific finding. Hydroxyapatite deposition disease (HADD) is a rare but well-described cause of acute knee pain14. Vascular supply to the gastrocnemius muscles is by stout short branches from the adjacent popliteal artery and vein; detailed studies of the venous vascular configuration has demonstrated 4 main patterns, with 2 to 12 branches per muscle head3. The treatment for symptomatic medial or lateral gastrocnemius proximal tendinosis is usually conservative, including rest from strenuous activities. Describe edema, stasis pigmentation or eczema, ulcers, or other skin or nail abnormalities. Patellar tendon proximally is too thick. Other conditions with similar presentations as hamstring strains are strained popliteus muscle, (MRI): MRI gives a detailed view of muscle injury. Nuclear medicine. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. In the handtwo sesamoid bones are commonly found in the distal portions of the first metacarpal bone (within the tendons of adductor pollicis and flexor pollicis brevis).There is also commonly a sesamoid bone in distal There is also femoral bone marrow edema deep to the tendon insertion (asterisk). It might show participation in osteoarthritis of the knee joint, with cartilage loss, subarticular marrow edema, and marginal osteophytes causing overall enlargement of the fabella which occasionally leads to localized pain related to impingement during knee flexion. RadioGraphics March 2008:481-499, 19 Quader AR, Shaxawan S. The gastrocnemius muscle flap used as cover for exposed upper tibia. If a focal fascial defect occurs, or at a pre-existing weak region, the Bakers cyst can enter the muscle compartment. There is fluid at the gastrocnemius-semimembranosus bursa (arrowheads). Fluid in the gastrocnemius bursa, located deep to the proximal tendon and immediately superficial to the posteromedial joint capsule, is associated with medial gastrocnemius tendon pathology but is non-specific as it is commonly found with many types of knee joint pathology. Clin Sport Med 2006:25:803-842, 7 Bencardino JT, Rosenberg ZS, Brown RR, Hassankhani A, Lustrin ES, Beltran J. Traumatic Musculotendinous Injuries of the Knee: Diagnosis with MR Imaging. The most frequently used imaging modalities are radiography (X-ray), computed tomography (CT) and magnetic resonance imaging (MRI).X-ray and CT require the Muscle strain: The most common leg muscle injury is a strain. 1 0 obj BMJ Case Reports 2010; 10:1136, 2 Watura C, Harries W. Isolated tear of the tendon to the head of gastrocnemius presenting as a painless lump in the calf. In patella a little bit of edema ( or bone bruise). The LCL is a strong connection between the lateral epicondyle of the femur and the head of the fibula, with Duhok Medical Journal 2010, 4:60-66, 20 Kalixto MA, Vegara R: Submuscular calf implants. endobj AJR Am J Roentgenol. (2004) ISBN: 9780781750066 -, 6. Diagnosis articulation: ball and socket joint between the head of the femur and the acetabulum ligaments: ischiofemoral, iliofemoral, pubofemoral and transverse acetabular ligaments, and the ligamentum teres 1 movements: thigh flexion and extension, adduction and abduction, internal and external rotation blood supply: branches of the medial and lateral Intratendinous interstitial longitudinal tearing has also been reported2. Unusual distribution of muscle tissue around the knee (Figure 15) may be related to prior reconstructive surgical procedures. Muscle strain: The most common leg muscle injury is a strain. b. MRI. This edema is in the expected location of the posterior oblique and oblique popliteal ligaments and the posterior joint capsule. The common peroneal nerve is located immediately lateral to the fibular neck (arrow) within the peroneal tunnel. Describe the status of peripheral vessels and pulses. The talocalcaneal coalition is one of the two most common subtypes of the tarsal coalition, the other being the calcaneonavicular coalition.It accounts for 45% of all tarsal coalitions, and although all three facets of the talocalcaneal joint can be involved, the middle facet is most commonly involved. 4. MRI MRI is more helpful for the assessment of cartilaginous or fibrous coalitions and also demonstrates bone marrow and soft-tissue edema. Posterior border is indistinct. Nerve conduction velocity (NCV) testing may be utilized in cases that also involve muscle, sensory or reflex loss. Nerve conduction studies, along with electromyography, can also be used to help pinpoint whether the problem is neurological or muscular. Acta Orthopedica Scandinavica 1979:179:1-43, 5 Stick C, Grau H, Witzleb E. On the edema-preventing effect of the calf muscle pump. Normal chest x ray. Treatment of Fabellar Syndrome with manual therapy: a case report. European Journal of Applied Physiol Occup Physiol 1989:59:39-47, 6 Armfield DR, Kim DH-M, Towers JD et al. Figure 2: Successive axial proton-density fat-saturated MR images through the proximal portion of the trochlea (beginning with the most superior axial section displaying trochlear cartilage) demonstrate edema at both the patellar and femoral attachments of the medial patellofemoral ligament (arrowheads), raising the possibility of a recent lateral patellar subluxation or dislocation. Fat-suppressed proton density-weighted axial (14a,14b) and sagittal images (14c) demonstrate an accessory medial gastrocnemius muscle belly in a 17 year-old asymptomatic patient. Stick C, Grau H, Witzleb E. On the edema-preventing effect of the calf muscle pump. Numbness or tingling. Popliteus, which sits deeper in your leg just behind your knee joints. The ACL is a band of dense connective tissue which courses from the femur to the tibia.It is considered as a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. 3: Joint effusion, with fluid within the gastrocnemius-semimembranosus bursa. % Gastrocnemius tendons may demonstrate MRI signal changes attributed to magic angle artifact, but when there is high T2 signal within the tendon, contour change or defect, and associated edema at bone marrow and soft tissues, gastrocnemius tendinopathy can be diagnosed on knee MRI exams, and may well be contributing to the patients clinical symptoms. Figure 4: Normal anatomy and MRI appearance of the popliteus tendon. Sagittal fat-suppressed proton density-weighted and T1-weighted images at the medial gastrocnemius tendon origin in a 41 year-old female without symptoms from the gastrocnemius tendon region, demonstrating a normal minimal amount of joint fluid (short arrow) at the posterior recess, and normal adjacent fat tissue (arrowhead) located next to the joint capsule and deep to the tendon fibers at the origin (long arrow). Popliteus, which sits deeper in your leg just behind your knee joints. Posterior border is indistinct. A case report. In addition, there is abnormality of the medial gastrocnemius tendon, with intratendinous high signal (short arrow, 2b), and focal surface fraying and contour abnormality (arrowheads). Infection Infection leads to acute inflammation and fluid build-up in the bone marrow. The next image shows a normal popliteus tendon but biceps femoris tendon is not attached to the fibula. In a non-osseous coalition, there is usually irregularity of the articular surface, narrowing of the joint space and subchondral sclerosis. The proximal tendons of the gastrocnemius muscles originate at the medial and lateral femoral epicondylar regions; the medial tendon is thicker along its medial margin and closer to midline contain small amounts of interspersed fat. Gastrocnemius tendon degeneration may result from prior gastrocnemius injury, chronic overuse, or underlying posteromedial or posterolateral knee joint instability. The axial fat suppressed T2-weighted image demonstrates denervation edema in the anterior compartment muscles (arrowheads). Severe muscle weakness or trouble moving your lower leg. Radiological anatomy is where your human anatomy knowledge meets clinical practice. The Synovasure test has greatly improved our ability to diagnose infection and helps differentiate inflammation and other causes of knee pain from infection. The most frequently used imaging modalities are radiography (X-ray), computed tomography (CT) and magnetic resonance imaging (MRI).X-ray and CT require the But sometimes it may not be clear according to the images. MRI MRI is more helpful for the assessment of cartilaginous or fibrous coalitions and also demonstrates bone marrow and soft-tissue edema. Examine for evidence of residuals of cold injury when indicated. %PDF-1.7 Soft tissue masses including intermuscular lipoma (16a,16b) and intramuscular lipoma may involve the proximal gastrocnemius tendon and muscle, and may be asymptomatic or present as a non-tender mass. (2b) The coronal image also shows posteromedial edema, posterior to the MCL (arrows). Numbness or tingling. 2: Chronic degenerative medial gastrocnemius tendinosis, with partial tearing of medial tendon fibers, and with femoral bone marrow edema. History and etymology This is the largest sesamoid bone. In the handtwo sesamoid bones are commonly found in the distal portions of the first metacarpal bone (within the tendons of adductor pollicis and flexor pollicis brevis).There is also commonly a sesamoid bone in distal Surgical excision of the small fragment is recommended if conservative management fails and has been reported to give good results 3. Summary. Treatment and prognosis. poor muscle strength; extrinsic. Severe muscle weakness or trouble moving your lower leg. Another surgical procedure involving the proximal gastrocnemius region involves muscle augmentation using silicone gastrocnemius implants placed in the submuscular plane between the gastrocnemius and the soleus20. It is a strong band made of connective tissue and collagenous fibers that originate from the anteromedial aspect of the intercondylar region of the tibial plateau and extends posteromedially to attach to the lateral femoral condyle. Bone marrow edema adjacent to the accessory fragment may indicate a symptomatic bipartite patella 3. Accessory muscles: anatomy, symptoms, and radiologic evaluation. This is in contrast to the well-described more distal gastrocnemius muscle injury (tennis leg). MRI MRI is more helpful for the assessment of cartilaginous or fibrous coalitions and also demonstrates bone marrow and soft-tissue edema. In the majority of cases, symptomatic bipartite patella improves without surgery. The LCL is a strong connection between the lateral epicondyle of the femur and the head of the fibula, with Other conditions with similar presentations as hamstring strains are strained popliteus muscle, (MRI): MRI gives a detailed view of muscle injury. Radsource MRI Clinic: Proximal Gastrocnemius Tendon Pathology. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. 2003:27:135-138. Radsource MRI Clinic: Proximal Gastrocnemius Tendon Pathology. Of interest, the gastrocnemius muscle bellies are known by bodybuilders to be quite difficult to hypertrophy. Patient guarding and soft tissue swelling in the acute setting, as well as strong secondary muscle restraints, may limit the sensitivity of the physical examination in detecting partial ACL tear. The ACL is a band of dense connective tissue which courses from the femur to the tibia.It is considered as a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. This is the largest sesamoid bone. The semimembranosus tendon (SM) is also indicated. The LCL is a cord-like structure of the arcuate ligament complex, together with the biceps femoris tendon, popliteus muscle and tendon, popliteal meniscal and popliteal fibular ligaments, oblique popliteal, arcuate and fabellofibular ligaments and lateral gastrocnemius muscle.. MRI is an excellent modality in the pediatric setting because of its ability to provide accurate assessment of bone marrow and cartilage without the use of ionizing radiation. Sclerosis around the articular margins of the talocalcaneal joint may also occur. Normal chest x ray. This has been attributed to the already high repetitive use of these muscles during daily activities. Surgical release procedures with tenotomy or myofascial recession have been developed for the gastrocnemius tendons in cases of resistant contracture, or spasticity related to cerebral palsy. On MRI, a focal area of high signal or edema on STIR or T2 weighted sequences is present at the inferolateral aspect of the patellofemoral joint, specifically the lateral portion of the infrapatellar fat pad (5a,5b). with our without marrow edema. Accessory gastrocnemius muscle bellies (third head of the gastrocnemius) have been associated with vascular claudication due to extrinsic vascular functional compression or entrapment17, though the majority of these congenital lesions are asymptomatic (Figure 14). Secondary radiographic features that suggest the diagnosis include close apposition of the middle facet of the talocalcaneal (subtalar) joint or non-visualization of the middle articular facet 1,5. poor muscle strength; extrinsic. A 3D representation of the popliteal fossa with partial resection of the semimembranosus (SM), gracilis (G), and semitendinosus (ST) musculotendinous junctions demonstrates the origin of the medial head of the gastrocnemius muscle (MH) with medial tendinous and muscular lateral portions, arising just posterior to the adductor magnus tendon (AM) insertion. (2b) The coronal image also shows posteromedial edema, posterior to the MCL (arrows). Additional normal variants of the knee have been discussed by Dr Carroll in Talocalcaneal coalition. Fluid is present in the gastrocnemius bursa (curved arrow, 2a), located anterior to the myotendinous region. Figure 2: Successive axial proton-density fat-saturated MR images through the proximal portion of the trochlea (beginning with the most superior axial section displaying trochlear cartilage) demonstrate edema at both the patellar and femoral attachments of the medial patellofemoral ligament (arrowheads), raising the possibility of a recent lateral patellar subluxation or dislocation. It happens when the muscle fibers stretch too far or tear. The next image shows a normal popliteus tendon but biceps femoris tendon is not attached to the fibula. CT can also nicely demonstrate the presence of an os sustentaculi. This edema is in the expected location of the posterior oblique and oblique popliteal ligaments and the posterior joint capsule. A common finding at the medial gastrocnemius involves the muscle adjacent to the origin extending partly into the most proximal aspect of the intercondylar notch (8a). Clinical History: 20 year-old male injured playing soccer. stream The ACL arises from the posteromedial corner of the medial aspect of the lateral femoral condyle in the intercondylar notch and inserted anterior to the intercondyloid eminence of the It is a strong band made of connective tissue and collagenous fibers that originate from the anteromedial aspect of the intercondylar region of the tibial plateau and extends posteromedially to attach to the lateral femoral condyle. The axial fat suppressed T2-weighted image demonstrates denervation edema in the anterior compartment muscles (arrowheads). Describe edema, stasis pigmentation or eczema, ulcers, or other skin or nail abnormalities. Venous thrombosis of the lower leg most commonly involves the deep vessels and often also the calf muscle veins, and is often thought to originate at these muscle veins. In the majority of cases, symptomatic bipartite patella improves without surgery. 4 0 obj There is often adjacent mild reactive bone marrow edema and synovitis at adjacent joint or bursa. endobj Space is then filled with soft tissues (e.g. 3 0 obj MR angiography has proven useful for evaluation of suspected popliteal artery entrapment syndrome18. The most frequently used imaging modalities are radiography (X-ray), computed tomography (CT) and magnetic resonance imaging (MRI).X-ray and CT require the poor muscle strength; extrinsic. The ACL is a band of dense connective tissue which courses from the femur to the tibia.It is considered as a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. Muscle strain: The most common leg muscle injury is a strain. It happens when the muscle fibers stretch too far or tear. It gathers several non-invasive methods for visualizing the inner body structures. Coronal MRI of a posterolateral corner injury to a left knee. The gastrocnemius muscles have a higher proportion of fast twitch fibers than the soleus, reflecting their function in jumping and running, while the soleus, with a higher proportion of slow twitch fibers, mainly functions in walking and postural control. muscle or fat). OBJECT The aim of this study was to enhance the planning and use of microsurgical resection techniques for intrinsic brainstem lesions by better defining anatomical safe entry zones. Radiological anatomy is where your human anatomy knowledge meets clinical practice. It is therefore not surprising that the MRI features of proximal gastrocnemius tendon injuries have rarely been reported in the literature1,2,7. In my experience, these studies have not been that useful. Talocalcaneal coalition often requires cross-sectional imaging for accurate diagnosis. with our without marrow edema. The medial gastrocnemius muscle belly (asterisk) is noted to extend slightly into proximal aspect of the intercondylar notch. Associated medial pericapsular edema is also seen (short arrows, 10b). Patient guarding and soft tissue swelling in the acute setting, as well as strong secondary muscle restraints, may limit the sensitivity of the physical examination in detecting partial ACL tear. A sagittal T1-weighted image demonstrates an unremarkable ossified fabella (arrow) in a 17 year-old male. Orange arrow points to an avulsion of the popliteus off of its insertion on the lateral femoral condyle. On bone scan, increased radionuclide uptake at the site of the coalition may occur due to altered biomechanics at the joint, although this is a non-specific finding. articulation: ball and socket joint between the head of the femur and the acetabulum ligaments: ischiofemoral, iliofemoral, pubofemoral and transverse acetabular ligaments, and the ligamentum teres 1 movements: thigh flexion and extension, adduction and abduction, internal and external rotation blood supply: branches of the medial and lateral <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Negative or isolated edema Structural Type 3: Partial muscle tear. The LCL is a strong connection between the lateral epicondyle of the femur and the head of the fibula, with Occasionally, the surgeon will request a bone scan, radioactive WBC labeled scan, or MARS MRI. 23a - History: 55-year-old male presents with clinical strain at the hamstring muscle insertion 24a - History: 66-year-old male is being evaluated for a right distal thigh mass 25a - History: 77-year-old female presents with a left thigh soft tissue mass Occasionally, the surgeon will request a bone scan, radioactive WBC labeled scan, or MARS MRI. Space is then filled with soft tissues (e.g. Sagittal proton density images with fat saturation at the medial aspect of the knee. However, case reports in the literature1,2, describe gastrocnemius tendon degenerative interstitial, longitudinal or partial-thickness tearing, and note that such abnormalities may cause clinical symptoms mimicking symptoms from more common lesions such as meniscal tears or collateral ligament strains. It has been stated that the medial gastrocnemius muscle flap is the workhorse of all muscle flaps around the knee19, due to the proximal entry of the main arterial and venous (sural) branches and the tibial nerve supply, the considerable size and length of the muscle belly, and that its transfer does not significantly impair knee joint function. A spin echo or gradient echo sequence is often acquired in the transaxial plane. MRI is more helpful for the assessment of cartilaginous or fibrous coalitions and also demonstrates bone marrow and soft-tissue edema. Skeletal Radiology 2004:33:367-371, 13 Krunes U, Teubner K, Knipp H et al. 1 Watura C, Ward A, Harries W. Isolated partial tear and partial avulsion of the medial head of the gastrocnemius tendon presenting as posterior medial knee pain. Diagnosis White arrow points to a disruption of the fibular collateral ligament. Clinical History: 20 year-old male injured playing soccer. History: 58 y/o woman with knee and leg pain and swelling medially for 3 wks, without injury. Association of gastrocnemius tendon calcification with chondrocalcinosis of the knee. MRI of Radsource MRI Web Clinic. Unable to process the form. The anterior cruciate ligament (ACL) is one of 2 cruciate ligaments that aids in stabilizing the knee joint. The fabella is a small sesamoid located within the lateral gastrocnemius at the level of the lateral femoral condyle. Around the knee, calcification of the medial gastrocnemius tendon has been reported15. Describe the status of peripheral vessels and pulses. Imaging tests, such as an X-ray, CT scan, or MRI scan, are used to better see the structures in the problem area. Figure 4: Normal anatomy and MRI appearance of the popliteus tendon. MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Aesth. Surgical management usually involves an osteotomy and removal of the whole coalition. Examine for evidence of residuals of cold injury when indicated. On MRI, a focal area of high signal or edema on STIR or T2 weighted sequences is present at the inferolateral aspect of the patellofemoral joint, specifically the lateral portion of the infrapatellar fat pad (5a,5b). This oedema is often termed primary bone marrow edema of unknown cause or transient migratory osteoporosis. Bone marrow edema adjacent to the accessory fragment may indicate a symptomatic bipartite patella 3. b. The gastrocnemius bursa is located deep to the tendon in the proximal myotendinous region, and usually communicates with the semimembranosus bursa. The LCL is a cord-like structure of the arcuate ligament complex, together with the biceps femoris tendon, popliteus muscle and tendon, popliteal meniscal and popliteal fibular ligaments, oblique popliteal, arcuate and fabellofibular ligaments and lateral gastrocnemius muscle.. Symptoms from the adjacent proximal myotendinous region may relate to retracted longitudinal partial tendon tears2, rare intramuscular dissecting Bakers cysts11,12, or venous thrombosis limited to the calf muscle veins13. Note the normal fat tissue deep to the tendon attachment (asterisks, 4b), present only at the lateral aspect of the origin. The gastrocnemius muscles extend half-way down the lower leg, distally contributing to the Achilles tendon. Figure 4: Normal anatomy and MRI appearance of the popliteus tendon. In case of resection failure or coexisting severe degenerative joint disease triple arthrodesis is usually performed, or alternatively (in case of a subtalar coalition) subtalar fusion 3. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. The main gastrocnemius muscle function is plantar flexion of the foot, but it also provides flexion of the non-weight-bearing knee, and acts as an agonist for the PCL. Patient guarding and soft tissue swelling in the acute setting, as well as strong secondary muscle restraints, may limit the sensitivity of the physical examination in detecting partial ACL tear. The medial and lateral gastrocnemius tendons proximal myotendinous regions are included in the field-of-view of knee MRI exams. History: 58 y/o woman with knee and leg pain and swelling medially for 3 wks, without injury. The next image shows a normal popliteus tendon but biceps femoris tendon is not attached to the fibula. See the article entitled Knee MRI - meniscal pathology for the pathology of the meniscus. A series of sagittal proton density-weighted images with fat saturation proceeding from medial to lateral and an axial proton density-weighted image with fat suppression (10a) demonstrate a partial insertional tear of the medial gastrocnemius tendon (arrows), with a longitudinal interstitial tendon tear seen as increased signal within the diffusely thickened tendon (arrowheads). A sagittal proton density-weighted image with fat saturation demonstrates the normal medial gastrocnemius tendon (arrows), which can be seen with normal low signal over a distance of 1-2 cm distal to the medial joint line. What are the findings? A dissecting Bakers cyst11 may present with tender fullness at the posteromedial aspect of the knee just below the joint; these lesions represent rare instances where a Bakers cyst enters through the muscle fascia and is present often both outside and within a muscle compartment. Check for errors and try again. One particular tumour that causes intense bone marrow edema is osteoid osteoma. (2a)The axial image demonstrates edema along the joint line in the posteromedial and posterior central knee (arrows). A spin echo or gradient echo sequence is often acquired in the transaxial plane. Nuclear medicine. Coronal MRI of a posterolateral corner injury to a left knee. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI. The lateral arm of the arcuate ligament extends from the posterior capsule and courses laterally over the popliteus muscle and inserts on the posterior aspect of the fibula. Six consecutive T1 weighted sagittal images demonstrate the thicker low-signal medial aspect of the tendon (arrows) inserting just posterior to the adductor magnus insertion and adductor tubercle (blue arrow, 4a), and the more attenuated tendon fibers towards the intercondylar region (arrowheads, 4b). Innervation is by the tibial nerve. The common peroneal nerve is located immediately lateral to the fibular neck (arrow) within the peroneal tunnel. Usually there is no associated proximal myotendinous muscle edema. History: 58 y/o woman with knee and leg pain and swelling medially for 3 wks, without injury. But sometimes it may not be clear according to the images. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The medial gastrocnemius bursa and semimembranosus bursa are indicated by asterisks. Thrombosis of the muscular calf veins reference to a syndrome which receives little attention. Radsource MRI Web Clinic. jumping in basketball, kicking sports) Ultrasound is the mainstay of imaging tendinopathy, with MRI as the second-line investigation. 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