This presentation is the first series of the MR imaging of Knee. In this presentation MRI anatomy has been discussed. As we all know good knowledge of medical imaging three dimensional anatomy is key for good reporting. Hope we all get benifitted. Suggestions are most welcome

1. MRI ANATOMY OF KNEE
DR. MUHAMMAD BIN ZULFIQAR
PGR IV FCPS SIMS/SHL
radiombz@gmail.com

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

4. 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 .

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

6. ARTICULAR SURFACE

8. Patellar Anatomy

9. Ligaments
Collateral ligament divided into
• Media collateral ligament
• Lateral collateral ligament
Cruciate ligament also has two
• Anterior cruciate ligament
• Posterior cruciate ligament

11. Menisci

13. Menisci

14. Menisci

15. Protocol of examination
• Axial T1 localizer
• Sagittal T1, PD, T2
• Coronal gradient echo, STIR
• If contrast is injected
• [ Axial, Sagittal and Coronal T1 WIs ]

16. T1 T2 Gradient STIR
How to know the pulse sequence?

17. Where?Items to be evaluated
Sagittal PD
Coronal.
Sagittal,coronal and
axial.
Coronal
Axial
Sagittal PD
Sagittal T1& T2
Sagittal T2
 Menisci (medial & lateral)
 Ligaments
- Cruciate (ACL, PCL)
- Collateral
- Retinacular
 Tendons ( Quadriceps, Pattelar)
 Bones
 Synovial effusion

18. Tissues T1 T2
Fat Hyperintense Hyperintense
Water Hypointense hyperintense
Cortical bone Hypointense Hypointense
Fibrous tissue Hypointense Hypointense
Cartilage Isointense Isointense

19. T2W Axial Fat SAT

20. T2W Axial Fat SAT
1. Quadricep femoris tendon
2. Vastus lateralis muscle
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis muscle
7. Semitendinosus muscle and tendon
8. Semimembranosus muscle and tendon
9. Popliteal vessels
10. Biceps femoris muscle

21. T2W Axial Fat SAT
1. Quadricep femoris tendon
2. Vastus lateralis muscle
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis muscle
7. Semitendinosus muscle and tendon
8. Semimembranosus muscle and tendon
9. Popliteal vessels
10. Tibial nerve
11. Common Peroneal nerve
12. Biceps femoris muscle

22. T2W Axial Fat SAT
1. Quadricep femoris tendon
2. Vastus lateralis muscle
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis muscle
7. Semitendinosus muscle and tendon
8. Semimembranosus muscle and
tendon
9. Popliteal vessels
10. Biceps femoris muscle

23. T2W Axial Fat SAT
1. patella
2. Vastus lateralis muscle
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis muscle
7. Semitendinosus tendon
8. Semimembranosus muscle and tendon
9. Tibial nerve
10. Common Peroneal nerve
11. Biceps femoris muscle

24. T2W Axial Fat SAT
1. Patella
2. Vastus lateralis muscle
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis muscle
7. Semitendinosus tendon
8. Semimembranosus muscle and tendon
9. Tibial nerve
10. Common Peroneal nerve
11. Biceps femoris muscle

25. T2W Axial Fat SAT
1. Patella
2. Vastus lateralis muscle
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis muscle
7. Semitendinosus tendon
8. Semimembranosus muscle and tendon
9. Biceps femoris muscle

26. T2W Axial Fat SAT
1. Patella
2. Iliotibial tract
3. Femur
4. Vastus medialis muscle
5. Sartorius Muscle
6. Gracilis tendon
7. Semimembranosus tendon
8. Semitendinosus tendon
9. Biceps femoris muscle

27. T2W Axial Fat SAT
1. Patella
2. Iliotibial tract
3. Femur
4. Sartorius Muscle
5. Gracilis tendon
6. Semimembranosus tendon
7. Semitendinosus tendon
8. Tibial nerve
9. Common Peroneal nerve
10. Biceps femoris muscle

28. T2W Axial Fat SAT
1. Patella
2. Iliotibial tract
3. Femur
4. Sartorius Muscle
5. Gracilis tendon
6. Semimembranosus tendon
7. Semitendinosus tendon
8. Medial head of gastrocnemius
9. Popliteal artery and vein
10. Biceps femoris muscle and tendon

29. T2W Axial Fat SAT
1. Patella
2. Femur
3. Sartorius Muscle
4. Semimembranosus tendon
5. Semitendinosus tendon
6. Medial head of gastrocnemius
7. Popliteal artery and vein
8. Biceps femoris muscle and tendon

30. T2W Axial Fat SAT
1. Patella
2. Femur
3. Sartorius Muscle
4. Semitendinosus tendon
5. Medial head of gastrocnemius
6. Popliteal artery and vein
7. Lateral head of gastrocnemius
8. Biceps femoris muscle and tendon

31. T2W Axial Fat SAT
1. Femur
2. Great saphenous vein
3. Sartorius Muscle
4. Semitendinosus tendon
5. Medial head of gastrocnemius
6. Popliteal artery and vein
7. Biceps femoris muscle and tendon

32. T2W Axial Fat SAT
1. Femur
2. Great saphenous vein
3. Sartorius Muscle
4. Semitendinosus tendon
5. Medial head of gastrocnemius
6. Biceps femoris muscle and tendon

33. T2W Axial Fat SAT
1. Patellar tendon
2. Infrapatellar fat pad of Hoffa
3. Lateral femoral condyle
4. Medial femoral condyle
5. Great saphenous vein
6. Sartorius Muscle
7. Semitendinosus tendon
8. Medial head of gastrocnemius
9. Posterior cruciate ligament
10. Lateral head of gastrocnemius
11. Biceps femoris muscle and tendon

34. T2W Axial Fat SAT
1. Patellar tendon
2. Infrapatellar fat pad of Hoffa
3. Lateral femoral condyle
4. Medial femoral condyle
5. Great saphenous vein
6. Semitendinosus tendon
7. Medial head of gastrocnemius
8. Posterior cruciate ligament
9. Lateral head of gastrocnemius
10. Biceps femoris muscle and tendon

35. T2W Axial Fat SAT
1. Patellar tendon
2. Infrapatellar fat pad of Hoffa
3. Medial meniscus
4. Great saphenous vein
5. Sartorius muscle and tendon
6. Semitendinosus tendon
7. Medial head of gastrocnemius
8. Posterior cruciate ligament
9. Lateral head of gastrocnemius
10. Lateral meniscus

36. T2W Axial Fat SAT
1. Patellar tendon
2. Lateral tibial plataeu
3. Medial tibial plataeu
4. Great saphenous vein
5. Sartorius muscle and tendon
6. Medial head of gastrocnemius
7. Planter and Lateral head of
gastrocnemius

37. T2W Axial Fat SAT
1. Patellar tendon
2. Tibia
3. Sartorius tendon
4. Medial head of gastrocnemius
5. Popliteal Vessels (A and V)
6. Lateral head of gastrocnemius

38. T2W Axial Fat SAT
1. Patellar tendon
2. Tibia
3. Sartorius tendon
4. Medial head of gastrocnemius
5. Popliteal Vessels (A and V)
6. Fibula

39. T2W Axial Fat SAT
1. Patellar tendon
2. Tibia
3. Sartorius tendon
4. Medial head of gastrocnemius
5. Popliteal Vessels (A and V)
6. Fibula

40. • 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

41. • 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

42. • 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

43. Coronal TIWI and T2 FAT SAT

44. 1. Patella
2. Quadricep femoris tendon

45. 1. Vastus medialis muscle
2. Quadricep femoris tendon
3. Patella
1. Infrapatellar fat pad of hoffa
2. Patellar tendon

46. 1. Vastus medialis muscle
2. Quadricep femoris tendon
3. Lateral femoral condyle
4. Tibia

47. 1. Vastus medialis muscle
2. Quadricep femoris tendon
3. Vastus lateralis muscle
1. Femur
2. Iliotibial tract
3. Tibia

48. 1. Vastus medialis muscle
2. Vastus lateralis muscle
3. Femur
4. Iliotibial tract
5. Tibia

49. 1. Vastus medialis muscle
2. Vastus lateralis muscle
3. Femur
4. Medial meniscus
5. Tibia

50. 1. Vastus medialis muscle
2. Vastus lateralis muscle
3. Femur
4. Medial meniscus
5. Lateral Meniscus

51. 1. Vastus medialis muscle
2. Vastus lateralis muscle
3. Femur
4. Posterior cruciate ligament
1. Medial meniscus
2. Lateral Meniscus
3. Tibia

52. 1. Vastus medialis muscle
2. Vastus lateralis muscle
3. Femur
4. Posterior cruciate ligament
1. Medial meniscus
2. Lateral Meniscus
3. Tibia

53. 1. Vastus medialis muscle
2. Femur
3. Vastus lateralis muscle
4. Posterior cruciate ligament
5. Anterior cruciate ligament
6. Tibial collateral ligament
1. Fibular collateral ligament
2. Medial meniscus
3. Lateral Meniscus
4. Tibia
5. fibula

54. 1. Vastus medialis muscle
2. Femur
3. Vastus lateralis muscle
4. Tractus ileotibial
5. Posterior cruciate ligament
1. Anterior cruciate ligament
2. Medial meniscus
3. Lateral Meniscus
4. Tibia
5. fibula

55. 1. Vastus medialis muscle
2. Vastus lateralis muscle
3. Bicep femoris muscle
4. Lateral head of gastrocnemius
5. Medial head of gastrocnemius
6. Femur
1. Medial meniscus
2. Lateral Meniscus
3. Posterior cruciate ligament
4. Tibia
5. fibula

56. 1. Sartorius muscle
2. Vastus medialis muscle
3. Vastus lateralis muscle
4. Popliteal vessels
5. Bicep femoris muscle
6. Lateral head of gastrocnemius
1. Femur
2. Medial meniscus
3. Lateral Meniscus
4. Tibia
5. Poplitius muscle
6. fibula

57. 1. Sartorius muscle
2. Popliteal vessels
3. Bicep femoris muscle
4. femur
1. Medial head of gastrocnemius
2. Lateral head of gastrocnemius
3. Tibia

58. 1. Sartorius muscle
2. Bicep femoris muscle
3. Medial head of gastrocnemius
4. Lateral head of gastrocnemius

59. 1. Sartorius muscle
2. Semimembranosus muscle
3. Bicep femoris muscle

60. • 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

61. • 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

62. • 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

63. • 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

64. Sagittal T2W FAT SAT

65. Sagittal T2W FAT SAT
1. Vastus medialis muscle
2. Femur
3. Medial meniscus
4. Tibia
5. Medial head of gastrocnemius
6. Gracilis tendon
7. Gracilis muscle

66. Sagittal T2W FAT SAT
1. Vastus medialis muscle
2. Femur
3. Medial meniscus
4. Tibia
5. Medial head of gastrocnemius
6. Semitendinosus tendon

67. Sagittal T2W FAT SAT
1. Vastus medialis muscle
2. Femur
3. Anterior horn of Medial meniscus
4. Medial Tibial pletaeu
5. Medial head of gastrocnemius
6. Posterior horn of Medial meniscus
7. Semitendinosus tendon
8. Semimembranosus tendon

68. Sagittal T2W FAT SAT
1. Vastus medialis muscle
2. Femur
3. Anterior horn of Medial meniscus
4. Tibia
5. Medial head of gastrocnemius
6. Posterior horn of Medial meniscus
7. Semitendinosus tendon
8. Semimembranosus muscle

69. Sagittal T2W FAT SAT
1. Femur
2. Tibia
3. Posterior horn of Medial meniscus
4. Semitendinosus tendon
5. Semimembranosus muscle

70. Sagittal T2W FAT SAT
1. Femur
2. Tibia
3. Medial head of gastrocnemius
4. Posterior horn of Medial meniscus
5. Semitendinosus tendon
6. Semimembranosus muscle

71. Sagittal T2W FAT SAT
1. Femur
2. Patella
3. Patellar tendon
4. Tibia
5. Medial head of gastrocnemius
6. Posterior cruciate ligament
7. Semitendinosus muscle
8. Semimembranosus muscle

72. Sagittal T2W FAT SAT
1. Vastus medialis muscle
2. Quadriceps tendon
3. Patella
4. Patellar tendon
5. Anterior cruciate ligament
6. Tibia
7. Medial head of gastrocnemius
8. Posterior cruciate ligament

73. Sagittal T2W FAT SAT
1. Femur
2. Quadriceps tendon
3. Patella
4. Patellar tendon
5. Anterior cruciate ligament
6. Tibia
7. Medial head of gastrocnemius
8. Posterior cruciate ligament
9. Popliteal artery and vein

74. Sagittal T2W FAT SAT
1. Femur
2. Quadriceps tendon
3. Patella
4. Patellar tendon
5. Tibia
6. Popliteal artery and vein

75. Sagittal T2W FAT SAT
1. Femur
2. Quadriceps tendon
3. Patella
4. Patellar tendon
5. Tibia

76. Sagittal T2W FAT SAT
1. Femur
2. Quadriceps tendon
3. Patella
4. Patellar tendon
5. Tibia
6. Posterior horn of lateral meniscus
7. Lateral head gastrocnemius muscle

77. Sagittal T2W FAT SAT
1. Quadriceps tendon
2. Femur
3. Anterior horn of lateral meniscus
4. Tibia
5. Posterior horn of lateral meniscus
6. Lateral head gastrocnemius muscle

78. Sagittal T2W FAT SAT
1. Femur
2. Anterior horn of lateral meniscus
3. Tibia
4. Posterior horn of lateral meniscus
5. Bicep femoris muscle

79. Sagittal T2W FAT SAT
1. Vastus lateralis muscle
2. Lateral femoral condyle
3. Lateral tibial plateau
4. Fibula
5. Soleus
6. Bicep femoris muscle

80. Sagittal T2W FAT SAT
1. Vastus lateralis muscle
2. Bicep femoris muscle
3. Fibula

81. 2-Posterior cruciate ligament
4-Posterior horn medial meniscus
7 Medial condyle of femur
11 Medial superior genicular artery
13 Patellar tendon
17 Medial tibial plateau
24 Vastus medialis muscle
26-Infrapatellar fat pad
27-semimembranosus muscle
29-Semitendinosus tendon
34 Medial head of gastrocnemius tendon
35 Medial patellar retinaculum
37 Posterior joint capsule
38 Transverse ligament
39 Meniscofemoral ligament (Wrisberg)

82. 28Semimembranosus tendon
30-Sartorius tendon
29-Semitendinosus tendon
31-Medial head of gastrocnemius
muscle
32-Adductor tubercle
3-Anterior horn medial meniscus
4-Posterior horn medial meniscus
10-Median intermuscular septum
17-Medial tibial plateau
24-Vastus medialis muscle

83. • 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

84. • 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

85. Normal MR meniscal Anatomy

86. 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.

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

88. 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

89. THANK
YOU