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MR Imaging of the Medial Collateral Ligament Bursa

Findings in Patients and Anatomic Data Derived from Cadavers

¹ Department of Radiology, Vrije Universiteit Brussel, Laerbeeklaan 101, 1090 Jette, Belgium.
² Department of Experimental Anatomy, Vrije Universiteit Brussel, Jette, Belgium.
³ Department of Pathology, Vrije Universiteit Brussel, Jette, Belgium.

View larger version (57K): [in a new window]   Fig. 1. —Line drawing represents anteromedial aspect of knee. Clamp (C) elevates anterior edge of superficial portion of medial collateral ligament (MCL). MCL bursa (black area) is seen between superficial (S) and deep MCL. Meniscofemoral (F) and meniscotibial (T) extensions are part of deep MCL. Also note posterior oblique (O) portion of MCL.

View larger version (33K): [in a new window]   Fig. 2. —Line drawing represents axial section of medial side of knee. Note three distinct layers (I, II, and III). Layer I corresponds to crural fascia, layer II contains superficial portion of medial collateral ligament (MCL), and layer III contains deep portion of MCL. MCL bursa (black area, B) is located between superficial and deep portion of MCL. Also note split in layer II along anterior margin of superficial MCL (arrowheads). Anteriorly, layer I is fused with layer II (curved arrow), whereas posteriorly, layer II joins layer III (short arrows). Sartorius tendon is embedded in layer I (S).

View larger version (116K): [in a new window]   Fig. 3A. —Cadaveric study. Coronal proton density—weighted MR image (TR/TE, 2900/15) reveals superficial medial collateral ligament (MCL, short arrows), as well as meniscofemoral and meniscotibial portions of deep MCL (curved arrows). MCL bursa is not seen.

View larger version (124K): [in a new window]   Fig. 3B. —Cadaveric study. Corresponding anatomic slice also shows superficial MCL (short arrows), and deep portion of MCL (curved arrows). MCL bursa is seen between superficial and deep MCLs.

View larger version (115K): [in a new window]   Fig. 4A. —Cadaveric study. Coronal T1-weighted MR image (TR/TE, 740/14) with fat saturation technique obtained after injection of gadolinium-based contrast medium mixed with dye into medial collateral ligament (MCL) bursa reveals MCL bursa (arrows).

View larger version (96K): [in a new window]   Fig. 4B. —Cadaveric study. Axial MR image also shows MCL bursa (arrows).

View larger version (106K): [in a new window]   Fig. 4C. —Cadaveric study. Corresponding coronal anatomic slice reveals MCL bursa (arrows) deep in relation to superficial portion of MCL.

View larger version (120K): [in a new window]   Fig. 5. —Photograph of histologic section along coronal plane of cadaveric tissue sample from medial side of knee including superficial and deep medial collateral ligaments (MCLs) shows thin layer of cells (arrowheads) along wall of MCL bursa (B). (H and E, x400)

View larger version (82K): [in a new window]   Fig. 6. —Immunologic staining (epithelial membrane antigen) of cadaveric specimen shows granular up-take in cytoplasm of marginal cell layer (arrows), indicating epithelial origin. (x1000)

View larger version (137K): [in a new window]   Fig. 7. —Axial T2-weighted MR image (TR/TE, 4700/93) in 33-year-old asymptomatic man undergoing imaging in medicolegal setting shows fluid confined to medial collateral ligament bursa in a perimeniscal location (arrows). No MR evidence of meniscal tear exists.

View larger version (135K): [in a new window]   Fig. 8. —Coronal short tau inversion recovery—weighted MR image (TR/TE, 5920/60; inversion time, 120 msec) in overweight 52-year-old man with medial knee pain and osteoarthritis shows fluid collection in femoral portion of medial collateral ligament (MCL) bursa (short arrows) located between superficial MCL (s) and meniscofemoral extension of deep MCL (d). Also note intraarticular joint fluid (long arrow).

View larger version (130K): [in a new window]   Fig. 9A. —58-year-old woman with medial knee pain and osteoarthritis. Coronal MR image (TR/TE, 4700/93) shows fluid collection in femoral portion of medial collateral ligament (MCL) bursa (B). Meniscofemoral portion of deep MCL is also seen (arrow).

View larger version (133K): [in a new window]   Fig. 9B. —58-year-old woman with medial knee pain and osteoarthritis. Axial MR image shows MCL bursa between superficial (s) and deep (d) MCL. Note free anterior edge of MCL (e) and posterior junction (j) of superficial and deep MCL. B = MCL bursa.

View larger version (120K): [in a new window]   Fig. 10. —Coronal T2-weighted MR image (TR/TE, 4500/93) in 57-year-old woman with medial knee pain and medial meniscal tear (not shown) that was arthroscopically treated reveals fluid in medial collateral ligament bursa (arrows) spanning joint line.

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