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The Medial Synovial Fold of the Posterior Cruciate Ligament: Cadaveric Investigation Together With Magnetic Resonance Imaging and Histology

Kim, Mimi MD*; Lee, Seunghun MD, PhD*; Lee, Bong Gun MD, PhD; Paik, Doo-Jin MD, PhD; Bae, Jiyoon MD§

Journal of Computer Assisted Tomography: July/August 2014 - Volume 38 - Issue 4 - p 503–506
doi: 10.1097/RCT.0000000000000089
Musculoskeletal Imaging

Objective The purposes of our study were to analyze magnetic resonance imaging (MRI) and cadaveric findings concerning the medial synovial fold of the posterior cruciate ligament (PCL) and to classify the types of fold according to anatomic location.

Methods Two musculoskeletal radiologists reviewed MR images of 17 cadaveric knees to classify the types of medial fold of the PCL by consensus. The MRI types were divided into 3 groups. In type A, there was no definitive medial fold; and in type B, inferior-short type, there was a small protrusion of the medial border. Type C, inferior-long type, had a long enough fold to exceed the imaginary line, which is connecting between the medial tibial condyle and posterolateral aspect of the medial femoral condyle. Correlations were sought between the findings derived from the MRI studies and cadaveric dissections. Histologic analyses of the medial fold were also performed.

Results On MRI, the most common type of medial fold was type B (76.4%), followed by type C (11.8%) and type A (11.8%). In the cadaveric investigation, the medial folds of both types B and C were found to project into the medial femorotibial joint. Moreover, there was also a protruding medial fold at the superior aspect of the PCL in the A. Histologic examination of the medial folds revealed collagenous tissue surrounded by synovial cells.

Conclusions Medial folds of the PCL are normal synovial structures that can be seen by MRI and in cadaveric studies in a large proportion of the population.

From the Departments of *Radiology, †Orthopaedic Surgery, and ‡Anatomy and Cell Biology, Hanyang University Seoul Hospital, Korea; §Department of Pathology, National Police Hospital, Seoul, Korea.

Received for publication December 15, 2013; accepted February 13, 2014.

Reprints: Seunghun Lee, MD, PhD, Department of Radiology, Hanyang University Hospital College of Medicine, Hanyang University Seoul Hospital, 17, Haengdang-dong, Seongdong-gu, Seoul, 133–792, Korea (e-mail:

This work was supported by the research fund of Hanyang University (HY-201300000000430).

The authors declare no conflict of interest.

© 2014 by Lippincott Williams & Wilkins