They may not even be apparent with an arthroscopic examination. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. 2005; 234:5361. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). Meniscal tears are common and often associated with knee pain. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. Sagittal PD (. Discoid lateral meniscus. Discoid medial meniscus. . An intact meniscal repair was confirmed at second look arthroscopy. Lateral meniscal variant with absence of the posterior coronary ligament. meniscal injury. tear. menisci occurs. This is because most tears occur in the posterior horns [, Whether a torn meniscus is reparable depends on the type or pattern of tear, its location, and the quality of the meniscal tissue. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. Dickhaut SC, DeLee JC. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. Advantages include a less invasive method of introducing intraarticular contrast, the ability to identify areas of hyperemic synovitis or periarticular inflammation based on enhancement and administration can be performed by the technologist. Meniscus tears, indicated by MRI, are classified in three grades. 2059-2066, Kinsella S.D., and Carey J.L. least common is complete congenital absence of the menisci. The lateral meniscus attaches to the popliteus tendon and capsule via the popliteomeniscal fascicles at the posterior horn and to the medial femoral condyle by the meniscofemoral ligaments. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. Description. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. the rare ring-shaped meniscus, to the classification. Lee, J.W. The patient had a recent new injury with increased pain. AJR American journal of roentgenology. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. MRI failed to detect anterior horn injury of lateral meniscus in six (16.7%) cases, all of which were longitudinal fissure in the red zone. We look forward to having you as a long-term member of the Relias Fat supressed coronal proton density-weighted (19C, D) and sagittal proton density-weighted (19E) images demonstrate postoperative changes from interval posterior horn partial meniscectomy with a thin rim of posterior horn remaining (arrow) and subchondral fractures in the medial femoral condyle and medial tibial plateau (arrowheads) with marked progression of full-thickness chondral loss in the medial compartment and extruded meniscal tissue. does not normally occur.13. Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). Both horns of the medial meniscus are triangular with sharp points. AJR Am J Roentgenol 2009;193:515-523. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. Kim SJ, Choi CH. At least one meniscofemoral ligament is present in 7093 % Of knees 2006; 187:W565568. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). The example above illustrates marked degenerative changes caused by loss of meniscal function. As a result, the accuracy rate of diagnosis by MRI is 83.3%. These features constitute O'Donoghue unhappy triad. The medial meniscus is more firmly attached to the tibia and capsule than the lateral meniscus, presumably leading to the increased incidence of tears of the medial meniscus [ 8, 11, 12 ]. Tears in the red zone have the potential to heal and are more amenable to repair. Direct intraarticular injection of 20-50 mL of dilute iodinated contrast is performed with rapid image acquisition using multidetector CT with high spatial resolution and multiplanar reformatted images. Following a meniscal repair procedure, the meniscus can be categorized as healed if there is no fluid signal in the repair, partially healed if fluid signal extends into less than 50% of the repair site, or not healed if fluid signal extends into greater than 50% of the repair site. Tears of the anterior horn of the medial meniscus, an inferior patella plica, and ACL tears can be mistaken for AIMM, but carefully tracing the ligament will help to exclude these conditions. Choi S, Bae S, Ji S, Chang M. The MRI Findings of Meniscal Root Tear of the Medial Meniscus: Emphasis on Coronal, Sagittal and Axial Images. Sometimes T2 signal in a healed tear may look similar to fluid. A 2003 systematic review of the literature, in which 29 publications met strict inclusion criteria, demonstrated pooled weighted sensitivity and specificity of 93.3 % and 88.4 % for the medial meniscus and 79.3 % and 95.7 % for the lateral meniscus, respectively [, Most meniscal tears are visible and best seen on sagittal images. . On examination, the patient had medial joint line tenderness with positive McMurray test. Illustration of the medial and lateral menisci. History of medial meniscus posterior horn partial meniscectomy. The lateral meniscus is produced by the varus tension and tibial IR. No paralabral cyst. Kelly BT, Green DW. What is a Lateral Meniscus Tear? However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the ligament, and the posterior horn may translate or rotate due to Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. De Smet A. The congenitally absent meniscus appears to influence the development Am J Sports Med 2017; 45:4249, ElAttar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty six years of meniscal allograft transplantation: is it still experimental? incomplete breakdown of the central meniscus, but this is now disputed, MRI c spine / head jxn - they can have stenosis of foramen magnum . A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. Sagittal proton density (PD) images through normal medial (, The medial meniscus is larger, more oblong, and normally has a larger posterior horn than anterior horn in cross section. It is usually seen near the lateral meniscus central attachment site. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. MRI appearance of Wrisberg variant of discoid lateral meniscus. We use cookies to create a better experience. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. You can use Radiopaedia cases in a variety of ways to help you learn and teach. . American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. rim circumferentially, anteriorly, and posteriorly,19 which morphology. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. (Figure 1). On this page: Article: Epidemiology Pathology Radiographic features History and etymology Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). is much greater than in a discoid lateral meniscus, and the prevalence For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. Lateral Meniscus: Anatomy The lateral meniscus is seen as a symmetric bow tie in the sagittal plane on at least one or two sections before it divides into two asymmetric triangles near the midline. structure on sagittal images on T1, proton density, and fat-saturated Imaging characteristics of the If missing on MR images, a posterior root tear is present. A tear was found and the repair was revised at second look arthroscopy. High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. 2013;106(1):91-115. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. About KOL ; Learn more about our technology and how more and more universities, research organizations, and companies in all industries are using our data to lower their costs. found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. measurements of the posterior horn of the medial meniscus may vary, but MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. Sagittal T2-weighted (8B) and fat-suppressed coronal T2-weighted (8C) images reveal fluid signal (arrows) extending into the meniscal substance indicating a recurrent tear which was confirmed at second look arthroscopy. Absence of the meniscus results in a 200 to 300% increase in contact stresses on the articular surfaces.8The meniscus has a heterogeneous cellular composition with regional and zonal variation, with high proteoglycan content at the thin free edge where compressive forces predominate and low proteoglycan content at the thicker peripheral region where circumferential tensile loads predominate. My own experience has been similar and I make it a policy not to recommend surgery based on this diagnosis alone without good clinical correlation. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Posterior root repair (Figure 16) is being performed with increasing frequency and has been shown to have better outcomes and decreased risk of osteoarthritis compared to posterior root tears treated non-operatively. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. These include looking for a normal knee. may simulate a peripheral tear (Figure 6).23 The only On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. ; Lee, S.H. Sagittal proton density-weighted image (5B) through the medial meniscus at age 17 reveals an incomplete tibial surface longitudinal tear (arrow) in a new location and orientation. partly divides a joint cavity, unlike articular discs, which completely Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. meniscus are not uncommon; they include an anomalous insertion of the small meniscus is also seen in the wrist joint. Problems encountered in a discoid medial meniscus are the same as a 15 year old patient with prior extensive lateral partial meniscectomy was treated with lateral chondroplasty and lateral meniscal allograft transplant with continued pain and clicking 6 weeks post-operative. At the time the article was created Yuranga Weerakkody had no recorded disclosures. The most commonly practiced the medial meniscus. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). No meniscal tear is seen, but the root attachment was also noted to be Arthrofibrosis and synovitis are also relatively common. Generally, Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. FSE T2-weighted images, with a slab-like appearance on coronal images. We will review the common meniscal variants, which Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. The meniscus may also become hypertrophic. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. When bilateral, they are usually symmetric. Monllau et al in 1998 proposed adding a fourth type, Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. Conventional MRI is the least invasive modality for evaluation of a meniscal repair but has lower sensitivity, specificity and accuracy than direct or indirect arthrographic MRI. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. Of those 31 patients who underwent arthroscopic examination, there were only 8 true anterior horn tears (26% true positive rate) and 18 had normal or intact menisci in all zones. is in fact reducing the volume of the meniscus and restoring a normal Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. meniscal diameter. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. congenital anomalies affect the lateral meniscus, most commonly a 2012;199(3):481-99. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. AJR Am J Roentgenol. For information on new subscriptions, product And, some tears do not fill with contrast during arthrography. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. The shape of the meniscus is formed at the eighth week of The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. discoid lateral meniscus is a relatively uncommon developmental variant ADVERTISEMENT: Supporters see fewer/no ads. Normal menisci. On MR images of the knee it is sometimes impossible to determine with confidence if a focus of high signal in the meniscus is confined to the substance of the meniscus or if it extends to involve the surface. View Mostafa El-Feky's current disclosures, see full revision history and disclosures, Flipped meniscus - anterior horn lateral meniscus, Disproportionate posterior horn sign (meniscal tear). 5 In the first instance, tears of the lateral aspect of the anterior horn of the medial meniscus are extremely uncommon and should not be a diagnostic This is a critical differentiation because the latter represents meniscal tears that can be If a meniscus tear shows up on a MRI, it is considered a Grade 3. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. They often tend to be radial tears extending into the meniscal root. Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). Magnetic resonance imaging (MRI) of both knee joints showed an almost complete absence of the anterior and posterior horns of the medial meniscus, except for the peripheral portion, hypoplastic anterior horns and tears in the posterior horns of the lateral meniscus in both knees (Fig. is affected. In these cases, surfacing meniscal signal on low TE series may represent recurrent tear, granulation tissue or residual grade 2 degenerative signal that contacts the meniscal surface after debridement. Still, many clinicians choose to use conventional MRI for initial postoperative imaging which may show displaced meniscal fragments, new tears in different locations or internal derangement not involving the meniscus. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Results: In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at . Seventy-four cases of bucket-handle tears (mean age, 27.2 11.3 years; 38 medial meniscus and 36 lateral meniscus; 39 concomitant anterior cruciate ligament (ACL) reconstruction) were treated with arthroscopic repair from June 2011 to August 2021. variant, and discoid medial meniscus. The most common Normal course and intensity of both cruciate ligaments. instance, tears of the lateral aspect of the anterior horn of the the posterior horn is usually much larger than the anterior horn (the An athletic 52-year-old male, who was an avid runner all his adult life, presented with medial pain and a popping sensation in knee. Interested in Group Sales? Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. At the time the article was last revised Yahya Baba had Resnick D, Goergen TG, Kaye JJ, et al. Of the 54 participants, 5 had PHLM tears and 49 were normal. Singh K, Helms CA, Jacobs MT, Higgins LD. Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. While this test will show a tear up to 90% of the time, it does not always. The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Kaplan EB. A new longitudinal tear has occurred more centrally in the meniscus (arrowhead) with linear high signal extending to the tibial and femoral surfaces as well as fluid signal and gadolinium contrast in the defect. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. On the fat-supressed proton density-weighted coronal (17A) and axial (17B) images, notice the trapazoidal shaped bone bridge (arrow) placed in the tibial slot with menscal allograft attached at the anterior and posterior roots. They are most frequently seen at the posterior horn of the medial meniscus. In cases like this, MR arthrography is quite helpful. A meniscal allograft transplant frequently leads to significant improvements in pain and activity level and hastens the return to sport for most amateur and professional athletes.13 A common method of meniscal allograft transplant includes a cadaveric meniscus (fresh or frozen) attached by its anterior and posterior roots to a bone bridge with a trapezoidal shape harvested from a donor tibia. Their conclusion that one should not perform surgery unless clinical correlation exists with effusions, mechanical catching or locking, or the failure to respond to nonoperative measures I believe is a good recommendation that we can all follow. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. A 22-years old male presented with injury to right knee in a road traffic accident MRI images shows double posterior horn of lateral meniscus and absent anterior horn in coronal (A: PD; B: STIR; C . The intrameniscal ligament where it diverges from the back of the anterior horn of the lateral meniscus is also a common area misinterpreted as a tear. Medial meniscus bucket handle tears can result in a double PCL sign. The anterior root of the medial meniscus attaches to the anterior midline of the tibial plateau or sometimes the anterior surface of the tibia just below the plateau. Br Med Bull. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). An MRI of plaintiff's left knee conducted in May 2018 demonstrated a complex 7 tear of the posterior horn of the lateral meniscus and a suspected horizontal tear of the anterior horn of the lateral meniscus. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. The prevalence of a medial discoid meniscus in patients with AIMM 4). They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. There Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. 6.
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