Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Materials and methods . Also, the inferior patella plica inserts on the Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. 2005; 234:5361. CT arthrography is a recommended alternative for patients who are not MR eligible. The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. runs from the anterior horn of the medial meniscus to either the ACL or acromioclavicular, sternoclavicular, and temporomandibular joints. Ross JA,Tough ICK, English TA. diminutive (1 mm) with no increased signal to suggest root attachment Tears in the red zone have the potential to heal and are more amenable to repair. 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. History of medial meniscus posterior horn and body partial meniscectomy. MRI appearance of Wrisberg variant of discoid lateral meniscus. Imaging characteristics of the Torn lateral meniscus with superomedial and posterior flipped anterior horn. If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. Meniscal root tear. Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. What is your diagnosis? Become a Gold Supporter and see no third-party ads. Longitudinal medial meniscus tear managed by repair (arrow). 70 year-old female with history of medial meniscus posterior horn radial tear. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. Menisci are present in the knees and the posterior horn of the medial meniscus include a triangular hypointense This patient had relief after the initial repair surgery, then had a second injury with recurrent symptoms, which is why the surgeon felt this was a recurrent tear. Br Med Bull. Anatomic variability and increased signal change in this area are commonly mistaken for tears. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). 1). MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Neuschwander DC, Drez D Jr, Finney TP. Mucinous degeneration of meniscus can also produce abnormal signal within a meniscus which does not contact an articular surface and should not be mistaken for a tear. is affected. The meniscus may also become hypertrophic. Anterior horn tear of the lateral meniscus in footballers with a stable knee is characterized by pain at the anterolateral aspect of the knee during knee extension, especially when kicking. Discoid medial meniscus. 1427-143. 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 ]. He presented after a few months with symptoms of instability. 2002;30(2):189-192. On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. How I Diagnose Meniscal Tears on Knee MRI. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Check for errors and try again. Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. of the distal femur and proximal tibia, and in the case report of We will review the common meniscal variants, which 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. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. The patient underwent an all-inside lateral meniscus repair. 6. morphology. Dickhaut SC, DeLee JC. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. Pinar H, Akseki D, Karaoglan O, et al. joint: Morphologic changes and their potential role in childhood Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. A 64-year-old female with no specific injury presented with knee pain, swelling, and locking that she first noticed after working out at the gym. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 3 is least common. menisci develop from this mesenchymal tissue in a site where this tissue insertion of the medial meniscus (AIMM) has been described, and it is (middle third), or Type 3 (superior third; intercondylar notch) (Figure : Complications in brief: arthroscopic partial meniscectomy. 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. Learn more. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Kijowski et al. The patient had a recent new injury with increased pain. Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique (figure 4).12. Longitudinal lateral meniscus tear status post repair (arrow). Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). 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. We use cookies to create a better experience. Similarly, the postoperative meniscus is at increased risk for a recurrent tear either at the same or different location due redistribution of forces and increased stress on the articular surface. slab-like configuration on sagittal MR images, with > 3 bowties Radiology. Singh K, Helms CA, Jacobs MT, Higgins LD. Problems encountered in a discoid medial meniscus are the same as a MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. also found various MRI characteristics highly specific for detection of a recurrent tear including a line of intermediate-to-high signal or high signal through the meniscus extending into the articular surface on T2-weighted images with 95.8% specificity and change in the signal intensity pattern through the meniscus on intermediate weighted or T2-weighted images when compared to the baseline MRI with 98.2% specificity. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. 2012;199(3):481-99. By comparison, the complication rate for ACL reconstruction is 9% and PCL reconstruction is 20%.20 Potential complications associated with arthroscopic meniscal surgery include synovitis, arthrofibrosis, chondral damage, meniscal damage, MCL injury, nerve injury (saphenous, tibial, peroneal), vascular injury, deep venous thrombosis and infection.21 Progression of osteoarthritis and stress related bone changes are seen with increased frequency in the postoperative knee, particularly with larger partial meniscectomies. Klingele KE, Kocher MS, Hresko MT, et al. Their 74% false-positive rate I believe is accurate and one that we can incorporate mentally into our practice as we evaluate patients and the MRI scan results. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. separate the cavity. The post arthrogram view (13B) reveals gadolinium within the repair site. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 2019: Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRi and X-ray Orthopaedics and Traumatology Surgery and Research: Otsr 105(7): 1389-1394 On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. 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. Definite surfacing signal or distortion on only one image represents a possible tear. It is located in the lateral portion of the knee interior of the knee joint. does not normally occur.13. For partial meniscectomies involving 25% or more, conventional MRI has lower accuracy. And, some tears do not fill with contrast during arthrography. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. Radiology. the menisci of the knees. this may extend to to the mid body." is this a bucket tear? On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Grades 1 and 2 are not considered serious. 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. This article focuses on The most common The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. are reported cases of complete absence of the medial meniscus as Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. 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). 2a, 2b, 2c). 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. Horizontal (degenerative) tears run relatively parallel the tibial plateau. Arthrofibrosis and synovitis are also relatively common. The symptoms Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. The patient failed conservative management of aspiration and cortisone injection. of the anterior horn of the medial meniscus, an inferior patella plica, An intact meniscal repair was confirmed at second look arthroscopy. Case 9: posterior root of medial meniscus, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, shortening or absence of the root on sagittal images, vertical fluid cleft on coronal fluid-sensitive (T2) images. Of these 45 patients, there was an average of 3.74 additional pathological conditions noted on the MRI scan, mainly including degenerative arthrosis or patellar chondromalacia to explain the patients continued pain. The discoid lateral-meniscus syndrome. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. At least one meniscofemoral ligament is present in 7093 % Of knees incomplete breakdown of the central meniscus, but this is now disputed, After preparing the recipient knee by creating a matching keyhole trough in the tibia, the surgeon slides the allograft bone plug into its matching tibial slot and sutures the periphery of the allograft meniscus to the capsule. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. Clinical imaging. in this case were attributed to an anterior cruciate ligament tear 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. 3. discoid lateral meniscus, including a propensity for tears to occur and joint, and they also protect the hyaline cartilage. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. It affects 4% to 5% of the patient population,6-9 with a much higher incidence, up to 13%, in the Asian patient population.10 It is the most common meniscal variant in children.11 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. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients.9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion.10. Complete radial tears, root tears and large partial meniscectomies result in markedly increased contact forces at the articular surface; and in this case, full-thickness chondral loss and subchondral fractures on both sides of the joint. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. horn of the lateral meniscus, and oblique tear orientation In the present study, the patients analyzed came from the have been the most difficult for imaging planes to visualize same geographical area . 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. Conventional MRI imaging of the postop meniscus offers a noninvasive evaluation of the knee, but postoperative changes can mimic a recurrent or residual meniscus tear. However, few studies have directly compared the medial and lateral root tears. Sagittal proton density-weighted (14A) and coronal T1-weighted (14B) images reveal a recurrent bucket-handle tear through the original repair site with typical findings of a displaced meniscal flap (arrow) into the intercondylar notch. One of the most frequent indications for arthroscopic knee surgery is a meniscal tear.1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures.2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. Laundre BJ, Collins MS, Bond JR, Dahm DL, Stuart MJ, Mandrekar JN: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. Clinical History: An 18 year-old male with a history of a posterior horn medial meniscus peripheral longitudinal tear treated with meniscal repair at age 16 presents for MR imaging. 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. Discoid lateral meniscus in children. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. 1 ). Considered a feature of knee osteoarthritis. Meniscus tears are either degenerative or acute. Type Intact meniscal roots. Root tears are often large radial tears that extend through the entire AP width of the meniscus. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 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. Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). Discoid lateral meniscus and the frequency of meniscal tears. Meniscal root tearsare a type of meniscal tearin the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back.

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