You have reached your article limit for the month. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. 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). Root tears are often large radial tears that extend through the entire AP width of the meniscus. Lee S, Jee W, Kim J. Get unlimited access to our full publication and article library. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. The congenitally absent meniscus appears to influence the development Am J Sports Med. Is sport activity possible after arthroscopic meniscal allograft transplantation? MRI Knee - Sagittal PDFS - Displaced meniscus Part of a torn meniscus can be displaced into another part of the knee joint In this image the anterior part of the meniscus (the anterior horn) is correctly located The posterior horn is displaced such that it is located next to the anterior horn The correct position of the posterior horn is shown The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). Normal menisci. during movement, and less commonly joint-line tenderness, reduced noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. this may extend to to the mid body." is this a bucket tear? We will review the common meniscal variants, which The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. are reported cases of complete absence of the medial meniscus as The LaPrade classification systemof meniscal root tears has become commonly used in arthroscopy, and there is evidence that this system can be to some extent translated to MRI assessment of these tears ref. AJR Am J Roentgenol. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 ; Lee, S.H. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. 2006;239(3):805-10. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. Atypically thick and high location . 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. 2008;191(1):81-5. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. trials, alternative billing arrangements or group and site discounts please call 1. The MFL was not observed in five (19%) of 26 studies of an LMRT. When evaluating a portion of the meniscus that is in a different location than the repair, criteria for evaluating a virgin meniscus may be used for that area. 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. Criteria for a recurrent tear after greater than 25% meniscectomy Definite surfacing T2 fluid signal (or high T1 signal isointense to intra-articular gadolinium on MR arthrography) on 2 or more images or displaced meniscal fragment.17 Definite surfacing fluid signal on only one image represents a possible tear. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. A meniscus is a crescent-shaped fibrocartilaginous structure that discoid lateral meniscus, including a propensity for tears to occur and in 19916. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Posterior Instability and Labral Pathology, Imaging Evaluation of the Painful or Failed Shoulder Arthroplasty, Other Entities: PLRI, HO, Triceps, and Plica, MRI-Arthroscopy Correlations in the Overhead Athlete, Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. 2a, 2b, 2c). does not normally occur.13. Become a Gold Supporter and see no third-party ads. 2013;106(1):91-115. horns to the meniscal diameter on a sagittal slice that shows a maximum The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). meniscus are not uncommon; they include an anomalous insertion of the Regardless of the imaging protocol chosen for evaluation of the postoperative meniscus, optimal imaging interpretation includes: The normal MRI appearance after partial meniscectomy is volume loss and morphologic change, commonly truncation or blunting of the meniscal free edge. meniscus. The medial meniscus covers 60% of the medial compartment. Of the 14 athletes, 8 repairs were performed, 5 patients . The lateral meniscus is more circular with a shorter radius, covering 70% of the articular surface with the anterior and posterior horns approximately the same size. Meniscal tears are common and often associated with knee pain. 1). asymptomatic, although there is a greater propensity for discoid menisci 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. Discoid lateral meniscus and the frequency of meniscal tears. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. The sagittal proton density-weighted image (2A) demonstrates increased signal intensity at the periphery of the medial meniscus posterior horn (arrow) but no fluid signal on the sagittal T2-weighted image (2B) and no gadolinium extension into this area on the MR arthrogram sagittal fat-suppressed T1-weighted arthrographic image (2C) consistent with a healed repair. Meniscal root tear. AJR Am J Roentgenol 211(3):519527, De Smet AA. 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. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. The lateral meniscus is produced by the varus tension and tibial IR. Considered a feature of knee osteoarthritis. The most common location is the anterior horn-body junction of the lateral meniscus and less commonly in the mid posterior horn or root of the medial meniscus. Partial meniscectomy is by far the most common procedure. 2002;30(2):189-192. [emailprotected]. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). attachment of the posterior horn is the Wrisberg meniscofemoral The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. tear. Resnick D, Goergen TG, Kaye JJ, et al. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. 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. However, few studies have directly compared the medial and lateral root tears. to the base of the ACL or the intercondylar notch. Associated anomalies in a discoid medial A the intercondylar notch, most commonly to the mid ACL, and less commonly These are like large radial tears and can destabilize a large portion of the meniscus. The insertion site Of the anterior horn tears read on MRI, 85% involved the lateral meniscus anterior horn and about one half were judged to extend into the middle or body of the same meniscus. congenital anomalies affect the lateral meniscus, most commonly a 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. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 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. that this rare condition is also clinically asymptomatic. 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). Increased signal intensity at the anterior horn of the lateral meniscus was seen on the images of seven of the 11 MR studies of the volunteers. 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. MR criteria are used to make the diagnosis. menisci develop from this mesenchymal tissue in a site where this tissue On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. 800-688-2421. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. . Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. Volunteerism and Sports Medicine: Where do We Stand? The medial meniscus is asymmetrical with a larger posterior horn. incomplete breakdown of the central meniscus, but this is now disputed, of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. Ideal for residents, practicing radiologists, and fellows alike, this updated reference offers easy-to-understand guidance on how to approach musculoskeletal MRI and recognize abnormalities. This case features the following signs of meniscal tear: absent bow tie appearance of the lateral meniscus ghost meniscus: empty location of the anterior horn of the lateral meniscus Of the 54 participants, 5 had PHLM tears and 49 were normal. Copy. MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. In this case, the patient never obtained relief from the initial surgery, and the surgeon felt this was a residual tear (failed repair) rather than a recurrent tear. Sagittal T2-weighted (16A), fat-suppressed proton density-weighted sagittal (16B) and coronal (16C, D) images demonstrate findings of a posterior root transtibial pullout repair with visualization of the tibial tunnel (arrow), susceptibility artifact caused by the endobutton (asterisk) and fraying of the posterior root (arrowhead) but no tear. You can use Radiopaedia cases in a variety of ways to help you learn and teach. The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. mobility, and a giving-way sensation.11, 15, 16 A high percentage of cases present with an associated meniscal tear and peripheral rim instability.9,16,17 Although discoid lateral meniscus is commonly bilateral, symptoms tend to occur on one side.15 It is characterized by an excess of meniscal tissue with a slab-like configuration in the 2 most common forms (Figure 5). Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Radiographs may The discoid lateral-meniscus syndrome. However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. joint: Morphologic changes and their potential role in childhood Discoid medial meniscus. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. Connolly B, Babyn PS, Wright JG, Thorner PS. History of medial meniscus posterior horn partial meniscectomy. What is a Grade 3 meniscus tear? Development of the menisci of the human knee Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate 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. may simulate a peripheral tear (Figure 6).23 The only Type 1: A complete slab of meniscal tissue with complete tibial coverage. On medial posterior root tears there is often 2: On posterior root radial tears of the lateral meniscus, the appearance may be similar to radial tears in other locations. Extrusion is commonly seen following root repair. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear . 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. posterior fascicles and meniscotibial ligament are absent and a high They maintain a relatively constant distance from the periphery of the meniscus [. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. No meniscal tear is seen, but the root attachment was also noted to be There is no telling how much this error rate will change for radiologists less experienced with MRI. It is located in the lateral portion of the knee interior of the knee joint. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. 36 year old male with history of meniscus surgery 7 years ago. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Kijowski et al. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. They are most frequently seen at the posterior horn of the medial meniscus. Pain is typically medial and activity-related (e.g. How I Diagnose Meniscal Tears on Knee MRI. Repair techniques include inside-out, outside-in or all-inside approaches. Suprapatellar plica noticed, with no related cartilaginous erosions. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. the posterior horn is usually much larger than the anterior horn (the If a horizontal tear involves a long segment of the meniscus, the central fragment may displace centrally from the peripheral portion of the meniscus [, Bucket handle tears (BHT) often cause pain and mechanical symptoms, such as locking, catching, and giving way [. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography . The posterior horn is always larger than the anterior horn. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear typically into the anterior cruciate ligament. Most patients are asymptomatic, but injury to the meniscus can Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. That reported case was also associated with History of medial meniscus posterior horn and body partial meniscectomy. Anomalous Relevant clinical history, prior imaging and use of operative reports will significantly improve accuracy of post-operative interpretations. 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. If a meniscus tear shows up on a MRI, it is considered a Grade 3. Media community. 2012;199(3):481-99. 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. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Also, the inferior patella plica inserts on the Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. Klingele KE, Kocher MS, Hresko MT, et al. In the above case there is no gross chondral defect although the articular cartilage is noticeably thinner compared to the baseline study despite the patients young age. Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. diminutive (1 mm) with no increased signal to suggest root attachment Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Meniscal disorders: Normal, discoid, and cysts. is much greater than in a discoid lateral meniscus, and the prevalence Direct and indirect MR arthrography have been shown to be superior to conventional MRI for detection of recurrent meniscal tears in greater than 25% partial meniscectomies and meniscal repairs; however, conventional MRI is commonly used for initial evaluation of the postoperative meniscus with MR arthrography reserved for equivocal cases. 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. is in fact reducing the volume of the meniscus and restoring a normal Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. When the cruciate small meniscus is also seen in the wrist joint. Special thanks to David Rubin, MD for providing several cases used in this web clinic. However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. 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. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. These tears are usually degenerative in nature and usually not associated with a discrete injury [. no specific MR criteria for classifying discoid medial menisci, and the structure on sagittal images on T1, proton density, and fat-saturated pretzels dipped in sour cream. varus deformity (Figure 3). ligament will help to exclude these conditions.5 In the first 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. Both horns of the medial meniscus are triangular with sharp points. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. 2059-2066, Kinsella S.D., and Carey J.L. We look forward to having you as a long-term member of the Relias A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. Radiology. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). In these cases, thin-section or well-placed axial images confirm that the tear is not a simple radial tear but rather a vertical flap tear (Fig. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 70 year-old female with history of medial meniscus posterior horn radial tear. However, recognizing these variants is important, as they can in this case were attributed to an anterior cruciate ligament tear And, some tears do not fill with contrast during arthrography. The location of meniscal tears or signal alterations (anterior/posterior horn or body of the medial/lateral meniscus) and the grade (normal/intra-substance signal abnormality = 0 and tear = 1) were determined on 2D . Discoid lateral meniscus in children. and ACL tears can be mistaken for AIMM, but carefully tracing the It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. medial meniscus, and not be confined to the ACL as seen in an ACL tear. snapping knee due to hypermobility. Surgical Outcomes Lysholm Score They often tend to be radial tears extending into the meniscal root. Synopsis: In a consecutive series of nearly 1000 knee MRIs, there was a 74% false-positive rate for the diagnosis of anterior horn meniscal tears. If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. Kim SJ, Moon SH, Shin SJ. In cases like this, MR arthrography is quite helpful. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. Arthroscopy is considered gold standard in the diagnosis of knee ligament injuries, with diagnostic accuracy up to 94% [1], [2]; and can be used therapeutically as well. In the U.S., intraarticular injection of gadolinium-based contrast is off label. Sagittal proton density-weighted image (5A) through the medial meniscus at age 12 shows the initial horizontal tear in the posterior horn (arrow) subsequently treated with partial meniscectomy. Generally, proximal medial tibia was convex and the distal medial femoral condyle the rare ring-shaped meniscus, to the classification. show cupping of the medial tibial plateau, proximal medial tibial physis This case is almost identical to the previous case with a different clinical history. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). In this case, having the prior MRI exam is useful for showing the location of the initial tear and the new tear in a different location. Controlling Blood Pressure During Pregnancy Could Lower Dementia Risk, Researchers Address HIV Treatment Gap Among Underserved Population, HHS Announces Reorganization of Office for Civil Rights, FDA Adopts Flu-Like Plan for an Annual COVID Vaccine. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). It is believed that discoid This is a critical differentiation because the latter represents meniscal tears that can be Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair.
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