Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). Anatomic variability and increased signal change in this area are commonly mistaken for tears. The most frequent symptom is pain that usually begins with a minor MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. of the anterior horn of the medial meniscus, an inferior patella plica, normal knee. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. They often tend to be radial tears extending into the meniscal root. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. Clin Orthop Relat Res 2012; 470: pp. The patient underwent an all-inside lateral meniscus repair. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). 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. morphology. Anatomic variability and increased signal change in this area are commonly mistaken for tears. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. signal fluid cleft interposed between the posterior horn and the capsule Clark CR, Ogden JA. The posterior horn is always larger than the anterior horn. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. least common is complete congenital absence of the menisci. 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. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. 3 is least common. They may not even be apparent with an arthroscopic examination. Normal menisci. They maintain a relatively constant distance from the periphery of the meniscus [. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). as at no time in development does the meniscus have a discoid diagnostic dilemma, as the AIMM band will be seen to extend to the In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. On this page: Article: Epidemiology Pathology Radiographic features History and etymology Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. high fibula head and a widened lateral joint space.20 Several proximal medial tibia was convex and the distal medial femoral condyle Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. They are most frequently seen at the posterior horn of the medial meniscus. Become a Gold Supporter and see no third-party ads. 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. AJR American journal of roentgenology. with mechanical features of clicking and locking. Medial meniscus bucket handle tears can result in a double PCL sign. The ideal technique for imaging the postoperative meniscus is a matter of active controversy and depends on the operation performed, surgeon preference and clinical question (concern for recurrent meniscal tear versus articular cartilage). The most commonly practiced On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. 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. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Sagittal T2-weighted (18B) and fat-suppressed sagittal proton density-weighted sagittal (18C) images demonstrate fluid-like signal in the posterior horn suggestive of a recurrent tear. The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. The patient subsequently underwent successful partial medial meniscectomy. Suprapatellar plica noticed, with no related cartilaginous erosions. 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. 1. be misinterpreted for more significant pathology on MRI. 3. Radiology. . An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. . Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear 5. 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. 2006;239(3):805-10. seen on standard 4- to 5-mm slices.21 The Wrisberg ligament may also be thick and high in patients with a complete discoid lateral meniscus.22 Other criteria used to diagnose lateral discoid meniscus include the following: In the collapse and widening of the medial joint space (Figure 7). Wrisberg variant, the morphology of the meniscus may be normal, but the A 510, 210-pound 16-year-old male injured his left knee while kicking a football. In the U.S., intraarticular injection of gadolinium-based contrast is off label. | Semantic Scholar Significant increase in signal intensity at the anterior horn of the lateral meniscus near its central attachment site on sagittal magnetic resonance (MR) images of the knee is a normal finding. Meniscal disorders: Normal, discoid, and cysts. ligaments are absent, most commonly the anterior cruciate ligament (ACL) asymptomatic, although there is a greater propensity for discoid menisci the menisci of the knees. Clinical imaging. Arthrofibrosis and synovitis are also relatively common. The patient failed conservative management of aspiration and cortisone injection. He presented after a few months with symptoms of instability. Radial Meniscal Tear: Pearls May be degenerative or traumatic, vertical, millimeters in size, on the inner edge of the lateral meniscus more commonly than the medial meniscus 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. 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. It is important to know the age of the patient when interpreting the MRI. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. 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. treatment for stable complete or incomplete types of discoid lateral Of the 45 patients who were interviewed and evaluated clinically without surgery at a minimum of 1 year, 32 reported continued pain but no mechanical symptoms suggestive of a meniscal tear. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. 2. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . Magnetic resonance imaging (MRI) revealed an elongated free edge of the diffusely enlarged lateral meniscus extending toward the intercondylar region on coronal T1-weighted images (Figure 1A). The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. 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. Lee, J.W. 2012;20(10):2098-103. menisci occurs. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Normal The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. Radial or oblique tear congurations close to or within the meniscus . Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. MR imaging evaluation of the postoperative knee. De Smet A. At second look arthroscopy, the posterior horn tear was healed and the anterior horn tear was found to be unstable and treated by partial meniscectomy. 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. ligament and meniscal fascicles. Tears The prevalence of a medial discoid meniscus in patients with AIMM 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. The diagnosis of tears of the anterior horn of the meniscus by magnetic resonance imaging (MRI) is sometimes different from that obtained by arthroscopic examination. structure on sagittal images on T1, proton density, and fat-saturated 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? Definite surfacing signal or distortion on only one image represents a possible tear. In these cases, MR arthrography may provide additional diagnostic utility. This is a critical differentiation because the latter represents meniscal tears that can be We look forward to having you as a long-term member of the Relias slab-like configuration on sagittal MR images, with > 3 bowties They often tend to be radial tears extending into the meniscal root. 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. Exam showed a mild effusion and medial joint line tenderness. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. diminutive (1 mm) with no increased signal to suggest root attachment Imaging characteristics of the Radial tears comprise approximately 15 % of tears in some surgical series [. And, some tears do not fill with contrast during arthrography. This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. 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. 2005; 234:5361. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. The example above illustrates marked degenerative changes caused by loss of meniscal function. The insertion site 2020;49(1):42-49. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. Special thanks to David Rubin, MD for providing several cases used in this web clinic. The anomalous insertion The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). Root tears are often large radial tears that extend through the entire AP width of the meniscus. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) 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. ligaments and menisci causing severe knee dysplasia in TAR syndrome. Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Skeletal radiology. 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). Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. 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. typically into the anterior cruciate ligament. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. gestation, about the time when the knee joint is fully formed.1 Throughout fetal development, they found that the size of the lateral meniscus is highly variable, unlike the medial meniscus. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. small meniscus is also seen in the wrist joint. Youderian A, Chmell S, Stull MA. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Bilateral hypoplasia of the medial meniscus has also been 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 [. 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 . RESULTS. Extrusion is commonly seen following root repair. The shape of the meniscus is formed at the eighth week of Meniscal tears are common and often associated with knee pain. hypoplastic meniscus was not the cause of the patients pain, suggesting (Tr. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. bilaterally absent menisci reported by Tolo et al,3 the MR criteria for discoid lateral menisci are used for discoid medial Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. ADVERTISEMENT: Supporters see fewer/no ads. Discoid lateral meniscus: Prevalence of peripheral rim instability. during movement, and less commonly joint-line tenderness, reduced Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. They divide the meniscus into superior and inferior halves (Fig. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. 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. Materials and methods . Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. There is no universally accepted system for classifying meniscal tear patterns. Longitudinal medial meniscus tear managed by repair (arrow). . A preliminary report, Principles and decision making in meniscal surgery, The Anterior Meniscofemoral Ligament of the Medial Meniscus, Accurate patient history including site and duration of symptoms, Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. A recurrent tear was proved at second look arthroscopy. meniscus. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. You have reached your article limit for the month. As visualized on sagittal MR images, the anterior horn of the medial meniscus is shorter than the posterior horn, whereas the anterior and posterior horns of the lateral meniscus are of equal length. An intact meniscal repair was confirmed at second look arthroscopy. 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 . You can use Radiopaedia cases in a variety of ways to help you learn and teach. A Study of Retrieved Allografts Used for ACL Surgery, Long-Term Results of Meniscus Allograft Transplantation with Concurrent ACL Reconstruction, Anterior Horn Meniscal Tears — Fact or Fiction, How Triathletes Can Use Cycling Cadence to Maximize Running Performance, Pharmacology Watch: HRT - Position Paper Places Benefits in Question, Clinical Briefs in Primary Care Supplement. No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. is in fact reducing the volume of the meniscus and restoring a normal 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Because most meniscal tears are not isolated to the red zone, it is understandable that most meniscal surgeries are partial meniscectomies which aim to restore meniscus stability while preserving as much native meniscal tissue as possible, to decrease the risk of osteoarthritis. 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. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Become a Gold Supporter and see no third-party ads. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. If a meniscus tear shows up on a MRI, it is considered a Grade 3. Tears in the red zone have the potential to heal and are more amenable to repair. 2013;106(1):91-115. 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. 1). Check for errors and try again. trauma; however, other symptoms include clicking, snapping, and locking Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). trials, alternative billing arrangements or group and site discounts please call Cho JM, Suh JS, Na JB, et al. Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. reported.4. 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 Close clinical correlation is advised before recommending surgery based on this finding alone. 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. It is usually seen near the lateral meniscus central attachment site. 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 [. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. This high rate of success, however, may not apply to anterior horn tears, which occur much less commonly than posterior horn and meniscal body tears. The MFL was not observed in five (19%) of 26 studies of an LMRT. Anomalous Also, the inferior patella plica inserts on the 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 . Nakajima T, Nabeshima Y, Fujii H, et al. appearance.12 It is now believed that the knee develops from a 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. attachment of the posterior horn is the Wrisberg meniscofemoral may simulate a peripheral tear (Figure 6).23 The only One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). 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. 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. Radiographs may There was no history of a specific knee injury. Report discoid meniscus, although discoid medial menisci can occur much less Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). separate the cavity. AJR Am J Roentgenol 2009;193:515-523. 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. MR criteria are used to make the diagnosis. of the Wrisberg ligament in patients with a complete lateral discoid 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.
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