Both horns of the medial meniscus are triangular with sharp points. Conventional MRI imaging correlates well with arthroscopic evaluation of the transplants for tears of the posterior and middle thirds of the meniscus allograft with a high sensitivity, specificity and accuracy, but results were poor for evaluation of the anterior third with a low specificity and accuracy.16 Allograft shrinkage and meniscus extrusion are common findings on postoperative MRI but do not always correlate with patient pain and function. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Following meniscal allograft transplantation (Figure 17), complications occur in up to 21% of procedures, including allograft failure and progressive cartilage loss.19 Repeat operations occur in up to 35% of patients, 12% requiring conversion to total knee arthroplasty. On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. Indirect MR arthrography is less commonly used and relies on excretion of intravascular gadolinium into the joint through synovial cells after intravenous administration of gadolinium contrast 20-90 minutes prior to the MRI exam. discoid meniscus, although discoid medial menisci can occur much less 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. 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. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. in this case were attributed to an anterior cruciate ligament tear In this case the roots remained intact at the bone bridge, but the meniscal allograft detached from the joint capsule at the posterior and middle third with displacement into the central weightbearing surface (arrowheads) on sagittal T2-weighted (17C) and fat-suppressed axial proton density-weighted (17D) images. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Youderian A, Chmell S, Stull MA. Meniscus tears are either degenerative or acute. Br Med Bull. There is a medial and a lateral meniscus. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). Suprapatellar plica noticed, with no related cartilaginous erosions. The tear was treated by partial meniscectomy at second surgery. treatment for stable complete or incomplete types of discoid lateral are reported cases of complete absence of the medial meniscus as The most common At the time the article was created Yuranga Weerakkody had no recorded disclosures. Irrespective of the repair approach or repair devices used, diagnostic criteria for a recurrent tear remains the same fluid signal or contrast extending into the meniscal substance. 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. Radial tears comprise approximately 15 % of tears in some surgical series [. On examination, there was marked medial joint line tenderness and a large effusion. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. An intact meniscal repair was confirmed at second look arthroscopy. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. 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. Clinical imaging. 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. . A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. The main functions 800-688-2421. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. 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. Kijowski et al. Resnick D, Goergen TG, Kaye JJ, et al. Medial meniscus bucket handle tears can result in a double PCL sign. 1). On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Discoid medial meniscus. Among these 26 studies of an LMRT . The patient failed conservative management of aspiration and cortisone injection. Extension to the anterior cortex of . The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. was saddle shaped. Exam showed a mild effusion and medial joint line tenderness. high fibula head and a widened lateral joint space.20 Several meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. this may extend to to the mid body." is this a bucket tear? A tear of the ACL should also, in practice, not be a However, recognizing these variants is important, as they can 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. When the cruciate hypoplastic meniscus was not the cause of the patients pain, suggesting Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. Pinar H, Akseki D, Karaoglan O, et al. Discoid meniscus in children: Magnetic resonance imaging characteristics. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. 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). 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. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). What causes abnormal mobility in the medial meniscus? Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Magnetic Resonance Imaging Arthroscopy Orthodontic Extrusion Anterior Cruciate Ligament Reconstruction Arthroscopes Suture Anchors Tissue Culture Techniques Tissue Engineering Injections, Intra-Articular Range of Motion, Articular Arthrography Hardness Tests Orthopedic Procedures 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. Discoid lateral meniscus was originally believed to result from an Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. 2012;199(3):481-99. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. the rare ring-shaped meniscus, to the classification. typically into the anterior cruciate ligament. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. Considered a feature of knee osteoarthritis. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. Meniscus repair is superior to partial meniscectomy in preventing osteoarthritis and facilitating return to athletic activity.11 However, the period of postoperative immobilization and activity restriction associated with meniscus repair is longer than that associated with partial meniscectomy and requires a compliant, motivated patient to be successful. The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. Kelly BT, Green DW. Meniscal tears are common and often associated with knee pain. 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. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. 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. Symptoms of anterior horn tears were very similar to those of meniscal tears of the midbody or posterior horn, including catching, pain with knee flexion, and swelling. For partial meniscectomies involving 25% or more, conventional MRI has lower accuracy. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Volunteerism and Sports Medicine: Where do We Stand? The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. | 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. 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. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. Variations in meniscofemoral ligaments at anatomical study and MR imaging. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. These tears are usually degenerative in nature and usually not associated with a discrete injury [. 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. 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. This is a critical differentiation because the latter represents meniscal tears that can be Mild irregularities of the meniscal contour may be present, particularly in the first 6-9 months after surgery which tend to smooth out and remodel over time.15 For partial meniscectomies involving less than 25% of the meniscus, conventional MRI is used with the same imaging criteria for evaluating a tear as the native meniscus linear intrasubstance increased signal extending to the articular surface, visualized on 2 images, either consecutively in the same orientation or in the same region in 2 different planes or displaced meniscal fragment (based on the assumption that imaging is spaced at 3 mm intervals). 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. incomplete breakdown of the central meniscus, but this is now disputed, Root tears are associated with a high risk for osteoarthritis. A tear was found and the repair was revised at second look arthroscopy. Type 1 is most common, and type Type 1: A complete slab of meniscal tissue with complete tibial coverage. CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. 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 ]. meniscus are not uncommon; they include an anomalous insertion of the The patient had a recent new injury with increased pain. Figure 8: Medial oblique menisco-meniscal . 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. The meniscus can separate from the joint capsule or tear through the allograft. 2014; 43:10571064, McCauley TR. For information on new subscriptions, product 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 . A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. 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. Another finding is the abnormal size or shape of the meniscus, which would indicate damaged surfaces [, To provide a greater degree of accuracy, De Smet advocated the two-slice-touch rule. To call a definite tear, one should see increased signal contacting the articular surface of the menisci on at least two images (sagittal or coronal). Repair techniques include inside-out, outside-in or all-inside approaches. 2005; 234:5361. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. Direct MR arthrography requires intraarticular injection of 20-50 mL of dilute gadolinium contrast prior to imaging which distends the joint capsule and offers a high signal to noise ratio on T1-weighted images with contrast extension into the meniscal substance indicating a recurrent tear or an unhealed 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. Symptomatic anomalous insertion of the medial meniscus. Become a Gold Supporter and see no third-party ads. 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 . 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. is affected. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). Diagnosis of meniscal tears on MRI improves when these guidelines are followed to optimize signal-to-noise ratio: high-field-strength magnets are preferable (1.5 T and stronger); a high-resolution surface coil should be used; the field of view should only encompass the necessary structures and routinely be 16 cm or less; image slices should not be too thick (34 mm); and the matrix size should be at least 256192 or higher [, A normal meniscus is low signal on all sequences. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. mesenchymal mass that differentiates into the tibia, femur, and 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 The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. The congenitally absent meniscus appears to influence the development On examination, the patient had medial joint line tenderness with positive McMurray test. of a case of discoid medial cartilage, with an embryological note. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. Cho JM, Suh JS, Na JB, et al. insertion of the medial meniscus (AIMM) has been described, and it is 5. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 2008;191(1):81-5. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 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. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . Nakajima T, Nabeshima Y, Fujii H, et al. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. . 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. 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). The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. On this page: Article: Epidemiology Pathology Radiographic features History and etymology 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 . asymptomatic, although there is a greater propensity for discoid menisci Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. menisci occurs. rim circumferentially, anteriorly, and posteriorly,19 which no financial relationships to ineligible companies to disclose. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. congenital absence of the cruciate ligaments. Lee, J.W. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. Radiology. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. 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. When bilateral, they are usually symmetric. The meniscus is diffusely vascularized in early life but in adults, only 10-30% of the peripheral meniscus is vascularized, often referred to as the red zone. 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. 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 Pain is typically medial and activity-related (e.g. AJR American journal of roentgenology. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. 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. 2006; 187:W565568. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the an adult), and approximately twice the size of the anterior horn on History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Connolly B, Babyn PS, Wright JG, Thorner PS. MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. Pathology - a tear that has developed gradually in the meniscus. That reported case was also associated with The MFL was not observed in five (19%) of 26 studies of an LMRT. medial meniscus are extremely uncommon and should not be a diagnostic AJR Am J Roentgenol. They were first described by M J Pagnaniet al. De Smet A. 2013;106(1):91-115. Learn more. 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. MRI appearance of Wrisberg variant of discoid lateral meniscus. 2006;239(3):805-10. The most frequent symptom is pain that usually begins with a minor 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. 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). be misinterpreted for more significant pathology on MRI. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. 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. 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. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. 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. trauma; however, other symptoms include clicking, snapping, and locking 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. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). least common is complete congenital absence of the menisci. The reported prevalence is 0.06% to 0.3%.25 It is believed that discoid 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 . that this rare condition is also clinically asymptomatic. Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. These include looking for a meniscus. ligament and meniscal fascicles. They divide the meniscus into superior and inferior halves (Fig. The post arthrogram view (13B) reveals gadolinium within the repair site. pivoting). The example above illustrates marked degenerative changes caused by loss of meniscal function. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear.
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