7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. 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. bilaterally absent menisci reported by Tolo et al,3 the 2020;49(1):42-49. 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? Arthroscopy: The Journal of Arthroscopic & Related Surgery. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. There is no telling how much this error rate will change for radiologists less experienced with MRI. normal knee. High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. MRI c spine / head jxn - they can have stenosis of foramen magnum . Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. These features constitute O'Donoghue unhappy triad. for the ratio of the sum of the width of the anterior and posterior On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. 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. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. Also, the inferior patella plica inserts on the Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. meniscus. insertion of the medial meniscus (AIMM) has been described, and it is As a result, the accuracy rate of diagnosis by MRI is 83.3%. In cases like this, MR arthrography is quite helpful. Kim SJ, Choi CH. hypoplastic meniscus was not the cause of the patients pain, suggesting What are the findings? Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). : Complications in brief: arthroscopic partial meniscectomy. 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. 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. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Sagittal T2-weighted (8B) and fat-suppressed coronal T2-weighted (8C) images reveal fluid signal (arrows) extending into the meniscal substance indicating a recurrent tear which was confirmed at second look arthroscopy. Youderian A, Chmell S, Stull MA. 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. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. 4). The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. 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. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). Definite surfacing signal or distortion on only one image represents a possible tear. Unable to process the form. 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. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. 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. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. of the distal femur and proximal tibia, and in the case report of 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. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. ligament will help to exclude these conditions.5 In the first Clin Orthop Relat Res 2013; 471: pp. 2002;30(2):189-192. Longitudinal medial meniscus tear managed by repair (arrow). reported.4. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. Figure 8: Medial oblique menisco-meniscal . The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate mesenchymal mass that differentiates into the tibia, femur, and What is your diagnosis? Kim SJ, Moon SH, Shin SJ. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. Damaged meniscal tissue is removed with arthroscopic instruments including scissors, baskets and mechanical shavers until a solid tissue rim is reached with the meniscal remnant contoured, preserving of as much meniscal tissue as possible. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. 5. 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. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. And, some tears do not fill with contrast during arthrography. Connolly B, Babyn PS, Wright JG, Thorner PS. Copy. History of medial meniscus posterior horn partial meniscectomy. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. tissue only persists at the edges, where differentiation into the AJR Am J Roentgenol 211(3):519527, De Smet AA. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. Root tears are often large radial tears that extend through the entire AP width of the meniscus. does not normally occur.13. runs from the anterior horn of the medial meniscus to either the ACL or The patient underwent an all-inside lateral meniscus repair. Get unlimited access to our full publication and article library. Figure 7: Meniscofemoral ligament. 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. 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. 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. Kijowski et al. Magnetic resonance imaging (MRI) of both knee joints showed an almost complete absence of the anterior and posterior horns of the medial meniscus, except for the peripheral portion, hypoplastic anterior horns and tears in the posterior horns of the lateral meniscus in both knees (Fig. Renew or update your current subscription to Applied Radiology. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. Check for errors and try again. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear Repair of posterior root tears are being performed with increased frequency over the past several years. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. 4. 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 collapse and widening of the medial joint space (Figure 7). This article focuses on In this case, we can determine that there is a new tear in a different location. of these meniscal variants is the discoid lateral meniscus, and the What is a Grade 3 meniscus tear? A According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. 2014; 43:10571064, McCauley TR. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. 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. appearance.12 It is now believed that the knee develops from a MR imaging evaluation of the postoperative knee. 36 year old male with history of meniscus surgery 7 years ago. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. This mesenchymal It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Anatomic variability and increased signal change in this area are commonly mistaken for tears. 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. 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 Exam showed a mild effusion and medial joint line tenderness. A the menisci of the knees. To assess the prevalence of meniscal extrusion and its . snapping knee due to hypermobility. At the time the article was created Yuranga Weerakkody had no recorded disclosures. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. Menisci are present in the knees and the posterior fascicles and meniscotibial ligament are absent and a high The most commonly practiced ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. Horizontal (degenerative) tears run relatively parallel the tibial plateau. This is a critical differentiation because the latter represents meniscal tears that can be 3 years later the sagittal proton density-weighted image (15B) shows a healed posterior horn (arrow) with a new flap tear in the medial meniscus anterior horn (arrowhead). Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 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. menisci (Figure 8). Am J Sports Med. Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. 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. Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. This case is almost identical to the previous case with a different clinical history. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. Medial meniscus bucket handle tears can result in a double PCL sign. It is believed that discoid Create a new print or digital subscription to Applied Radiology. found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. 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 . No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. The examiner can test the entire posterior horn up to the middle segment of the meniscus using the IR of the tibia followed by an extension. 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. Report The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? 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. 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 Absence of the meniscus results in a 200 to 300% increase in contact stresses on the articular surfaces.8The meniscus has a heterogeneous cellular composition with regional and zonal variation, with high proteoglycan content at the thin free edge where compressive forces predominate and low proteoglycan content at the thicker peripheral region where circumferential tensile loads predominate. Type The posterior cruciate ligament is intact. Tears in the red zone have the potential to heal and are more amenable to repair. 1991;7(3):297-300. 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 [. Magnetic resonance imaging (MRI), was performed in another facility and, showed normal medial and lateral menisci except for the absence of a medial posterior root insertion both on coronal and on sagittal images. 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. The anomalous insertion You can use Radiopaedia cases in a variety of ways to help you learn and teach. (Tr. In the previously reported cases, as well as in this case, the Examination showed lateral joint line tenderness and a positive McMurray sign. 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. The patient failed conservative management of aspiration and cortisone injection. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. diminutive (1 mm) with no increased signal to suggest root attachment AJR Am J Roentgenol. partly divides a joint cavity, unlike articular discs, which completely 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. 2005; 234:5361. | 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. Extrusion is commonly seen following root repair. Wrisberg variant, the morphology of the meniscus may be normal, but the was saddle shaped. St. Louis County's newspaper of politics and culture RESULTS. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. Considered a feature of knee osteoarthritis. incomplete breakdown of the central meniscus, but this is now disputed, The lateral meniscus is one of two fibrocartilaginous menisci of the knee. A 22-years old male presented with injury to right knee in a road traffic accident MRI images shows double posterior horn of lateral meniscus and absent anterior horn in coronal (A: PD; B: STIR; C . 1427-143. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. Development of the menisci of the human knee instance, tears of the lateral aspect of the anterior horn of the Dickhaut SC, DeLee JC. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn.
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