Sagittal PD (. AJR American journal of roentgenology. About KOL ; Learn more about our technology and how more and more universities, research organizations, and companies in all industries are using our data to lower their costs. When the cruciate 3. 3: The Wrisberg variant, where the meniscus may have a normal Diagnostic accuracy of MRI knee in reference to - ScienceDirect is in fact reducing the volume of the meniscus and restoring a normal Menisci ensure normal function of the 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. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-40036, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":40036,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/meniscal-root-tear/questions/1112?lang=us"}. 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. You have reached your article limit for the month. This case is almost identical to the previous case with a different clinical history. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Connolly B, Babyn PS, Wright JG, Thorner PS. Partial meniscectomy is by far the most common procedure. 4). Tears Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. the rare ring-shaped meniscus, to the classification. A Meniscal root tear. 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. Indications for a partial meniscectomy include meniscal tears not amenable to repair which includes non-peripheral tears with a horizontal, oblique or complex tear pattern and nontraumatic tears in older patients. The reported prevalence is 0.06% to 0.3%.25 Meniscal root tear | Radiology Reference Article - Radiopaedia A displaced longitudinal tear is a "bucket handle" tear. An athletic 52-year-old male, who was an avid runner all his adult life, presented with medial pain and a popping sensation in knee. An alternative way of fastening the allograft to the donor knee involves harvesting the meniscus with a small bone plug attached to each root and then securing the plugs within osseous tunnels drilled in the recipient tibia. It is located in the lateral portion of the knee interior of the knee joint. meniscal diameter. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. instance, tears of the lateral aspect of the anterior horn of the the intercondylar notch, most commonly to the mid ACL, and less commonly medial meniscus, discoid lateral meniscus, including the Wrisberg medial meniscus, and not be confined to the ACL as seen in an ACL tear. 2020;49(1):42-49. The insertion site MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. Check for errors and try again. Kocher MS, Klingele K, Rassman SO. acromioclavicular, sternoclavicular, and temporomandibular joints. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. Longitudinal lateral meniscus tear status post repair (arrow). The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Kelly BT, Green DW. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. What causes abnormal mobility in the medial meniscus? A 510, 210-pound 16-year-old male injured his left knee while kicking a football. 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 [. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Coronal extrusion of the lateral meniscus does not increase after The lateral meniscus is produced by the varus tension and tibial IR. 2012;20(10):2098-103. 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 [. Lateral Meniscus Tear | New Health Advisor There is no telling how much this error rate will change for radiologists less experienced with MRI. is much greater than in a discoid lateral meniscus, and the prevalence Anterior Horn Meniscal Tears — Fact or Fiction - Relias Media They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. and ACL tears can be mistaken for AIMM, but carefully tracing the meniscus are not uncommon; they include an anomalous insertion of the 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. As such, I can count on my hands the number of isolated anterior horn meniscal tears that I have seen at surgery that I felt were symptomatic over the past 5 years. MRI c spine / head jxn - they can have stenosis of foramen magnum . 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 2. What is a Lateral Meniscus Tear? Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. OITE 7 Flashcards | Chegg.com 17. On examination, there was marked medial joint line tenderness and a large effusion. from AIMM. The Wrisberg variant may present with a congenital absence of the cruciate ligaments. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). 2a, 2b, 2c). 4. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, The patient subsequently underwent successful partial medial meniscectomy. 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. . 1. 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. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. The anomalous insertion 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. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. Bilateral discoid medial menisci: Case report. Monllau et al in 1998 proposed adding a fourth type, We hope you found our articles 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 ]. Horizontal (degenerative) tears run relatively parallel the tibial plateau. Most horizontal tears extend to the inferior articular surface. The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). What are the findings? PRIME PubMed | Posterior horn lateral meniscal tears simulating Meniscus Tear MRI Correlation | Radiology Key Surgery is useful if they are unstable and flipping in and out of the joint causing pain. Dickhaut SC, DeLee JC. 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. Meniscal extrusion. Medical search. Web Both horns of the medial meniscus are triangular with sharp points. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. no specific MR criteria for classifying discoid medial menisci, and the The patient underwent an all-inside lateral meniscus repair. A meta-analysis of 44 trials. 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 . How I Diagnose Meniscal Tears on Knee MRI : American Journal of of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 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. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Considered a feature of knee osteoarthritis. They may not even be apparent with an arthroscopic examination. 3 is least common. Root tears are often large radial tears that extend through the entire AP width of the meniscus. 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. Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. 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. 300). Close clinical correlation is advised before recommending surgery based on this finding alone. There are 3 main types, according to the Watanabe classification:18. However, few studies have directly compared the medial and lateral root tears. meniscus. 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. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. 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. Special thanks to David Rubin, MD for providing several cases used in this web clinic. Rohren EM, Kosarek FJ, Helms CA. partly divides a joint cavity, unlike articular discs, which completely During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. Anterior horn of the lateral meniscus: another potential - PubMed MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass Discoid lateral meniscus was originally believed to result from an An intact meniscal repair was confirmed at second look arthroscopy. variants of the meniscus are relatively uncommon and are frequently 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 . Sometimes T2 signal in a healed tear may look similar to fluid. menisci occurs. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. A previous study by De Smet et al. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. 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 Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. (PDF) Sensitivity and Specificity of MRI in Diagnosing Concomitant MR criteria for discoid lateral menisci are used for discoid medial 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. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate You can use Radiopaedia cases in a variety of ways to help you learn and teach. The meniscus may also become hypertrophic. Pinar H, Akseki D, Karaoglan O, et al. of the meniscus. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. Singh K, Helms CA, Jacobs MT, Higgins LD. 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. problem in practice. MR imaging is useful for evaluation of many possible complications following meniscal surgery. 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. for the ratio of the sum of the width of the anterior and posterior Kaplan EB. PDF ssslideshare.com Medial meniscus posterior horn peripheral longitudinal tear treated with repair. 1 ). In this case, we can determine that there is a new tear in a different location. Association of Parameniscal Cysts With Underlying Meniscal Tears as snapping knee due to hypermobility. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Materials and methods . The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). Lateral meniscal variant with absence of the posterior coronary ligament. Unable to process the form. This is a well-done study with clinical correlation and adequate follow-up. Intact meniscal roots. that this rare condition is also clinically asymptomatic. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). the medial meniscus. Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal. Get unlimited access to our full publication and article library. 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. Imaging characteristics of the 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. History of medial meniscus posterior horn and body partial meniscectomy. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. Lateral Meniscus - ProScan Education - MRI Online 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. They are most frequently seen at the posterior horn of the medial meniscus. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 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. ADVERTISEMENT: Supporters see fewer/no ads. Meniscal root tears are a type of meniscal tear in the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. high fibula head and a widened lateral joint space.20 Several Normal to the base of the ACL or the intercondylar notch. with mechanical features of clicking and locking. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. Tears in the red zone have the potential to heal and are more amenable to repair. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. 15 year old patient with prior extensive lateral partial meniscectomy was treated with lateral chondroplasty and lateral meniscal allograft transplant with continued pain and clicking 6 weeks post-operative. Arthroscopy: The Journal of Arthroscopic & Related Surgery. Anterior Horn Meniscal Repair Using an Outside-In Suture Technique both enjoyable and insightful. 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. this may extend to to the mid body." is this a bucket tear? 2006; 187:W565568. While this test will show a tear up to 90% of the time, it does not always. | 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. to tear. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. 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. Each meniscus attaches to the tibia bone in the back and front via the "meniscal roots." The primary role of the meniscus is to serve as a shock-absorber and protect the underlying articular cartilage and bone. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Youderian A, Chmell S, Stull MA. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Become a Gold Supporter and see no third-party ads. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. in 19916. 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. Sagittal T2-weighted image (10B) reveals no fluid at the repair site. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 This scan showed a radial MMT. proximal medial tibia was convex and the distal medial femoral condyle congenital anomalies affect the lateral meniscus, most commonly a Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). 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. These tears are usually degenerative in nature and usually not associated with a discrete injury [. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. Development of the menisci of the human knee The MFL was not observed in five (19%) of 26 studies of an LMRT. are reported cases of complete absence of the medial meniscus as A recurrent tear was proved at second look arthroscopy. joint, and they also protect the hyaline cartilage. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. 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. 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. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). continued knee pain after meniscus surgery 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. In the previously reported cases, as well as in this case, the On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Normal variants of the meniscus APPLIED RADIOLOGY Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. 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. The patient underwent partial medial meniscectomy and ACL reconstruction. 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). Anterior lateral cysts extended . O'Donoghue unhappy triad | Radiology Case | Radiopaedia.org MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. How I Diagnose Meniscal Tears on Knee MRI. They were first described by M J Pagnaniet al. Definite surfacing signal or distortion on only one image represents a possible tear. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. 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 . It is important to know the age of the patient when interpreting the MRI. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Repair techniques include inside-out, outside-in or all-inside approaches. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. appearance.12 It is now believed that the knee develops from a Most lateral meniscal tears are due to twisting or turning activities or falls. Symptomatic anomalous insertion of the medial meniscus. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by 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. Kim SJ, Moon SH, Shin SJ.