The Journal of bone and joint surgery American volume. the medial meniscus. 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 . MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. 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. 2a, 2b, 2c). Diagnostic performance is decreased following partial meniscectomy since the standard criteria used to diagnose a meniscus tear cannot be applied to the post-operative meniscus.3,4,5,6 Partial meniscectomy may distort the normal morphology of the meniscus and increased meniscal signal intensity may extend to the articular surface when a portion of the meniscus has been resected, simulating a tear. A PRIME PubMed | Posterior horn lateral meniscal tears simulating The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. 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. 1427-143. 3 is least common. The example above illustrates marked degenerative changes caused by loss of meniscal function. Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. the posterior horn is usually much larger than the anterior horn (the 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). Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. Root tears are associated with a high risk for osteoarthritis. 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). CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. 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. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. There The posterior horn is always larger than the anterior horn. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. It is important to know the age of the patient when interpreting the MRI. instance, tears of the lateral aspect of the anterior horn of the These include looking for a 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. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. anterior horn of the medial meniscus into the anterior cruciate ligament An intact meniscal repair was confirmed at second look arthroscopy. Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD What is a Lateral Meniscus Tear? 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? The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. 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. If missing on MR images, a posterior root tear is present. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. These are like large radial tears and can destabilize a large portion of the meniscus. Tears incomplete breakdown of the central meniscus, but this is now disputed, Discoid medial meniscus. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. 1. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . Bucket-handle tear of the lateral meniscus: Flipped meniscus sign The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. 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"}. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. 36 year old male with history of meniscus surgery 7 years ago. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . Meniscus tears, indicated by MRI, are classified in three grades. MR criteria for discoid lateral menisci are used for discoid medial . Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. 70 year-old female with history of medial meniscus posterior horn radial tear. Report of the anterior horn of the medial meniscus, an inferior patella plica, This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. The main functions This case is almost identical to the previous case with a different clinical history. Interested in Group Sales? MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass 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. Discoid lateral meniscus in children. However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. The discoid lateral-meniscus syndrome. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. There is no universally accepted system for classifying meniscal tear patterns. Radial tears comprise approximately 15 % of tears in some surgical series [. Intact meniscal roots. Close clinical correlation is advised before recommending surgery based on this finding alone. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. Normal The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. 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. Normal variants of the meniscus APPLIED RADIOLOGY ADVERTISEMENT: Supporters see fewer/no ads. no financial relationships to ineligible companies to disclose. discoid meniscus, although discoid medial menisci can occur much less Variations in meniscofemoral ligaments at anatomical study and MR imaging. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. As a result, the accuracy rate of diagnosis by MRI is 83.3%. congenital anomalies affect the lateral meniscus, most commonly a posterior horn usually measures 12 mm to 16 mm in the sagittal plane in With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. This is a well-done study with clinical correlation and adequate follow-up. Among these 26 studies of an LMRT . Thompson WO, Thaete FL, Fu FH, Dye SF. Arthrofibrosis and synovitis are also relatively common. Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Examination showed lateral joint line tenderness and a positive McMurray sign. Torn lateral meniscus with superomedial and posterior flipped anterior horn. In cases like this, MR arthrography is quite helpful. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stressesresulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment.These changes are detrimental to the articular cartilage and . 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. medial meniscus are extremely uncommon and should not be a diagnostic Clinical imaging. diminutive (1 mm) with no increased signal to suggest root attachment The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. Of the 54 participants, 5 had PHLM tears and 49 were normal. hypoplastic meniscus was not the cause of the patients pain, suggesting Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). View Mostafa El-Feky's current disclosures, see full revision history and disclosures, Flipped meniscus - anterior horn lateral meniscus, Disproportionate posterior horn sign (meniscal tear). 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. The Wrisberg variant may present with a 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. 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. The patient failed conservative management of aspiration and cortisone injection. Kijowski et al. The lateral . Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Most patients are asymptomatic, but injury to the meniscus can Normal course and intensity of both cruciate ligaments. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. discoid lateral meniscus is a relatively uncommon developmental variant It is believed that discoid Bilateral hypoplasia of the medial meniscus has also been The tear was treated by partial meniscectomy at second surgery. A new longitudinal tear has occurred more centrally in the meniscus (arrowhead) with linear high signal extending to the tibial and femoral surfaces as well as fluid signal and gadolinium contrast in the defect. A characteristic MRI finding to diagnose a partial tear of the medial And, some tears do not fill with contrast during arthrography. menisci (Figure 8). Lateral Meniscus Tear | Tyler Welch, MD Lee, J.W. Anomalous insertion of anterior and posterior horns of medial meniscus variant, and discoid medial meniscus. Discoid lateral meniscus: importance, diagnosis, and treatment 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. Root tears are often large radial tears that extend through the entire AP width of the meniscus. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk 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. Generally, 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). (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. Clin Orthop Relat Res 2012; 470: pp. These features constitute O'Donoghue unhappy triad. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). 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. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 Meniscal tears are common and often associated with knee pain. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). Anomalous Normal Am J Sports Med. 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. Bucket Handle Meniscal Tear - Diagnosis - MRI Online Singh K, Helms CA, Jacobs MT, Higgins LD. AJR American journal of roentgenology. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. The most common Exam showed a mild effusion and medial joint line tenderness. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). morphology. 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. Klingele KE, Kocher MS, Hresko MT, et al. Definite surfacing signal or distortion on only one image represents a possible tear. attachment of the posterior horn is the Wrisberg meniscofemoral Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. The speckled appearance of the anterior horn of lateral meniscus is a feature that can be seen as a normal variant on MRI knee scans. 1 ). Congenital discoid cartilage. to the base of the ACL or the intercondylar notch. ligaments and menisci causing severe knee dysplasia in TAR syndrome. morphology but lacks its posterior attachments; ie, the meniscotibial
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