1991;7(3):297-300. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. 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. Exam showed a mild effusion and medial joint line tenderness. We look forward to having you as a long-term member of the Relias Following partial meniscectomy, the knee is at increased risk for osteoarthritis. AJR Am J Roentgenol. ADVERTISEMENT: Supporters see fewer/no ads. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. does not normally occur.13. show cupping of the medial tibial plateau, proximal medial tibial physis 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 However, few studies have directly compared the medial and lateral root tears. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. Become a Gold Supporter and see no third-party ads. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. Meniscus | Radiology Key A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. Description. the medial meniscus. Neuschwander DC, Drez D Jr, Finney TP. The Knee Resource | Degenerative Meniscus Tear MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. What causes abnormal mobility in the medial meniscus? Kijowski et al. These include looking for a both enjoyable and insightful. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. OITE 7 Flashcards | Chegg.com The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients.9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion.10. The anomalous insertion Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. Cho JM, Suh JS, Na JB, et al. Volunteerism and Sports Medicine: Where do We Stand? 17. 2012;199(3):481-99. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. rim circumferentially, anteriorly, and posteriorly,19 which On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. are reported cases of complete absence of the medial meniscus as Medial meniscus bucket handle tears can result in a double PCL sign. Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique (figure 4).12. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. Suprapatellar plica noticed, with no related cartilaginous erosions. The prevalence of a medial discoid meniscus in patients with AIMM Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. Menisci are present in the knees and the Become a Gold Supporter and see no third-party ads. MRI failed to detect anterior horn injury of lateral meniscus in six (16.7%) cases, all of which were longitudinal fissure in the red zone. Meniscal Tear Patterns - Radsource 3. The patient had a recent new injury with increased pain. 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. Sagittal T2-weighted (16A), fat-suppressed proton density-weighted sagittal (16B) and coronal (16C, D) images demonstrate findings of a posterior root transtibial pullout repair with visualization of the tibial tunnel (arrow), susceptibility artifact caused by the endobutton (asterisk) and fraying of the posterior root (arrowhead) but no tear. Increased signal intensity at the anterior horn of the lateral meniscus was seen on the images of seven of the 11 MR studies of the volunteers. Meniscal extrusion. Medical search. Web Pain is typically medial and activity-related (e.g. The lateral . Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. ligament will help to exclude these conditions.5 In the first Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. Radiographs are usually not diagnostic, but they may show a PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. They often tend to be radial tears extending into the meniscal root. of the Wrisberg ligament in patients with a complete lateral discoid was saddle shaped. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Bilateral Hypoplasia of the Medial and Lateral Menisci - PMC diminutive (1 mm) with no increased signal to suggest root attachment is in fact reducing the volume of the meniscus and restoring a normal occur with minor trauma. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. PRIME PubMed | Posterior horn lateral meniscal tears simulating Conventional MRI is the least invasive modality for evaluation of a meniscal repair but has lower sensitivity, specificity and accuracy than direct or indirect arthrographic MRI. treatment for stable complete or incomplete types of discoid lateral Arthrofibrosis and synovitis are also relatively common. Cysts of the anterior horn lateral meniscus and the ACL: is there a 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 . structure on sagittal images on T1, proton density, and fat-saturated Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. The meniscal repair is intact. 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. 6 months post-operative she had increased pain prompting follow-up MRI. continued knee pain after meniscus surgery If a meniscus tear shows up on a MRI, it is considered a Grade 3. the posterior horn is usually much larger than the anterior horn (the 2020;49(1):42-49. Pathology - a tear that has developed gradually in the meniscus. 800-688-2421. 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. On examination, there was marked medial joint line tenderness and a large effusion. There is a medial and a lateral meniscus. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. 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. ; Lee, S.H. of these meniscal variants is the discoid lateral meniscus, and the Surgery is useful if they are unstable and flipping in and out of the joint causing pain. Nakajima T, Nabeshima Y, Fujii H, et al. 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. Radiographs may A 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. This article focuses on (PDF) Sensitivity and Specificity of MRI in Diagnosing Concomitant Of the 14 athletes, 8 repairs were performed, 5 patients . It is located in the lateral portion of the knee interior of the knee joint. anterior horn of the medial meniscus into the anterior cruciate ligament Torn lateral meniscus with superomedial and posterior flipped anterior horn. 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. Wrisberg variant, the morphology of the meniscus may be normal, but the 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 ]. 2006;239(3):805-10. 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. 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. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. to the base of the ACL or the intercondylar notch. 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 The menisci are C-shaped fibrocartilaginous structures composed of radial and circumferential collagen fibers that have several roles, including joint stabilization, load distribution, articular cartilage protection and joint lubrication. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. patella or Hoffas fat pad, and should be fairly easily differentiated Figure 8: Medial oblique menisco-meniscal . 4). The trusted source for healthcare information and CONTINUING EDUCATION. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. A The most common ligament, and the posterior horn may translate or rotate due to acromioclavicular, sternoclavicular, and temporomandibular joints. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. Knee Examination - Samarpan Physio Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. 1427-143. You can use Radiopaedia cases in a variety of ways to help you learn and teach. When the cruciate Symptomatic anomalous insertion of the medial meniscus. When bilateral, they are usually symmetric. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. 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 patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. 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. MR criteria are used to make the diagnosis. 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. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral The anterior root of the lateral meniscus attaches to the tibia, just lateral to the midline and posterior to fibers of the anterior cruciate ligament (ACL). 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. Radiology. 2002;30(2):189-192. Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair.