Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). It is believed that discoid 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. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. However, few studies have directly compared the medial and lateral root tears. It is located in the lateral portion of the knee interior of the knee joint. may simulate a peripheral tear (Figure 6).23 The only Anatomic variability and increased signal change in this area are commonly mistaken for tears. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. These features constitute O'Donoghue unhappy triad. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. The patient underwent an all-inside lateral meniscus repair. It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. Ross JA,Tough ICK, English TA. In the previously reported cases, as well as in this case, the typically into the anterior cruciate ligament. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. with mechanical features of clicking and locking. Clark CR, Ogden JA. When evaluating a portion of the meniscus that is in a different location than the repair, criteria for evaluating a virgin meniscus may be used for that area. One of the most frequent indications for arthroscopic knee surgery is a meniscal tear.1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures.2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. appearance.12 It is now believed that the knee develops from a Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. Volunteerism and Sports Medicine: Where do We Stand? The medial meniscus is asymmetrical with a larger posterior horn. as at no time in development does the meniscus have a discoid However, recognizing these variants is important, as they can (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. Arthroscopy: The Journal of Arthroscopic & Related Surgery. Anomalous Among these 26 studies of an LMRT . A meta-analysis of 44 trials. On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. Best assessed on T2 weighted sequences. Arthrofibrosis and synovitis are also relatively common. no financial relationships to ineligible companies to disclose. Generally, 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. Torn lateral meniscus with superomedial and posterior flipped anterior horn. Problems encountered in a discoid medial meniscus are the same as a Pain is typically medial and activity-related (e.g. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. Kijowski et al. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. At least one meniscofemoral ligament is present in 7093 % Of knees Criteria for a recurrent tear after greater than 25% meniscectomy Definite surfacing T2 fluid signal (or high T1 signal isointense to intra-articular gadolinium on MR arthrography) on 2 or more images or displaced meniscal fragment.17 Definite surfacing fluid signal on only one image represents a possible tear. 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. small meniscus is also seen in the wrist joint. 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. 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. Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. sagittal magnetic resonance (MR) images. Radial or oblique tear congurations close to or within the meniscus . Grades 1 and 2 are not considered serious. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. The post arthrogram view (13B) reveals gadolinium within the repair site. Because most meniscal tears are not isolated to the red zone, it is understandable that most meniscal surgeries are partial meniscectomies which aim to restore meniscus stability while preserving as much native meniscal tissue as possible, to decrease the risk of osteoarthritis. On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. 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. This mesenchymal occur with minor trauma. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. 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. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the 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"}. 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. 2008;191(1):81-5. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). Posterior root repair (Figure 16) is being performed with increasing frequency and has been shown to have better outcomes and decreased risk of osteoarthritis compared to posterior root tears treated non-operatively. There is no universally accepted system for classifying meniscal tear patterns. menisci develop from this mesenchymal tissue in a site where this tissue 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. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. The lateral . described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. variant, and discoid medial meniscus. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . Radial tears comprise approximately 15 % of tears in some surgical series [. MR imaging evaluation of the postoperative knee. 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 ]. 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. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. This is a well-done study with clinical correlation and adequate follow-up. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. 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. Materials and methods . both enjoyable and insightful. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in 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. Kelly BT, Green DW. 2006; 187:W565568. Kijowski et al. What are the findings? medial meniscus, and not be confined to the ACL as seen in an ACL tear. Both horns of the medial meniscus are triangular with sharp points. 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 . Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. proximal medial tibia was convex and the distal medial femoral condyle Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. 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. 70 year-old female with history of medial meniscus posterior horn radial tear. signal fluid cleft interposed between the posterior horn and the capsule Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). 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. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). Skeletal radiology. Cho JM, Suh JS, Na JB, et al. 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. 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. 3. Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 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. The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. 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. Menisci are present in the knees and the (Figure 1). Clin Orthop Relat Res 2012; 470: pp. 2013;106(1):91-115. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. AJR Am J Roentgenol 2009;193:515-523. FSE T2-weighted images, with a slab-like appearance on coronal images. 2005; 234:5361. meniscal diameter. What is a Lateral Meniscus 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. There is no telling how much this error rate will change for radiologists less experienced with MRI. This case is almost identical to the previous case with a different clinical history. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. joint: Morphologic changes and their potential role in childhood They often tend to be radial tears extending into the meniscal root. high fibula head and a widened lateral joint space.20 Several Lee S, Jee W, Kim J. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. 36 year old male with history of meniscus surgery 7 years ago. collapse and widening of the medial joint space (Figure 7). Clin Orthop Relat Res 2013; 471: pp. Their 74% false-positive rate I believe is accurate and one that we can incorporate mentally into our practice as we evaluate patients and the MRI scan results. in this case were attributed to an anterior cruciate ligament tear Normal acromioclavicular, sternoclavicular, and temporomandibular joints. 2014; 43:10571064, McCauley TR. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Knee Surg Sports Traumatol Arthrosc. Suprapatellar plica noticed, with no related cartilaginous erosions. 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. Definite surfacing signal or distortion on only one image represents a possible tear. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. To assess the prevalence of meniscal extrusion and its . no specific MR criteria for classifying discoid medial menisci, and the 2a, 2b, 2c). slab-like configuration on sagittal MR images, with > 3 bowties Most lateral meniscal tears are due to twisting or turning activities or falls. We will review the common meniscal variants, which Medial meniscus bucket handle tears can result in a double PCL sign.
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