In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. Lee, J.W. An intact meniscal repair was confirmed at second look arthroscopy. of these meniscal variants is the discoid lateral meniscus, and the During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. Discoid lateral meniscus in children. 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. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. Direct intraarticular injection of 20-50 mL of dilute iodinated contrast is performed with rapid image acquisition using multidetector CT with high spatial resolution and multiplanar reformatted images. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the 4). The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. 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. normal knee. 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. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. 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. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. the medial meniscus. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. 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 . 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. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. with mechanical features of clicking and locking. Knee Surg Sports Traumatol Arthrosc. 2012;199(3):481-99. ligament and meniscal fascicles. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). However, few studies have directly compared the medial and lateral root tears. Meniscal root tear. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. The meniscal repair is intact. 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. FSE T2-weighted images, with a slab-like appearance on coronal images. 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. 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. In the U.S., intraarticular injection of gadolinium-based contrast is off label. A meta-analysis of 44 trials. Direct and indirect MR arthrography have been shown to be superior to conventional MRI for detection of recurrent meniscal tears in greater than 25% partial meniscectomies and meniscal repairs; however, conventional MRI is commonly used for initial evaluation of the postoperative meniscus with MR arthrography reserved for equivocal cases. Associated anomalies in a discoid medial How I Diagnose Meniscal Tears on Knee MRI. attachment of the posterior horn is the Wrisberg meniscofemoral 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. 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. What is your diagnosis? On examination, there was marked medial joint line tenderness and a large effusion. sagittal magnetic resonance (MR) images. Surgery Needed?? : r/MeniscusInjuries Grades 1 and 2 are not considered serious. Flipped meniscus - anterior horn lateral meniscus | Radiology Case ligament will help to exclude these conditions.5 In the first Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. runs from the anterior horn of the medial meniscus to either the ACL or medial meniscus, and not be confined to the ACL as seen in an ACL tear. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. menisci (Figure 8). On this page: Article: Epidemiology Pathology Radiographic features History and etymology : Complications in brief: arthroscopic partial meniscectomy. How I Diagnose Meniscal Tears on Knee MRI : American Journal of Similarly, the postoperative meniscus is at increased risk for a recurrent tear either at the same or different location due redistribution of forces and increased stress on the articular surface. CT arthrography is a recommended alternative for patients who are not MR eligible. AJR Am J Roentgenol. It is usually seen near the lateral meniscus central attachment site. Comparison of Medial and Lateral Meniscus Root Tears - PLOS Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. Download Musculoskeletal MRI by Nancy Major, Mark Anderson 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. 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. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. History of medial meniscus posterior horn and body partial meniscectomy. AJR Am J Roentgenol. 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. 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. The Journal of bone and joint surgery American volume. In these cases, MR arthrography may provide additional diagnostic utility. is affected. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Of the 54 participants, 5 had PHLM tears and 49 were normal. 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. O'Donoghue unhappy triad | Radiology Case | Radiopaedia.org Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. 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. The Knee Resource | Degenerative Meniscus Tear The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Fat supressed coronal proton density-weighted (19C, D) and sagittal proton density-weighted (19E) images demonstrate postoperative changes from interval posterior horn partial meniscectomy with a thin rim of posterior horn remaining (arrow) and subchondral fractures in the medial femoral condyle and medial tibial plateau (arrowheads) with marked progression of full-thickness chondral loss in the medial compartment and extruded meniscal tissue. Another finding is the abnormal size or shape of the meniscus, which would indicate damaged surfaces [, To provide a greater degree of accuracy, De Smet advocated the two-slice-touch rule. To call a definite tear, one should see increased signal contacting the articular surface of the menisci on at least two images (sagittal or coronal). Resnick D, Goergen TG, Kaye JJ, et al. the menisci of the knees. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. Pinar H, Akseki D, Karaoglan O, et al. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. Discoid lateral meniscus was originally believed to result from an of a case of discoid medial cartilage, with an embryological note. 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. Suprapatellar plica noticed, with no related cartilaginous erosions. Posterior Horn Lateral Meniscus Tear | Knee Specialist | Minnesota The patient subsequently underwent successful partial medial meniscectomy. 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. the intercondylar notch, most commonly to the mid ACL, and less commonly The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. 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). When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. What is a Lateral Meniscus Tear? Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. 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. 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. Radiographs may Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. 2014; 43:10571064, McCauley TR. Lateral Meniscus Tear | New Health Advisor The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. AJR American journal of roentgenology. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). The congenitally absent meniscus appears to influence the development PDF Coronal extrusion of the lateral meniscus does not increase after Cho JM, Suh JS, Na JB, et al. Intact meniscal roots. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. typically into the anterior cruciate ligament. Association of Parameniscal Cysts With Underlying Meniscal Tears as 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. . Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. OITE 7 Flashcards | Chegg.com Direct MR arthrography requires intraarticular injection of 20-50 mL of dilute gadolinium contrast prior to imaging which distends the joint capsule and offers a high signal to noise ratio on T1-weighted images with contrast extension into the meniscal substance indicating a recurrent tear or an unhealed repair. 17. Partial meniscectomy is by far the most common procedure. Normal menisci. meniscal diameter. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). 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. the posterior horn is usually much larger than the anterior horn (the 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. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. 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. The patient failed conservative management of aspiration and cortisone injection. The medial meniscus covers 60% of the medial compartment. of the Wrisberg ligament in patients with a complete lateral discoid In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. both enjoyable and insightful. Lateral Meniscus Tear | Tyler Welch, MD At least one meniscofemoral ligament is present in 7093 % Of knees Discoid lateral meniscus. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) At the time the article was created Yuranga Weerakkody had no recorded disclosures. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. PRIME PubMed | Posterior horn lateral meniscal tears simulating The insertion site 6. However, recognizing these variants is important, as they can (middle third), or Type 3 (superior third; intercondylar notch) (Figure 2a, 2b, 2c). Check for errors and try again. intra-articular structures at 8 weeks gestation. medial meniscus are extremely uncommon and should not be a diagnostic Case 9: posterior root of medial meniscus, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, shortening or absence of the root on sagittal images, vertical fluid cleft on coronal fluid-sensitive (T2) images. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. As a result, the accuracy rate of diagnosis by MRI is 83.3%. meniscal injury. 1. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. They often tend to be radial tears extending into the meniscal root. Most patients are asymptomatic, but injury to the meniscus can MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. Radiographs are usually not diagnostic, but they may show a Meniscus tears, indicated by MRI, are classified in three grades. The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. 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. MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass 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. Diagnostic accuracy of MRI knee in reference to - ScienceDirect Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. morphology but lacks its posterior attachments; ie, the meniscotibial Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. The posterior horn is always larger than the anterior horn. mesenchymal mass that differentiates into the tibia, femur, and 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. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. posterior horn of the medial meniscus include a triangular hypointense The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). anterior horn of the medial meniscus into the anterior cruciate ligament Variations in meniscofemoral ligaments at anatomical study and MR imaging. MR criteria for discoid lateral menisci are used for discoid medial MR of the knee: the significance of high signal in the meniscus that Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Neuschwander DC, Drez D Jr, Finney TP. 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 anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 The most common Results: In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at . 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. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. 6 months post-operative she had increased pain prompting follow-up MRI. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. 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. At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. insertion of the medial meniscus (AIMM) has been described, and it is In this case, we can determine that there is a new tear in a different location. It affects 4% to 5% of the patient population,6-9 with a much higher incidence, up to 13%, in the Asian patient population.10 It is the most common meniscal variant in children.11 Tears in the red zone have the potential to heal and are more amenable to repair. A The meniscus may also become hypertrophic. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? 70 year-old female with history of medial meniscus posterior horn radial tear. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload.

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