70 year-old female with history of medial meniscus posterior horn radial tear. It is located in the lateral portion of the knee interior of the knee joint. However, recognizing these variants is important, as they can Most lateral meniscal tears are due to twisting or turning activities or falls. The lateral meniscus is produced by the varus tension and tibial IR. MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. 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. 800-688-2421. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. 300). Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Materials and methods . 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. 6 months post-operative she had increased pain prompting follow-up MRI. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. Dickhaut SC, DeLee JC. In cases like this, MR arthrography is quite helpful. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. 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. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Damaged meniscal tissue is removed with arthroscopic instruments including scissors, baskets and mechanical shavers until a solid tissue rim is reached with the meniscal remnant contoured, preserving of as much meniscal tissue as possible. mesenchymal mass that differentiates into the tibia, femur, and morphology. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. variant, and discoid medial meniscus. Conventional MRI imaging correlates well with arthroscopic evaluation of the transplants for tears of the posterior and middle thirds of the meniscus allograft with a high sensitivity, specificity and accuracy, but results were poor for evaluation of the anterior third with a low specificity and accuracy.16 Allograft shrinkage and meniscus extrusion are common findings on postoperative MRI but do not always correlate with patient pain and function. medial meniscus are extremely uncommon and should not be a diagnostic In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. Kaplan EB. was saddle shaped. AJR American journal of roentgenology. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. of the Wrisberg ligament in patients with a complete lateral discoid 1. an adult), and approximately twice the size of the anterior horn on A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. 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. Am J Sports Med. 36 year old male with history of meniscus surgery 7 years ago. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. that this rare condition is also clinically asymptomatic. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). (middle third), or Type 3 (superior third; intercondylar notch) (Figure Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. ligament will help to exclude these conditions.5 In the first Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Kijowski et al. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. 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. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. The Journal of bone and joint surgery American volume. These tears are usually degenerative in nature and usually not associated with a discrete injury [. Normal menisci. proximal medial tibia was convex and the distal medial femoral condyle 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. sagittal magnetic resonance (MR) images. What is your diagnosis? (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Meniscus tears are either degenerative or acute. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. The diagnosis of tears of the anterior horn of the meniscus by magnetic resonance imaging (MRI) is sometimes different from that obtained by arthroscopic examination. Youderian A, Chmell S, Stull MA. Become a Gold Supporter and see no third-party ads. Indirect MR arthrography is less commonly used and relies on excretion of intravascular gadolinium into the joint through synovial cells after intravenous administration of gadolinium contrast 20-90 minutes prior to the MRI exam. The tear was treated by partial meniscectomy at second surgery. 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? 1427-143. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. The insertion site Lee, J.W. Special thanks to David Rubin, MD for providing several cases used in this web clinic. A tear of the ACL should also, in practice, not be a 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). Extension to the anterior cortex of . menisci occurs. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. posterior fascicles and meniscotibial ligament are absent and a high ligaments and menisci causing severe knee dysplasia in TAR syndrome. Anterior lateral cysts extended . 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. ; Lee, S.H. On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. Root tears are associated with a high risk for osteoarthritis. Exam showed a mild effusion and medial joint line tenderness. They often tend to be radial tears extending into the meniscal root. Bilateral discoid medial menisci: Case report. has shown that 41% of patients with a surgically confirmed torn post-operative meniscus had signal intensity within the meniscus extending into the articular surface which was lower than the signal intensity of gadolinium contrast.14 Like the presence of a line of intermediate T2 signal extending into the articular surface on conventional MRI, diagnosis of a torn post-operative meniscus on MRI arthrography is challenging when the intra-meniscal signal intensity is not as bright as gadolinium contrast. Grades 1 and 2 are not considered serious. Problems encountered in a discoid medial meniscus are the same as a Also, the inferior patella plica inserts on the If a meniscus tear shows up on a MRI, it is considered a Grade 3. Normal 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. 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. The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Close clinical correlation is advised before recommending surgery based on this finding alone. Unable to process the form. small meniscus is also seen in the wrist joint. Check for errors and try again. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . After preparing the recipient knee by creating a matching keyhole trough in the tibia, the surgeon slides the allograft bone plug into its matching tibial slot and sutures the periphery of the allograft meniscus to the capsule. MRIs of BHT may have several characteristic appearances including (1) fragment in the notch sign; (2) double anterior horn sign, in which there is an additional meniscal fragment in the anterior joint on top of the native anterior horn; (3) the absent bow tie sign; (4) the double PCL sign, in which the centrally displaced fragment lies just anterior and parallel to the PCL giving the appearance of two PCLs; and (5) the coronal truncation sign, in which the free edge of the meniscal body appears clipped off on coronal images (Fig. medial meniscus, discoid lateral meniscus, including the Wrisberg These features constitute O'Donoghue unhappy triad. The prevalence of a medial discoid meniscus in patients with AIMM A meniscus is a crescent-shaped fibrocartilaginous structure that posterior horn usually measures 12 mm to 16 mm in the sagittal plane in MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). 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). What is a Grade 3 meniscus tear? 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 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. of the distal femur and proximal tibia, and in the case report of 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. 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. MR imaging evaluation of the postoperative knee. Clark CR, Ogden JA. They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. Tears The meniscus may also become hypertrophic. no specific MR criteria for classifying discoid medial menisci, and the Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. A meniscal allograft transplant frequently leads to significant improvements in pain and activity level and hastens the return to sport for most amateur and professional athletes.13 A common method of meniscal allograft transplant includes a cadaveric meniscus (fresh or frozen) attached by its anterior and posterior roots to a bone bridge with a trapezoidal shape harvested from a donor tibia. The Wrisberg variant may present with a 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 The lateral . 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. There is a medial and a lateral meniscus. Radial or oblique tear congurations close to or within the meniscus . diagnostic dilemma, as the AIMM band will be seen to extend to the ADVERTISEMENT: Supporters see fewer/no ads. 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. On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Kim SJ, Choi CH. mimicking an anterior horn tear. 17. At least one meniscofemoral ligament is present in 7093 % Of knees 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 symptoms Knee Surg Sports Traumatol Arthrosc. Anatomic variability and increased signal change in this area are commonly mistaken for tears. The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . An intact meniscal repair was confirmed at second look arthroscopy. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Type 1 is most common, and type 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. Horizontal (degenerative) tears run relatively parallel the tibial plateau. On this page: Article: Epidemiology Pathology Radiographic features History and etymology Media community. . Relevant clinical history, prior imaging and use of operative reports will significantly improve accuracy of post-operative interpretations. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). posterior horn of the medial meniscus include a triangular hypointense He presented after a few months with symptoms of instability. Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. Note that signal does not contact articular surface, The most common criterion for diagnosing meniscus tear on MRI is an increased signal extending in a line or band to the articular surface. (Tr. Type 1: A complete slab of meniscal tissue with complete tibial coverage. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. 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. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. 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. variants of the meniscus are relatively uncommon and are frequently 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 . 2013;106(1):91-115. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. | 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. Variations in meniscofemoral ligaments at anatomical study and MR imaging. On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. Among these 26 studies of an LMRT . This case features the following signs of meniscal tear: absent bow tie appearance of the lateral meniscus ghost meniscus: empty location of the anterior horn of the lateral meniscus We will review the common meniscal variants, which On examination, there was marked medial joint line tenderness and a large effusion. It is usually seen near the lateral meniscus central attachment site. incomplete breakdown of the central meniscus, but this is now disputed, This is a well-done study with clinical correlation and adequate follow-up. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. joint: Morphologic changes and their potential role in childhood Kocher MS, Klingele K, Rassman SO. the intercondylar notch, most commonly to the mid ACL, and less commonly congenital absence of the cruciate ligaments. 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.
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